Showing papers in "Surgical Laparoscopy Endoscopy & Percutaneous Techniques in 2014"
TL;DR: RYGB was more effective than SG in the resolution of obesity-related comorbidities, and SG was a safer procedure with a reduced rate of complications and reoperation.
Abstract: Purpose:Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are 2 of the most widely used bariatric procedures today, in this meta-analysis, both techniques were compared for evaluating the efficacy and safety of the treatment of morbid obesity.Materials and Methods:Systematic literature sea
116 citations
TL;DR: There is a lack of evidence about a connection between the late occurrence of gastric adenocarcinoma and the bariatric surgery, and there is no need for a regular endoscopic evaluation of patients after surgery.
Abstract: Background:Bariatric procedures can induce a massive weight loss that lasts for >15 years after surgery; in addition, they achieve important metabolic effects including diabetes resolution in the majority of morbidly obese patients. However, some bariatric interventions may cause gastroesophageal re
65 citations
TL;DR: The use of low-pressure pneumoperitoneum (8 mm Hg) for LC is associated with a significantly lower postoperative pain, however, the use of this low- pressure pneum operitoneum can jeopardize the surgeon’s comfort.
Abstract: Background and objective With the safety of laparoscopic cholecystectomy (LC) having been established, the current stress is on reducing the postoperative morbidity associated with this procedure. Hence, this study was undertaken to compare the effect of low-pressure (8 mm Hg) (LPLC) versus standard-pressure (12 mm Hg) (SPLC) pneumoperitoneum on postoperative pain, respiratory and liver functions, the stress response, and the intraoperative surgeon comfort in patients undergoing LC. Materials and methods Patients undergoing LC (n=43) were randomized into the LPLC (8 mm Hg) group (n=22) and the SPLC (12 mm Hg) group (n=21). Postoperative pain, changes in liver function, peak expiration flow rate, C-reactive protein level, and intraoperative surgeon comfort were assessed. Results The postoperative pain scores (P=0.003, 0.000, 0.001, and 0.002 at 0, 4, 8, and 24 h), total analgesic requirement (P=0.001), and the number (total and good) of demands for analgesic in the first 24 hours (P=0.002 and 0.001) were lower in the LPLC group. The surgeon comfort in the LPLC group was significantly lesser (P=0.000). The liver function and peak expiration flow rate did not show any significant changes. C-reactive protein levels varied significantly only at 24 hours postoperatively (P=0.001). Conclusions The use of low-pressure pneumoperitoneum (8 mm Hg) for LC is associated with a significantly lower postoperative pain. However, the use of this low-pressure pneumoperitoneum can jeopardize the surgeon's comfort.
50 citations
TL;DR: A meta-analysis of available randomized controlled trials shows that LH is superior to FH in the short-term outcomes, and future studies addressing long- term outcomes are needed to prove these results.
Abstract: The aim of this meta-analysis was to compare the outcomes of Ligasure hemorrhoidectomy and stapled hemorrhoidectomy for prolapsed hemorrhoids. Original studies in any language were searched from MEDLINE database, PubMed, Web of science and the Cochrane Library database, and Wangfang database. Randomized control trials that compared Ligasure hemorrhoidectomy with stapled hemorrhoidectomy were identified. Data were extracted independently for each study, and a meta-analysis was performed using fixed and random-effects models. Five trials including 397 patients met the inclusion criteria. Patients treated with Ligasure had a significantly shorter operative time compared with patients who underwent stapler techniques. The recurrence rate was higher in patients who underwent stapled hemorrhoidectomy. No statistically significant differences were observed in postoperative bleeding, urinary retention, difficult defecating, anal fissure, anal stenosis, incontinence, postoperative pain, return to normal activities, and hospital stay. Our meta-analysis shows that Ligasure is an effective instrument for hemorrhoidectomy, which results in shorter operation time and lower recurrence rate.
48 citations
TL;DR: Because of possible medicolegal implications, the endoscopists should consider mentioning splenic injury on the consent form of colonoscopy after bowel perforation and bleeding, particularly in higher risk patients.
Abstract: This study reviewed all single experience of splenic injuries after colonoscopy in the last 40 years to define the possible risk factors and the management of this complication. A MEDLINE and a PubMed search was undertaken to identify articles in English, French, Spanish, and Italian from 1974 to 20
43 citations
TL;DR: This meta-analysis indicates minimally invasive pancreaticoduodenectomy may be associated with shorter hospital stay, less estimated blood loss, and positive margin rate without compromising surgical safety as open surgery.
Abstract: Background: Laparoscopic and robotic pancreaticoduodenectomy have started utilization tentatively; however, the clinical benefits are still controversial. This study aims to evaluate the safety and efficiency of minimally invasive pancreaticoduodenectomy. Methods: A systematic literature search was performed through PubMed, EMBASE, and Cochrane Library database without restriction to regions, publication types, or languages. Nine studies that compared laparoscopic/robotic with open pancreaticoduodenectomy were included. Fixed or random-effects models was used to measure the pooled estimates. Sensitivity and subgroup analysis were performed to evaluate the study quality. Results: Patients who underwent minimally invasive pancreaticoduodenectomy experienced longer operative time (P = 0.007), but the estimated blood loss (P = 0.007), length of stay, (P = 0.02), and wound infection (P = 0.04) decreased. Perioperative complications, such as pancreatic fistula, delayed gastric emptying, hemorrhage, bile leakage, reoperation, and mortality, were of no significant differences. Pathologically, lymph node number was similar (P = 0.11); meanwhile, margin R0 ratio was higher in minimally invasive approach group (P = 0.03). Subgroup analysis manifested robotic surgery spent comparable surgical time (P = 0.16) as laparotomy, with earlier discharge (P = 0.04). Conclusions: This meta-analysis indicates minimally invasive pancreaticoduodenectomy may be associated with shorter hospital stay, less estimated blood loss, and positive margin rate without compromising surgical safety as open surgery. Surgical duration of robotic method could even be equivalent as laparotomy. Minimally invasive approach can be a reasonable alternative to laparotomy pancreaticoduodenectomy with potential advantages. Nevertheless, future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.
42 citations
TL;DR: BABA robotic thyroidectomy revealed that a less-extensive CND was obtained when compared with an open procedure, and may be suitable for thyroid cancer without lymphadenopathy in central neck compartment.
Abstract: Background:Despite advancements in surgical robot technology, the da Vinci-assisted central neck dissection (CND) in thyroid cancer remains challenging. The aim of this study is to evaluate the feasibility of robotic thyroidectomy and CND.Methods:Between March 2011 and July 2012, 515 consecutive pat
42 citations
TL;DR: Robotic colorectal operations provide favorable results, with acceptable operative times and low conversion rates and morbidity, and surgical robots may provide additional benefits treating challenging pathologies, such as rectal cancer.
Abstract: Introduction Surgical practice has been changed since the introduction of robotic techniques and robotic colorectal surgery is an emerging field. Innovative robotic technologies have helped surgeons overcome many technical difficulties of conventional laparoscopic surgery. Herein, we review the clinical studies regarding the application of surgical robots in resections for colorectal cancer. Methods A systematic review of the literature was conducted for articles published up to September 9, 2012, using the MEDLINE database. The keywords that were used in various combinations were: "surgical robotics," "robotic surgery," "computer-assisted surgery," "colectomy," "sigmoid resection," "sigmoidectomy," and "rectal resection." Results Fifty-nine articles reporting on robot-assisted resections of colon and/or rectum were identified and 41 studies were finally included in the analysis. A total of 1635 colorectal procedures were performed: 254 right colectomies, 185 left colectomies/sigmoid resections, 969 anterior resections, 182 abdominoperineal or intersphincteric resections, 34 colectomies (without being specified as right or left), and 11 total/subtotal colectomies. In general, blood loss, conversion rates, and complications were low but the operative time was longer than the open procedures, whereas the duration of hospitalization was shorter. The number of harvested lymph nodes was also quite satisfactory. Conclusions Robotic colorectal operations provide favorable results, with acceptable operative times and low conversion rates and morbidity. Surgical robots may provide additional benefits treating challenging pathologies, such as rectal cancer. Further clinical studies and long-term follow-up are required to better evaluate the outcomes of robotic colorectal surgery.
42 citations
TL;DR: LATG with extended lymphadenectomy for middle or upper early and locally advanced gastric cancer can achieve a radical oncologic resection equivalent to that of OTG and is a feasible and safe procedure, and has several advantages over conventional OTG.
Abstract: Purpose:In recent years, laparoscopy-assisted distal gastrectomy has become the recognized procedure for treatment of early gastric cancer because of improved cosmesis and reduced postoperative pain. However, there are a few reports of laparoscopic-assisted total gastrectomy (LATG) performed for gas
36 citations
TL;DR: It is suggested that laparoscopic surgery is suitable for very elderly patients with colorectal cancer because it is less invasive than open surgery and has a shorter postoperative hospital stay.
Abstract: Purpose:Short-term and midterm outcomes of surgery remain unclear in very elderly patients (≥85 y) with colorectal cancer. This study was designed to clarify the safety and therapeutic usefulness of surgery for colorectal cancer in this subgroup of patients. We compared postoperative short-term and
35 citations
TL;DR: This “opioid-sparing” effect, combined with less PONV and a faster discharge from the PACU, makes sugammadex an indispensable drug in this type of patients and allows fast-track surgery in the MO.
Abstract: Background:Morbid obese (MO) population is increasing every year worldwide, and laparoscopic bariatric surgery (LBS) has a central role in their treatment. The postoperative period of MO is not free from complications. The introduction of sugammadex has brought huge developments in patient’s safety
TL;DR: TIF provided a safe and effective therapeutic option for carefully selected patients with chronic gastroesophageal reflux disease at 12-month follow-up, and there were no major complications reported.
Abstract: Purpose:This study aimed to assess the impact of transoral incisionless fundoplication (TIF) on patients with chronic gastroesophageal reflux disease (GERD) at 12-month follow-up.Methods:Clinical outcomes of 100 consecutive patients with chronic GERD who underwent TIF between January 2010 and Februa
TL;DR: PC is a safe and efficient treatment option for patients with AC who are less eligible for surgery and after patients recover from PC, further treatment such as cholecystectomy may not be needed.
Abstract: Purpose:To evaluate the efficacy, long-term outcome, and safety of percutaneous cholecystostomy (PC) in high-risk surgical patients.Methods:This was a retrospective descriptive review of the medical records of 36 patients who underwent PC for acute cholecystitis (AC) at a single institution between
TL;DR: GATS compared with NKS increases biliary cannulation rate and requires less cannulation time during difficult biliary access, and seems to be an effective and safe alternative for bile duct access during difficult endoscopic retrograde cholangiopancreatography.
Abstract: PURPOSE Precut techniques have been used to facilitate biliary cannulation during difficult endoscopic retrograde cholangiopancreatography. Presently, needle-knife sphincterotomy (NKS) is a commonly used precut technique. Since its first description, transpancreatic sphincterotomy, as an alternative method for bile duct entry when conventional biliary cannulation failed, has been debated on its success rate of cannulation and its complications, such as increased incidence of pancreatitis. Guidewire techniques are another effective method to improve the success rate of selective bile duct cannulation. This is a single-center prospective randomized controlled trial aimed to compare success rate, cannulation time, and complications of guidewire-assisted transpancreatic sphincterotomy (GATS) and NKS for difficult biliary cannulation. METHODS Between July 2010 and October 2013, consecutive patients who failed in the standard biliary cannulation were randomly assigned to the GATS and NKS groups. The outcome measures included success rate, cannulation time, and complications. RESULTS A total of 149 patients were enrolled and analyzed: 73 in the GATS group and 79 in the NKS group. The characteristics of the 2 groups were similar. Bile duct cannulation was successful in 70 patients (95.9%) in the GATS group and 64 (84.2%) in the NKS group (P=0.018). The median cannulation time spent in precut was 193 seconds in the GATS group and 485 seconds in the NKS group (P<0.001). There was no difference between the groups for the incidence of complications, pancreatitis, and hemorrhage (9.6% vs. 10.5%, 6.8% vs. 6.6%, 1.4% vs. 3.9%, respectively). No perforation occurred. CONCLUSIONS GATS compared with NKS increases biliary cannulation rate and requires less cannulation time during difficult biliary access. This technique is not associated with an increased risk for complications. It seems to be an effective and safe alternative for biliary access during difficult endoscopic retrograde cholangiopancreatography.
TL;DR: The results demonstrate the advantages of robotic system on short-term outcomes and suggest the extended indication of minimally invasive hepatectomy even in the technically challenging anatomic area.
Abstract: Purpose:To evaluate the technical feasibility and safety of robot-assisted laparoscopic partial caudate lobe resection using the robotic surgical system.Materials and Methods:This is a report of the use of robot-assisted laparoscopic partial caudate lobe resection on 2 patients with hepatocellular c
TL;DR: Converted patients had significant larger tumor size, advanced stage, increased operative blood loss, time to walk independently, prolonged hospital stay, number of massive hemorrhages, ileus, anastomotic hemorrhage, abdominal hemorrhage/septic shock, and wound infection than completed laparoscopy patients.
Abstract: This study investigated risk factors and impact of open conversion on outcomes of 207 consecutive patients who had laparoscopic resection of colorectal cancer at our institution. Conversion occurred in 15.9% of patients, mostly because of invasion to adjacent structures (30.3%), bulky tumor (21.2%), and adhesions (18.2%). Converted patients had significant larger tumor size, advanced stage, increased operative blood loss, time to walk independently, prolonged hospital stay, number of massive hemorrhage, ileus, anastomotic hemorrhage, abdominal hemorrhage, peritonitis/septic shock, and wound infection than completed laparoscopy patients. Factors associated with conversion were obesity [relative risk (RR)=6.92; 95% confidence interval (CI), 1.7-28.09], date of operation (RR=0.37; 95% CI, 0.15-0.95), advanced tumor stage (RR=7.67; 95% CI; 1.19-49.2), size (RR=1.97; 95% CI, 1.42-2.72), and rectum location (RR=2.73; 95% CI, 1.09-6.84). Converted patients had worse cumulative disease-free (P<0.001) and overall survival (P<0.001) than laparoscopic completed patients.
TL;DR: The initial results supports previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in reduced postoperative analgesia use, and reduced length of hospital stay when compared with the laparoscopic transperitoneal approach.
Abstract: BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) was popularized by Walz and colleagues as an alternative approach to minimally invasive adrenalectomy, offering less postoperative pain and faster return to normal activity compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their outcomes. METHODS Data were prospectively collected for 10 patients who underwent PRA, and a chart review and telephone interviews were conducted with 13 consecutive patients who underwent LA by the same surgeon. Patient demographics, tumor characteristics, analgesia use, operative and anesthetic time, length of stay, and complications were recorded. RESULTS Data were collected for 13 LAs and 10 PRAs. Patients' baseline characteristics, including age, BMI, and tumor size, were similar between the 2 groups. There were no conversions to open surgery, transfusions, or deaths. Operative time was similar between the 2 groups. PRA patients required less, inpatient postoperative opioid analgesia compared with LA patients (median 1.25 vs. 23 mg of intravenous morphine equivalent, P=0.003), and had a shorter length of stay (median 1 vs. 2 d, P<0.001). The median total days on opioids were lower for PRA patients compared with LA patients (0.5 vs. 9 d, P<0.001). CONCLUSION Our initial results supports previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in reduced postoperative analgesia use, and reduced length of hospital stay when compared with the laparoscopic transperitoneal approach.
TL;DR: It is important to perform gastric ESD with particular care in patients with risk factors, and a statistically significant association between postoperative bleeding and oral anticoagulant or antiplatelet drugs is indicated.
Abstract: Purpose:This study aimed to determine risk factors for postoperative complications of gastric endoscopic submucosal dissection (ESD).Methods:This retrospective study included 647 lesions in 580 consecutive patients who underwent ESD for gastric noninvasive neoplasia from January 1, 2002 through Dece
TL;DR: The available data suggest that the efficacy of RT is similar to OT in the treatment of thyroid diseases on the whole, and RT has a better cosmetic effect than OT, but longer operative time is needed by RT.
Abstract: Purpose It remains controversial whether the transaxillary robotic thyroidectomy (RT) is a feasible or better alternative to open thyroidectomy (OT) in thyroid surgery. We aimed to evaluate the efficacy of RT by pooling comparative studies of RT and OT in a systematic review and meta-analysis. Materials and methods Original articles comparing transaxillary RT and conventional OT for thyroid diseases, published in the English language from1990 until February 3, 2013 were systematically searched in PubMed, Embase, Medline, and the Cochrane Library. The outcomes analyzed were postoperative complications, number of retrieved lymph nodes, operative time, postoperative hospital stay, and cosmetic satisfaction. Results Nine studies that fulfilled the eligibility criteria were included in the meta-analysis, of a total of 1615 patients (510 RT and 1105 OT). Compared with OT, RT showed a similar incidence of complications, number of retrieved lymph nodes, and length of postoperative hospital stay. The cosmetic effect of RT was superior to OT. But the operative time of RT was significantly longer than OT. Conclusions The available data suggest that the efficacy of RT is similar to OT in the treatment of thyroid diseases on the whole. RT has a better cosmetic effect than OT. But longer operative time is needed by RT.
TL;DR: Splenic flexure mobilization can provide a tension-free anastomosis and sufficiently vascularized anastOMosis in laparoscopic colorectal surgery for distal colon pathology, with no impact on immediate postoperative outcomes, despite longer operative time.
Abstract: Background:Depending on the extent of left colon resection, splenic flexure mobilization is sometimes necessary to achieve a tension-free anastomosis. The aim of the study was the assessment of necessity and impact on morbidity of splenic flexure mobilization for laparoscopic colectomy with anastomo
TL;DR: CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity.
Abstract: Introduction:Infective complications are the most significant cause of morbidity associated with elective colorectal surgery It can sometimes be difficult to differentiate complications from the normal postoperative course C-reactive protein (CRP) is an acute phase reactant which has been reported
TL;DR: In this study, endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is a safe and effective form of treatment for intractable pain secondary to advanced pancreatic cancer.
Abstract: Visceral pain secondary to pancreatic cancer is often difficult to control and poses a challenge to the physician. We retrospectively analyzed the efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with unresectable pancreatic cancer. Forty-one patients with severe pain despite treatment with opioids underwent EUS-CPN with absolute alcohol. Patients scored their pain on a scale of 0 to 10 and were interviewed after the procedure. Of the 41 patients, 33, 37, and 25 patients reported improvement in their pain within 3 days, at 1 week, and at 3 months, respectively, following the procedure. Of all the patients, 19 patients reported substantial improvement and 4 patients showed complete disappearance of pain. Complication appeared in 2 patients with transient hypotension. In our study, EUS-CPN is a safe and effective form of treatment for intractable pain secondary to advanced pancreatic cancer.
TL;DR: Laroscopic pancreaticoduodenectomy may confer benefits over robotic pancreasectomy, although it is expected that outcomes of both modalities are likely to improve with greater experience and better patient selection.
Abstract: In pancreatic surgery, there is an increasing interest in the feasibility of minimal access techniques. Robotic surgery has improved some limitations of standard laparoscopy and it is expected as a promising access. We provide a comparative review between laparoscopic and robotic pancreaticoduodenectomies. Between 1996 and 2013, we found 284 patients in the laparoscopic group and 147 in the robotic. Operative time, morbidity, and mortality were similar for both the groups (425.94 min, 30.28%, 2.19% in the laparoscopic group and 415.88 min, 36.78%, and 2.72% for the robotic arm, respectively). The mean hospital stay, mean estimated blood loss, fistula, and conversion rates were 11.09 days, 172,93 mL, 13.02%, and 5.63% and 13.84 days, 346.44 mL, 27.69%, and 11.56% for the laparoscopic and robotic group, respectively (P<0.05). Laparoscopic pancreaticoduodenectomy may confer benefits over robotic pancreaticoduodenectomies, although it is expected that outcomes of both modalities are likely to improve with greater experience and better patient selection.
TL;DR: Assessment of the current incidence of Mirizzi syndrome in the area and experience in the clinical, diagnostic, and therapeutic management, focussing in laparoscopic approach found preoperative diagnosis of MS is difficult, but it is essential in the proper management of the disease.
Abstract: Introduction:Mirizzi syndrome (MS) is a rare complication of cholelithiasis. The objective of this study was to assess the current incidence of MS in our area and present our experience in the clinical, diagnostic, and therapeutic management, focussing in laparoscopic approach.Materials and Methods:
TL;DR: LH is a practicable replacement for OH with probable advantages within the short-term outcomes for elected HCRM patients and remains an approach in advancement; in addition, randomized controlled trails and prolonged follow-up are necessary to verify its oncologic benefits and long-term survival.
Abstract: BACKGROUND Laparoscopic hepatectomy (LH) provides significant promising results when compared with open hepatectomy (OH). However, the oncologic outcome of LH for hepatic colorectal metastases (HCRM) remains controversial. The purpose of this study was to review the results of LH retrospectively and to compare them with those obtained using the conventional OH procedure for HCRM patients. MATERIALS AND METHODS Demographic details of 24 patients with pathologic determination of HCRM who underwent LH were reviewed retrospectively and weighed against the 25 HCRM patients chosen from the prospective OH database. Postsurgical benefits and 3-year outcomes of these 2 groups were compared. RESULTS The LH had a significantly less estimated blood loss (210 vs. 380 mL; P<0.01), less analgesic requirements (20.8% vs. 50.2%; P<0.001), shorter hospital stay (7.4 vs. 11.4 d; P<0.0001), and less postoperative complication rates (25% vs. 48%; P=0.02) compared with the OH approach. The operative time, positive surgical margin, and postoperative liver function changes were similar in the 2 groups. There were no significant differences between the 2 groups in tumor recurrence and the 3-year overall survival rate (24% vs. 30%; P=0.83), respectively. CONCLUSIONS LH is a practicable replacement for OH with probable advantages within the short-term outcomes for elected HCRM patients. Nevertheless, it remains an approach in advancement; in addition, randomized controlled trails and prolonged follow-up are necessary to verify its oncologic benefits and long-term survival.
TL;DR: This case is a case of detecting endometriosis with indocyanine green using the fluorescence imaging technology built into the daVinci Si surgical platform.
Abstract: Indocyanine green has long been used to determine the vascularity of various anatomic structures. Endometriosis is a disease that features neovascularization as a part of its pathologic process. Presented is a case of detecting endometriosis with indocyanine green using the fluorescence imaging technology built into the daVinci Si surgical platform.
TL;DR: TE-P for patients with esophageal cancer was safe and feasible and might be a potentially less invasive procedure than TE-L, retrospectively compared clinical outcomes and surgical stress.
Abstract: AIM Thoracoscopic esophagectomy (TE) in the prone position for patients with esophageal cancer has received a great deal of attention. We retrospectively compared clinical outcomes and surgical stress of TE in the prone position (TE-P) and in the lateral position (TE-L) at our institution. METHODS A total of 58 consecutive patients (28 in the TE-L group and 30 in the TE-P group) were studied. Between the 2 groups, clinical outcomes and various parameters were compared. RESULTS There were no hospital deaths in both TEL and TEP groups. Blood loss during the thoracoscopic part of the surgery were significantly (P<0.01) lower in the TE-P group (118±72 mL) compared with the TE-L (245±203 mL) group. The incidence of respiratory complications tended to be lower (P=0.07) in the TE-P group (3.3%) than in the TE-L (17.8%) group. The duration of systemic inflammatory response syndrome condition was significantly (P=0.02) shorter in the TE-P group (1.5±2.5 d) than in TE-L (3.6±3.5 d) group. The levels of serum C-reactive protein on postoperative days 1 and 2 were significantly (P<0.01) lower in the TE-P group than in the TE-L group. CONCLUSIONS TE-P for patients with esophageal cancer was safe and feasible. TE-P might be a potentially less invasive procedure than TE-L.
TL;DR: R-Y reconstruction after TLDG appears to be a safe and feasible procedure, and is associated with a reduced severity of gastritis and bile reflux in the remnant stomach.
Abstract: PURPOSE The purpose of this study was to compare Roux-en-Y (R-Y) reconstruction with Billroth-II (B-II) reconstruction after a totally laparoscopic distal gastrectomy (TLDG). METHODS Eighty-one consecutive TLDG procedures were performed by a single surgeon and subsequently examined. Postoperative outcomes, clinicopathologic features, and postoperative endoscopic findings between the 2 groups were evaluated and compared. RESULTS The mean operation time was not significantly higher in the R-Y than in the B-II group (P=0.396). Postoperative hospital stay was longer in the R-Y than in the B-II group (P=0.037). The severities of gastritis and bile reflux were reduced significantly in the R-Y group as compared with that in the B-II group (P<0.001). There was no significant difference in the amount of residual food between the 2 groups. CONCLUSIONS R-Y reconstruction after TLDG appears to be a safe and feasible procedure, and is associated with a reduced severity of gastritis and bile reflux in the remnant stomach.
TL;DR: Gasless ET is comparable to open thyroidectomy in terms of early surgical outcomes and complications, and it bridges the gap between conventional open surgery and robotic transaxillary thyroidectomy.
Abstract: Purpose In 2001, the authors developed a novel method of gasless transaxillary endoscopic thyroidectomy (ET) and have now performed >1000 operations. This review was performed to document surgical outcomes after 10 years of experience with this technique and to determine what the role of ET has in the current era. Patients and methods All patients who underwent elective ET using the gasless transaxillary approach from November 2001 to December 2010 were evaluated. Patient demographics, surgical data, histologic analysis results, and complications were recorded and analyzed. Results A total of 1085 patients underwent ET during the study period. Mean patient age was 36.9±9.7 years; the gender ratio was 1:49 (male:female). There were 228 benign thyroid tumor cases and 857 thyroid malignancies. Trend analysis showed a progressive increase in case numbers per month until the end of 2007, followed by a steady decline. There were 175 total thyroidectomy cases and 910 cases of less-than-total thyroidectomy. Mean overall operating time was 132.92±48.6 minutes, and the overall complication rate was 13.5%. The most common complications were: transient hypocalcemia (6.3%), transient hoarseness (3.9%), hematoma (0.4%), permanent hypocalcemia (0.1%), and permanent recurrent laryngeal nerve injury (0.2%). Conclusions Gasless ET is comparable to open thyroidectomy in terms of early surgical outcomes and complications, and it bridges the gap between conventional open surgery and robotic transaxillary thyroidectomy.
TL;DR: Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks and it is very important to insert the stent before sepsis is established.
Abstract: INTRODUCTION Partially covered self-expanding metal stents (SEMS), have been suggested as an alternative to surgery in the treatment of esophageal fistulas of benign etiology. Nevertheless, uncomplicated removal remains difficult. The use of fully covered (FC) SEMSs could solve this problem. OBJECTIVES To review our experience with FC-SEMS placement in patients with benign upper gastrointestinal leaks or perforations. We wanted to assess successful closure of the perforations and short-term and long-term complications. MATERIALS AND METHODS Multicenter study, including 3 tertiary centers. Retrospective review of patients who underwent FC-SEMS placement for benign perforations. RESULTS Eighty-eight stents were placed in 56 patients. We achieved leak closure in 44 patients (78.6%). There were 18 migrations. All of them could be solved endoscopically. A severe septic situation was associated with a higher mortality rate (27.6% vs. 7.4%; P=0.049) and a lower success rate (34.5% vs. 7.4%; P=0.088), compared with those patients who did not present severe sepsis. However, these differences could not be confirmed by multivariable analysis. The results in the subgroup of 11 patients with leaks after sleeve gastrectomy were also good (73% success without surgery and 0% mortality). CONCLUSIONS Temporary placement of FC-SEMS for benign perforations, fistulas, and leaks is feasible in sealing the leaks. All migrations could be solved endoscopically. It is very important to insert the stent before sepsis is established. This article also would be an addition to the growing body of literature supporting stenting as a good alternative if not standard approach to controlling these leaks.