Abstract:

Objective: To evaluate the outcomes and initial results of laparoscopic sleeve gastrectomy (LSG) and review of the literature. Methods: A retrospective analysis of the initial ten patients who underwent LSG was performed. Study endpoints included operative time, complication rates, hospital length of stay, and percentage of excess body weight loss. Results: This study included five women and five men, with a mean age of 43 (range: 31-52) years. Their mean preoperative weight was 182 kg (range: 125 kg-247 kg), with a mean preoperative body mass index (BMI) of 64 (range: 61- 80). Indication for LSG was the importance of BMI in all patients. One patient had previous restrictive bariatric surgery. Mean operative time was two (range: 1.5-2.5) hours. No patients required conversion. No postoperative complications nor mortality were noted. The median hospital stay was 7.2 days. Average excess body weight loss and BMI at one year were 51% and 23 kg/m2, respectively. Conclusions: LSG can be integrated safely into a bariatric treatment program with good results in terms of weight loss and quality of life. LSG can be a first-step procedure before gastric bypass or duodenal switch, or a one-step restrictive procedure if long-term results are good. LSG should be considered as a surgical option in the bariatric field, but further studies are needed to determine its exact use

Authors:

Philippe Mognol, M.D.; Denis Chosidow, M.D.; Jean-Pierre Marmuse, M.D., Ph.D., Hôpital Bichat, Paris, France

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Abstract:

Gastroesophageal reflux disease (GERD) is one of the most common pathologies treated by primary care physicians. Despite advances in antacid pharmacological treatments, many patients remain refractory to maximal medical therapy. In addition, many others are either unable to tolerate the side effects of the drugs or simply are unwilling to receive life-long daily medications. Laparoscopic Nissen fundoplication has evolved as the surgical procedure of choice for patients with GERD. Although the durability of surgical management has been questioned, experienced surgeons achieve long-term reflux cure rates of about 85% to 95%. Barrett's esophagus has recently been considered an additional indication for surgical therapy of reflux due to evidence of dysplasia regression following a 360° fundoplication. However, the timing of surgical intervention and the exact procedure for patients with both short- and long-segment Barrett's esophagus remains debatable. Esophageal dysmotility in surgical patients with GERD has traditionally been approached by "tailoring" the degree of fundoplication. Recent evidence suggests that partial fundoplication may not be effective and that full fundoplication should still be employed. The degree of dysmotility prohibitive to a full 360° fundoplication remains controversial and should be addressed with future randomized trials. Finally, patients with failed fundoplication represent a formidable diagnostic dilemma and a technical challenge. In experienced hands, these patients can still benefit from minimally-invasive restorative or "re-do" fundoplications with minimal perioperative morbidity and good long-term results.

Authors:

Yuri W. Novitsky, M.D.; B. Lauren Paton, M.D.; Kent W. Kercher, M.D.; B. Todd Heniford, M.D., Carolinas Medical Center, Charlotte, NC

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Abstract:

Background: The feasibility and safety of laparoscopic adjustable gastric banding for treatment of morbid obesity has been demonstrated in a large number of studies. Access port-related complications constitute a significant part of all complications related to gastric banding. Further, adjustment of hydraulic gastric bands can be fairly lengthy, uncomfortable, and is not a precise procedure. A study was performed to assess the usefulness and efficacy of a new type of band adjusted telemetrically without the need for an access port. The initial worldwide results of the first telemetrically adjustable gastric band for morbid obesity (EASYBAND®; EndoArt Medical Technologies, Switzerland) in two German academic centers are described herein.

Authors:

Rudolph A. Weiner, M.D., Krankenhaus Sachsenhausen, Frankfurt am Main; Michael Korenkov, M.D., University Mainz, Mainz, Germany; Esther Matzig, M.D., Krankenhaus Sachsenhausen, Frankfurt am Main; Sylvia Weiner, M.D., Krankenhaus Sachsenhausen, Frankfurt am Main, Germany; Woiteck K. Karcz, M.D., Krankenhaus Sachsenhausen, Frankfurt am Main, Germany

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Abstract:

The procedure of stapled hemorrhoidectomy has been established as a safe and effective method for treating symptomatic hemorrhoids not responsive to more conservative measures. This chapter discusses the issues of safety, efficacy, durability, and cost of this procedure. In addition, we outline techniques for performing the procedure safely and effectively.

Authors:

Andrew G. Hill, M.B.Ch.B., M.D., F.R.A.C.S., South Auckland Clinical School, University of Auckland, Middlemore Hospital, Auckland, New Zealand; Arend E. H. Merrie, M.B.Ch.B., Ph.D., F.R.A.C.S., Auckland City Hospital, Auckland, New Zealand

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Abstract:

The essential objectives for thyroidectomy are avoidance of injury to the recurrent laryngeal nerves (RLNs), conservation of the parathyroid glands, an accurate haemostasis, and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these mini-invasive thyroidectomy, regional anaesthesia, and intraoperative neuromonitoring. Moreover, new devices for achieving dissection and haemostasis have been proposed. The purpose of ligating vessels is to maintain the surgical site free from an excess of blood and reduce blood loss in patients. This chapter reviews relevant medical literature published in the English language since 1990 on thyroid surgery techniques with well-controlled trials on haemostasis and dissection. Searches were last updated October 2005.

Authors:

Gianlorenzo Dionigi, M.D.; Luigi Boni, M.D.; Francesca Rovera, M.D.; Renzo Dionigi, M.D., F.A.C.S., F.R.C.S. (Hon. Edin.), University of Insubria, Varese, Italy

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Abstract:

Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in General Surgery with more than 500,000 performed annually. Overall, the complication rate is less than 1.5%, and the mortality rate is less than 0.1%. As such, laparoscopic cholecystectomy was considered by most to be at its zenith since its inception in the early 1990s. Advancements in technology and equipment have opened new doors to physicians and allowed the laparoscopic cholecystectomy to once again evolve. Traditional four-port cholecystectomy has given way to three- and even two-port techniques. Standard 12-mm ports have been replaced by 2-mm ports, and experiments have now been implemented to achieve cholecystectomy with no ports—known as the transgastric technique. The authors reviewed evolution of these techniques that included a synopsis of our experience with the three-port cholecystectomy, as well as the future direction of laparoscopic surgery.

Authors:

Dana A. Osborne, M.D.; Gerald Alexander, B.S.; Brian Boe, B.S.; Emmanuel E. Zervos, M.D., F.A.C.S., University of South Florida, Tampa, FL

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Abstract:

More so than with other types of colon cancer, rectal cancer is associated with a range of laparoscopic surgical techniques. Treatment of cancer of the lower rectum requires favorable operative fields, minimal contact with the tumor during dissection, and delicate surgical procedures to avoid nerve damage. Such surgery thus requires immobilizing the trunk so the patient can be repositioned as needed, placing ports at appropriate locations, as well as careful handling of surgical equipment. To minimize the risk of disseminating cancer cells during the procedure, the surgery should be restricted to patients with early-stage cancer. The most difficult surgical procedure is resection of the lower rectum. While safe resection of the intestinal tract was difficult using previously available surgical equipment, newly developed equipment makes today's resections much safer and easier. Indications for surgical intervention should be broadened carefully, based on a deeper understanding of the surgical anatomy within the pelvis and on various relevant oncological and technical factors.

Authors:

Yukihito Kokuba, M.D., Ph.D.; Takeo Sato, M.D., Heita Ozawa, M.D.; Takatoshi Nakamura, M.D.; Kazuhiko Hatate, M.D.; Masahiko Watanabe, M.D., Ph.D., Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan

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Abstract:

Minimally invasive surgery has undergone rapid development over the last 20 years and has greatly impacted the field of General Surgery. Removal of the appendix and gallbladder by way of laparoscopic means has become standard in surgical training and care. More complex procedures also are becoming incorporated into surgical resident education and routine clinical practice. Colon cancer operations, previously performed by an open approach to ensure adequate resection of the specimen and draining lymph nodes, are currently being performed laparoscopically by experienced surgeons with equivalent recurrence, morbidity, and overall mortality rates. In this chapter, the technique of laparoscopic colectomy is described and advantages and disadvantages are discussed. The literature is reviewed and this technique compared with the open procedure. The authors contend that laparoscopic colectomy is a suitable, and perhaps preferable, alternative to open procedures for benign or malignant colon disease, with acceptable long-term results.

Authors:

Allen P. Kong, M.D., Cam-Ly P. Tran, M.D.; Michael J. Stamos, M.D., F.A.C.S., F.A.S.C.R.S., University of California, Irvine, Orange, CA

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