Surgical endoscopy
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Lung transplantation has emerged as a viable therapeutic option for patients with a variety of end-stage pulmonary diseases. As immediate posttransplant surgical outcomes have improved, the greatest limitation of lung transplantation remains chronic allograft dysfunction. Gastroesophageal reflux disease (GERD) with resultant aspiration has been implicated as a potential contributing factor in allograft dysfunction. GERD is prevalent in end-stage lung disease patients, and it is even more common in patients after transplantation. We report here on the safety of laparoscopic fundoplication surgery for the treatment of GERD in lung transplant patients. ⋯ GERD occurs commonly in the posttransplant lung population. Laparoscopic fundoplication surgery, when indicated, can be done safely with minimal morbidity and mortality. In addition to the resolution of reflux symptoms, improvement in pulmonary function may be seen in this population after fundoplication. Lung transplant patients with severe GERD should be strongly considered for antireflux surgery.
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Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population. We report an outcome analysis of our early experience with laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment of morbid obesity. ⋯ Although technically challenging, LRYGB can be performed safely with excellent long-term results. The mean operating room time and conversion rate improved with experience. As this study showed, LRYGB achieves an excellent rate of weight loss and improvement in preoperative comorbidities with a minimal length of hospital stay and an acceptable complication rate.
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Comparative Study
A prospective comparative study of needlescopic and conventional endoscopic extraperitoneal inguinal hernioplasty.
Needlescopic inguinal hernioplasty has been made feasible with the miniaturization of instruments and recent advances in laparoscopic surgical technique. Postoperative outcome of needlescopic totally extraperitoneal inguinal hernioplasty (TEP) has not been previously compared with that of conventional TEPs. The objective of the current study is to compare the postoperative outcomes of needlescopic and conventional TEPs. ⋯ Needlescopic TEP is a safe technique for the repair of inguinal hernia. Postoperative recovery following needlescopic and conventional TEPs was similar. Needlescopic TEP conferred a significantly lower pain score upon coughing on the first day after operation.
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Laparoscopic bariatric surgery is a challenging procedure with a high risk of technical misadventures that may increase postoperative morbidity. Routine intraoperative endoscopy may reduce postoperative morbidity. This article reviews our 6-year experience. ⋯ Routine intraoperative endoscopy identified 34 correctable technical errors in a series of 825 laparoscopic bariatric procedures. Of these, 33 (97%) were repaired successfully, which reduced postoperative morbidity.
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The surgical management of acute appendicitis presenting with appendicular mass remains controversial. The aim of this study was to evaluate the role of early laparoscopy and laparoscopic appendectomy (LA) in the management of appendicular mass. ⋯ Early LA during the index admission of patients with an appendicular mass is feasible and safe, obviates the need for a second hospital admission, and avoids misdiagnoses.