Surgical endoscopy
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The proper diagnosis and appropriate treatment are paramount in ensuring a satisfactory outcome after a bile duct injury associated with laparoscopic cholecystectomy. Immediate recognition of a bile duct injury during laparoscopic cholecystectomy can allow proper treatment at that time, averting difficult complications that could occur in the postoperative period should the injury be missed. Unfortunately, most bile duct injuries are not recognized at the time of laparoscopic cholecystectomy. An appropriate level of suspicion followed by prompt and complete evaluation should result in accurate delineation of the biliary anatomy, which is essential for directing appropriate surgical reconstruction.
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A prospective animal study involving 12 female swine aimed to measure the strength of tissue attachment to composite mesh at various time points after laparoscopic ventral hernia repair in a porcine model. ⋯ The findings demonstrate that the majority of tissue ingrowth and strength has occurred by 2 weeks after laparoscopic placement of a composite hernia prosthesis. Strength very gradually increases until 12 weeks after surgery. This has clinical implications for human ventral hernia repair. Further study is needed to evaluate the necessity of transfascial sutures for securing polypropylene-based prostheses to the abdominal wall during ventral hernia repair.
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Laparoscopic distal pancreatectomy with or without splenectomy is becoming an acceptable alternative to open resection for selected pancreatic lesions. One of the difficulties with this approach is manipulating the pancreas with laparoscopic instruments to avoid unnecessary injury to the pancreas, and yet obtain adequate margins. The described technique accomplishes these goals. ⋯ The lasso technique simplifies intraoperative manipulation of the pancreas during laparoscopic distal pancreatectomy. It allows for safe manipulation of the pancreas and may expand the indications for the laparoscopic approach to pancreatic resection.
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Randomized Controlled Trial Multicenter Study Comparative Study
An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study.
Self-expandable metal stents placed across the esophagogastric junction for palliative treatment of malignant strictures may lead to gastroesophageal reflux and pulmonary aspiration. This study compared the effects of a Dua antireflux stent with those of a conventional stent. ⋯ Antireflux stents may be used without increased risk of complications, mortality, esophageal symptoms, or reduced global quality of life. These results should encourage large-scale randomized trials that can establish potentially beneficial effects of antireflux stents.
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Comparative Study
Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival.
Surgical treatment of esophageal cancer is associated with a high rate of morbidity and mortality even in specialized centers. Minimally invasive surgery has been proposed to decrease these complications. ⋯ The transthoracic and transhiatal open approaches have similar early and late results. Minimally invasive surgery is an option for patients with esophageal carcinoma, with reported results similar to those for open surgery. This approach is indicated mainly for selected patients with early stages of the disease.