Surgical endoscopy
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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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Experience alone is not sufficient to protect surgeons and their patients from biliary injury. This article suggests valuable technical considerations for the performance of laparoscopic cholecystectomy. Against the background of a widely accepted biliary injury classification system, the risk factors and causes of biliary injury are considered. The concept of the critical view exposure technique for Calot's triangle is emphasized from the practical standpoint of avoiding misidentified injuries.
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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.
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The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus. ⋯ Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence.
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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.