Surgical endoscopy
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Comparative Study Clinical Trial
Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery.
Anastomotic leaks are a major complication of oesophagogastric surgery. We compare contrast swallow fluoroscopy, computed tomography (CT) with oral contrast and endoscopy in identifying anastomotic leaks following oesophagogastric surgery. ⋯ Routine tests of anastomotic integrity are unnecessary. When clinically suspected, contrast swallow or CT with oral contrast will identify most leaks. Endoscopy is useful in cases where there are incongruous results.
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Randomized Controlled Trial Multicenter Study
Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial.
A new persistent groin pain is reported by a significant number of patients following laparoscopic totally extraperitoneal hernia repair (TEP). Mesh fixation has been implicated as a possible cause, but is widely considered essential for mesh stabilization and early recurrence prevention. This study investigates whether any association exists between mesh fixation by metal tacks and the incidence of new groin pain or early hernia recurrence. ⋯ Mesh fixation in TEP is associated with increased operative cost and chronic pain but no difference in the risk of hernia recurrence at six months was observed.
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Comparative Study
Comparing fibrin sealant with staples for mesh fixation in laparoscopic transabdominal hernia repair: a case control-study.
Laparoscopic hernia repair is not as popular as cholecystectomy. We have performed more than 3,000 laparoscopic herniorrhaphies using the trans-abdominal (TAPP) technique. To prevent recurrences we fix the polypropylene mesh with staples. The use of fibrin glue for graft fixation is a possible alternative. ⋯ Less post-operative pain, and a faster return to usual activities are the main advantages of laparoscopic repair compared to the traditional approach. The use of fibrin sealant reduces in our experience the risk of post- and intra-operative complications such as bleeding and incisional hernia; recurrence rates are similar, but the operative time is longer.
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Comparative Study
Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects.
Laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for advanced gastric cancer is still controversial. To evaluate the technical and oncologic feasibility and advantage of LADG with D2 lymph node dissection, the authors compared the surgical outcomes of LADG with D2 dissection and those of conventional open distal gastrectomy (ODG) for patients with early gastric cancer (EGC). ⋯ LADG with D2 lymph node dissection is a safe and feasible procedure, and it is oncologically compatible with open gastrectomy. A large-scaled prospective randomized trial with advanced gastric cancer patients should be conducted to confirm the benefit of LADG.
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Comparative Study
Hand-assisted versus laparoscopic-assisted colorectal surgery: Practice patterns and clinical outcomes in a minimally-invasive colorectal practice.
Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon's hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice. ⋯ Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits.