Surgical endoscopy
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Comparative Study
Minimally invasive surgical approach for the treatment of gastroparesis.
Gastroparesis is a chronic disorder resulting in decreased quality of life. The gastric electrical stimulator (GES) is an alternative to gastrectomy in patients with medically refractory gastroparesis. The aim of this study was to analyze the outcomes of patients treated with the gastric stimulator versus patients treated with laparoscopic subtotal or total gastrectomy. ⋯ The gastric electrical stimulator is an effective treatment for medically refractory gastroparesis. Laparoscopic subtotal gastrectomy should also be considered as one of the primary surgical treatments for gastroparesis given the significantly higher rate of symptomatic improvement with acceptable morbidity and comparable mortality. Furthermore, the gastric stimulator patients who have no improvement of symptoms can be successfully treated by laparoscopic subtotal gastrectomy.
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Comparative Study
Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
Early laparoscopic cholecystectomy for acute cholecystitis is safe and effective. However, the potential cost savings of this management strategy have not been well studied in a North American context. This study aimed to estimate the cost effectiveness of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy in Canada. ⋯ Adoption of a policy in favor of early laparoscopic cholecystectomy will result in better patient quality of life and substantial savings to the Canadian health care system.
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Comparative Study
Loop ileostomy closure after laparoscopic versus open surgery: is there a difference?
Temporary loop ileostomy is commonly performed to protect the distal anastomosis during both open and laparoscopic colectomies. This study aimed to evaluate the impact of initial open and laparoscopic colorectal resection on the outcomes of ileostomy closure. ⋯ Loop ileostomy closure after laparoscopic colorectal surgery is associated with a significantly shorter operative time and hospital stay as well as a lower rate of postoperative complications. Superior outcomes after loop ileostomy closure lend further support to the use of laparoscopy.
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The aim of this study was to report the trends in provision of cholecystectomy in the National Health System in England over the 9 year period from 2000 to 2009 and to determine the major risk factors associated with subsequent poor outcome. ⋯ The provision of laparoscopic cholecystectomy in England has increased. This has been associated with improvements in outcomes such as mortality and length of stay. However, emergency cholecystectomy uptake remains sub-optimal and is more likely to be performed at high-volume or specialist hospitals without adverse outcomes. Further research into the routine provision of emergency cholecystectomy in England is needed in order to optimize patient outcomes.
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Certification in fundamentals of laparoscopic surgery (FLS) is required by the American board of surgery for graduating residents. This study aimed to evaluate the feasibility and need for certifying practicing surgeons and to assess proficiency of operating room (OR) personnel. ⋯ This study demonstrated that FLS certification for practicing surgeons and proficiency verification for OR personnel are feasible. A baseline skills failure rate of 33% and a certification failure rate of 13% suggest that FLS certification may be necessary to ensure surgeon competency. Fortunately, with only moderate practice, significant improvement can be achieved.