Surgical endoscopy
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Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients.
Surgical treatment for giant paraesophageal hernias (PEH) in morbidly obese patients (BMI > 35) continues to be a difficult problem. Prior studies have demonstrated recurrence rates of up to 40% with higher rates in morbidly obese patients. Reports have shown success combining repair with a bariatric procedure to decrease recurrence rates while achieving weight loss. We report mid-term results from a larger series with combining laparoscopic giant PEH repair with sleeve gastrectomy (SG). ⋯ PEH in morbidly obese patients remain a complex surgical problem. Our case series shows that combination with SG may decrease recurrence rates but more importantly leads to lower rates of reoperation for symptomatic recurrence. Patients also garner the added medical benefits of weight loss.
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Single-incision minimally invasive surgery has previously been associated with incisions 2.0-3.0 cm in length. We present a novel single-incision surgical platform compatible for insertion through a standard 15-mm trocar. The objective of this study is to evaluate the safety and feasibility of the platform. ⋯ This phase I study demonstrates that single-incision cholecystectomy through a 15-mm trocar with the Fortimedix Surgical B.V. single-incision surgical platform is feasible, safe, and reproducible. Additional benefits include excellent triangulation and range of motion as well as exceptional cosmetic results. Further studies will be needed to evaluate long-term hernia rates.
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Although surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection. ⋯ Additional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor.