Surgical endoscopy
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Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence. ⋯ LVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM-LVHR a reference procedure.
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In esophageal squamous cell carcinoma, the number of dissected lymph nodes (LNs), including those along the recurrent laryngeal nerves (RLNs), influences prognosis and nodal staging accuracy. However, dissection of LNs along the RLN increases the risk of complications, especially RLN palsy. Therefore, complete dissection of these LNs with prevention of RLN palsy is recommended. We present herein a new method for lymphadenectomy along the right RLN, named the Pincers maneuver, during thoracoscopic esophagectomy in the prone position (TEP). ⋯ The Pincers maneuver for lymphadenectomy along the right RLN during TEP is technically safe and feasible. It increases the number of dissected LNs along the right RLN.
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Bariatric surgery is the most effective treatment for morbidly obese type II diabetics. However, guidelines for perioperative glucose control are not well established. We examined management of perioperative glucose levels in diabetic patients undergoing bariatric surgery and determined the impact of optimal glucose control as defined by the American Society for Metabolic and Bariatric Surgery (ASMBS) on patient outcomes, including long-term diabetes resolution. ⋯ Bariatric surgery leads to significant resolution of type II diabetes and a prompt improvement in glucose tolerance in the perioperative period. Optimal glucose control as defined by the ASMBS was not associated with improved postoperative outcomes in our patient population but was highly predictive of long-term diabetes resolution.
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Randomized Controlled Trial
Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial.
The incidence of shoulder pain (SP) following laparoscopic cholecystectomy (LC) varies between 21 and 80 %. A few randomised controlled trials and meta-analysis have shown lesser SP in LC performed under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC. ⋯ CTRI/2016/02/006590.
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Decreased blood perfusion is an important risk factor for postoperative anastomotic leakage (AL). Fluorescence imaging with indocyanine green (ICG) provides a real-time assessment of intestinal perfusion. This study evaluated the utility of ICG fluorescence imaging in determining the transection line of the proximal colon during laparoscopic colorectal surgery with double stapling technique (DST) anastomosis. ⋯ ICG fluorescence imaging is useful for determining the transection line in laparoscopic colorectal surgery with DST anastomosis. Anticoagulation therapy and preoperative chemotherapy are important risk factors for poor intestinal perfusion.