Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Nov 2003
Comparative StudyOld and new TNM in carcinoma of the gastric antrum: analysis of our personal experience.
Various tumor node metastasis (TNM) classifications have been proposed for staging of gastric carcinoma, including the fourth edition of the TNM classification and the Japanese Research Society for Gastric Cancer (JRSGC) system. In 1997 the fifth edition of TNM classification introduced the concept of the number of metastatic lymph nodes. We review our experience with staging gastric cancer in light of both the fourth and fifth editions of the TNM classification system. ⋯ According to the fifth edition, the difference in survival probability was P<0.001 between N0 and N1 patients and N2 and N3 patients. The fifth TNM edition presents a greater ease of stratification in bringing together and mediating diverse cultural experiences between West and East. This staging lays the basis for a more accurate comparison between the groups.
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Asymptomatic cystic pancreatic neoplasms are being detected by abdominal imaging with increasing frequency. Enucleation of small cystic neoplasms can be performed without recurrence but has been associated with a higher incidence of pancreatic fistula. Thus the procedure has been modified to include intraoperative ultrasound imaging and closure of the pancreatic defect. ⋯ Pancreatic fistula rates (27% vs. 26%) and length of hospital stay (12.6 vs. 15.7 days) were similar in the two groups. Enucleation of benign cystic pancreatic neoplasms reduces operative time and blood loss without increasing postoperative complications or length of stay. Therefore enucleation should be the standard operation for small benign cystic neoplasms in the uncinate, head, neck, and body of the pancreas.
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J. Gastrointest. Surg. · Nov 2003
Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator.
The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task. ⋯ Measures of consistency and reliability were greater than 0.8 in both groups with the exception of novice completion time where test-retest reliability was 0.74. The GI Mentor II simulator can distinguish between novice and intermediate endoscopists. The simulator assesses skills with levels of consistency and reliability required for high-stakes assessment.
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J. Gastrointest. Surg. · Jul 2003
Intratracheal long-term pH monitoring: a new method to evaluate episodes of silent acid aspiration in patients after esophagectomy and gastric pull up.
Aspiration of gastric contents is considered a leading cause of postoperative pulmonary complications after esophagectomy and gastric pull up but has been difficult to diagnose. We used intratracheal long-term pH monitoring to evaluate the prevalence of aspiration of gastric contents in patients undergoing these operations. Continuous intratracheal pH monitoring was carried out during the first 72 postoperative hours in 16 patients with esophageal carcinoma who had undergone esophagectomy and gastric pull up. ⋯ Both of them had several episodes of acid aspiration detected by pH monitoring immediately postoperatively. Intratracheal pH monitoring is a safe, feasible, and well-tolerated method for detecting episodes of acid aspiration after esophagectomy and gastric pull up. Aspiration of gastric contents is a common phenomenon particularly during the first 24 postoperative hours after transthoracic esophagectomy and gastric pull up in the posterior mediastinum and appears to correlate with the development of postoperative pneumonia.
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Obese patients carry a higher risk of wound complications and cardiopulmonary complications along with a higher incidence of comorbidity, all of which have the potential to affect outcome after a variety of surgical procedures. The data regarding outcomes after laparoscopic colectomy in obese and nonobese patients are limited. The purpose of this report was to compare the outcome of laparoscopic bowel resection in obese and nonobese patients. ⋯ There were no significant differences between the two groups with respect to age, sex, operative procedure, length of hospital stay, or readmission rates. The obese group had significantly more conversions to an open procedure (23.7% vs. 10.9%), a longer operative duration (109 minutes vs. 94 minutes), a higher morbidity rate (22% vs. 13%) and a higher anastomotic leakage rate (5.1% vs. 1.2%). This large experience with laparoscopic colectomy for a variety of conditions demonstrates that despite higher conversion rates, an increased risk of pulmonary complications, and anastomotic leakage rates in obese laparoscopic patients that parallel those of open surgery, laparoscopic colectomy can be performed safely in both obese and nonobese patients with the similar benefit of a shorter hospital stay in both groups.