Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Mar 2013
Randomized Controlled Trial Comparative StudyLigaSure™ vs. conventional dissection techniques in pancreatic surgery--a prospective randomised single-centre trial.
Surgical procedures in pancreatic surgery are well established, but still involve time-consuming manual dissection. We compared the use of LigaSure with conventional dissection techniques in pancreatic surgery in a prospective randomised single-centre trial (registration number: NCT00850291). ⋯ Our data indicate that the LigaSure device is equivalent to conventional dissection modalities in pancreatic surgery.
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J. Gastrointest. Surg. · Mar 2013
Comparative StudyLaparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique.
Laparoscopic surgery benefits obese patients but technical difficulties associated with suboptimal exposure and access in these subjects may prompt conversion to open surgery. Hand-assisted laparoscopic surgery (HALS) confers advantages over standard laparoscopy (LAP) by facilitating tactile feedback, assisted dissection, and retraction. These benefits could be particularly valuable in obese patients, allowing completion of difficult laparoscopic procedures in this subgroup. Our aim was to compare intra-operative and post-operative outcomes of HALS and LAP approaches in obese patients undergoing colorectal resection at our institution. ⋯ In obese patients who require colectomy, the HALS approach increases the likelihood of a successful minimally invasive operation. At the cost of a clinically negligible increase in incision length, HALS may save a high-risk group conversion to formal laparotomy and the adverse outcomes related to this.
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J. Gastrointest. Surg. · Mar 2013
Laparoscopic gastric electrical stimulation for medically refractory diabetic and idiopathic gastroparesis.
Gastric electrical stimulator (GES) implantation is effective in certain patients with gastroparesis; however, laparotomy is often employed for placement. The aim of this study is to review outcomes of patients who underwent laparoscopic GES therapy for diabetic and idiopathic gastroparesis at a large referral center. ⋯ GES placement is feasible using a laparoscopic approach. Medical refractory gastroparesis in the diabetic and idiopathic groups had significant symptom improvement with no difference between the two groups. Need for supplemental nutrition is decreased following GES.
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J. Gastrointest. Surg. · Feb 2013
Randomized Controlled TrialLength and pressure of the reconstructed lower esophageal sphincter is determined by both crural closure and Nissen fundoplication.
Laparoscopic Nissen fundoplication is comprised of: a wrap thought responsible for the lower esophageal sphincter function and crural closure performed to prevent herniation. We hypothesized gastroesophageal junction competence effected by Nissen fundoplication results from closure of the crural diaphragm and creation of the fundoplication. ⋯ The Nissen fundoplication restores the function of the gastroesophageal junction and thus the reflux barrier by means of two main components: the crural closure and the construction of a 360° fundal wrap. Each of these components is equally important in establishing both increased sphincter length and pressure.
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J. Gastrointest. Surg. · Feb 2013
Comparative StudyThe management of acute cholecystitis in chronic hemodialysis patients: percutaneous cholecystostomy versus cholecystectomy.
Treatment of acute cholecystitis in chronic hemodialysis (HD) patients still remains controversial. Because of underlying disease that can influence surgical results, less invasive alternative managements have been tried over the last decades. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis (AC) in chronic HD patients. ⋯ This study confirms that the safety and effectiveness of CC has a higher success rate and lower morbidity and mortality rate compared with percutaneous cholecystostomy for acute cholecystitis in chronic HD patients.