JSLS : Journal of the Society of Laparoendoscopic Surgeons
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Unilateral versus bilateral wrap crural fixation in laparoscopic Nissen fundoplication for children.
Gastroesophageal reflux (GERD) is common in neurologically impaired (NI) children. Fundoplication and gastrostomy have previously been indicated in NI children with GERD who have not responded to medical treatment. The most common reason for fundoplication failure is intrathoracic migration of the wrap. ⋯ Bilateral fixation of the wrap to diaphragmatic crura significantly reduced recurrent GERD, in laparoscopic Nissen fundoplication for neurologically impaired children, with no increased risk of morbidities. Future prospective studies should be conducted with larger patient populations and longer follow-up periods.
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The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. ⋯ In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.
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Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR). ⋯ Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia.
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The loss of an instrument during a surgical procedure is a potentially dangerous medical event. Retained surgical needles are reported to cause chronic pain, chronic irritation, and organ injury. Surgical needles lost during minimally invasive surgery are particularly difficult to retrieve because of their diminutive size and the camera's limited visual field, often prompting protracted recovery attempts that can add to surgical costs. Few detailed recommendations exist for the recovery of a misplaced needle. ⋯ On the basis of survey results and current literature, our protocol incorporates a camera survey of the abdomen, intraoperative fluoroscopic radiography, port inspection, and a quadrant-based systematic visual search for the recovery of needles lost during minimally invasive surgery.