Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Randomized Controlled Trial Comparative StudySingle-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial.
We report the outcomes of a randomized clinical trial of single-port laparoscopic cholecystectomy (SPLC) and multiport laparoscopic cholecystectomy (MPLC). ⋯ Although SPLC takes longer than MPLC, experienced laparoscopic surgeons can perform SPLC safely with results comparable with those for MPLC. SPLC is superior to MPLC in terms of short-term cosmetic outcomes.
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Laparoscopy grading system of acute appendicitis: new insight for future trials.
The mini-invasive techniques have revolutionized the surgery; however, the superiority of laparoscopic access for complicated appendicitis is still controversial. The most critical point has been the dismal quality of the methodology found in the series comparing laparoscopic and laparotomic procedures. The lack of stratification criteria to evaluate the inflammation in the appendix and abdomen has been pointed out by several authors. ⋯ Laparoscopy showed good to excellent accuracy for diagnosis and grading of acute appendicitis. The better grading system allowed the evaluation of patients with acute appendicitis in the same clinical stage.
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Comparative StudyBiliary tract imaging for retained calculi after laparoscopic cholecystectomy: is risk stratification useful?
The aim of this study was to determine the incidence of common bile duct (CBD) calculi patients undergoing laparoscopic cholecystectomy (LC) without routine intraoperative cholangiography (IOC) and the usefulness of risk stratification in guiding appropriate biliary tract imaging. Five hundred forty consecutive LCs were performed during the 12-month study period. Four hundred fifty-eight (84.8%) patients with low risk of CBD stones proceeded immediately to LC. ⋯ The preoperative incidence of CBD stones was 29/540 (5.4%), while 11 patients (2.04%) were readmitted with retained CBD calculi and underwent successful stone extraction with ERCP. The incidence of retained CBD calculi after LC without IOC is low. Risk stratification helps to accurately predict CBD stones and facilitates appropriate and cost-effective use of ERCP and magnetic resonance cholangiopancreatography.
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Comparative StudyTransanal near-infrared imaging of colorectal anastomotic perfusion.
The influence of perfusion on colorectal anastomotic healing and, conversely, the role of ischemia in anastomotic dehiscence have been reported by many investigators, and yet identifying a modality that can evaluate perfusion in real time and thus guide intraoperative management has proven elusive. This study describes our initial experience using transanal near-infrared (NIR) imaging to evaluate anastomotic perfusion after colorectal anastomoses. Patients undergoing colectomy with an anastomosis within 25 cm of the anal verge were included in this study. ⋯ The rectum was easily navigated under direct vision and the anastomotic staple line visualized. High-quality NIR mucosal angiography was obtained in all subjects, confirming that transanal NIR angiography is feasible and simple to perform. Although NIR mucosal angiography is a promising modality, further study is needed to correlate this technique to the clinical outcome.