Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Dec 2012
Review Meta Analysis Comparative StudyLower recurrence rates after mesh-reinforced versus simple hiatal hernia repair: a meta-analysis of randomized trials.
Mesh hiatoplasty has been postulated to reduce recurrence rates, it is however prone to esophageal stricture, and early-term and mid-term dysphagia. The present meta-analysis was designed to compare the outcome between mesh-reinforced and primary hiatal hernia repair. The databases of Medline, EMBASE, and the Cochrane Library were searched; only randomized controlled trials entered the meta-analytical model. ⋯ Pooled analysis demonstrated increased risk of recurrence in primary hiatal closure (odds ratio, 4.2; 95% confidence interval, 1.8-9.5; P=0.001). Mesh-reinforced hiatal hernia repair is associated with an approximately 4-fold decreased risk of recurrence in comparison with simple repair. The long-term results of mesh-augmented hiatal closure remain to be investigated.
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Surg Laparosc Endosc Percutan Tech · Dec 2012
Review Meta AnalysisSingle-incision versus conventional laparoscopic cholecystectomy in patients with uncomplicated gallbladder disease: a meta-analysis.
Laparoscopic cholecystectomy is the gold standard treatment for cholecystectomy. Recently, single-incision laparoscopic cholecystectomy (SILC) has been suggested as an alternative technique. ⋯ The current evidence shows that patients with uncomplicated cholelithiasis or polypoid lesions of the gallbladder who prefer a better cosmetic outcome, SILC offers a safe alternative to CLC. Further high-powered randomized trials are need to determine whether SILC truly offer any advantages, especially be focused on failure of technique, adverse events, cosmesis, and quality of life.
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Surg Laparosc Endosc Percutan Tech · Dec 2012
Full-thickness gastroplication for the treatment of gastroesophageal reflux disease: short-term results of a feasibility clinical trial.
This was a prospective study that evaluates subjective and objective patient parameters 3 months after full-thickness gastroplication. Forty-one patients with documented gastroesophageal reflux disease and persistent symptoms despite medical treatment, without radiologic visible hiatal hernia, were enrolled in the study and underwent endoscopic full-thickness gastroplication with one or more plicator implants. Evaluation of Gastrointestinal Quality of Life Index, symptoms typically related to reflux, gas bloat, and bowel dysfunction and esophageal manometry, and impedance-pH monitoring were performed at baseline and 3 months after the procedure. ⋯ DeMeester score reduced nonsignificantly (P<0.098). 21.6% of the patients were on proton-pump inhibitor medication on a daily basis after the procedure. There was only 1 postprocedure incident (bleeding) that required intervention. In conclusion, endoscopic full-thickness plication is a safe and well-tolerated procedure that significantly improves quality of life and eliminates gastroesophageal reflux disease symptoms in the majority of patients, without side effects seen after laparoscopic fundoplication.
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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.