196,398 research outputs found
Hand-assisted laparoscopic pancreatic resection
No full textThe extent of reported laparoscopic pancreatic resections vary from enucleation to pancreaticoduodenectomy. Nevertheless, most patients with pancreatic disease who require resection are still treated with a traditional approach. Technological advancements in recent years may play an important role for the future diffusion of laparoscopic pancreatectomy. In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen through a small laparotomy while pneumoperitoneum is maintained, and uses the hand to assist with dissection, palpation and retraction, control of blood vessels, manipulation of organs, and removal of the specimen. We present a review of our experience and of the world literature on hand-assisted laparoscopic pancreatic resection. Based on the first encouraging results, we believe that the hand-assisted technique should allow for substantial advantages to laparoscopic pancreatic surgery in the future
Laparoscopic pancreatic resection
No full textThe extent of reported laparoscopic resections vary from enucleation to pancreaticoduodenectomy. Although initial series have been reported with encouraging results, most patients with pancreatic disease requiring resection are still treated with an open approach. We present a review of our experience and of the world literature on laparoscopic pancreatic resection. Laparoscopic pancreaticoduodenectomy has been attempted in 12 patients with a conversion rate of 33%. Complications occurred in the laparoscopic group. The laparoscopic patients have experienced no benefit in the postoperative recovery and convalescence. Early experience with the hand-assisted approach is promising. Sixty-eight laparoscopic distal pancreatectomies and enucleations have been reported to date. They were 42 distal pancreatectomies and 26 enucleations. Thirteen procedures have been converted to open surgery (19.1%). There was no mortality and the main postoperative complication was pancreatic leak (5 patients, 7.3%). Average hospital stay was 9 days. These results compare favorably with the outcomes after open pancreatic resection. While laparoscopic pancreaticoduodenectomy is not associated with patient benefit and may be accompanied by increased morbidity, laparoscopic distal pancreatectomy and enucleation are safe, carry low morbidity and have encouraging results in terms of postoperative recovery
Correction: Creation of Side-to-Side Compression Anastomosis Using the GT Metabolic SolutionsTM Magnet System, DI Biofragmentable (MagDITM System) to Achieve Duodeno-Ileal Diversion in Patients with Obesity: Preliminary Italian Multi-Center Results (Obesity Surgery, (2025), 10.1007/s11695-025-08409-z)
No full textIn the published article there is an error in the name of the fourth author. The correct name is Giovanni Cesana
Evidence-based medicine: Open and laparoscopic bariatric surgery
No full textBackground: The aim of this study was to perform an evidence-based analysis of the literature on open and laparoscopic surgery for morbid obesity.Methods: Human studies on surgery for morbid obesity were conducted. Multiple publications of the same studies, abstracts, and case reports were reviewed. Current Contents, MEDLINE, EMBASE, and Cochrane Library databases were investigated.Results: Open Roux-en-Y gastric by pass (RYGB) for morbidly obese patients and long-limb RYGB for superobese patients are highly effective procedures. Randomized controlled trials comparing malabsorptive procedures with other bariatric operations are needed. The long-term efficacy of adjustable silicone gastric banding (ASGB) still is undetermined because of poor evidence. Laparoscopic RYGB is as safe as its open counterpart, although its long-term results are lacking. Laparoscopic ASGB is less invasive than open ASGB. although its efficacy cannot be determined because of poor evidence. Laparoscopic vertical banded gastroplasty (VBG) is becoming unpopular since the decreasing trend of open VBG. Laparoscopic biliopancreatic diversion with duodenal switch is feasible, but needs further studies.Conclusions: Randomized controlled trials comparing the various laparoscopic operations are strongly needed
Palliative laparoscopic hepatico- and gastrojejunostomy for advanced pancreatic cancer
No full textOnly 10% to 20% of pancreatic tumors are resectable at the time of diagnosis. Patients with advanced disease have a median survival of 4.9 months. Palliation is often required for biliary or duodenal obstruction, or both, and for pain. Optimal palliation should guarantee the shortest possible hospital stay and as long a survival as possible with a good quality of life. In recent years, treatment options for palliation of biliary and duodenal obstruction due to pancreatic cancer have broadened. Endoscopic and percutaneous biliary stenting have been shown to be successful tools for safe palliation of high-risk patients. Nevertheless, fit patients with unresectable pancreatic cancer benefit from surgery, which allows long-lasting biliary and gastric drainage. While laparoscopic cholecystojejunostomy and gastroenterostomy in patients with advanced pancreatic cancer have been widely reported, laparoscopic hepatico-jejunostomy has been rarely described. In this article, we describe our technique of laparoscopic hepatico-jejunostomy and gastrojejunostomy. We also discuss current evidence on the indications for these procedures in patients with unresectable pancreatic cancer
A biodegradeable membrane from porcine intestinal submucosa to reinforce the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: Preliminary report
No full textBackground: A Silastic ring has been used to prevent dilation of the gastrojejunostomy in Roux-en-Y gastric bypass (RYGBP), The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with prostheses. The aim of this study was to evaluate the feasibility and safety of applying such a bio-membrane around the gastrojejunostomy in Laparoscopic RYGBP (LRYGBP).Methods: We used a new bio-membrane, that is derived from porcine small intestinal submucosa (SIS) and acts as a scaffolding for the ingrowth of connective tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastomosis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared these patients to a control group of LRYGBP patients matched for BMI.Results: The average age of the patients was 35.0 years (control group: 45.1 years),The patients had a mean initial BMI of 44.7 kg/m(2) (+/-5.9) standard error, and the control subjects had a mean initial BMI of 46.7 kg/m(2) (+/-6.5). SIS application took a mean time of 11 (+/-3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a symptomatic stenosis at the gastrojejunostomy following surgery. In the control group there were two stenoses, At an average followup of 87 days (controls: 95 days), the mean reduction in BMI was 7.8 (+/-0.8) kg/m(2) [controls 8.6 kg/m(2) (+/-1.5)].Conclusion: Application of SIS around the gastrojejunostomy in patients undergoing LRYGBP is feasible and safe. Further follow-up is required, however, to evaluate the effectiveness in preventing dilation of the anastomosis
Subcutaneous endoscopic fasciotomy in a porcine model of abdominal compartment syndrome: A feasibility study
No full textPurpose: Treatment of abdominal compartment syndrome (ACS) involves abdominal decompression via a laparotomy, which can result in significant wound-related morbidity. Our aim was to determine if subcutaneous endoscopic abdominal fasciotomy in a porcine model of ACS is feasible and what effect it may have on intra-abdominal pressure (IAP) and superior mesenteric artery (SMA) blood flow.Materials and Methods: A total of 6 female pigs weighing 50 kg each were used for the study. Each animal underwent placement of an arterial line, pulmonary artery catheter, SMA blood flow probe, IAP catheter, and intra-abdominal saline infusion line. After endoscopic dissection of a subcutaneous pocket overlying the rectus muscles, saline was infused into the abdomen to a pressure of 40 mm Hg. Physiologic parameters were measured before and after bilateral endoscopic anterior rectus fasciotomies were performed, and analyzed with a paired t-test.Results: Mean subcutaneous dissection time was 42.5 +/- 11.3 minutes, and mean fasciotomy time was 5.5 +/- 2.3 minutes. There were no significant changes in heart rate, cardiac output, pO(2), or pH during the experiment. IAP increased exponentially as fluid was instilled into the abdomen. SMA blood flow decreased reliably and linearly with increasing IAP. Mean baseline IAP was 4.0 +/- 1.7 mm Hg. IAP decreased from 37 nun Hg to 25 mm Hg after fasciotomy (P < 0.001). Mean baseline SMA blood flow was 629 +/- 164 mL/min. SMA blood flow improved from 265 mL/min to 389 mL/min after fasciotomy (P < 0.01).Conclusion: Subcutaneous endoscopic abdominal fasciotomy is feasible and appears to lower IAP and raise SMA blood flow in a porcine model of ACS
Histologic studies of the bypassed stomach after Roux-en-Y gastric bypass in a porcine model
No full textLaparoscopic Roux-en-Y gastric bypass (LRYGBP) is highly effective for morbid obesity. However, the long-term effects in the bypassed segments are unknown. The aim of this study is to evaluate gastrin and histologic changes in bypassed segments after LRYGBP
Laparoscopic reoperative bariatric surgery: Experience from 27 consecutive patients
No full textBackground: 10 to 25% of patients undergoing bariatric surgery will require a revision, either for unsatisfactory weight loss or for complications. Reoperation is associated with a higher morbidity and has traditionally been done in open fashion. The purpose of this study was to determine the safety and efficacy of reoperative surgery using a laparoscopic approach.Methods: A retrospective review of medical records over a 22-month period was conducted. 27 consecutive obesity surgery patients, who had undergone a laparoscopic revision, were identified. 26 of the 27 patients were women. The average age was 40.3 years (range 20 to 58 years) and average original preoperative body mass index (BMI) was 51.6 kg/m(2) (range 42 to 66.5). The 27 primary bariatric operations consisted of vertical banded gastroplasty (12), gastric band placement (9) and gastric bypass (6). 17 of them were open procedures. After the primary surgery, the lowest average BMI was 37.6 kg/m(2) (range 21 to 52), which increased to 42.7 kg/m(2) (range 29 to 56) before reoperation. 24 of the 27 reoperations were indicated for insufficient weight loss. On average, revision was undertaken 52 months after the primary procedure (range 12 to 240 months).Results: 24 of the 27 laparoscopic reoperations were conversions to a gastric bypass. A second reoperation was indicated for insufficient weight loss on four occasions. In one case, conversion to open surgery was required. The average operative time was 232 +/- 18.5 minutes (range 120 to 480) and length of hospital stay was 3.7 days (range 1 to 9). 22% percent of patients (6) experienced complications, including pneumothorax, gastric remnant dilation, gastrojejunostomy stenosis, port-site hernia and protein malnutrition. There was no mortality in the study. The average BMI was 35.9 kg/m(2) (range 27 to 45.5) 8 months after surgery (range 1 to 22 months). Compared with a preoperative BMI of 42.7 kg/m(2), the weight loss was statistically significant (p<0.001).Conclusion: Our results compare favorably with those reported for open reoperative bariatric surgery. A laparoscopic approach may be considered a feasible and safe alternative to an open operation
Dr. Duane M. Jackson, Morehouse College, July 2011
No full textThis video is a conversation with Dr. Duane M. Jackson. Dr. Jackson talks about his paper, "Recall and the Serial Position Effect: The Role of Primacy and Recency on Accounting Students' Performance." Jackie Daniel, AUC Woodruff Library, is the interviewer
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