PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Χαμηλή Πρόσθια Εκτομή : «Η Λαπαροσκοπική Προσπέλαση Πλεονεκτεί για τον Ασθενή...Dimitris P. Korkolis
Potential Advantages of Lap TME
- Less blood loss
- Faster recovery
- Earlier return of gut function
- Lower morbidity and mortality
- Magnified view allows precise dissection (pelvic autonomics)
- Earlier hospital discharge
The document discusses minimally invasive oesophagectomy (MIO), which refers to a group of surgical techniques for removing the esophagus through smaller incisions than traditional open surgery. It notes that while MIO is becoming more common, no randomized clinical trials have directly compared outcomes of MIO versus open surgery. The document also outlines different technical approaches to MIO, variations in techniques for the gastric conduit and anastomosis, and the steep learning curve associated with MIO adoption. It raises questions about balancing access versus radicality in resection and identifies areas for continued development, such as vagal-sparing techniques and sentinel lymph node biopsy.
ACHALASIA CARDIA: ENDOSCOPIC THERAPY (POEM)Dr Amit Dangi
POEM is a highly effective treatment for achalasia, providing long-term symptom relief in over 90% of patients. Studies have shown POEM to have similar efficacy to laparoscopic Heller myotomy with benefits including shorter procedure time, less pain, and shorter hospital stay. POEM allows for a longer myotomy and more complete treatment of achalasia compared to Heller myotomy and has been shown to be particularly effective for type 3 achalasia. While short-term complications are low, concerns remain around POEM's learning curve. Further research is still needed regarding its use in special cases like sigmoid achalasia and treatment failure patients.
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
LSG exposes severe complications occurring in patients with benign condition.
Endoscopic stents entail high failure rate.
Total gastrectomy is required in one third of the cases.
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPDr Amit Dangi
THIS PRESENTATION DESCRIBES THE NOVEL SURGICAL TECHNIQUE OF TOTAL ANORECTAL RECONSTRUCTION WITH ANTROPYLORUS TRANSPOSITION AND GLUTEOPLASTY AND ITS RESULTS.
Χαμηλή Πρόσθια Εκτομή : «Η Λαπαροσκοπική Προσπέλαση Πλεονεκτεί για τον Ασθενή...Dimitris P. Korkolis
Potential Advantages of Lap TME
- Less blood loss
- Faster recovery
- Earlier return of gut function
- Lower morbidity and mortality
- Magnified view allows precise dissection (pelvic autonomics)
- Earlier hospital discharge
The document discusses minimally invasive oesophagectomy (MIO), which refers to a group of surgical techniques for removing the esophagus through smaller incisions than traditional open surgery. It notes that while MIO is becoming more common, no randomized clinical trials have directly compared outcomes of MIO versus open surgery. The document also outlines different technical approaches to MIO, variations in techniques for the gastric conduit and anastomosis, and the steep learning curve associated with MIO adoption. It raises questions about balancing access versus radicality in resection and identifies areas for continued development, such as vagal-sparing techniques and sentinel lymph node biopsy.
ACHALASIA CARDIA: ENDOSCOPIC THERAPY (POEM)Dr Amit Dangi
POEM is a highly effective treatment for achalasia, providing long-term symptom relief in over 90% of patients. Studies have shown POEM to have similar efficacy to laparoscopic Heller myotomy with benefits including shorter procedure time, less pain, and shorter hospital stay. POEM allows for a longer myotomy and more complete treatment of achalasia compared to Heller myotomy and has been shown to be particularly effective for type 3 achalasia. While short-term complications are low, concerns remain around POEM's learning curve. Further research is still needed regarding its use in special cases like sigmoid achalasia and treatment failure patients.
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
Evaluating Current Laparoscopic Applications In SurgeryGeorge S. Ferzli
The document discusses current laparoscopic applications in various areas of surgery based on available evidence from medical literature. For the esophagus, laparoscopic Heller myotomy is established as the preferred approach for achalasia over open or thoracoscopic based on studies showing lower rates of postoperative GERD and similar symptom improvement. For hiatal hernia and GERD, laparoscopic fundoplication is the gold standard procedure based on randomized trials showing advantages over open surgery in outcomes. For gastric bypass surgery, laparoscopic approaches are preferred for treatment of morbid obesity based on cohort studies demonstrating shorter hospital stay and lower complication rates compared to open surgery. For pancreatic surgery, laparoscopic approaches are being used increasingly
Selection of surgical procedure for esophageal cancer ver 3.0Vivek Verma
Esophageal cancer is typically treated through surgical resection, which involves removing part of the esophagus. The type of surgery depends on the location and stage of the cancer. Common procedures include McKeown esophagectomy, transhiatal esophagectomy, and Ivor Lewis esophagectomy. While esophagectomy is a major surgery with risks of complications, minimally invasive techniques and extensive lymph node dissection may improve short and long-term outcomes for patients.
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
This document reviews 10 randomized controlled trials comparing single port laparoscopic cholecystectomy to conventional laparoscopic cholecystectomy. It finds that single port laparoscopic cholecystectomy has a longer operating time but provides an equivocal benefit in terms of postoperative pain. It offers an improved cosmetic outcome but is associated with a low risk of bile duct injuries or the need for conversion to conventional laparoscopic cholecystectomy. The review concludes that single port laparoscopic cholecystectomy is as safe as conventional laparoscopic cholecystectomy in carefully selected patients.
Laparoscopic Sigmoid Colon Resection for Diverticular DiseaseGeorge S. Ferzli
The document discusses laparoscopic sigmoid colon resection for diverticular disease. It describes two approaches for the procedure - the lateral approach and anterior approach. It provides details on trocar placement, patient positioning, and advantages/disadvantages of each approach. Outcome data is presented from studies comparing laparoscopic and open colectomy procedures. Long-term survival rates are shown to be similar between laparoscopic and open resections for colon cancer.
1. The document discusses endoluminal procedures for weight regain after gastric bypass surgery, including endoluminal gastric pouch reduction (EGPR) and the ROSE procedure.
2. EGPR uses fasteners to narrow the gastric pouch and stoma, resulting in 10-20% excess weight loss typically. The ROSE procedure uses sutures to create folds in the pouch and around the stoma.
3. Studies found these procedures produced 12-25% excess weight loss on average and resolved issues like diarrhea and heartburn in many patients. However, long-term durability is still unknown and behavioral factors impact success.
This chapter discusses the 100-year history of surgery for achalasia. Early treatments involved dilation, but the cause was unknown. In the early 1900s, theories proposed causes like esophageal irritability or paralysis. The term "achalasia" was coined in 1913. Heller performed the first cardiomyotomy in 1913, dramatically improving symptoms. Later, fundoplications were added to reduce side effects. Today, treatments include minimally invasive options like pneumatic dilation and peroral endoscopic myotomy (POEM), with excellent outcomes. The evolution of understanding and treatment of this disease over the last century is described.
Laparoscopy-assisted distal gastrectomy with D1+β compared with D1+α lymph no...Goto Pablo
This study compared outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D1+a lymph node dissection versus D1+b lymph node dissection for early gastric cancer. D1+b dissection removed more lymph nodes along the common hepatic artery and celiac artery compared to D1+a. However, there were no significant differences in short-term outcomes such as complications, recovery times, or length of stay between the two procedures. The study concluded that LADG with D1+b dissection is as minimally invasive as D1+a dissection while providing the oncological benefits of more extensive lymph node removal.
"No Anastomosis" Combined Colon Conduit and Colostomy Diversion with Pelvic Exenteration: An Underutilized, Cost-Effective Technique Reducing Bowel Complications by Sayyid KR, Neal DE, Albo D, Kruse EJ, Wallbillich JJ, Rungruang BJ, Ghamande SJ and Martha K Terris* in Experimental Techniques in Urology & Nephrology
Colonic stenting is an endoscopic procedure used to relieve large bowel obstruction caused by malignant tumors. It allows for patient evaluation and staging, avoids emergency surgery and stomas, and can provide long-term palliation. While technically challenging, stenting has high rates of technical and clinical success for both bridge to surgery and palliative cases when performed by an experienced multidisciplinary team. However, there are risks of perforation and re-obstruction that require careful patient selection, especially for those receiving bevacizumab therapies.
- Gallbladder polyps are common findings that require evaluation to determine if they are true polyps with malignant potential or pseudopolyps which are benign.
- Transabdominal ultrasound is usually the initial imaging study, while EUS may help in certain cases, though evidence is limited.
- Polyps greater than 10mm or those exhibiting certain high risk features like being sessile or in patients over 50 years old typically warrant cholecystectomy.
- For smaller polyps, follow up imaging is reasonable if they lack concerning characteristics, though risk of malignancy increases with size.
The document discusses the learning curve associated with laparoscopic inguinal hernia repair techniques. It notes that the learning curve for total extraperitoneal (TEP) repair is longer than for other hernia surgeries or transabdominal preperitoneal (TAPP) repair. Several sources suggest it may take 30 to 50 procedures or more to become proficient, and that outcomes like operating time and recurrence rates improve with increased experience.
This case report describes a young morbidly obese patient with achalasia who underwent a per-oral endoscopic myotomy (POEM) procedure in preparation for a future laparoscopic sleeve gastrectomy to treat her obesity. POEM was chosen over the traditional Heller myotomy and fundoplication procedure to avoid altering the gastric anatomy and ensure the sleeve gastrectomy remained a viable option. The report discusses the rare combination of achalasia and morbid obesity in a young patient and compares treatment options and surgical decision making for addressing both conditions simultaneously.
Long term outcomes of the laparoscopic sleeve gastrectomyforegutsurgeon
This document examines long-term weight loss outcomes of laparoscopic sleeve gastrectomy as a definitive bariatric procedure. It studied 77 patients who underwent sleeve gastrectomy between 2000-2007, with a median follow up of 8 years. At 8 years, excess weight loss remained above 60%. While super-obese patients (BMI over 50) had less weight loss at 1 year (49% vs 77%), there was no significant difference at 3 years. Sleeve gastrectomy can therefore provide effective, long-term weight loss without the need for additional procedures in most patients.
Diagnostic Laparoscopy for ITU patientsArshad Hayat
Diagnostic laparoscopy can be used safely in the ICU to diagnose intra-abdominal pathology in critically ill patients without moving them to the operating room. It has a high diagnostic accuracy of 90-100% and can help avoid unnecessary laparotomies in 36-95% of cases. While it has some limitations for retroperitoneal processes, diagnostic laparoscopy is recommended for use in the ICU when an intra-abdominal catastrophe is suspected but cannot be ruled out noninvasively, or to evaluate for conditions like acalculous cholecystitis or ischemic bowel. Any complications are typically minor and it does not increase mortality, which remains high for the critically ill ICU patient population.
Endoluminal procedures like EGPR and ROSE aim to treat weight regain after gastric bypass through minimally invasive techniques. EGPR uses tissue fasteners to reduce the gastric pouch size and narrow the stoma, resulting in 15.5 lb weight loss on average in 6 months. ROSE uses expandable anchors to similarly reduce pouch size and stoma diameter, stopping weight regain in 88% of patients. Both procedures appear safe and can produce near 50% loss of regained weight, though long-term durability is still unknown. Success may depend on factors like a patient's initial weight loss after gastric bypass.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
This document provides guidelines for laparoscopic cholecystectomy. It outlines indications for the procedure including symptomatic gallstones and acute cholecystitis. High-risk patients for bile duct stones are evaluated preoperatively with ERCP. The basic operative technique is described including abdominal access and establishing the critical view of safety. Intraoperative cholangiography is routinely performed to detect common bile duct stones which may be treated endoscopically or with exploration. Conversion to open surgery should be considered for infected or scarred gallbladders or if the anatomy cannot be clearly defined. Major complications are bile duct injury and bleeding.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
Evaluating Current Laparoscopic Applications In SurgeryGeorge S. Ferzli
The document discusses current laparoscopic applications in various areas of surgery based on available evidence from medical literature. For the esophagus, laparoscopic Heller myotomy is established as the preferred approach for achalasia over open or thoracoscopic based on studies showing lower rates of postoperative GERD and similar symptom improvement. For hiatal hernia and GERD, laparoscopic fundoplication is the gold standard procedure based on randomized trials showing advantages over open surgery in outcomes. For gastric bypass surgery, laparoscopic approaches are preferred for treatment of morbid obesity based on cohort studies demonstrating shorter hospital stay and lower complication rates compared to open surgery. For pancreatic surgery, laparoscopic approaches are being used increasingly
Selection of surgical procedure for esophageal cancer ver 3.0Vivek Verma
Esophageal cancer is typically treated through surgical resection, which involves removing part of the esophagus. The type of surgery depends on the location and stage of the cancer. Common procedures include McKeown esophagectomy, transhiatal esophagectomy, and Ivor Lewis esophagectomy. While esophagectomy is a major surgery with risks of complications, minimally invasive techniques and extensive lymph node dissection may improve short and long-term outcomes for patients.
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
This document reviews 10 randomized controlled trials comparing single port laparoscopic cholecystectomy to conventional laparoscopic cholecystectomy. It finds that single port laparoscopic cholecystectomy has a longer operating time but provides an equivocal benefit in terms of postoperative pain. It offers an improved cosmetic outcome but is associated with a low risk of bile duct injuries or the need for conversion to conventional laparoscopic cholecystectomy. The review concludes that single port laparoscopic cholecystectomy is as safe as conventional laparoscopic cholecystectomy in carefully selected patients.
Laparoscopic Sigmoid Colon Resection for Diverticular DiseaseGeorge S. Ferzli
The document discusses laparoscopic sigmoid colon resection for diverticular disease. It describes two approaches for the procedure - the lateral approach and anterior approach. It provides details on trocar placement, patient positioning, and advantages/disadvantages of each approach. Outcome data is presented from studies comparing laparoscopic and open colectomy procedures. Long-term survival rates are shown to be similar between laparoscopic and open resections for colon cancer.
1. The document discusses endoluminal procedures for weight regain after gastric bypass surgery, including endoluminal gastric pouch reduction (EGPR) and the ROSE procedure.
2. EGPR uses fasteners to narrow the gastric pouch and stoma, resulting in 10-20% excess weight loss typically. The ROSE procedure uses sutures to create folds in the pouch and around the stoma.
3. Studies found these procedures produced 12-25% excess weight loss on average and resolved issues like diarrhea and heartburn in many patients. However, long-term durability is still unknown and behavioral factors impact success.
This chapter discusses the 100-year history of surgery for achalasia. Early treatments involved dilation, but the cause was unknown. In the early 1900s, theories proposed causes like esophageal irritability or paralysis. The term "achalasia" was coined in 1913. Heller performed the first cardiomyotomy in 1913, dramatically improving symptoms. Later, fundoplications were added to reduce side effects. Today, treatments include minimally invasive options like pneumatic dilation and peroral endoscopic myotomy (POEM), with excellent outcomes. The evolution of understanding and treatment of this disease over the last century is described.
Laparoscopy-assisted distal gastrectomy with D1+β compared with D1+α lymph no...Goto Pablo
This study compared outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D1+a lymph node dissection versus D1+b lymph node dissection for early gastric cancer. D1+b dissection removed more lymph nodes along the common hepatic artery and celiac artery compared to D1+a. However, there were no significant differences in short-term outcomes such as complications, recovery times, or length of stay between the two procedures. The study concluded that LADG with D1+b dissection is as minimally invasive as D1+a dissection while providing the oncological benefits of more extensive lymph node removal.
"No Anastomosis" Combined Colon Conduit and Colostomy Diversion with Pelvic Exenteration: An Underutilized, Cost-Effective Technique Reducing Bowel Complications by Sayyid KR, Neal DE, Albo D, Kruse EJ, Wallbillich JJ, Rungruang BJ, Ghamande SJ and Martha K Terris* in Experimental Techniques in Urology & Nephrology
Colonic stenting is an endoscopic procedure used to relieve large bowel obstruction caused by malignant tumors. It allows for patient evaluation and staging, avoids emergency surgery and stomas, and can provide long-term palliation. While technically challenging, stenting has high rates of technical and clinical success for both bridge to surgery and palliative cases when performed by an experienced multidisciplinary team. However, there are risks of perforation and re-obstruction that require careful patient selection, especially for those receiving bevacizumab therapies.
- Gallbladder polyps are common findings that require evaluation to determine if they are true polyps with malignant potential or pseudopolyps which are benign.
- Transabdominal ultrasound is usually the initial imaging study, while EUS may help in certain cases, though evidence is limited.
- Polyps greater than 10mm or those exhibiting certain high risk features like being sessile or in patients over 50 years old typically warrant cholecystectomy.
- For smaller polyps, follow up imaging is reasonable if they lack concerning characteristics, though risk of malignancy increases with size.
The document discusses the learning curve associated with laparoscopic inguinal hernia repair techniques. It notes that the learning curve for total extraperitoneal (TEP) repair is longer than for other hernia surgeries or transabdominal preperitoneal (TAPP) repair. Several sources suggest it may take 30 to 50 procedures or more to become proficient, and that outcomes like operating time and recurrence rates improve with increased experience.
This case report describes a young morbidly obese patient with achalasia who underwent a per-oral endoscopic myotomy (POEM) procedure in preparation for a future laparoscopic sleeve gastrectomy to treat her obesity. POEM was chosen over the traditional Heller myotomy and fundoplication procedure to avoid altering the gastric anatomy and ensure the sleeve gastrectomy remained a viable option. The report discusses the rare combination of achalasia and morbid obesity in a young patient and compares treatment options and surgical decision making for addressing both conditions simultaneously.
Long term outcomes of the laparoscopic sleeve gastrectomyforegutsurgeon
This document examines long-term weight loss outcomes of laparoscopic sleeve gastrectomy as a definitive bariatric procedure. It studied 77 patients who underwent sleeve gastrectomy between 2000-2007, with a median follow up of 8 years. At 8 years, excess weight loss remained above 60%. While super-obese patients (BMI over 50) had less weight loss at 1 year (49% vs 77%), there was no significant difference at 3 years. Sleeve gastrectomy can therefore provide effective, long-term weight loss without the need for additional procedures in most patients.
Diagnostic Laparoscopy for ITU patientsArshad Hayat
Diagnostic laparoscopy can be used safely in the ICU to diagnose intra-abdominal pathology in critically ill patients without moving them to the operating room. It has a high diagnostic accuracy of 90-100% and can help avoid unnecessary laparotomies in 36-95% of cases. While it has some limitations for retroperitoneal processes, diagnostic laparoscopy is recommended for use in the ICU when an intra-abdominal catastrophe is suspected but cannot be ruled out noninvasively, or to evaluate for conditions like acalculous cholecystitis or ischemic bowel. Any complications are typically minor and it does not increase mortality, which remains high for the critically ill ICU patient population.
Endoluminal procedures like EGPR and ROSE aim to treat weight regain after gastric bypass through minimally invasive techniques. EGPR uses tissue fasteners to reduce the gastric pouch size and narrow the stoma, resulting in 15.5 lb weight loss on average in 6 months. ROSE uses expandable anchors to similarly reduce pouch size and stoma diameter, stopping weight regain in 88% of patients. Both procedures appear safe and can produce near 50% loss of regained weight, though long-term durability is still unknown. Success may depend on factors like a patient's initial weight loss after gastric bypass.
Background: Nonalcoholic Fatty Liver Disease (NAFLD) is the most common liver disease in the developed countries. Patients with Nonalcoholic Steatohepatitis (NASH), a subset of NAFLD, are at risk for progressive liver disease and in need of effective treatment options. There is a lack of data assessing sleeve gastrectomy and their effect on NAFLD.
Objective: To assess the effects of Sleeve Gastrectomy (SG) on NAFLD.
Methods: An online search of PubMed, Medline, and Google Scholar was independently carried out by two researchers using key words like Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steato-Hepatitis, Bariatric Surgery, Obesity Surgery, Sleeve Gastrectomy and Liver Biopsy, percutaneous liver biopsy, to identify all articles. Articles were also identified from references of relevant articles. All sleeve gastrectomies that had ntraoperative and postoperative liver biopsies were included.
This document provides guidelines for laparoscopic cholecystectomy. It outlines indications for the procedure including symptomatic gallstones and acute cholecystitis. High-risk patients for bile duct stones are evaluated preoperatively with ERCP. The basic operative technique is described including abdominal access and establishing the critical view of safety. Intraoperative cholangiography is routinely performed to detect common bile duct stones which may be treated endoscopically or with exploration. Conversion to open surgery should be considered for infected or scarred gallbladders or if the anatomy cannot be clearly defined. Major complications are bile duct injury and bleeding.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
A laparoscopic cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder through several small incisions in the abdomen. During the procedure, carbon dioxide is used to inflate the abdomen so instruments can be inserted to tie off the cystic duct and artery before removing the gallbladder. It is usually performed to treat gallstones, gallbladder polyps, or cholecystitis. Compared to open surgery, laparoscopic cholecystectomy results in less pain, shorter hospital stays, and better cosmetic outcomes, though there are risks such as injury to other organs or postoperative bleeding.
A cholecystectomy involves the surgical removal of the gallbladder. The gallbladder stores and concentrates bile produced by the liver to aid in fat digestion. Cholecystectomy is commonly performed to treat gallstones and related complications like gallbladder inflammation. The surgery can be performed through traditional open surgery or through laparoscopic methods involving small incisions. Conditions that may require open rather than laparoscopic cholecystectomy include severe inflammation, abdominal lining inflammation, liver cirrhosis, late-stage pregnancy, or bleeding disorders.
Post-cholecystectomy complications can be early or late, biliary or non-biliary. Early complications include bile leak, hematoma, abscess, and dropped stones. Late complications include port site hernia, postoperative pain, stricture, and retained stones. The risk of these complications is higher with laparoscopic cholecystectomy during acute cholecystitis and for inexperienced surgeons. Important prevention strategies include surgical experience, proper technique such as obtaining the critical view of safety, and conversion to open when needed.
This document discusses post-cholecystectomy syndrome, beginning with case studies of patients who developed symptoms after gallbladder removal surgery. It then defines post-cholecystectomy syndrome as the persistence or development of new symptoms after cholecystectomy. The document outlines that 15% of patients develop symptoms, which can be due to functional disorders, prior surgery complications, or other underlying causes affecting the biliary tract, pancreas, or other organs. Investigation and management depends on identifying the specific cause, which can be found in 95% of cases, through imaging, endoscopy, or surgery to address conditions like sphincter of Oddi dysfunction.
Similar to Alternative sites for laparoscopic cholecystectomy, in thin and obese patients from the point of view of changes in the abdominal dimensions
esophageal cancer surgery types and complicationsved sah
Background-Anatomy & Staging
Surgical Candicate
Contraindication of sx
Assessment of patients for surgery
Approaches of esophagectomies
Esophageal reconstruction
Complications of esophagectomy
State of the Art Consensus Conference on Prevention of Bile Duct Injury Durin...JosephDAguanno2
Strategies for Minimizing Bile Duct Injuries during cholecystectomy are founded in a Patient Safety Mindset, ensuring proper clearing of the surgical field, careful identification of cystic structures, and confidence in surgical technique.
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
Laparoscopic Natural Orifice Specimen Extraction (NOSE) Total Colectomy with ...semualkaira
The benefit of laparoscopic surgery in terms of
reduced pain and fewer cosmetic problems is not always obvious,
and surgeons continue to seek the best ways to limit incision trauma and improve outcomes in laparoscopic colorectal surgery
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
This article reviews the current evidence for laparoscopic surgery in treating colorectal cancers. It discusses several large randomized controlled trials that compared short-term and long-term outcomes of laparoscopic versus open surgery. The trials found no significant differences in cancer recurrence rates, survival rates, or number of lymph nodes retrieved between the two surgical methods. Meta-analyses of the trials validated that laparoscopic surgery is as safe and effective as open surgery for treating colorectal cancer. While the laparoscopic approach has benefits like less blood loss and shorter hospital stays, long-term oncologic outcomes are comparable to open surgery.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) were performed on 31 patients with peritoneal recurrence of ovarian cancer. Complete cytoreduction was achieved in 90% of patients. Morbidity rates were acceptable and comparable to literature. Organ-preserving cytoreductive surgery, when possible, reduced complications and hospital stay compared to those requiring colon resection. 25% of patients experienced tumor recurrence within a median follow-up period of 798 days, most commonly in the parietal abdominal wall. This multimodal approach shows promise for recurrent ovarian cancer but randomized trials are still needed.
This document discusses laparoscopic colonic surgery. It provides an overview of different types of laparoscopic colon surgery techniques including standard laparoscopic surgery, laparoscopic-assisted surgery, and hand-assisted laparoscopic surgery. It also discusses indications for laparoscopic colonic resection including colon cancer. Guidelines are provided for performing laparoscopic colonic resection while maintaining oncologic principles.
This document discusses prone versus supine positioning for percutaneous nephrolithotomy (PCNL). It provides a history of prone positioning being the traditional approach, with supine positioning being described later. The advantages of supine positioning include the surgeon working more comfortably, less risk of anesthesia issues, and ability to perform other procedures simultaneously like ureteroscopy. Prone positioning allows for easier upper pole access and kidney positioning. Overall, the evidence suggests no overwhelming differences in outcomes between positions, so surgeon preference can help determine which to use based on patient factors.
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Information about Lap vs Open Colorectal Resection by Dr Dhaval Mangukiya.
Details of Factors compared, COST Trial, CLASSIC Trial, COLOR Trial, COREAN Trial, ALCCS Trial, Summary, SAGES Guidelines,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
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Similar to Alternative sites for laparoscopic cholecystectomy, in thin and obese patients from the point of view of changes in the abdominal dimensions (20)
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Alternative sites for laparoscopic cholecystectomy, in thin and obese patients from the point of view of changes in the abdominal dimensions
1. Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.4, No.14, 2014
1
Alternative Sites for Laparoscopic Cholecystectomy, in Thin and
Obese Patients from the Point of View of Changes in the
Abdominal Dimensions
Hiwa omer ahmed
Assistant Professor in general surgery
CABS, FABMS, D.L.S
Member of E.A.E.S, Member of ALS(GB&I), Member of E.A.T.S,
senior lecturer and consultant Surgeon
Iraq-Kurdistan Region –Al-Sulaimaneyah City-of Medicine/ University of Al-Sulaimaneyah
drhiwaomer@hatwan.com; drhiwaomerahmed@gmail.com; hatwan@hatwan.com
Abstract
Background: Laparoscopic cholecystectomy is the standard operation for treatment of gallstone disease, which
is difficult in obese patients, but narrow abdomen and thin patients are also a challenge, resulting in
complications which mainly affect patients at the extreme ends of the weight spectrum. This represents a major
source of morbidity and mortality from laparoscopic procedures; the majority (80%) of these complications is
due to placement of the primary trocar,
Searching for techniques to prevent involuntary injuries must be put as the priority, to ensure the optimal
retraction,
allows enough space available for manipulation of the active jaws of the laparoscopic graspers or
scissors.
Aim: To define alternative sites for laparoscopic cholecystectomy, in thin and obese patients from the point of
view of alteration in the abdominal dimensions, which may reduces laparoscopic, related injury.
Methods:
In Al Sulaimaniyah Teaching Hospital and Hatwan Private Hospitral , from (July 15th
2004-July14th 2009) 1076
patients underwent laparoscopic cholecystectomy by same team and 35% of them by the same surgeon. Standard
4 ports were used, with first entry port in the periumblical region. Sixty patients were selected, because of their
extreme weight and the patients were classified accordingly in to two groups:
Group A:had downward displacement of umbilicus (43-60 cm width & 30-45cm height of the abdomen).
Group B; had narrow abdominal dimensions (28-38 cm width & 14-27cm height of the abdomen).
Results: Different alternative sites for trocar insertion were selected in order to overcome abdominal thickness
and discrepancy between length of the hand instruments and distance of the port to the gall bladder
Conclusions: We recommend using this principle in the patients with extreme weight and narrow abdomen
when XU is less than 15 cm or (more than 25cm), to decrease challenges of sequel of laparoscopic
cholecystectomy in these groups of patients.
Keywords: Abdominal dimensions, laparoscopy, cholecystectomy, port position
INTRODUCTION
Laparoscopic cholecystectomy is the standard operation for treatment of gallstone disease (1)
, and the advantages
of minimally invasive surgery have been widely accepted (2)
. Laparoscopy is difficult in obese patients because
of the thickness of adipose panicle (3)
, and it presents unique technical challenges. The ease of the operation and
the operative time seem to be more dependent on body habitués than body mass index (BMI).(4)
Specially
patients with significant central obesity (apple-shaped) were surgically more challenging and needed prolonged
operative time compared to pear-shaped patients, independent of their BMI.(4)
As the BMI increased, the location
of the umbilicus shifts inferiorly and the distance between the umbilicus and xiphoid process (XU) will increase
(5).
Although visceral surgeons are more often confronted with laparoscopic surgery in obese patients (6)
, but
narrow abdomen and thin patients are also a challenge, resulting in complications which mainly affect patients at
the extreme ends of the weight spectrum (thin and obese) and patients who have had previous abdominal
operations, they represent a major source of morbidity and mortality from laparoscopic procedures and a major
reason for conversion to the open approach. (7).
The majority (80%) of these complications are due to placement of the primary trocar, (8)
, which is put classically
in the periumbilical region. (9)
It is mentioned in the literature that,
patients who are extremely thin or obese, or
known to have abdominal adhesions are at increased risk for laparoscopic entry-related injury at the umbilical
entry point. (10)
According to current evidence, based mainly on observational studies, there is wide variation among clinicians
as to which entry method should be recommended (11)
and no one laparoscopic entry method has demonstrated
clear superiority over another. (12)
2. Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.4, No.14, 2014
2
Searching for techniques to prevent involuntary injuries must be put as the priority, to ensure the optimal
retraction which allows enough space available for manipulation of the active jaws of the laparoscopic graspers
or scissors, (13)
Also to overcome triangulation, and provides suitable vision in every step of the procedure of
laparoscopy. (14)
This concept made some authors to dictate the use of another site for primary entry, (9)
in a study
by Nathaniel J. Soper on laparoscopic cholecystectomy during pregnancy, he used alternative site for insertion
of the initial port in all patients (15)
. Selection of abdominal wall locations for the port arrangement is a critical
step of every laparoscopic operation. The port arrangement must provide the surgeon with adequate access to the
target quadrant(s) while avoiding critical structures and the ideal port arrangement for a
given operation will vary from patient to patient. (16)
This paper is a trial to define alternative sites for laparoscopic cholecystectomy, in thin and obese patients from
the point of view of changes in the abdominal dimensions, which may reduce laparoscopic related injuries
METHODS
In Al Sulaimaniyah Teaching Hospital and Hatwan Private Hospitral , from (July 15th
2004-July14th 2009) 1076
patients underwent laparoscopic cholecystectomy by same team and 35% of them by the same surgeon. Standard
4 ports were used, with first entry port in the periumblical region. Sixty patients were selected, because of their
extreme weight and the patients were classified accordingly in to two groups:
Group A; 37 patients, had abdominal circumference obesity (BMI 28-32), had downward displacement of
umbilicus (43-60 cm width & 30-45cm height of the abdomen).
Group B; 23 patients (BMI 15-20) had narrow abdominal dimensions (28-38 cm width & 14-27cm height of the
abdomen).
After signing of the informed consent, collection of demographic data, height and weight of the patients were
measured, and BMI calculated by equation,
BMI= body weight (Kg)
Height2 (m)
Circumference and width of the abdomen, height of the abdomen from xiphoid process to umbilicus (XU) and to
pubic symphysis ( torso) were measured using a standard tape measure with patient in supine and standing
position .In the view of the discrepancy of the length of the telescope & hand instrument to the distance of the
gallbladder from the site of the ports ,also angulated course of the tract , particularly subxiphoid port , we
selected alternative sites for the trocar insertion .
Virtual port sites determined prior to placing ports and shifting port positions toward target quadrants
accordingly. In group A, site for telescope port selected before CO2 insufflation above umbilicus, sustaining (3/5)
of the length of the telescope to the site of gallbladder (below costal margin, in the right midclavicular
line).Other assistant’s 5mm port sites were modified and displaced cephalic according to the same principle.
While in obese patients with hepatomegally or fatty liver the subxiphoid port site displaced caudally to gain
direct course and overcome angulations in the tract.
While in the group B, we selected port sites more caudal than usual; periumblical port incisions were done in the
midline down in the hypogastrium .,Sustaining same distance( 3/5 of the length of the hand instrument or
telescope) from the port site to the target quadrant ,and gall bladder.Other ports also displaced caudually
according to the same principles ,while subxiphoid port site was done in most cases in the usual standard site
6cm below xiphoid process in the midline, but in two patients with kyphosis we were obliged to displace this
port site by 5 and 6.5 cm caudally to overcome angulated course to the Callot’s triangle.
After entrance and putting other ports under direct vision, theses approaches gave adequate exposure of the
operative field, and clear idefinitfication of the anatomy and pathology.
RESULTS
Most of the patients were female 78.3% (n = 47) ;( Table 1), median age was 37±5.4 years for females and was
41±5.7 years for male patients. BMI in the group A were different (from 28 to 32), (Table 1)
Circumference, girth and torso( height of the abdomen)of the patients in both groups are shown in table 2, in
group A there is caudal dropping of the umbilicus up to 7-10 cm, while in the group B its just up to 1cm .We
could also noticed larger circumference of the abdomen in standing position in group A, up to 3-4cm. while in
group B there is 1cm increase in circumference in standing position. Height of the abdomen ( torso), decreased
in supine position in both groups ,in group A up to 3-5cm ,and up to 3cm in group B
Morbidity in patients included in this paper (group A &B (n=60), compared with patients had normal weight and
abdominal dimensions (n=306) by the same surgeon and in the same period of time (Table 3).,we could noticed
that differences are in number of complications and staying in hospital more in weight and abdominal
dimensions
P value is non-significant (greater than0.05), means that there is no significant difference in morbidity between
3. Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.4, No.14, 2014
3
the patients in whom classical 4 port position were used compared with those in which advanced port sites were
used accordingly
Discussion
Classical sites for 4 port cholecystectomy in the patients with extremities of weight and abdominal dimensions
will creates a technical challenge related principally to” retraction and triangulation ,necessary to expose the
surgical field”( 14)
and target organ. Displacement of umbilicus and abdominal wall caudally or cephalic in obese
and thin patients respectively do not allow adequate exposure of the gallbladder , this will restricts movements.
In patients with narrow abdominal dimensions there will be collision of hand instruments. (13),
which results in
misidentification of anatomical structures, which is regarded as one of the major causes of biliary tract injury in
laparoscopic cholecystectomy. (17)
In obese and thin patients with disproportional abdominal dimensions respectively, the hand instruments will
not reach the target organ.In thin patients with narrow abdominal dimensions there is no enough “space available
for manipulation of the active jaws of the laparoscopic graspers or scissors, (13)
the surgeon cannot move the
surgical instruments freely in the abdominal cavity (i.e., the chasing swords phenomenon) or cannot reach
particular regions in the surgical field. (16, 18)
All these short comings, when standard port sites used, “represent a
major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to the
open approach” (7)
In the literature there are widely different port sites used, for many reasons i.e. pregnancy, previous laparotomy,
managing hernias and in obese, tall patients (6,7,15,19, 20, 21,22 )
, which allow ethically searching for alternative port
sites .In this paper we used advanced port sites caudally in thin patients when the XU distance was less than
15cm, and advanced cephalic when this distance was more than 25cm(4)
. Keeping the distance from the port site
to the target organ,( gallbladder) ; fixed at 3/5 of the length of the hand instruments (35cm) , with comparable
ease and morbidity and no mortality(Table3), as there is no significant difference in morbidity between the
patients in whom classical 4 port position were used compared with those in which advanced port sites were
used accordingly
CONCLUSIONS
We recommend using this principle in the patients with extreme weight and narrow abdomen when XU is less
than 15 cm or (more than 25cm), to decrease challenges of sequelle of laparoscopic cholecystectomy in these
groups of patients.
AKNOWLEDGEMENT
I would like to thank all medical and paramedical staffs in Hatwan pPrivate hospital for Endopscopic Surgery
and 16th
surgical unit in Al Sulaimaneyah Teaching Hospital for their technical help
REFERENCES
1. Bittner R (2004), Tthe standard of laparoscopic cholecystectomy. Langenbecks ArchSurg 389: 157–163
2. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) , Randomised trial of laparoscopic versus open
cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325
3. Madan AK, Menachery S (2006) Safety and efficacy of initial port-site placement in morbidly obese patients.
Arch Surg 141:300–303
4. Namir Katkhouda Æ Ashkan Moazzez Æ Sarah Popek Æ Shirin Towfigh Æ
Brett Cohen Æ Billy Lam Æ Valy Boulom, A new and standardized approach for trocar placement in
laparoscopic Roux-en-Y gastric bypass, Surg Endosc (2009) 23:659–662
5. Chee SS, Godfrey CD, Hurteau JA, Schilder JM, Rothenberg JM, Hurd WW (1998) Location of the transverse
colon in relationship to the umbilicus: implications for laparoscopic techniques. J am Assoc Gynecol Laparosc
5(4):385–388
6. Jean Baptiste Deguines , Quentin Qassemyar , Abdennaceur Dhahri , Olivier Brehant , David Fuks , Pierre
Verhaeghe , Jean-Marc Regimbeau، Technique of open laparoscopy for supramesocolic surgeryin obese patients.
Surg Endosc، 29 November 2009 ،009-0872
7. F، . Agresta,1 P. DeSimone,2 L. F. Ciardo,1 N. Bedin1Direct trocar insertion vs veress needle in nonobese
patients undergoing laparoscopic procedures، Surg Endosc، (2004)18: 1778–1781
8. Fuller J, Scott W, Ashar B, Corrado J (2005) Laparoscopic Trocar
Injuries: a report from a US Food and Drug Administration (FDA)
Center for Devices and Radiological Health (CDRH) Systematic
Technology Assessment of Medical Products (STAMP) Committee.
9. Society of American Gastrointestinal and Endoscopic Surgeons, Diagnostic laparoscopy guidelines, Surg
Endosc (2008) 22:1353–1383
10. Rajesh Varma Æ Janesh K. Gupta، Laparoscopic entry techniques: clinical guideline, national survey, and
4. Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.4, No.14, 2014
4
medicolegal ramifications،Surg Endosc (2008) 22:2686–2697
11. Vilos GA, Ternamian A, Dempster J, Laberge PY (2007) Laparoscopic entry: a review of techniques,
technologies, and complications. Society of Obstetricians and Gynaecologists of Canada Clinical Practice
Guideline. J Obstet Gynaecol Can
29(5):433–447
12. Molloy D, Kaloo PD, Cooper M, Nguyen TV (2002) Laparoscopic entry: a literature review and analysis of
techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol 42(3):246–254
13. A. M. Hamade, M. E. Issa, K. R. Haylett, B. J. Ammori، Fixity of ports to the abdominal wall during
laparoscopic surgery: a randomized comparison of cutting versus blunt trocars،Surg Endosc (2007) 21: 965–969
14. Guillermo Dominguez Æ Luis Durand Æ Julia´n De Rosa Æ Eduardo Danguise Æ
Carlos Arozamena Æ Pedro A. Ferraina. Retraction and triangulation with neodymium magnetic forceps for
single-port laparoscopic cholecystectomy, Surg Endosc (2009) 23:1660–1666
15. Nathaniel J. Soper, John G. Hunter, and Roy H. Petrie ،Laparoscopic cholecystectomy during
pregnancy،Surg Endosc (1992) 6:115-117
16. S. Ambardar Æ J. Cabot Æ V. Cekic Æ K. Baxter Æ T. D. Arnell Æ K. A. Forde Æ A. Nihalani Æ R. L.
Whelan,Abdominal wall dimensions and umbilical position vary widely with BMI and should be taken into
account when choosing port locations, Surg Endosc (2009) 23:1995–2000
17. Anthony G. Gallagher Æ Musallam Al-Akash Æ Neal E. Seymour Æ Richard M. Satava، An ergonomic
analysis of the effects of camera rotation on laparoscopic performance،Surg Endosc (2009) 23:2684–2691
18. Andrea Cestari *, Nicolo` Maria Buffi, Emanuele Scapaticci, Giovanni Lughezzani, Andrea Salonia, Alberto
Briganti, Patrizio Rigatti, Francesco Montorsi, Giorgio Guazzoni، Simplifying Patient Positioning and Port
Placement During Robotic-Assisted Laparoscopic Prostatectomy، EUROPEAN UROLOGY 5 7 (2 01 0 ) 5 3 0 –
5 3 3
19. D. M. Le, R. K. Woo, K. Sylvester, T. M. Krummel, C. T. Albanese, Laparoscopic resection of type 1
choledochal cysts in pediatric Patients,Surg Endosc (2006) 20: 249–251
20. Prepared by the Guidelines Committee of the Society of American Gastrointestinal and Endoscopic
SurgGuidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy،Surg
Endosc (2008) 22:849–861
21. Heidi Jackson Æ Steven Granger Æ Raymond Price Æ Michael Rollins Æ
David Earle Æ William Richardson Æ Robert Fanelli، Diagnosis and laparoscopic treatment of surgical diseases
during pregnancy: an evidence-based review،Surg Endosc (2008) 22:1917–1927
22. Ahmed E. Lasheen . Awni Elzeftawy . Abdel-Hafez M. Ahmed .. Wael E. Lotfy، Anatomical closure of
trocar site by using tip hole needle and redirecting suture hook،Surg Endosc-22 February 2010 ,1012-3
Table I; BMI in the patients of group
BMI
Kg/m2
Male patients
no, & %
Female patients
no, & %
28 1
2.7%
4
10.8%
29 0
0.0%
7
18.9%
30 2
5.4%
6
16.2%
31 2
5.4%
7
18.9%
32 1
2.7%
7
18.9%
5. Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921 (Online)
Vol.4, No.14, 2014
5
Table II; Abdominal dimensions in both groups
Group A B
Circumference
at umbilical level in standing
89-110
cm
60-71
cm
Circumference
at umbilical level in supine position
82-106
cm
60-70
cm
Girth
Between Anterior axillary lines
43-60
cm
28-38
cm
Torso in standing position
( Xiphioid process to pubic symphysis)
28-42
cm
19 -28
cm
Torso in supine position
( Xiphioid process to pubic symphysis)
37-54
cm
14-27
cm
Upper half of the abdomen
( Xiphioid process to pubic symphysis)
26-35
cm
8--15
cm
Lower half of the abdomen ;
Umbilicus to pubic symphysis
11-19
cm
10-13
cm
Table III: Comparison of duration of operation, complications in study group and a group with normal
BMI and abdominal dimensions.
Patients included in
this paper (group A
& B (n=60)
Patients had normal weight and
abdominal dimensions (n=306)
by the same surgeon and in the
same period of time
Chi-Square Df P-Value
Wound infection I
(1.60 %)
6
(1.96%)
1.81 3 0.6183
Duration of the
operation
From skin to skin
30±10
minutes
30±9
minutes
Duration of
hospitalization
4-6
hours
4-6
hours
Number of
patients need
overnight
hospitalization
1
(1.60 %)
5
(1.63%)
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