Journal of Laparoendoscopic & Advanced Surgical Techniques (J LAPAROENDOSC ADV S)

Publisher: Mary Ann Liebert

Journal description

A bimonthly peer-reviewed journal for practicing surgeons on the surgical techniques that encompass laparoscopy, endoscopy, and advanced surgical technology in all surgical disciplines. It is the first journal to focus on these techniques both in general surgery and in areas of specialization which include gastroenterology, gynecology, ENT, and cardiovascular and thoracic surgery.

Current impact factor: 1.34

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.335
2013 Impact Factor 1.187
2012 Impact Factor 1.066
2011 Impact Factor 1.4
2010 Impact Factor 1.198
2009 Impact Factor 1.012
2008 Impact Factor 0.912
2007 Impact Factor 0.606
2006 Impact Factor 0.718
2005 Impact Factor 0.648
2004 Impact Factor 0.862
2003 Impact Factor 1.127
2002 Impact Factor 0.873
2001 Impact Factor 1.069
2000 Impact Factor 0.783
1999 Impact Factor 0.787
1998 Impact Factor 0.098

Impact factor over time

Impact factor

Additional details

5-year impact 1.24
Cited half-life 5.10
Immediacy index 0.27
Eigenfactor 0.01
Article influence 0.35
Website Journal of Laparoendoscopic & Advanced Surgical Techniques website
Other titles Journal of laparoendoscopic & advanced surgical techniques. Part A, Journal of laparoendoscopic and advanced surgical techniques
ISSN 1557-9034
OCLC 36334866
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Mary Ann Liebert

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's personal website
    • On institutional repository, pre-print server or research network after 12 months embargo
    • Publisher's version/PDF cannot be used
    • Set statement to accompany deposit (see policy)
    • Publisher copyright and source must be acknowledged
    • NIH authors will have their final paper, (post peer review, copy-editing and proof-reading) deposited in PubMed Central on their behalf
    • Must link to publisher version with DOI
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: As previously reported, the magnetic sphincter augmentation device (MSAD) preserves gastric anatomy and results in less severe side effects than traditional antireflux surgery. The final 5-year results of a pilot study are reported here. Patients and methods: A prospective, multicenter study evaluated safety and efficacy of the MSAD for 5 years. Prior to MSAD placement, patients had abnormal esophageal acid and symptoms poorly controlled by proton pump inhibitors (PPIs). Patients served as their own control, which allowed comparison between baseline and postoperative measurements to determine individual treatment effect. At 5 years, gastroesophageal reflux disease (GERD)-Health Related Quality of Life (HRQL) questionnaire score, esophageal pH, PPI use, and complications were evaluated. Results: Between February 2007 and October 2008, 44 patients (26 males) had an MSAD implanted by laparoscopy, and 33 patients were followed up at 5 years. Mean total percentage of time with pH <4 was 11.9% at baseline and 4.6% at 5 years (P < .001), with 85% of patients achieving pH normalization or at least a 50% reduction. Mean total GERD-HRQL score improved significantly from 25.7 to 2.9 (P < .001) when comparing baseline and 5 years, and 93.9% of patients had at least a 50% reduction in total score compared with baseline. Complete discontinuation of PPIs was achieved by 87.8% of patients. No complications occurred in the long term, including no device erosions or migrations at any point. Conclusions: Based on long-term reduction in esophageal acid, symptom improvement, and no late complications, this study shows the relative safety and efficacy of magnetic sphincter augmentation for GERD.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2015; DOI:10.1089/lap.2015.0394
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    ABSTRACT: Objectives: Hemostatic clip migration into the lower urinary tract is a potential complication of radical prostatectomy that may cause symptoms, anxiety, and functional concern. Our objective was to evaluate initial presentation, endoscopic management, and outcomes of patients with hemostatic clip migration following radical prostatectomy. Patients and methods: We retrospectively identified all patients with hemostatic clip migration at our institution from 1977 to 2012. Patient records were then reviewed to identify causative factors, presentation, and long-term functional outcomes. Results: Seventeen patients were identified with clip migration following radical prostatectomy. Eight (47%) patients had undergone open retropubic radical prostatectomy, and 9 (53%) had received robot-assisted radical prostatectomy. Hemostatic clip migration was diagnosed at a median of 8 (range, 1-252) months after prostatectomy. The majority of patients (n = 16, 94%) were symptomatic upon the diagnosis of clip migration. Symptoms included irritative urinary symptoms (n = 14, 82%), perineal pain (n = 3, 18%), hematuria (n = 2, 12%), and infection (n = 2, 12%). Five (29%) had concomitant bladder neck contracture. Fifteen (88%) underwent successful endoscopic clip removal, whereas 2 (13%) patients required a repeat operation for recurrent clip erosion. With a median follow-up of 1.6 years, the majority (n = 13, 87%) had complete symptom resolution after clip removal, although 2 patients had recurrent bladder neck contracture. Conclusions: Hemostatic clip migration after prostatectomy is often symptomatic with irritative voiding complaints, perineal pain, hematuria, infection, or bladder neck contracture. Fortunately, clips can be removed endoscopically with expected symptom resolution in the vast majority of patients.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0054
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    ABSTRACT: Background: Diagnostic peritoneoscopy is typically performed by using a rigid laparoscope. Inspired by gastric submucosal tunneling for peritoneal natural orifice transluminal endoscopic surgery access and peroral endoscopic myotomy for the treatment of achalasia, we developed a novel esophago-cardial-gastric tunneling (ECGT) peritoneoscopy technique with a flexible endoscope. This study aims to evaluate its feasibility and safety. Materials and methods: The study comprised 10 Beagle dogs. A longitudinal mucosal incision was made on the esophageal wall, and a submucosal tunnel was created through the cardia into the stomach. An incision was made in the muscular layer of the stomach, and then the endoscope was advanced into the peritoneal cavity. Peritoneoscopy with the flexible endoscope was performed. After intraperitoneal exploration, the esophageal mucosal entry was closed with endoclips. All dogs resumed food intake 12 hours after the procedures. Diets, behavior, and body temperature of all of the dogs were observed. Endoscopic examinations were performed 4 weeks after the procedure, and then the animals were sacrificed for necropsy. Results: The ECGT peritoneoscopy was successfully done in all dogs. Diets, behavior, and body temperature were normal in all dogs. The entry of the esophagus was healed well in 9 dogs; the mucosa of the entry was torn in 1 dog, but the submucosal tunnel was healed well at the cardia. Necropsy showed complete closure of the gastric serosal exit, and no intraperitoneal abscess was found. Histopathological examinations showed submucosal tunnels healed well. Conclusions: The ECGT peritoneoscopy is feasible and safe for peritoneal exploration. It should be a good choice for the clinical application of diagnostic peritoneoscopy.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0275
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    ABSTRACT: Introduction: Gastrojejunostomy (GJ) tubes are an option for durable enteral access for critically ill infants with congenital cardiac disease who struggle with obtaining adequate nutrition. Materials and methods: Infants weighing less than 10 kg with cardiac disease who received placement of a laparoscopic GJ tube from November 2011 to January 2015 were reviewed. The operative technique used an umbilical port for the camera and a single stab incision for the gastric access site. After insufflation to 5-8 mm Hg, the stomach was suspended to the abdominal wall, after which a dilator was maneuvered into a postpyloric position using laparoscopic visualization and fluoroscopy, and a glidewire was passed into the duodenum. The GJ tube was then fluoroscopically threaded over the glidewire; final position was confirmed by contrast injection. Results: There were 32 laparoscopic GJ tube placement operations performed; 7 (21.9%) of these tubes were standard single-unit GJ tubes, and 25 (78.1%) were low-profile gastrostomy tubes modified with a nasojejunal feeding tube threaded through the feeding port. Median patient age was 3.5 months (range, 0.75-11 months), with a median weight of 4.2 kg (range, 2.4-7.4 kg). Congenital defects were varied, including hypoplastic left heart syndrome and pulmonary vein stenosis. Median operative time was 62 minutes for isolated GJ placement (range, 35-114 minutes). There were three postoperative complications, resulting in a 30-day complication rate of 9.4%. Thirty-day mortality was 9.4% with no mortality related to the operation. Conclusions: Laparoscopic GJ tube placement may be performed safely in infants with cardiac disease and allows these patients to receive adequate nutrition despite intolerance of gastric feeding.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0118
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    ABSTRACT: Background: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6 ± 94.6 versus 217.6 ± 111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0317
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    ABSTRACT: Objective: To assess whether pubovesical complex (PVC) reconstruction (termed Kim's stitch) improves urinary continence following robot-assisted laparoscopic prostatectomy (RALP). Patients and methods: The cohort consisted of 130 consecutive patients who underwent RALP in a tertiary-care hospital between July 2012 and June 2013. The first 70 patients did not undergo PVC reconstruction with Kim's stitch and formed the control group. The subsequent 60 patients underwent Kim's stitch and formed the intervention (Kim's stitch) group. The primary outcome measure was degree of urinary continence assessed 1, 3, and 6 months after surgery using the Expanded Prostate Cancer Index Composite Questionnaire. Continence was compared between the two groups using propensity scores and inverse-probability weighting to adjust for treatment selection bias. To evaluate adverse treatment effects, all patients underwent uroflowmetry before and 1 month after surgery. Results: The prevalence of continence at 1, 3, and 6 months was 23.9%, 57.7%, and 77.6%, respectively, in the control group and 25.9%, 60.0%, and 89.7%, respectively, in the Kim's stitch group. After adjustment, the 6-month continence was different between the two groups (odds ratio = 2.25; 95% confidence interval, 0.91-5.55; P = .08). The 1- and 3-month continence rates and postoperative maximal urinary flow rate were similar between the two groups (Kim's stitch group, 21.5 ± 9.5; control group, 22.1 ± 8.6; P = .72). Conclusions: A PVC reconstruction (Kim's stitch) with posterior reconstruction during RALP has a beneficial effect on continence recovery without producing additional adverse effects.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2014.0584
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    ABSTRACT: Background: Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. The prolonged prefiring compression (PFC) technique to reduce PF has been described by Nakamura and colleagues in Japan. The present study assessed if this technique can be applied to the United Kingdom patient population in a tertiary referral center and replicate the low incidence of PF after the laparoscopic approach to distal pancreatectomy (Lap-DP). Materials and methods: This is a retrospective study of all patients who underwent Lap-DP using the modified PFC technique by the senior author between June 2011 and July 2014. The modified PFC technique involved compression of the pancreatic parenchyma with an endo-stapler for a 3-minute period prior to firing and further 1-minute compression after firing prior to removal of the stapler, which is a small variant to the original technique of maintaining a 2-minute compression post firing. Results: Twenty patients (15 females; median age, 66 [range, 25-77] years) underwent Lap-DP using the PFC technique during the study period. Six patients had splenic-preserving Lap-DP. Median operating time was 240 minutes (range, 150-420 minutes) with a median length of hospital stay of 6 days (range, 3-22 days). Six patients (30%) developed Type A (biochemically noted as high drain fluid amylase) PF, and none of the patients had Type B/C PF. In the splenic preservation group, 1 patient had complete splenic infarction requiring laparoscopic splenectomy on Day 3, and 1 patient had partial infarction requiring prolonged hospital stay for pain relief. One patient required prolonged respiratory support due to severe preexisting lung disease. Overall mortality was zero. Conclusions: Our data confirm that the PFC technique is safe, feasible, and effective in reducing clinically significant PF post-Lap-DP in the United Kingdom patient population.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0200
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    ABSTRACT: Purpose: Laparoscopic gastric greater curvature plication (LGGCP) is an emerging, alternative form of restrictive weight loss surgery. We present our experiences of LGGCP with the primary focus on surgical techniques and weight loss. In addition, an investigation was performed on the food tolerance of LGGCP patients. Materials and methods: This study was conducted by retrospectively reviewing the prospectively collected data of patients who underwent LGGCP from March 2013 to February 2015. Results: Of the 64 patients were eligible for the study, 59 (92.2%) were female. Mean (range) patient age was 34 (21-49) years. Mean ± standard deviation (SD) preoperative body mass index was 31.4 ± 4.3 kg/m(2). There were no mortalities or postoperative complications. Immediate postoperative nausea and vomiting occurred in 58 patients (90.6%), mean postoperative hospital stay duration was 2.3 days (range, 1-7 days), and mean percentage excess body mass index losses at 1, 3, 6, 12, and 18 months were 34.7% (n = 64), 50.8% (n = 60), 61.1% (n = 40), 82.1% (n = 19), and 82.9% (n = 12), respectively. Follow-up endoscopy was performed at 12 months postoperatively in 19 patients, and reflux esophagitis of grade LA-M was observed in 16 patients (84.2%), LA-A in 2 patients (10.5%), and LA-B in 1 patient (5.3%). Mean ± SD satisfaction score with current eating and total food tolerance score was 4.27 ± 0.55 and 20.95 ± 4.30, respectively. Conclusions: LGGCP is an intervention that may be comparable with sleeve gastrectomy or adjustable gastric banding, especially for Class I or II obesity in an Asian population. Furthermore, quality of eating, as determined using food tolerance scores, was excellent.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0164
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    ABSTRACT: Introduction: Enteric duplication (ED) cysts are rare. The commonness of ultrasonographic investigation contributes to an earlier diagnosis of such a pathology before the onset of the first clinical symptoms. A planned mini-invasive surgical treatment during the infancy is proposed. This study presents the possibility and safety of elective laparoscopic or laparoscopy-assisted mini-invasive resection of ileal (IL) and ileocecal (IC) duplications, thus avoiding bowel resection. Materials and methods: A retrospective review was conducted of medical records of 6 patients at the age from 3 to 22 months with the diagnosis of ED, treated in the Department of Pediatric Surgery, Jagiellonian University Medical College, Krakow, Poland, within the period from January 2012 to September 2014. Results: Excision of cysts without bowel resection was performed in five children with IC and IL duplications. Laparoscopic excision was performed in two children with IC duplication; in the other three children (1 IC and 2 IL duplication), laparoscopy confirmed the diagnosis with consecutive cyst excision without bowel resection after external evacuation of the cyst. The external resection of the cecum and Bauhin's valve was necessary in 1 patient with large IC duplication and malrotation. The postoperative course was satisfactory in all the cases. Conclusions: The laparoscopic approach allows for confirming the diagnosis and accurately defining the exact site of duplication, as well as for effective and safe mini-invasive treatment. Laparoscopic or laparoscopy-assisted excision of ED without bowel resection is a safe option in a significant number of IL and IC duplications.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0103
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    ABSTRACT: Purpose: Retroperitoneoscopic partial nephrectomy (RPN) in children is considered a complex technique with limited diffusion among pediatric surgeons and urologists. We aimed to report the outcome of this technique in infants and children with duplex kidney in a 5-year retrospective multicentric international survey. Materials and methods: Data on 50 children who underwent RPN (41 upper-pole nephrectomies and 9 lower-pole nephrectomies) were retrospectively collected in this six-institution survey. Median age at surgery was 3.3 years. There were 35 girls and 15 boys. The left side was affected in 28 patients, versus the right side in 22 patients. We assessed intraoperative and postoperative morbidity. Follow-up (median, 2.5 years; range, 12 months-5 years) was based on clinical controls and echo color Doppler renal ultrasound scans. Results: Median duration of surgery was 255 minutes. Surgery was always performed with the patient in a lateral position. Special hemostatic devices were used for dissection and parenchymal section in all centers. Three patients from two centers (6%) required conversion to open surgery. We recorded seven complications (six peritoneal perforations, one opening of the remaining calyxes) in the 50 cases. Re-operation rate was 0%. Average length of hospital stay was 4.1 days. Conclusions: Our survey shows that RPN remains a challenging procedure with a long learning curve, performed only in pediatric centers with huge experience in this field. In our survey operative time was longer than 4 hours. The complication rate remains high (7/50, or 14%), with complications classified as Grade II according to the Clavien-Dindo classification. They did not require further surgery, but they were associated with a prolonged hospital stay.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2014.0654
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; 25(9):695-701. DOI:10.1089/lap.2015.29003.trd
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    ABSTRACT: Background: This study evaluates the safety and cost of introducing minimally invasive pancreaticoduodenectomy (MIPD) to a surgeon's practice. Subjects and methods: All MIPDs performed between December 2011 and July 2013 were compared with open pancreaticoduodenectomy (OPD) cases by the same surgeon. The primary outcomes were mortality, major morbidity, and re-operation. Secondary outcomes were perioperative and oncologic outcomes and cost. MIPD include total laparoscopic pancreaticoduodenectomy (TLPD) and laparoscopic-assisted pancreaticoduodenectomy (LAPD), where a small incision is used for reconstruction. Bivariate comparisons of outcomes were performed using nonparametric tests. Results: In total, 44 pancreaticoduodenectomies were performed: 15 MIPDs (2 TLPDs and 13 LAPDs) and 29 OPDs. One death occurred in each group. Major complication rates were not significantly different (33% for MIPD versus 17% for OPD); however, there was a trend toward more re-operation after MIPD compared with OPD (20% versus 3%; P=.07). The incidence of pancreatic leak (20% for MIPD versus 14% for OPD), biliary leak (0% versus 7%, respectively), abscess formation (27% versus 14%, respectively), and intraabdominal hemorrhage (13% versus 3%, respectively) were not significantly different. MIPD achieved equivalent oncologic outcomes as OPD with 100% R0 margin and adequate lymph node retrieval. There was no statistical difference in median operative time (342 minutes for MIPD versus 358 minutes for OPD), length of stay (8 versus 9 days, respectively), operating room expenses (Canadian) ($7246.0 versus $6912.0, respectively), or total cost (Canadian) per case ($15,034.0 versus $18,926.0, respectively). Conclusions: MIPD and OPD had similar safety and cost in this introductory series. However, a trend toward a higher rate of re-operation for pancreatic leak suggests the need for caution in introducing this novel technique.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; 25(9):712-9. DOI:10.1089/lap.2015.0059
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    ABSTRACT: Objective: Few studies have directly assessed the impact of tumor anterior/posterior location during transperitoneal robotic-assisted laparoscopic partial nephrectomy (TPRPN). The present study sought to assess perioperative and pathological outcomes associated with TPRPN among patients with anterior versus posterior tumors. Patients and methods: The Institutional Review Board-approved Mount Sinai Kidney Cancer database was used to identify 123 patients who underwent TPRPN from May 2011 to April 2015. Perioperative outcomes, including operative time, warm ischemia time (WIT), estimated blood loss (EBL), hospital length of stay (LOS), surgical margin status, complications, and reduction in estimated glomerular filtration rate (eGFR) at discharge and at last follow-up, were compared between those with anterior and posterior masses while controlling for clinical and pathological variables (i.e., age, gender, body mass index, tumor size, tumor laterality, malignancy, hilar location, and R.E.N.A.L. nephrometry score). Results: Clinical and pathological characteristics were comparable between groups; mean tumor size was 3.1 cm anterior versus 2.8 cm posterior (P = .187). Tumor complexity (i.e., nephrometry scores, 6.9 versus 6.3; P = .097) and proportion of malignancy (74.5% versus 73.1%; P = .799) were also similar between posterior and anterior masses. In multivariable analyses, perioperative outcomes, including operative time, WIT, EBL, LOS, surgical margin status, reduction in eGFR, and postoperative complication rates, did not significantly differ between groups. Conclusions: The transperitoneal approach to partial nephrectomy for posterior tumors resulted in no difference in operative time, WIT, EBL, LOS, positive surgical margins, reduction in eGFR, or postoperative complications. The TPRPN approach to treat a posterior tumor is reasonable and is the preferred technique at our institution.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0308
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    ABSTRACT: Objectives: Translumenal access site closure remains a major challenge in natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]). We assessed the feasibility and safety of using reserved threads to close the bladder perforation during NOTES and analyzed this novel technique in a live porcine model. Materials and methods: Five female pigs were used in this study. With the animal under general anesthesia, a self-made trocar was inserted into the bladder. Under ureteroscopic guidance, the anterior bladder wall was punctured by a needle into the abdominal wall, and two reserved lines were placed. The bladder perforation was closed with the reserved lines. Procedure time and effectiveness of the closure were recorded and evaluated. Results: We completed a total of 5 cases of animal experiments. The first case failed because the weight and size of the animal were too large. The remaining 4 cases were successful. The procedure times were 45, 30, 25, and 25 minutes, respectively. The perforations were closed completely. Conclusions: The novel method of using reserved thread to close the bladder perforation was safe and effective. Further large-scale survival studies are needed to prove its clinical potential.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; DOI:10.1089/lap.2015.0303
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    ABSTRACT: Since its introduction in 1956, the Duhamel procedure has been and remains one of the most widely performed for Hirschsprung's disease (HD). The most significant modification to this procedure has been the incorporation of laparoscopy, while the original principles of the method have been retained. This study compared long-term outcomes for open Duhamel (OD) and laparoscopic Duhamel (LD) procedures for HD, to identify any added advantage of the laparoscopic technique. We undertook a systematic review of all studies published over a period of 20 years (1994-2014) that assessed functional outcomes for OD and/or LD procedures. Odds ratios were calculated for dichotomous variables, and mean difference values were calculated for continuous variables. From 11 articles 456 patients were included (253 OD, 203 LD), with no significant difference in age at surgery and length of follow-up (P > .05). The open group had a significantly greater incidence of soiling/incontinence (11% versus 4%; P = .02) and further surgery (25% versus 14%; P = .005), longer hospital stay (9.79 versus 7.3 days; P < .00001), and time to oral feed (4.05 versus 3.27 days; P < .00001). Operative time was significantly longer in the laparoscopic group (3.83 versus 4.09 hours; P = .004). There was no significant difference in incidence of enterocolitis (15% versus 10%; P = .14) and constipation (23% versus 30%; P = .12). Our meta-analysis convincingly demonstrates the superiority of LD over OD pull-through for HD. Prospective, randomized control trials are required to overcome limitations in the current literature.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; DOI:10.1089/lap.2015.0121
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    ABSTRACT: Since the introduction of the Nuss technique for pectus excavatum (PE) repair, stabilization of the bar has been a matter of debate and a crucial point for the outcome, as bar dislocation remains one of the most frequent complications. Several techniques have been described, most of them including the use of a metal stabilizer, which, however, can increase morbidity and be difficult to remove. Our study compares bar stabilization techniques in two groups of patients, respectively, with and without the metal stabilizer. A retrospective study on patients affected by PE and treated by the Nuss technique from January 2012 to June 2013 at our institution was performed in order to evaluate the efficacy of metal stabilizers. Group 1 included patients who did not have the metal stabilizer inserted; stabilization was achieved with multiple (at least four) bilateral pericostal Endo Close™ (Auto Suture, US Surgical; Tyco Healthcare Group, Norwalk, CT) sutures. Group 2 included patients who had a metal stabilizer placed because pericostal sutures could not be used bilaterally. We compared the two groups in terms of bar dislocation rate, surgical operative time, and other complications. Statistical analysis was performed with the Mann-Whitney U test and Fisher's exact test. Fifty-seven patients were included in the study: 37 in Group 1 and 20 in Group 2. Two patients from Group 2 had a bar dislocation. Statistical analysis showed no difference between the two groups in dislocation rate or other complications. In our experience, the placement of a metal stabilizer did not reduce the rate of bar dislocation. Bar stabilization by the pericostal Endo Close suture technique appears to have no increase in morbidity or migration compared with the metal lateral stabilizer technique.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; DOI:10.1089/lap.2015.0230
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    ABSTRACT: Age, superobesity, and cardiopulmonary comorbidities define patients as high risk for bariatric surgery. We evaluated the outcomes following bariatric surgery in extremely high-risk patients. Among 3240 patients who underwent laparoscopic bariatric surgery at a single academic center from January 2006 through June 2012, extremely high-risk patients were identified using the following criteria: age ≥65 years, body mass index (BMI) ≥50 kg/m(2), and presence of at least two of six cardiopulmonary comorbidities, including hypertension, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, and history of venous thromboembolism. Perioperative and intermediate-term outcomes were assessed. Forty-four extremely high-risk patients underwent laparoscopic Roux-en-Y gastric bypass (n=23), adjustable gastric banding (n=11), or sleeve gastrectomy (n=10). Patients had a mean age of 67.9±2.7 years, a mean BMI of 54.8±5.5 kg/m(2), and a median of two (range, two to five) cardiopulmonary comorbidities. There was no conversion to laparotomy. Thirteen (29.5%) 30-day postoperative complications occurred; only six were major complications. Thirty-day postoperative re-admission, re-operation, and mortality rates were 15.9%, 2.3%, and 0%, respectively. Within a mean follow-up time of 24.0±18.4 months, late morbidity and mortality rates were 18.2% and 2.3%, respectively. The mean percentage total weight and excess weight losses after at least 1 year of follow-up were 26.7±12.0% and 44.1±20.6%, respectively. Laparoscopic bariatric surgery is safe and can be performed with acceptable perioperative outcomes in extremely high-risk patients. Advanced age, BMI, and severe cardiopulmonary comorbidities should not exclude patients from consideration for bariatric surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; DOI:10.1089/lap.2015.0013