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ABSTRACT: Single-port access (SPA) is an emerging concept in minimally invasive colorectal surgery. The authors report their experience using SPA sigmoidectomy as an early-elective approach to complicated diverticulitis with paracolic abscess.
Between September 2009 und April 2010, 4 patients underwent SPA sigmoidectomy for Hinchey-I diverticulitis using the reusable X-Cone device.
After a median time of antibiotic treatment of 8 days, SPA sigmoidectomy was performed successfully in all patients. The median operative time was 200 minutes (range, 187-221 minutes). No intraoperative or postoperative complications were recorded; the median postoperative hospital stay was 7 days (range, 5-7 days). No incisional hernias were observed at midterm follow-up (median, 11.5 months; range, 8-14 months).
When performed by an experienced laparoscopic surgeon, early-elective SPA sigmoidectomy is a feasible and safe approach to complicated diverticulitis. The reusability of the X-Cone device ensures that the costs of the procedure are not high.
Surgical Innovation 07/2011; 19(1):45-9. · 2.13 Impact Factor
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ABSTRACT: Recent reports on the feasibility and safety of single-incision cholecystectomy have challenged the conventional multiport access to the gallbladder. Nevertheless, the proximity of different instruments and the laparoscope may lead to interference that potentially compromises the safety of the operation. This article describes the use of a customary flexible restraint system for the gallbladder fundus to achieve triangulation by means of a three-instrument technique and an optimized view to the Calot's triangle.
Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2011; 21(5):427-9. · 1.40 Impact Factor
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ABSTRACT: Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB.
Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared.
Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique.
Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention.
Surgical Endoscopy 10/2009; 24(5):1025-30. · 4.01 Impact Factor
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Surgery Today 02/2009; 39(4):275-80. · 1.22 Impact Factor
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ABSTRACT: The choice between different bariatric procedures for each patient is an important question in bariatric surgery. In this article, we explain criteria for patient selection for laparoscopic Roux-en-Y gastric bypass at the Obesity Center Wuerzburg and compare the corresponding outcomes for these selection criteria.
60 consecutive patients underwent gastric bypass surgery (34 female, 26 male; mean age 45.1 +/- 10.2 years). Mean preoperative BMI was 53.7 +/- 8.7 kg/m2. Selection criteria were age > 40, male sex,BMI > 50, metabolic syndrome, and/or reduced compliance.Results: 42 patients (70%) were >40 years old, 26 patients(43%) were male, 42 patients (70%) had a BMI > 50, and 28 patients had a metabolic syndrome (47%). 10 out of these 60 patients were reoperated after failed gastric banding. Overall weight loss was 43.7 +/- 18.7 kg, BMI loss was 15.0 +/- 6.4 kg/m2,and excess body weight loss (EBWL) was 54.3 +/- 19.7%. There were 34 patients with an EBWL of > or = 50%. Age, sex, and presence or absence of metabolic syndrome were irrelevant for postoperative weight loss. Although the EBWL was slightly higher in patients with a BMI < 50, patients with a BMI > 50 lost significantly more weight.
The indication for a gastric bypass may be substantiated by the higher weight reduction in patients with a BMI > 50. Other selection criteria had no influence on the postoperative outcome.
Obesity Facts 01/2009; 2 Suppl 1:54-6. · 1.86 Impact Factor
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ABSTRACT: BACKGROUND: The success rate of laparoscopic adjustable gastric banding (LAGB) in the treatment of morbid obesity is very variable.A reasonable preoperative selection of eligible patients seems to be important for a successful outcome of LAGB. In the present study, criteria were investigated to predict the outcome of LAGB. Methods: 85 morbidly obese patients were operated with LAGB between 1999 and 2005. 71 of these patients were analysed according to several possible predictive parameters of success or failure of LAGB. Success was defined as excess body weight loss(EBWL) > 50% without band removal, failure was defined as EBWL < 20% and/or band removal. Median follow-up was 27 months (range 8-90 months). Results: After LAGB a median EBWL of 43% (-41 to 171.5%) was observed in all patients with a decrease in BMI of 8.0 kg/m2 (-9 to 35 kg/m2). The success rate after LAGB was 37%, the failure rate 19.7%. Female sex(p = 0.023), baseline weight (p = 0.024), and eating behaviour after LAGB (p = 0.008) were significant predictors of success following LAGB, whereas complications such as port dislocation and reoperation after LAGB did not have a significant impact on a successful course following LAGB. Significant predictors of failure were male sex (p = 0.038) and missing physical activity after LAGB (p = 0.045), whereas the eating behaviour did not have a significant effect concerning failure following LAGB. Baseline excess body weight (EBW) was identified as an independent predictor of failure in a multivariate analysis. Conclusion: According to the results of this study, female patients with a lower EBW who improve their postoperative eating behaviour have the best chance of success following LAGB.
Obesity Facts 01/2009; 2 Suppl 1:27-30. · 1.86 Impact Factor
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ABSTRACT: Laparoscopic gastric banding (LAGB) is the most popular surgical procedure for morbid obesity in Europe. Long-term complications like slippage of the band or pouch dilatation are well known and lead to reoperations in a substantial number of patients. In this study, results and follow-ups of patients with reoperations after gastric banding were analyzed.
Between May 1997 and June 2006, 172 patients were treated with LAGB for morbid obesity. 41 of these patients underwent one or more band-related reoperations (female symbol = 32, male symbol = 9). Causes for and type of reoperation were analyzed. Weight loss and comorbidities were compared for different types of reoperations.
There were no deaths following the reoperations. Band replacement (n = 18), band repositioning (n = 7), conversion to sleeve gastrectomy (SG, n = 2) and Roux-en-Y gastric bypass (RYGBP, n = 2) or band removal without any further substitution (n = 12) were performed as first reoperation. Seven patients had a second reoperation: RYGBP (n = 3), SG (n = 1), or band removal (n = 3). Median follow-up since reoperation was 56 months (range 7-113). Excess weight loss (EBWL%) of patients was 59.4% after RYGBP (n = 5), 45.1% after re-banding (n = 18), and 33.4% after SG (n = 2). Comorbidities were further reduced or even resolved after reoperation. Patients whose band was removed without subsequent bariatric procedures lost significantly less weight (n = 13, EBWL% 23.4) than patients with band replacement (n = 18, EBWL% 46.4, p = 0.04).
Laparoscopic reoperation after LAGB is safe and feasible. Reoperation leads to further decrease of BMI and obesity-related comorbidities. Band replacement is a good option for patients with good weight loss after initial LAGB. Alternative procedures, preferably RYGBP, are required for cases of band failure. Overall, RYGBP appears to be the most effective option to induce further weight loss.
Surgical Endoscopy 05/2008; 23(2):334-40. · 4.01 Impact Factor
