Laparoscopic Revision of Failed Bariatric Procedures.

Background: The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications. The objective of revision is to restore the restrictive component and/or add a malabsorptive component.

Objectives: To evaluate the effectiveness of revisional laparoscopic bariatric surgery for loss of weight and assess the risks and benefits associated with these technically demanding procedures.

Laparoscopic transgastric esophageal mucosal resection: a treatment option for patients with high-grade dysplasia in Barrett's esophagus.

Background: We present long-term follow-up data on patients with esophageal high-grade dysplasia and/or carcinoma in situ who were treated with laparoscopic transgastric esophageal mucosal resection (LTEMR).

Methods: Patient demographics, operative outcomes, and follow-up results were tabulated.

Results: LTEMR was performed in 11 patients (9 male, 2 female).

Routine anticoagulation for venous thromboembolism prevention following laparoscopic gastric bypass.

Objective: To compare the rates of venous thromboembolism (VTE) by using routine postoperative enoxaparin versus early ambulation, SCDs, hydration, and selective prophylactic pharmacologic anticoagulation.

Methods: 1,692 patients undergoing laparoscopic gastric bypass from October 2001 to October 2008 were included and divided into 2 groups based on when they were operated upon. Group A (435 patients) received routine enoxaparin 12 hours after surgery.

Cardiac tamponade as a life-threatening complication in hernia repair.

Background: The placement of mesh in the repair of all types of hernia has been reported to decrease recurrence rates. There are several well known complications related to mesh repairs, including infection, erosion, seroma, and pain. Lesser reported are cardiac injuries secondary to anchoring of the mesh to the diaphragm.

A survey of dumping symptomatology after gastric bypass with or without lesser omental transection.

Background: Lesser omental transection during gastric bypass for morbid obesity may be associated with postoperative dumping. A survey of postoperative symptoms was performed in patients undergoing laparoscopic Roux-en-Y gastric bypass with transection vs. preservation of the lesser omentum.

Laparoscopic transgastric esophageal mucosal resection: 4-year minimum follow-up.

Background: The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection.

Methods: Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy.

Hiatal hernia repair with mesh: a survey of SAGES members.

Background: Primary repair of large hiatal hernia is associated with a high recurrence rate. The use of mesh may reduce this recurrence rate. The indication for mesh use, the type of mesh to use, and the placement technique are controversial.

Laparoscopic revision of failed fundoplication and hiatal herniorraphy.

Objective: The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication.

Background: Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure.

Nonsurgical skills do not predict baseline scores in inanimate box or virtual-reality trainers.

Introduction: Laparoscopic basic skills are best trained in the nonclinical setting. Box trainers and virtual-reality trainers have been shown to be useful in training laparoscopic skills. Certain nonsurgical skills may predict baseline skills in these trainers.

Laparoscopic peritoneal dialysis catheter insertion using a Quinton percutaneous insertion kit.

Objective: We assessed a unique technique of laparoscopic peritoneal dialysis (PD) catheter insertion which can minimize catheter dysfunction.

Methods: We performed a retrospective review of patients undergoing laparoscopic PD catheter placement with a Quinton percutaneous insertion kit between July 2000 and December 2004.

Results: Thirty-one catheters were placed laparoscopically.

Substituting virtual reality trainers for inanimate box trainers does not decrease laparoscopic skills acquisition.

Objectives: Inanimate and virtual reality box training help in developing basic laparoscopic skills. The lack of tactile feedback and lack of reality may be a detriment when training with virtual reality trainers. This study examined the hypothesis that there is no difference in laparoscopic skills acquisition when virtual reality trainers are partially substituted for inanimate box trainers.

L5-S1 laparoscopic anterior interbody fusion.

Objective: We evaluated our experience with laparoscopic L5-S1 anterior lumbar interbody fusion (ALIF).

Methods: This represents a retrospective analysis of consecutive patients who underwent L5-S1 laparoscopic ALIF between February 1998 and August 2003.

Results: Twenty-eight patients underwent L5-S1 LAIF (15 males and 13 females).

Laparoscopic repair of incarcerated diaphragmatic hernia with mesh.

Diaphragmatic hernias are now being approached laparoscopically. Incarcerated diaphragmatic hernia poses a special problem due to concerns about contamination. We describe a laparoscopic repair of such a hernia with the use of prosthetic mesh.

Laparoscopic Roux-en-Y Gastric bypass utilizing the triple stapling technique.

Objective: To evaluate the outcomes of a single surgeon's experience with laparoscopic Roux-en-Y gastric bypass (LRYGB) utilizing the triple stapling technique for creation of the jejunojejunostomy.

Methods: A retrospective review of patients who underwent LRYGB utilizing the triple stapling technique for creation of the jejunojejunostomy (JJ) between 10/01 and 12/04 was performed.

Results: LRYGB was performed in 435 consecutive patients.

Postoperative gastrointestinal complaints after laparoscopic Nissen fundoplication.

Objectives: Approximately 80% of patients complain of various symptoms immediately after laparoscopic Nissen fundoplication. These symptoms typically are treated medically without an extensive evaluation to identify the cause. We reviewed our experience of laparoscopic Nissen fundoplication to determine the course of postoperative symptomatology in our patient population, and present a rational approach to this problem.

Survey of minimally invasive surgery fellowship programs.

Introduction: Since there was no accrediting body for minimally invasive surgery fellowships, this investigation was performed to characterize minimally invasive surgery fellowships.

Materials And Methods: All minimally invasive surgery fellowships that were noted on the Society of American Gastrointestinal Endoscopic Surgeons website in July 2002 were sent a survey. Only those fellowships that had fellow(s) for the year 2001-2002 were included in the survey.

Laparoscopic repair of congenital duodenal obstruction.

CHARGE syndrome (or association) refers to a group of physical abnormalities occurring together: coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, and ear anomalies/deafness. We report the successful use of laparoscopy in a patient with CHARGE syndrome and congenital duodenal obstruction.

Value of preoperative upper endoscopy in patients undergoing laparoscopic gastric bypass.

Background: Preoperative evaluation of patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) has included esophagogastroduodenoscopy (EGD) with little data to substantiate its use.

Methods: A retrospective analysis was conducted of patients from Feb 04 to Mar 05 who underwent preoperative EGD and subsequently LRYGBP.

Results: 169 patients underwent EGD prior to surgery.

Effects of a laparoscopic course on student interest in surgical residency.

Background: The number of surgical residency applicants has been declining. Early introduction of the discipline of surgery is thought to stimulate early interest in surgical residency. This study investigated the hypothesis that a laparoscopic skills course introduced in preclinical years would stimulate student interest in entering surgical residency.

Participants' opinions of laparoscopic training devices after a basic laparoscopic training course.

Background: Basic laparoscopic skills are initially best taught and practiced in an inanimate setting. Various devices are used to aid in this education of laparoscopic skills. These devices range from simple box trainers to sophisticated virtual reality trainers.

Laparoscopic baseline ability assessment by virtual reality.

Background: Assessment of any surgical skill is time-consuming and difficult. Currently, there are no accepted metrics for most surgical skills, especially laparoscopic skills. Virtual reality has been utilized for laparoscopic training of surgical residents.

Laparoscopic transgastric esophageal mucosal resection for high-grade dysplasia.

Background: High-grade dysplasia of the esophageal mucosa has been shown to be a precursor to adenocarcinoma. In addition to esophagectomy, multiple ablative endoscopic techniques have evolved for the management of this condition. As a surgical alternative to esophagectomy, we describe for the first time a new option in the treatment of high-grade dysplasia.

Effect of body mass index on nonalcoholic fatty liver disease in patients undergoing minimally invasive bariatric surgery.

The risk factors for nonalcoholic fatty liver disease in patients undergoing bariatric surgery are under study. We wanted to determine the correlation between nonalcoholic fatty liver disease and patient factors such as obesity and liver function tests. A retrospective analysis was performed on 177 nonalcoholic morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass with liver biopsy, to identify risk factors for nonalcoholic fatty liver disease.

Evaluation of specialized laparoscopic suturing and tying devices.

Background: Laparoscopic suturing and tying constitute advanced minimally invasive surgery skills. Developing proficiency in the standard methods with needle drivers is often an arduous process. Recent advances in laparoscopic instrumentations has allowed for easier methods of suturing and tying.

Laparoscopic wedge resection of gastric leiomyoma.

Gastric leiomyoma is a relatively rare gastric neoplasm. Before the routine use of laparoscopy, various methods of treatment for gastric leiomyoma included open celiotomy with gastric wedge resection, partial gastrectomy, enucleation, and extended gastrectomy with en bloc resection of adjacent organs. Below, we describe a case of laparoscopic wedge resection and review the various laparoscopic techniques for the treatment of gastric leiomyoma.