Laparoscopic repair of interparietal abdominal wall hernias.

Interparietal hernias are rare abdominal defects where intraabdominal contents protrude between layers of the abdominal wall. There is limited experience using laparoscopic technique for repairing substantially large interparietal hernias. Computed tomography scans of both cases herein demonstrated intact external oblique, but the internal oblique and transversus abdominis were widely detached from the linea semilunaris.

Small Bowel Obstruction.

Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management.

Doxycycline administration improves fascial interface in hernia repair.

Background: Despite improvements in ventral hernia repair techniques, their recurrence rates are unacceptably high. Increased levels of matrix metalloproteinases (MMPs) and reduced collagen-1 to -3 ratios are implicated in incisional hernia formation. We have recently shown doxycycline treatment for 4 wk after hernia repair reduced MMP levels, significantly increased collagen-1 to -3 ratios, and increased tensile strength of repaired interface fascia.

Bouveret syndrome: gallstone ileus of the duodenum.

This is a case of a 59-year-old woman with Bouveret syndrome. An initial endoscopic approach to management is described. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula or a choledochoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocecal valve.

Single incision laparoscopic ventral hernia repair.

Background And Objectives: Laparoscopic ventral hernia repair (LVH) requires several skin incisions for trocar placement. We have developed a single incision approach to LVH repair. The technique was introduced in clinical practice to any consenting patients who were candidates for a standard multi-port laparoscopic hernia repair.

Using the StomaphyX(TM) endoplicator to treat a gastric bypass complication.

Background And Objectives: As the number of bariatric operations performed increases, the number of patients requiring reoperation for failed weight loss is expected to proportionately increase. Natural orifice surgery is an alternative approach to revisional gastric bypass surgery when postoperative complications, such as dilatation of the gastrojejunostomy, gastrogastric fistula, and gastric pouch, dilation occur.

Methods: The present article reports on the safe and successful use of an endoscopic tissue plicating device in a patient found to have a dilated gastric pouch and a gastrogastric fistula 12 years after an open, nondivided RYGB.

Single-incision laparoscopic cholecystectomy: a cost comparison.

Background: Single-incision laparoscopic cholecystectomy (SILC) should not cost more or less than traditional laparoscopic cholecystectomy (LC).

Methods: Retrospective cost data were collected from the accounting records of a single institution. A direct comparison of LC and SILC was conducted.

Effect of Vacuum Assisted Closure Therapy on early systemic cytokine levels in a swine model.

Vacuum Assisted Closure (V.A.C.

Acute effects of suction retraction on atrial hemodynamics and histology.

Objectives: In minimally invasive and robotic mitral valve surgery, a blade retractor is used to elevate the left atrial roof, which often distorts tissue and impairs visualization. We tested the hemodynamic and histologic changes of intra-atrial suction, using a new suction retractor that may improve stabilization and visualization.

Methods: Swine were divided into 3 equal (n = 4) groups: blade retractor, suction retractor, and arrested heart control.

Robotic mitral valve annuloplasty with double-arm nitinol U-clips.

Purpose: Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times.

Reexamining contraindications for minimally invasive mitral valve surgery.

Historically, contraindications to minimally invasive or robotic mitral valve surgery have included prior mastectomy, thoracic reconstruction, or chest radiation. However, we believe that by granting flexibility in the choice of skin incision site while performing careful dissection, surgeons can provide these patients the outstanding results afforded by a minithoracotomy. We present a patient who had undergone a prior mastectomy and radiation treatment in whom we performed a minimally invasive mitral valve repair through a right-sided minithoracotomy using the previous mastectomy incision.

Combining robotic mitral valve repair and microwave atrial fibrillation ablation: techniques and initial results.

Background: Left atrial microwave ablation for atrial fibrillation has become popular for isolating autonomous atrial foci. Previously, mitral valve repairs (MVP) with atrial fibrillation ablation have been performed through sternotomy. We present a technique that combines robotic MVP with left atrial fibrillation ablation.

Laparoscopic omental harvest for flap coverage in complex mediastinitis.

Mediastinitis is one of the most serious complications of cardiac surgery. The standard of care in mediastinitis includes thorough sequential debridement, flap coverage, and culture-directed antibiotics. The most frequently utilized muscles for flap reconstruction include the rectus abdominus and the pectoralis major.

Sutureless robot-assisted mitral valve repair: an animal model.

Background: Robotic mitral valve repair with the da Vinci robotic surgical system has been performed in more than 70 patients at our institution. This procedure reduces the need for blood transfusions, shortens hospital stay, and hastens return to normal activities. However, the robot-assisted repair also requires longer cardiopulmonary bypass and arrested-heart times than conventional open repairs.