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.

Susceptibility to gut leakiness: a possible mechanism for endotoxaemia in non-alcoholic steatohepatitis.

Introduction: One of the proposed second hit mechanisms in the pathophysiology of non-alcoholic steatohepatitis (NASH) is hepatic oxidative stress triggered by elevated levels of endotoxin. We investigated one possible mechanism for the endotoxaemia--disruption of intestinal barrier integrity.

Methods: We enrolled 16 subjects with fatty liver (10 NASH; 6 steatosis) and 12 healthy subjects.

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.

Minimally invasive ventral herniorrhaphy: an analysis of 6,266 published cases.

Background: Over 300,000 ventral abdominal wall hernias are repaired each year in the United States; many of these operations are done with a minimally invasive approach. Despite these numbers, there are few controlled data that evaluate the minimally invasive method of ventral hernia repair.

Methods: A review of over 6,000 published cases of minimally invasive ventral herniorrhaphy was performed in order to determine major outcome statistics for this procedure.

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.

Prospective randomized controlled trial of laparoscopic trainers for basic laparoscopic skills acquisition.

Background: Laparoscopic surgery requires a different set of skills than traditional open surgery. The acquisition of basic laparoscopic skills may help novices when learning laparoscopic procedures. This study tested the hypothesis that the combination of virtual reality and box trainers leads to better basic laparoscopic skill acquisition than either method alone or no training.

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.

Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery.

Background: Laparoscopy has become the standard surgical approach to both surgery for gastroesophageal reflux disease and large/paraesophageal hiatal hernia repair with excellent long-term results and high patient satisfaction. However, several studies have shown that laparoscopic hiatal hernia repair is associated with high recurrence rates. Therefore, some authors recommend the use of prosthetic meshes for either laparoscopic large hiatal hernia repair or laparoscopic antireflux 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.