Percutaneous cholecystostomy versus laparoscopic cholecystectomy in patients with acute cholecystitis and failed conservative management: a matched-pair analysis.

Introduction: The role of percutaneous cholecystostomy (PC) or laparoscopic cholecystectomy (LC) in the management of patients with acute cholecystitis presenting beyond 72 hours from the onset of symptoms is unclear and undefined. The aim of this study was to examine and compare the outcomes of PC or LC in the management of these patients, who failed 24 hours of initial nonoperative management.

Patients And Methods: A retrospective chart review between January 1999 and October 2010 revealed 261 patients with acute calculus cholecystitis beyond 72 hours from onset of symptoms who failed initial nonoperative management.

Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis.

Background: The current standard of treatment for most ventral hernias is a mesh-based repair. Little is known about the safety and efficacy of biologic versus nonbiologic grafts. A meta-analysis was performed to examine two primary outcomes: recurrence and wound complication rates.

Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer.

Background: Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE).

The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

Objective: To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures.

Background: Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not.

Argon beam coagulation versus fibrin sealant for hemostasis following liver resection: a randomized study in a porcine model.

Background/aims: Bleeding from the raw liver surface represents a significant surgical complication after elective liver resection or hepatic trauma. The application of argon beam coagulation (ABC) has been proposed to improve hemostasis, but is associated with significant necrosis of the liver parenchyma. Topical hemostatic agents, i.

Single-access laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials.

Background: Single-incision laparoscopic surgery has been proposed as a minimally invasive technique with the advantages of fewer scars and reduced pain. The aim of this study was to perform a systematic review and meta-analysis of prospective randomized clinical trials of single-access laparoscopic cholecystectomy (SALC) versus classic laparoscopic cholecystectomy (CLC).

Methods: All randomized controlled trials were identified through electronic searches (MEDLINE, PubMed, SAGES, and Cochrane Central Register of Controlled Trials) up to October 2011.

Thirty-day outcomes of laparoscopic versus open appendectomy in elderly using ACS/NSQIP database.

Background: Although laparoscopic appendectomy is becoming the procedure of choice over open appendectomy in the treatment of appendicitis, its role in the elderly has not been widely studied. The objective of this study was to compare the 30-day outcomes after laparoscopic versus open for appendicitis in the elderly patients.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS/NSQIP) databases for years 2005-2009, 3,674 patients (age >65 years) who underwent an appendectomy for appendicitis were identified.

Minimally invasive surgical approach for the treatment of gastroparesis.

Background: Gastroparesis is a chronic disorder resulting in decreased quality of life. The gastric electrical stimulator (GES) is an alternative to gastrectomy in patients with medically refractory gastroparesis. The aim of this study was to analyze the outcomes of patients treated with the gastric stimulator versus patients treated with laparoscopic subtotal or total gastrectomy.

Laparoscopic vs open appendectomy in obese patients: outcomes using the American College of Surgeons National Surgical Quality Improvement Program database.

Background: Although open and laparoscopic appendectomies are comparable operations in terms of outcomes, it is unknown whether this is true in the obese patient. Our objective was to compare short-term outcomes in obese patients after laparoscopic vs open appendectomy.

Study Design: Using the American College of Surgeons National Surgical Quality Improvement Program database (2005-2009), 13,330 obese patients (body mass index ≥ 30) who underwent an appendectomy were identified (78% laparoscopic, 22% open).

Evaluation and treatment of patients with cardiac disease undergoing bariatric surgery.

Background: Bariatric surgery is a proven tool in reducing the co-morbidities associated with morbid obesity. The aim of the present review was to assess the current data and discuss the strategies for preoperative evaluation, preoperative treatment, and intraoperative management of the obese patient with cardiac disease seeking bariatric surgery, including those who have undergone previous angiographic intervention with coronary stenting and/or antiplatelet therapy. The setting was a university hospital in the United States.

Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis.

Background: The objective was to conduct a meta-analysis of randomized controlled trials evaluating the efficacy and morbidity of the management of acute uncomplicated (no abscess or phlegmon) appendicitis by antibiotics versus appendectomy.

Methods: Appropriate trials were identified. The seven outcome variables were overall complication rate, treatment failure rate for index hospital admission, overall treatment failure rate, length of stay (LOS), utilization of pain medication, duration of pain, and sick leave.

Laparoscopic versus open anterior abdominal wall hernia repair: 30-day morbidity and mortality using the ACS-NSQIP database.

Objective: To compare short-term outcomes after laparoscopic and open abdominal wall hernia repair.

Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2009), 71,054 patients who underwent an abdominal wall hernia repair were identified (17% laparoscopic, 83% open). Laparoscopic and open techniques were compared.

Significant reduction of wound infections with daily probing of contaminated wounds: a prospective randomized clinical trial.

Hypothesis: Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction.

Design: Prospective randomized clinical trial.

Setting: Academic medical center.

Laparoscopic appendectomy: new concepts.

Over the last three decades more surgeons have used laparoscopic appendectomy as their surgical approach of choice in the management of patients with appendicitis. This includes special groups of patients, namely, pediatric, pregnant, and obese patients. Laparoscopy has the benefit of lower morbidity, decreased rate of wound complications, faster recovery, shorter length of hospital stay, and faster return to work over open appendectomy.

A new technique for minimally invasive abdominal wall reconstruction of complex incisional hernias: totally laparoscopic component separation and incisional hernia repair.

Since Ramirez et al. presented the first case of component separation for abdominal wall hernias in 1990, it has undergone multiple modifications. This technique, which has been mainly used for large hernias where primary closure of the abdominal wall is not feasible, or for staged management of patients with open abdomens, results in multiple wound complications.

Laparoscopic versus open appendectomy for the obese patient: a subset analysis from a prospective, randomized, double-blind study.

Background: The clinical outcomes for patients randomized to either open or laparoscopic appendectomy are comparable. However, it is not known whether this is true in the subset of the adult population with higher body mass indexes (BMIs). This study aimed to compare the outcomes of open versus laparoscopic appendectomy in the obese population.

Fibrin glue for intraperitoneal laparoscopic mesh fixation: a comparative study in a swine model.

Background: The classic method of mesh fixation in laparoscopic ventral hernia repair is transfascial sutures with tacks. This method has been associated with low recurrence rates, but yields significant morbidity from pain and bleeding. Fibrin glue has been used successfully in inguinal hernia repair with decreased incidence of chronic pain without an increase in recurrence rates, but its utility for laparoscopic ventral hernia repair is unknown.

Prediction of patients with acute cholecystitis requiring emergent cholecystectomy: a simple score.

The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score) was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation.

Establishing an acute care surgery service: lessons learned from the epidemiology of emergent non-trauma patients and increasing utilization of laparoscopy.

Background: Acute care surgery is a fellowship training model created to address the growing crisis in emergency healthcare due to decreased availability of on-call surgeons and reduction in operative procedures for trauma. Our objective was to identify the demographics and spectrum of diseases in patients presenting with non-trauma surgical emergencies and the use of laparoscopy in emergent surgery in light of implementing an acute care surgery model.

Methods: All non-trauma emergency surgical consultations at a large urban academic medical center from January 2005 to December 2008 were retrospectively reviewed.