Journal of Minimally Invasive Surgical Sciences最新文献

{"title":"Comparison of Early Outcomes and Costs Between Laparoscopic and Open Cholecystectomy for Mild and Moderate Cases of Cholelithiasis in Rural Morocco: A Retrospective Comparative Study","authors":"M. Majbar, A. Benkabbou, A. Souadka","doi":"10.17795/MINSURGERY-34182","DOIUrl":"https://doi.org/10.17795/MINSURGERY-34182","url":null,"abstract":"Background: Laparoscopic cholecystectomy (LC) was first introduced in the late 80’s, replacing open cholecystectomy as the standard surgical approach for cholelithiasis in developed countries. In contrast, there were initially many controversies in developing countries regarding the laparoscopic techniques. Objectives: This study aimed to compare the early outcomes and costs between laparoscopic and open cholecystectomy for cholelithiasis in a rural hospital in a developing country. Patients and Methods: This retrospective study included all consecutive patients who underwent cholecystectomy for mild and moderate symptomatic gallstone, in the Marche Verte hospital, in the Boulemane province in Morocco between January and December 2011. Demographics, postoperative outcomes, and costs were compared between laparoscopic and open surgery groups. Duration of hospital stay was calculated from the time of operation to the time of discharge. The total costs for each patient included the sum of: the average hospitalization costs per day; the average operating room costs; and material and medications costs. Chi-square test or Fisher’s exact test and student or Mann-Whitney U tests were used for comparison, as appropriate. Results: During the study period, 95 patients were included; among them, 53 patients underwent laparoscopic surgery and 42 laparotomy. There were no statistical differences between the two groups concerning age, gender distribution, American society of anesthesiologists (ASA) classification, and number of acute cholecystitis. Rate of conversion to open surgery was 5.6% (3 patients). Patients in the laparoscopic group had shorter hospital stay (2.9 vs. 4.7 days, P = 0.0001), lower rates of infectious complications (3.7% vs. 16.6%, P = 0.04), and lower costs (169 vs. 231.62 US dollars, P = 0.0001). Conclusions: The results of the present study showed that, in a rural hospital setting in a developing country, laparoscopic cholecystectomy for symptomatic cholelithiasis was associated with shorter hospital stay, less infectious morbidity rates, and reduced costs, compared to open surgery. Thus, laparoscopic cholecystectomy should be advised as a routine technique for management of cholelithiasis in rural areas of developing countries.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115523395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Surgical Complications in Morbid Obese Patients, The Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy)","authors":"A. Pazouki, S. Mokhber, S. Riazi, P. Alibeigi, M. Abdolhosseini, F. Jesmi","doi":"10.17795/MINSURGERY-19040","DOIUrl":"https://doi.org/10.17795/MINSURGERY-19040","url":null,"abstract":"Background: In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985). Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery. Objectives: This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up. Materials and Methods: Participants were selected regarding the U.S. National Institute of Health (NIH) guidelines, which indicates BMI > 40 kg/m 2 alone, or BMI > 35 kg/m 2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%). The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year. Results: Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001), while no significant difference was found in which the parameters between two studied procedures were in this regard. Conclusions: To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123517709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Management of a Cholecystocutaneous Fistula: A Case Report","authors":"A. Almotlaq","doi":"10.17795/MINSURGERY-32036","DOIUrl":"https://doi.org/10.17795/MINSURGERY-32036","url":null,"abstract":"Introduction: A cholecystocutaneous fistula an abnormal epithelial tract that allows communication between the gallbladder and the skin, manifests as a rare complication of gall stones.The treatment of choice is definitive surgical excision of both the gallbladder and the tract, usually by an open operation. However, a laparoscopic approach is another option, especially if the patient is elderly and has other co morbidities. We report a case of a laparoscopically managed cholecystocutaneous fistula. Case Presentation: A 55-year-old male with comorbidities presented with a discharging sinus at the right upper quadrant area after an abdominal wall abscess drainage. A Computerized tomography scan showed a biliary fistula. Laparoscopic cholecystectomy was carried out successfully. Conclusions: Laparoscopic cholecystectomy is a safe and feasible technique to manage cholecystocutaneous fistulas.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128508349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass Surgical Treatment of Obesity and Type-2 Diabetes: Now is the Right Time","authors":"M. Gagner","doi":"10.17795/MINSURGERY-32633","DOIUrl":"https://doi.org/10.17795/MINSURGERY-32633","url":null,"abstract":"Copyright © 2015, Minimally Invasive Surgery Research Center and Mediterranean & Middle Eastern Endoscopic Surgery Association. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. I recently wrote a provocative commentary (1) following the article written by Anita Courcoulas on in JAMA surgery (2). After the Second World War, with the raise of tobacco usage, high alcohol concentrations intake, urban pollution, high fat diets and sedentary lifestyle, coronary atherosclerotic disease became one of the most important public enemy. The response came in 1950, at McGill University in Montreal, where Vineberg and Buller were the first to implant an internal mammary artery into the myocardium to treat cardiac ischemia and angina (3). Indeed, coronary disease peaked in the sixties and seventies, and saphenous vein graft coronary bypasses popularized by the Argentinian Rene Favaloro, while he worked at the Cleveland Clinic, increased exponentially (4). Mass surgical treatment took its course, with cardiac surgical institutes growing like mushrooms everywhere in the world. Hospitals were built solely on this pathology, with cardiologists, coronarographers, perfusionnists and dedicated cardiac surgeons doing more than half a million procedures a year in USA, and an estimated > 1 million per year worldwide (4). That volume has recently gone down by almost half these numbers, from interventional cardiology, but mostly from a decrease in tobacco and alcohol usage, a better lesser fat diet, statins and increased regular exercises (in lesser local atmospheric pollution). Is it possible that in order to target obesity and type2 diabetes, we have to go the same path? That is, mass surgical treatment, is again ahead of lifestyle changes and medical treatment. We should be building obesity/ diabetes institutes, entire hospitals with multidisciplinary teams, complete with internists, endocrinologists, bariatric and metabolic surgeons, psychologists and nutritionists, as well as public health stakeholders. We could operate millions of affected patients in the World and really have an impact on those 2 chronic diseases, as there is an estimate of 350 million affected (5). We should be operating fast enough, so that the new pool of patients would not overlap on the ones we are treating annually. Already, with the rapid rise of sleeve gastrectomy, the number one choice in USA, 200,000 patients are operated annually, and perhaps a projected < 500000 operations per year in the globe for 2015. That is not enough; we should be doing 10 times these numbers, at the very least. Even at 5 million patients per year, it would take us 70 years to operate everybody. But that is a reasonable goal in the short-term. It would take a p","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129675886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Zinc Deficiency in Iranian Morbid Obese Patients Undergoing Bariatric Surgery","authors":"G. M. Farsani, Fateme Zabetian Targhi, M. Pishgahroudsari, Somayeh Mokhber, A. Pazouki","doi":"10.17795/MINSURGERY-33347","DOIUrl":"https://doi.org/10.17795/MINSURGERY-33347","url":null,"abstract":"Background: Bariatric surgery’s efficacy in morbid obesity therapy has been proven; but post-operational zinc deficiency is a problematic issue as its essential role in post-operational recovery of patients. Objectives: The aim of this study is to evaluate the rate of zinc deficiency in Iranian morbidly obese candidates for bariatric surgery. Patients and Methods: We assessed zinc status in 996 morbidly obese subjects (BMI > 40 kg/m 2 or BMI > 35 kg/m 2 with any comorbidities) (841 females, 155 males) who were candidate for bariatric surgery. Comorbidities related to obesity including dyslipidemia, abnormal fasting glucose, hypertension and type-2 diabetes (T2D) were evaluated. Also we checked albumin and SGPT as markers of liver function. Data analyzed by SPSS. Results: Zinc deficiency was found in 13.6% of patients. Zinc levels had an inverse and significant association with age (P Value = 0.016). Although greater levels of circulating zinc were observed in patients with higher BMI, there were no significant correlation between zinc deficiency and adiposity. Dyslipidemia was found to be the most prevalent comorbidity in this population. Conclusions: These results show a high prevalence of zinc deficiency in morbidly obese subjects. Thus, we suggest the evaluation of the zinc status in patients undergoing bariatric surgery and treatment of zinc deficiency before doing the surgery.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132963253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DATABASES AND REGISTRIES IN MEDICINE","authors":"J. Melissas","doi":"10.17795/MINSURGERY-31759","DOIUrl":"https://doi.org/10.17795/MINSURGERY-31759","url":null,"abstract":"","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115392211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CLINICAL PREDICTIVE FACTORS FOR DIAGNOSIS OF ENDOMETRIOSIS IN IRANIAN INFERTILE POPULATION","authors":"S. Chaichian, Abolfazl Mehdizadehkashi, Z. Najmi, Alireza Mobasseri, A. Jahanloo, Behnaz Mohabbatian, M. Marashi, M. Pishgahroudsari","doi":"10.17795/MINSURGERY-24236","DOIUrl":"https://doi.org/10.17795/MINSURGERY-24236","url":null,"abstract":"Background: Endometriosis changes the management of infertile women. Objectives: Our aim was to evaluate some of the clinical predictive factors among an Iranian infertile population. Patients and Methods: Infertile women, scheduled for diagnostic laparoscopy, were recruited into the study and their information including age, weight, height, educational level, marriage and breast-feeding duration, history of fertility, menstrual characteristics, dysmenorrhea, and dyspareunia were collected. Clinical characteristics were then compared with laparoscopic results. Results: Of 441 infertile women, 82 (18.6%) had endometriosis. No statistically significant difference was identified in the participants’ age, educational level, duration of breast-feeding, duration of infertility, and menstrual flow. On the contrary, women with endometriosis had longer duration of marriage (OR = 1.03, P = 0.002), older age at first pregnancy (OR = 1.21, P < 0.05), lower BMI (OR = 0.9, P = 0.001), shorter interval of menses (OR = 0.98, P < 0.05), and history of irregular menstrual cycles (OR = 0.54, P < 0.05), compared to those without endometriosis. The risk of the endometriosis also decreased significantly with increased numbers of previous pregnancies. The OR for endometriosis in the presence of dysmenorrhea and dyspareunia were 1.80 (1.02 - 3.04) and 1.82 (1.01 - 3.29), respectively. Conclusions: Lower BMI, longer duration of marriage, shorter menstrual cycles, dyspareunia, and dysmenorrhea are predictive factors for diagnosis of endometriosis in infertile population. These clinical factors should be considered prior to diagnostic laparoscopy for infertility.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132943371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Colorectal Resection in Patients With Previous Abdominal and Colonic Surgery","authors":"N. Siddiqi, Q. Zaman, K. Patel, M. Odermatt, J. Khan, A. Parvaiz","doi":"10.17795/MINSURGERY-31968","DOIUrl":"https://doi.org/10.17795/MINSURGERY-31968","url":null,"abstract":"Background: Previous abdominal surgery and its related adhesions are usually a relative contraindication for laparoscopic surgery or reason for conversion. Objectives: This study aim to identify patients with previous abdominal surgery and compare the clinical outcomes in patients with and without previous abdominal surgery. Patients and Methods: Data was collected prospectively from September 2006 to Dec 2010 of all laparoscopic colorectal resections done for both benign and malignant diseases. Results: Out of 718 patients 476 had no previous abdominal surgery (Group A), whilst 190 patients had previous abdominal surgery not involving colonic surgery (Group B), and 52 had previous bowel surgery (Group C). The conversion rate was 4% for all groups, the readmission rate was 11.8% for Group A, 12.6% for Group B and 9.6% for Group C, the median length of stay was 4 days for Groups A and B and 5 days for Group C. There was no statistically significant difference between groups for any of the above measures. However, there was a statistically significant difference in the length of operative time between groups. Patients in Group A and Group B requiring a median of 180 minutes, whilst Group C required a median of 210 minutes of operative time. (P = 0.026 and 0.002, respectively). Conclusions: Previous abdominal surgery, including previous colonic surgery, confers no added risk of conversion to an open operation, morbidity or mortality for patients undergoing laparoscopic colorectal surgery. The operative time however is longer (30 minutes) for patients with previous colonic surgery.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121741407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Mesh Repair of Giant Morgagni-Larrey Hernia With Three Ports: A Case Report","authors":"Y. Ekici, G. Moray","doi":"10.17795/MINSURGERY-30212","DOIUrl":"https://doi.org/10.17795/MINSURGERY-30212","url":null,"abstract":"Introduction: A bilateral anterior parasternal hernia is commonly called a Morgagni-Larrey hernia. Morgagni hernias are rare in adults, accounting for 3% of all treated diaphragmatic hernias. This article reports a giant bilateral Morgagni-Larrey hernia, repaired with a laparoscopic reduced-port technique. Case Presentation: An 83-year-old female was admitted to the general surgery outpatient clinic with gastrointestinal, respiratory symptoms, and retrosternal pain. A computed tomography (CT) scan showed a 12-cm retrosternal hernia defect on the right and a 3-cm defect on the left of the diaphragm The stomach and colon were herniated from the right defect and the omentum was herniated from the left defect to the thorax. The hernia contents were pushed back to the abdomen and the defects were repaired with single sutures through a three-port laparoscopic procedure. A composite mesh material was placed and fixed with pro-tack (Covidien). The patient was discharged on the fourth postoperative day without any complaints. Conclusions: Transabdominal laparoscopic Morgagni-Larrey hernia repairs with reduced number of ports are safe and feasible.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116403587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Cholecystectomy: A Retrospective Four-Year Study","authors":"M. R. Mashhadi, A. Abdollahi, A. Tavassoli, M. Forghani, H. Shabahang, E. Keykhosravi, Azadeh Jabbari Nooghabi, R. Rezaei","doi":"10.17795/MINSURGERY-25253","DOIUrl":"https://doi.org/10.17795/MINSURGERY-25253","url":null,"abstract":"Background: Today, laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystectomy, which is mainly due to improved results of laparoscopic surgery compared to the open surgery, and its cosmetic benefits. Objectives: The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in our institution. Patients and Methods: This is a retrospective study. Medical records of patients who underwent laparoscopic cholecystectomy from 2004 to 2008 were reviewed. The results and complications of surgery were collected using a checklist. Results: Participants included 500 patients with mean age of 47 ± 11 years. Three hundred ninety-one (78.2%) were female and 109 (21.8%) were male. Four hundred (80.0%) of patients had symptomatic cholelithiasis. The mean operating time was 70 ± 8 minutes. The most common intra-operative complication was bradycardia during gas insufflation into the abdominal cavity. In 430 (86.0%) of patients length of hospital stay was less than two days. Six patients (1.2%) were complicated by hernia at incision site, 18 (3.6%) by bile leakage, and 15 (3.0%) required laparotomy. Surgical site bleeding and surgical site infection were observed respectively in 11 patients (2.2%) and 17 patients (3.4%). Totally, 52 patients (10.4%) had surgically-induced complications, two (0.4%) of whom died. Conclusions: Laparoscopic cholecystectomy as the method of choice in treatment of gallbladder stone is associated with high success rate. This approach is increasingly being performed because of the decrease in patients' hospital stay, morbidity, and rapid return to normal life.","PeriodicalId":158928,"journal":{"name":"Journal of Minimally Invasive Surgical Sciences","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126986683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}