Intra-abdominal Trocar-Free Vacuum Liver Retractor for Upper-Gastrointestinal Surgery

Background. In laparoscopic upper-gastrointestinal (GI) surgery, an adequate retraction of the liver is crucial. Especially in single-port surgery and obese patients, problems may occur during liver retraction. The current study seeks to evaluate the efficacy and safety of the LiVac trocar-free liver retractor in laparoscopic upper-GI surgery. Methods. The present study is a nonrandomized dual-center clinical series describing our preliminary results using the LiVac system for liver retraction. The primary end points of the present study included the effectiveness and safety of the LiVac device as well as complications and documentation of problems with the device during surgery. Results. The device was used in 11 patients for simple and complex laparoscopic procedures. The mean age of the study population was 59.6 years (SD = 20.6; range = 30-84). There were 6 female and 5 male patients with a mean body mass index (BMI) of 31.9 kg/m2 (SD = 8.1; range = 26.0-45.3). The efficacy of the device was excellent in all cases, reducing the number of trocars needed. There were no device-related complications. Conclusion. The LiVac liver retractor is easy to use and provides a good exposure of the operative field in upper-GI laparoscopic surgery, even in obese patients with a high BMI.

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Upper gastrointestinal surgery

Oxford Assess and Progress: Clinical Surgery ◽

10.1093/oso/9780199696420.003.0015 ◽

2014 ◽

Author(s):

James Wood

Keyword(s):

Gastrointestinal Surgery ◽

Clinical Findings ◽

Junior Doctors ◽

Ulcer Disease ◽

Upper Gi ◽

Life Threatening ◽

The Impact ◽

Upper Gi Malignancy ◽

Symptoms And Signs ◽

Upper Gastrointestinal

Diseases of the upper gastrointestinal tract (GI) have changed a great deal both in their aetiology and presentations as well as their management in the last three decades. Modern students and junior doctors need to understand the range of upper GI conditions which now present, especially the increasing issues of upper GI malignancy and the impact of morbid obesity on medical and surgical practice. Old text books full of operations for benign peptic ulcer disease have been replaced with texts on the constantly advancing treatment of oesophagogastric cancer and operations for obesity management. Symptoms and signs in upper GI disease are often subtle and non-specific so a sound knowledge of clinical findings and the choices for appropriate investigations are extremely important and are covered in this chapter. Lastly, some of the most urgent and life-threatening surgical emergencies can occur due to upper GI disease and the management of these conditions is a vital area of knowledge for all junior doctors.

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Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery

Nutrients ◽

10.3390/nu13082655 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2655

Author(s):

Maria Wobith ◽

Arved Weimann

Keyword(s):

Enteral Nutrition ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gastrointestinal Surgery ◽

Nutritional Therapy ◽

Oral Feeding ◽

Calorie Intake ◽

Obese Patients ◽

Oral Nutritional Supplements ◽

Upper Gastrointestinal

Nowadays, patients undergoing gastrointestinal surgery are following perioperative treatment in enhanced recovery after surgery (ERAS) protocols. Although oral feeding is supposed not to be stopped perioperatively with respect to ERAS, malnourished patients and inadequate calorie intake are common. Malnutrition, even in overweight or obese patients, is often underestimated. Patients at metabolic risk have to be identified early to confirm the indication for nutritional therapy. The monitoring of nutritional status postoperatively has to be considered in the hospital and after discharge, especially after surgery in the upper gastrointestinal tract, as normal oral food intake is decreased for several months. The article gives an overview of the current concepts of perioperative enteral nutrition in patients undergoing gastrointestinal surgery.

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CHRONIC LIVER DISEASE (CLD);

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.03.2136 ◽

2012 ◽

Vol 19 (03) ◽

pp. 351-355

Author(s):

SHAHZAD ALAM KHAN ◽

TARIQ MUHAMMAD KHAN TAREEN ◽

IJAZ-UL- HAQUE TASEER ◽

SOHAIL Safdar

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Upper Gastrointestinal Bleeding ◽

Case Series ◽

Personal Data ◽

Chronic Liver ◽

Upper Gi ◽

Male Patients ◽

Gi Bleed ◽

Upper Gastrointestinal

Objective: To determine the frequency of chronic liver disease in patients presenting with upper gastrointestinal bleeding(UGIB) at Nishtar Hospital, Multan. Study Design: Descriptive case series. Duration of study: Six months from August 2009 to January 2010.Setting: Department of Internal Medicine, Nishtar Hospital Multan. Methodology: A total of 88 patients with upper GI bleed were registered.Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GIEndoscopy was done to find out the source of bleeding. For identification of each patient, personal data was collected. All the data collectedwere entered and analyzed using SPSS-10. Results: Mean age was 41.64±13.56 years with 49 (55.70%) male patients and 39 (44.30%)female patients. Majority of the patients 38(43.18%) were between 36-50 years of age. In our series frequency of chronic liver disease was56.82%. Conclusions: Chronic liver disease is the most common cause of upper GI bleeding in our setting.

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Novel Trocar-Free Elastic Liver Retractor in Bariatric Surgery Patients: Comparison of a Standard Laparoscopic Retraction With the First Series Using the LiVac Sling System

Surgical Innovation ◽

10.1177/1553350619894415 ◽

2020 ◽

Vol 27 (2) ◽

pp. 187-192

Author(s):

Claudia Bures ◽

Philippa Seika ◽

Rossano Alvim Keppler Fiorelli ◽

Dino Kröll ◽

Ricardo Zorron

Keyword(s):

Bariatric Surgery ◽

Adverse Events ◽

Demographic Data ◽

Gastrointestinal Surgery ◽

Skin Incision ◽

Study Data ◽

Liver Retraction ◽

Liver Injuries ◽

Liver Retractor ◽

Surgical Field

During upper gastrointestinal surgery, retraction of the liver plays an essential role in the visualization and creation of an optimal surgical field. Liver retraction may be problematic, particularly in obese patients. The use of conventional liver retractors requires additional skin incision and has the potential to cause pain as well as liver injuries. The present study is the first to evaluate the performance and safety of the LiVac Sling (Livac Pty Ltd, Melbourne, Australia) trocar-free retractor system in bariatric surgery patients. In this retrospective study, data from laparoscopic primary or revisional bariatric surgeries that were performed with the LiVac Sling system and a standard retractor between May 2017 and December 2017 were collected. Demographic data, body mass index, type of surgery, number and indication of LiVac Sling system used, surgery time, and complications were analyzed. In total, 51 procedures were included. Twenty Sling devices have been used in 17 patients (13 female; 75%). The distribution of baseline characteristics was similar between the standard retractor group and LiVac Sling retractor group. In the LiVac Sling group, the number of trocars used was significantly reduced over the study period. Within 30 days postoperatively, no complications could be identified, and no device-related adverse events were reported. In this bariatric population, the use of the LiVac Sling for liver retraction was safe. No device-related adverse events were registered, and compared with standard retraction, the number of trocars used could be reduced by one.

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Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽

10.1055/a-1375-8151 ◽

2021 ◽

Author(s):

Carlo Jung ◽

Rachel Hallit ◽

Annegret Müller-Dornieden ◽

Melanie Calmels ◽

Diane Goere ◽

...

Keyword(s):

Negative Pressure ◽

Treatment Duration ◽

Treatment Success ◽

Univariate Analysis ◽

Gastrointestinal Surgery ◽

Vacuum Therapy ◽

Internal Drainage ◽

Upper Gi ◽

Endoscopic Internal Drainage ◽

Endoscopic Vacuum Therapy

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

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Otological manifestation of temporomandibular joint disorder in Ekiti, a sub-Saharan African country

Journal of International Medical Research ◽

10.1177/0300060521996517 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052199651

Author(s):

Waheed Atilade Adegbiji ◽

Gabriel Toye Olajide ◽

Anthony Tosin Agbesanwa ◽

Omotola Oluwaseyi Banjo

Keyword(s):

Temporomandibular Joint ◽

Clinical Features ◽

Temporomandibular Joint Disorder ◽

Prehospital Treatment ◽

Muscle Disorders ◽

Joint Disorder ◽

Study Population ◽

Male Patients ◽

Sub Saharan ◽

Nose And Throat

Objective To determine the prevalence, sociodemographic features, and clinical presentation of temporomandibular joint disorder in otorhinolaryngological practice. Methods This prospective hospital-based study involved patients diagnosed with temporomandibular joint disorder in our institution’s ear, nose, and throat department. Data for this study were obtained from the patients using pretested interviewer-assisted questionnaires. Results The prevalence of temporomandibular joint disorder in this study was 1.3%. The study population included 17 (26.2%) male patients with a male:female ratio of 1.0:2.8. Joint disorder accounted for 75.4% of all disorders, while both mastication muscle and joint disorder accounted for 21.5%. A majority of the patients (47.7%) presented between weeks 1 and 13 of the illness. Unilateral temporomandibular joint disorder accounted for 98.5% of all disorders. The main otologic clinical features were earache and a dull tympanic membrane in 100% and 35.4% of patients, respectively. Middle ear assessment revealed type A in 73.8% of patients and type B in 20.0% according to Jerger’s classification system of tympanometry. Most patients (81.5%) were referred by their family physician. All patients had undergone prehospital treatment prior to presentation. Conclusion Temporomandibular joint disorder is a common presentation in medical practice. Common clinical features include ear, joint, and mastication muscle disorders.

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A colour atlas of upper gastrointestinal surgery

Gut ◽

10.1136/gut.24.10.965-b ◽

1983 ◽

Vol 24 (10) ◽

pp. 965-965

Author(s):

A G Johnson

Keyword(s):

Gastrointestinal Surgery ◽

Upper Gastrointestinal

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A Comparative study between Dexmedetomidine versus Propofol for sedation in upper GI endoscopy procedure considering effect on intraoperative vital data, patient amnesia and onset of recovery after the procedure

QJM ◽

10.1093/qjmed/hcab086.025 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eslam Ahmed Mohamed Elsamahi ◽

Bassem P Ghobrail ◽

Ghada Mohamed Samir ◽

Hany Victor Zaki

Keyword(s):

Heart Rate ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Day Case ◽

Upper Gi ◽

Significant Difference ◽

Upper Gi Endoscopy ◽

Upper Gastrointestinal

Abstract Background In the modern medicine, upper gastrointestinal endoscopy has become a definitive tool for diagnosis and management of many diseases. It is usually preformed in separate unit as day-case procedure and for outpatient clinic. The search of a safe and effective sedation for these patients is still an open topic. Objective The aim of the study is to compare the use of propofol and dexmedetomedine in upper GI endoscopy regarding the hemodynamics, sedative effect and the patient satisfaction. Methods Double – blinded, randomized controlled trial with allocation ratio 1:1 arranged in two parallel groups. This study was conducted in the endoscopy unit of Ainshams University Hospital, Cairo, Egypt within a period of 6 months started from April 2019. All recruited patients were adults undergoing upper gastrointestinal endoscopy. They were included in the study according to the following criteria: Age 21-60 years; elective procedures under general anesthesia with patients who completed eight hours of fasting; and physical Status: ASA I and II Patients after taking written and informed consent. Results Concerning the results of the study, there was no statistically significant difference considering the heart rate in relation to base line readings. The changes of heart rate between the two groups were significantly different with dexmedetomidine associated with lower readings. Respiratory rate and oxygen saturation were insignificantly different in both groups. Time of induction was significantly shorter in propofol than dexmedetomidine (P < 0.001) and time to reach full recovery identified by modified Alderete’s score 10/10 was significantly shorter in dexmedetomidine than propofol (P < 0.014). There was a significant difference between the two dugs concerning the patients and endoscopists satisfaction. The patients were more satisfied with propofol (P 0.047), while the endoscopists were more satisfied with dexmedetomidine (P 0.034). Conclusion Dexmedetomidine and propofol are equally effective and safe to provide enough sedation for upper gastrointestinal endoscopy in a day-case manner. Advantages of dexmedetomidine were providing analgesic effect, rapid recovery from sedation and stability of respiratory rate and oxygen saturation. However, there were some disadvantages such as the bradycardia and patient dissatisfaction although the bradycardia can be utilized in cardiac patients as a safety factor against myocardial ischemia. Other point noticed that using dexmedetomidine for sedation was more costly than propofol and requires the usage of a syringe pump for accurate dosing. On the contrary, propofol is cheap and available in all centers with rabid onset of induction but it causes hypotension and respiratory depression which might be risky in cardiac patients.

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EP.WE.1048Weight Regain After Sleeve Gastrectomy More Common in Male and Less Common in Super-Obese Patients - Results of an 18-Month Follow-up Study

British Journal of Surgery ◽

10.1093/bjs/znab308.111 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ahmed Salman Bodla ◽

Jenny Abraham ◽

Neha Shah ◽

Vinod Menon

Keyword(s):

Sleeve Gastrectomy ◽

Revisional Surgery ◽

Patient Specific ◽

Obese Patients ◽

Inclusion Criteria ◽

Super Obese ◽

Burn Out ◽

Single Centre Study ◽

Male Patients

Abstract Aims Long-term success of Sleeve Gastrectomy (SG) is undermined by weight regain (WR). Several procedure- and patient-specific factors have been proposed in previous studies. Here we look at 18-month follow-up post-SG to investigate WR and patient-specific variables influencing this. Methods A single-centre study involving retrospective analysis of a prospectively-maintained database. Inclusion criteria: Primary non-revisional SG patients with adequate follow-up data to assess WL/WR trends. Patients were divided into two subgroups based on their %EWL between 6-to-12 and 12-to-18 months: weight regainers (WR) and weight losers/maintainers (WL/M). Results Out of 338 SG cases between 2012-2017, 180 met inclusion criteria of which 18.3% were men and 45% were super-obese. All patients lost weight during first 6 months (mean %EWL 52.3%, P < 0.0001). Between 6-to-12 months, 87.6% patients continued WL with a further mean %EWL of 10.35% (P < 0.0001). Between 12-to-18 months, a drastic deceleration/reversal of WL progress was observed with an average of only 0.76% EWL (P = 0.84), with 42% of patients regaining weight in this period (mean EWG 6.8%). Male patients encountered significantly higher WR rate (OR 3.27, P = 0.003), whereas it was much less frequent in pre-operatively super-obese patients (OR 0.48, P = 0.036). Moreover, there was no difference in the 6-month %EWL between WR and WL/M subgroups (P = 0.62), thus negating the possibility of WL burn-out phenomenon. Conclusions Different rates of WR in men and super-obese patients may indicate underlying behavioural and biological differences. More research is needed to investigate them in detail, having implications for revisional surgery and follow-up support.

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