scholarly journals The laparoscopic approach for epiphrenic diverticula with achalasia

2019 ◽  
Vol 101 (4) ◽  
pp. 256-260 ◽  
Author(s):  
P Mandovra ◽  
V Kalikar ◽  
A Patel ◽  
RV Patankar
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Approach ◽  
Motility Disorder ◽  
Partial Fundoplication ◽  
Epiphrenic Diverticulum ◽  
Distal Oesophagus ◽  
Excellent Outcome ◽  
Eckardt Score ◽  
Duration Of Surgery ◽  
The Mean

IntroductionEpiphrenic diverticulum (ED) is an uncommon disease that is invariably associated with an underlying oesophageal motility disorder such as achalasia. Management of ED should always be accompanied by treatment of the underlying motility disorder to prevent recurrence of symptoms. Traditionally, ED were approached via a left thoracotomy but as laparoscopy offers better access to the distal oesophagus, its use is becoming more widespread.MethodsA total of 72 patients with oesophageal achalasia underwent laparoscopic surgery at our centre over a period of 7 years. Five (6.9%) of these had associated symptomatic ED. These patients were treated with a laparoscopic transhiatal epiphrenic diverticulectomy using intraoperative oesophagoscopy guidance, combined with a Heller myotomy and Dor fundoplication. Patients were followed up regularly and symptoms were assessed at 12 months.ResultsThe median age of the five patients with associated symptomatic ED was 56 years (range: 38–69 years). Three were male. The mean duration of surgery was 150 minutes (range: 120–180 minutes). One patient (20%) developed a postoperative oesophageal leak. The mean follow-up duration was 25 months (range: 12–36 months). At 12 months, the mean Eckardt score reduced from 6.8 to 1.6. Three patients (60%) reported an excellent outcome, one (20%) reported a good outcome and one (20%) reported a fair outcome.ConclusionsAlong with diverticulectomy, treating the underlying motility disorder with an adequate Heller myotomy and partial fundoplication is of prime importance for a good surgical outcome without symptom recurrence. Laparoscopy offers better access to the distal oesophagus than the conventional thoracic approach for ED.

scholarly journals Laparoscopic Urological Surgery: Our Initial Experiences

2020 ◽  
Vol 23 (1) ◽  
pp. 17-23
Author(s):  
Shiba Prasad Nandy ◽  
AKM Akramul Bari ◽  
Anirban Ghose ◽  
Hasmot Ali Mia ◽  
Md Alamgir ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Radical Nephrectomy ◽  
Open Surgery ◽  
Renal Cyst ◽  
Conversion To Open Surgery ◽  
Cyst Excision ◽  
Excellent Outcome ◽  
Duration Of Surgery ◽  
The Mean

Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

scholarly journals Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center

2019 ◽  
Vol 11 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Alireza Mirsharifi ◽  
Ali Ghorbani Abdehgah ◽  
Rasoul Mirsharifi ◽  
Mehdi Jafari ◽  
Noor Fattah ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Cross Sectional Study ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder ◽  
Cross Sectional ◽  
Retrosternal Pain ◽  
Tertiary Center ◽  
The Mean

BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

scholarly journals Laparoscopic Revisional Surgery After Failed Heller Myotomy for Esophageal Achalasia: Long-Term Outcome at a Single Tertiary Center

2021 ◽  
Author(s):  
Giovanni Capovilla ◽  
Renato Salvador ◽  
Luca Provenzano ◽  
Michele Valmasoni ◽  
Lucia Moletta ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Revisional Surgery ◽  
Stage Iv ◽  
Postoperative Outcomes ◽  
Control Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Eckardt Score ◽  
Stage Iv Disease

Abstract Background Laparoscopic Heller myotomy (HM) has gained acceptance as the gold standard of treatment for achalasia. However, 10–20% of the patients will experience symptom recurrence, thus requiring further treatment including pneumodilations (PD) or revisional surgery. The aim of our study was to assess the long-term outcome of laparoscopic redo HM. Methods Patients who underwent redo HM at our center between 2000 and 2019 were enrolled. Postoperative outcomes of redo HM patients (redo group) were compared with that of patients who underwent primary laparoscopic HM in the same time span (control group). For the control group, we randomly selected patients matched for age, sex, FU time, Eckardt score (ES), previous PD, and radiological stage. Failure was defined as an Eckardt score > 3 or the need for re-treatment. Results Forty-nine patients underwent laparoscopic redo HM after failed primary HM. A new myotomy on the right lateral wall of the EGJ was the procedure of choice in the majority of patients (83.7%). In 36 patients (73.5%) an anti-reflux procedure was deemed necessary. Postoperative outcomes were somewhat less satisfactory, albeit comparable to the control group; the incidence of postoperative GERD was higher in the redo group (p < 0.01). At a median 5-year FU time, a good outcome was obtained in 71.4% of patients in the redo group; further 5 patients (10.2%) obtained a long-term symptom control after complementary PD, thus bringing the overall success rate to 81.6%. Stage IV disease at presentation was independently associated with a poor outcome of revisional LHD (p = 0.003). Conclusions This study reports the largest case series of laparoscopic redo HM to date. The procedure, albeit difficult, is safe and effective in relieving symptoms in this group of patients with a highly refractory disease. The failure rate, albeit not significantly, and the post-operative reflux are higher than after primary HM. Patients with stage IV disease are at high risk of esophagectomy.

scholarly journals Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

2016 ◽  
Vol 18 (3) ◽  
pp. 281-286 ◽  
Author(s):  
S. Alex Rottgers ◽  
Subash Lohani ◽  
Mark R. Proctor
Keyword(s):  
Hospital Stay ◽  
Head Circumference ◽  
Major Complication ◽  
Csf Leak ◽  
Perioperative Morbidity ◽  
Syndromic Craniosynostosis ◽  
Duration Of Surgery ◽  
Coronal Synostosis ◽  
The Mean

OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

scholarly journals Posterior Transpedicular Dynamic Stabilization versus Total Disc Replacement in the Treatment of Lumbar Painful Degenerative Disc Disease: A Comparison of Clinical Results

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Tunc Oktenoglu ◽  
Ali Fahir Ozer ◽  
Mehdi Sasani ◽  
Yaprak Ataker ◽  
Cengiz Gomleksiz ◽  
...  
Keyword(s):  
Degenerative Disc Disease ◽  
Total Disc Replacement ◽  
Clinical Results ◽  
Dynamic Stabilization ◽  
Disc Replacement ◽  
Disc Prosthesis ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Duration Of Surgery ◽  
The Mean

Study Design. Prospective clinical study.Objective. This study compares the clinical results of anterior lumbar total disc replacement and posterior transpedicular dynamic stabilization in the treatment of degenerative disc disease.Summary and Background Data. Over the last two decades, both techniques have emerged as alternative treatment options to fusion surgery.Methods. This study was conducted between 2004 and 2010 with a total of 50 patients (25 in each group). The mean age of the patients in total disc prosthesis group was 37,32 years. The mean age of the patients in posterior dynamic transpedicular stabilization was 43,08. Clinical (VAS and Oswestry) and radiological evaluations (lumbar lordosis and segmental lordosis angles) of the patients were carried out prior to the operation and 3, 12, and 24 months after the operation. We compared the average duration of surgery, blood loss during the surgery and the length of hospital stay of both groups.Results. Both techniques offered significant improvements in clinical parameters. There was no significant change in radiologic evaluations after the surgery for both techniques.Conclusion. Both dynamic systems provided spine stability. However, the posterior dynamic system had a slight advantage over anterior disc prosthesis because of its convenient application and fewer possible complications.

scholarly journals A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

2021 ◽  
Vol 105 (1-3) ◽  
pp. 585-590
Author(s):  
Junpei Takashima ◽  
Keizo Taniguchi ◽  
Toshiaki Yasui ◽  
Masahiro Yamane ◽  
Yutaka Hattori ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Mesh Repair ◽  
Pain Scale ◽  
Barbed Suture ◽  
Intraperitoneal Onlay Mesh ◽  
Barbed Sutures ◽  
Duration Of Surgery ◽  
Onlay Mesh ◽  
The Mean ◽  
Hernial Orifice

Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum &lt;2 cm or ≥10 cm, age &lt; 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.

scholarly journals Laparoscopic myotomy in achalasia cardia treatment: Experience after 36 operations

2013 ◽  
Vol 141 (7-8) ◽  
pp. 475-481
Author(s):  
Milos Bjelovic ◽  
Bratislav Spica ◽  
Dragan Gunjic ◽  
Danko Grujic ◽  
Ognjan Skrobic ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Time Interval ◽  
Partial Fundoplication ◽  
Laparoscopic Myotomy ◽  
Posterior Aspect ◽  
First Choice ◽  
Duration Of Surgery ◽  
Dor Operation

Introduction. Laparoscopic Heller?Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006. Objective. The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller?Dor operations. Methods. This partly retrospective, partly prospective study presented our results after laparoscopic Heller?Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra? and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms. Results. Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation. Conclusion. Laparoscopic Heller?Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.

scholarly journals Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures

2020 ◽  
Vol 14 (4) ◽  
pp. 466-474
Author(s):  
Shanmuganathan Rajasekaran ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty ◽  
Rishi Mugesh Kanna
Keyword(s):  
Neck Disability Index ◽  
Optimal Placement ◽  
Range Of Movement ◽  
Ct Guided ◽  
Duration Of Surgery ◽  
The Mean ◽  
The Right ◽  
Neck Disability ◽  
Displaced Fracture

Study Design: Prospective observational study.Purpose: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation.Overview of Literature: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes.Methods: The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0–C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years.Results: A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (<i>p</i> <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months.Conclusions: Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.

scholarly journals Application of platysma muscle suture after thyroidectomy

2020 ◽  
pp. 147-150
Keyword(s):  
Postoperative Pain ◽  
Wound Infection ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Platysma Muscle ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean ◽  
Length Of Hospitalization

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

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