Emmanouil Leandros

Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%.

BackgroundThe aim of this study was to test the use of preincisional and intraperitoneal levobupivacaine (L-B) 0.25% in laparoscopic cholecystectomies for postoperative analgesia.MethodsA total of 108 patients under general anesthesia were randomly assigned to receive preincisional local infiltration of 20 ml solution and intraperitoneal instillation of another 20 ml solution. Group A received for local infiltration and intraperitoneal instillation normal saline (NS). Group B received for local infiltration L-B 0.25% and for intraperitoneal instillation NS. Group C received for local infiltration NS and for intraperitoneal instillation L-B 0.25%. Group D received both for local infiltration and intraperitoneal instillation L-B 0.25%. Abdominal and right shoulder pain were recorded for 24 h postoperatively.ResultsThe pain scores were lower in group D than in the other groups during rest, cough, and movement (p < 0.05). Rescue analgesic treatment was significantly lower in patients of group D (35%) as compared with that of group A (84%) (p < 0.05). The incidence of right shoulder pain was significantly lower in groups C (22%) and D (18%) than in any of the other groups (p < 0.05).ConclusionsThe combination of preincisional local infiltration and intraperitoneal instillation of L-B 0.25% shows an advantage for postoperative analgesia after laparoscopic cholecystectomy.

Impact of Laparoscopic Sleeve Gastrectomy on Weight Loss and Associated Comorbidities in Adolescents and Young Adults.

BACKGROUND Obesity is a common disease affecting young adults and adolescents worldwide. This study aims to delineate the role of laparoscopic sleeve gastrectomy (LSG) in weight loss and associated comorbidities to adolescents and young adults. PATIENTS AND METHODS This study is a retrospective analysis of a prospective cohort of all young adults 16-22 years old who underwent LSG for morbid obesity and were followed up for 24 months. Demographic data, weight loss, and the status of several comorbidities, such as diabetes mellitus, hypertension, and dyslipidemia, were assessed at postoperative Months 1, 3, 6, 12, 18, and 24. RESULTS Overall, at baseline and after 24 months of close follow-up of 37 adolescents and young adults who had undergone LSG, the body mass index of the patients was 46.93 ± 6.07 kg/m(2) versus 26.2 ± 3.6 kg/m(2) (P < .001), and the body weight was 143 ± 29 kg versus 78 ± 15 kg (P < .001). From the first follow-up visit after operation to the last one at the 24 months, there was also a significant difference in percentage excess weight loss (22.40 ± 6.58% versus 81 ± 17%; P < .001), body mass index difference (-5.47 ± 1.69 kg/m(2) versus -18.08 ± 4.38 kg/m(2); P < .001), and percentage excess body mass index loss (26.06 ± 7.56% versus 96 ± 21%; P < .001). The percentage of the adolescents and young adults with diabetes mellitus, hypertension, and dyslipidemia were diminished gradually at 6 months postoperatively (P < .001). CONCLUSIONS LSG represents a safe and attractive treatment strategy for morbidly obese adolescents and young adults with comorbidities. In this study group excellent resolution of excess weight and comorbid conditions is achieved 2 years after LSG.

Gastrobronchial fistula as a late complication of sleeve gastrectomy

Sleeve gastrectomy is currently one of the most popular operations for morbid obesity. However, staple line leaks occur in up to 4.3% of cases, depending on the experience of the center, and can lead to major morbidity [1,2]. Abdominal sepsis, abscesses, fistulas, and respiratory failure are some of the most common complications of a leak. Most of these complications occur soon after the appearance of a leak. However, a gastrobronchial fistula usually occurs late after the procedure. We report 2 cases in which gastrobronchial fistulas developed several months after sleeve gastrectomy.

Gastritis might be considered as a technical factor affecting laparoscopic sleeve gastrectomy

Abstract There is a paucity of data regarding gastritis as a technical factor affecting the surgical technique. Antritis and gastritis usually cause stomach wall thickness which can interrupt stapler function or even can cause serosal tear during the dissection. We report a video presentation of laparoscopic sleeve gastrectomy in a morbidly obese patient with antritis. Choosing black cartridge for patients with Helicobacter pylori gastritis might be the optimal technique for division of the antrum in laparoscopic sleeve gastrectomy. Further studies are required to clarify this parameter.

The Use of Serum Uric Acid Concentration as an Indicator of Laparoscopic Sleeve Gastrectomy Success

Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight by restricting gastric capacity and altering gut hormones levels. We designed a prospective study to investigate the correlation of serum uric acid (SUA) concentration and weight loss. SUA and body mass index (BMI) were measured preoperatively and on first postoperative month and year in patients who underwent LSG in our department of bariatric surgery. Data on 55 patients were analyzed. Preoperative SUA concentration had a significant positive correlation with percentage of total weight loss (TWL) on first postoperative month (P = 0.001) and year (P = 0.002). SUA concentration on first postoperative month had a positive correlation with percentage of TWL on first postoperative year (P = 0.004). SUA concentration could be used as a predictor of LSGs success and could help in early detection of patients with rapid loss of weight, in order to prevent complications.

Laparoscopic excision of a lymphangioma of the cystic duct

Lymphangiomas are benign tumors that originate from malformations of the lymphatic vessels. They are rarely seen in adults and are extremely rare in the cystic duct. Herein, we report the case of a 48‐year‐old woman who presented with a cystic lymphangioma that originated in the cystic duct and was excised laparoscopically. Preoperative imaging revealed the cystic and benign nature of the lesion. Laparoscopic abdominal exploration and excision of the 10‐cm cystic lymphangioma were performed. Four trocar sites were used, and the excision was achieved using clips and electrocautery. The laparoscopic excision of these benign masses is safe and efficacious in experienced hands. This procedure requires preoperative planning and must be individualized.