Grace J. Kim

Single-Incision Laparoscopic Cholecystectomy Using a Flexible Endoscope

OBJECTIVE To describe our experience with a single-incision laparoscopic cholecystectomy (SILC) performed using a flexible endoscope as the means of visualization and surgical dissection. The use of flexible endoscopy in intra-abdominal surgery has never been described. DESIGN Prospective observational case series. PATIENTS Eleven patients with symptomatic cholelithiasis were selected based on age, clinical presentation, body habitus, and history of previous abdominal surgery. Patients with acute or chronic cholecystitis were excluded. RESULTS All procedures were completed laparoscopically via the single umbilical incision without the need to convert to an open operation and without introduction of any additional laparoscopic instruments or trocars. The mean operative time was 149.5 minutes (range, 99-240 minutes). The mean length of hospital stay was 0.36 days. There were no associated intraoperative or postoperative complications. CONCLUSIONS In our experience, SILC performed with a flexible endoscope is feasible and safe. Further studies are needed to determine its advantages in reference to postoperative pain and complication rate in juxtaposition with the current standard laparoscopic cholecystectomy.

Su1572 Is Weight Loss Correlated With Race in Laparoscopic Adjustable Gastric Banding (LAGB) Patients? Yes

Introduction: Variability of percentage excess weight loss (%EWL) in LAGB patients can be influenced by many preoperative factors, such as gender, race/ethnicity, and age. We hypothesize that race/ethnicity plays an important predictor in the post-operative weight loss. Methods: A retrospective analysis of 428 patients using electronic medical record was performed to assess differential %EWL for patients across a period of three years post-band implantation, with an average of 1.53 years for all groups and no significant differences between ethnic groups. Average initial BMI is 42 ± 5. ANOVA was used to analyze data and P<0.05 considered significant. Results: Percent excess weight loss (EWL) are reported for the following racial groups. Asians lost the most, followed by Caucasians, the Hispanics and finally African Americans. The Caucasian group lost 66.33% ± 2.4% %EWL (N=209); the Asian group lost 88.6% ± 7.7 %EWL (N=23); the Hispanic group (50.2% ± 2.3%; P= 1.5E-05, N=123), and African American group lost 44.4% ± 3.3%; P=9.96E-06, (N=73). Furthermore, the average number of adjustments was 6 for the Caucasian group, 5 for the Asian group, and 4 for the Hispanic and African American groups. Conclusion: Our findings suggest that weight loss outcome for LAGB may be related to a patients race/ethnicity. Patients in the Caucasian group have significantly more adjustments than any other group. Excess weight loss is correlated with race and number of adjustments as well as willingness to diet and exercise. Cultural differences in types of food and exercise is also important in weight loss outcome.

Is There a Golden Window for the Lap-Bandtm: Greater Intra-Band Pressure is Needed as Time Passes With LAGB?

third portion (D3) underwent segmental resection, while 1 patient with tumor at the second portion (D2) underwent standard Whipple resection and 1 patient with tumor at D2/D3 junction underwent standard Whipple with en bloc resection. On follow up, 5 patients are alive today (follow-up range 15-48 months) including 2 of the patients presenting with recurrent disease. Of these 5 patients, 2 had positive nodes and 3 had negative nodes. Since rescue surgery, all have no evidence of recurrent disease. Conclusion: Long-term survival can be achieved in select patients with initially unresectable duodenal adenocarcinoma. From our experience, neoadjuvant chemotherapy may improve resectability of previously unresectable duodenal adenocarcinoma.