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Videolaparoscopy with Omentopexy: A New Technique to Allow Placement of a Catheter for Continuous Ambulatory Peritoneal Dialysis

Abstract Malfunction of a peritoneal dialysis (PD) catheter is common and usually occurs shortly after its insertion, due to omental wrapping. In fact, we have encountered this complication in 183 of 578 (31.6%) patients treated at our hospital since 1987. To overcome this problem, I have devised a new laparoscopic technique for catheter insertion. First, the omentum is fixed onto the peritoneum of the lateral abdominal wall at two points using a laparoscopic instrument (Pro Tack 5-mm Auto Suture, Norwalk, CT, USA) placed at the level of the umbilicus. The catheter is then introduced through the umblical trocar deep into the true pelvis. The cuff is positioned between the posterior rectus sheath and the rectus fibers, and the fascia is sewn. The catheter is then pulled through the 5-mm trocar site. This technique was successfully performed on ten patients with a median age of 46.1 years. There was no morbidity or any malfunction in continuous ambulatory peritoneal dialysis (CAPD) during follow-up periods ranging from 20 days to 9 months. Therefore, this new laparoscopic technique may prevent the obstruction caused by omental wrapping in CAPD.

Adjustable Gastric Banding in a Multicenter Study in Turkey

Background: Adjustable gastric banding (AGB) is a minimally-invasive approach which allows adjustment of gastric restriction. Methods: The AGB was evaluated retrospectively in a consecutive series at 3 centers. From October 1998 to October 2001, 70 patients (49 women), mean age 34.3 years (18-59) with morbid obesity (preoperative mean BMI 45.2 kg/m2) underwent AGB The open approach was employed in the first 35 patients. Laparoscopic placement was used in the second 35 patients. Complete follow-up has been obtained in all patients. Results: Mean postoperative follow-up has been 18 months (12-39). Mean operative time was 120 minutes in the open approach and 150 minutes in the laparoscopic AGB. Mean hospital stay was 5 days after the open approach and 1.7 days after the laparoscopic surgery. The excess weight loss after 18 months was 59%. Incidence of early postoperative complications was 27.1%, including nausea and vomiting in 8 patients (5 in open approach, 3 in laparoscopic placement), wound infection in 10 patients (all 10 in open approach), and Wernickes encephalopathy in 1 patient (open approach). Incidence of late complications was 28.5%, and included band migration in 2 patients (both by laparoscopic placement), pouch dilatation in 10 patients (6 in open approach, 4 in laparoscopic placement), incisional hernias in 4 patients (all by open approach), and port infections in 4 patients (all 4 in open approach). Conclusion: AGB has been effective in achieving good weight loss to 3 years follow-up. The ability to adjust the degree of gastric restriction has enabled progressive weight loss.

Digital evaluation of the muscle functions of the lower extremities among inguinal hernia patients treated using three different surgical techniques: a prospective randomized study

PurposeAn inguinal hernia is a common pathology that can be treated using several different surgical procedures. Although there have been many studies comparing the clinical results of these techniques, there has so far been no digital analysis of the alterations developing secondary to pain with regard to the muscle functions of the lower extremities. This prospective randomized trial was designed to compare this aspect for subjects treated using the laparoscopic techniques and those treated using the conventional method.MethodsA total of 75 patients, 25 of whom who had undergone hernia repair using the total extraperitoneal technique, 25 of whom who had undergone repair using the transabdominal preperitoneal technique, and 25 who had undergone repair using the Prolene mesh graft technique, were evaluated preoperatively and on the third postoperative day by isometric and isokinetic measurements, the visual analog score (VAS), the necessity of postoperative analgesia, complications, and the time that had elapsed before returning to work, and these results were recorded.ResultsHernia repair using the conventional method led to an average of 3 times more muscle function loss compared with the laparoscopic techniques, and this difference was shown to be statistically significant. The VAS, postoperative complications, and time elapsed before returning to work were lower for laparoscopic surgeries and also were compatible with the findings described in the previous literature.ConclusionsUse of a digital environment with numerical parameters and measurements recorded using a dynamometer demonstrated that in the early postoperative period and on the third postoperative day, open surgery causes more functional loss in the lower extremities than laparoscopic methods. Therefore, surgeons should use laparoscopic methods whenever possible to reduce both pain and loss of muscle function.

Real-time monitoring for recovery of gastrointestinal tract motility detection after abdominal surgery

Loss of gastrointestinal motility occurs for patients who experience abdominal surgery and in order to avoid postoperative nausea and vomiting a period of fasting is commonly practiced. This study presents a system which acquires bowel sound signals by means of a devised stethoscope, performs real-time signal processing and notifies clinicians if bowel activity is present. The idea behind this practice is to provide enough time for intestinal motility to return to normal and benefit from early feeding in order to shorten hospital stay. Research findings indicate that a detection algorithm using statistical approach is suitable for real time monitoring in noisy clinical environments.

Bioacoustic sensor system for automatic detection of bowel sounds

This study presents a bioacoustic sensor system developed for early detection of the recovery of bowel activity after abdominal surgery and to perform analysis on bowel sounds. Different than other studies, in order to be able to attenuate noise, two capacitive microphones oriented in opposite directions are used. Bowel sounds are typically observed at a frequency between 100 Hz and 1500 Hz and amplitude between 0 and 20mV. The signal strength is boosted 48 times with an amplifying circuit. The second microphone is used to observe environmental noise such as examination room noise. Both signals are digitized using an ADC (NI DAQ Data Acquisition USB 6009). Finally, we developed a software that can extract spectral properties of the signal and present the results in real time.

Wireless bioacoustic sensor system for automatic detection of bowel sounds

Due to anesthesia loss of gastrointestinal motility is a common situation for patients who underwent abdominal surgery. The aim of this study is to present the bioacoustic sensor system developed for real time detection of recovery of gastrointestinal tract motility by observing bowel sounds and for bowel sound signal analysis. Different than other studies, in this study, in order to be able to attenuate environmental noise, bowel sounds were observed using two microphones. Bowel sounds were observed between 100 Hz and 1 kHz with maximum amplitude of 20mV. The signal was amplified 121 times and final signal amplitude was between 0-2, 4V. Similarly, environmental noise observed by the second microphone was amplified. Both of the signals were digitized using 12 bit analog digital converter of the ZigBee module (JN5139-Z01) and were transferred with wireless connection. With the developed software, spectral and temporal properties were obtained and presented in real-time. Finally, a stethoscope shaped box was designed for easy use of the sensor system.

Mesenchymale Stromatumoren des Magens: Retrospektive Analyse von 9 Patienten

Ziel: Ziel dieser Arbeit ist es, unsere Erfahrungen in der chirurgischen Therapie stromaler Tumoren des Magens vorzustellen. Material und Methoden: Diese retrospektive Studie evaluiert die klinischen und pathologischen Ergebnisse von 9 Patienten, die im Zeitraum zwischen Dezember 1998 und Dezember 2003 im Universitätshospital der Akdeniz-Universität an einem stromalen Magentumor operiert wurden. Ergebnisse: Das Alter der Patienten (7 Frauen, 2 Männer) lag zwischen 52 Jahren und 75 Jahren (Median 62 Jahre). Die häufigsten Symptome waren Gewichtsverlust und Dyspepsie, gefolgt von gastrointestinaler Blutung und abdominellen Schmerzen. Eine Lokalisation des Tumorherds in der Magenwand war mittels Ultraschall und/oder CT in allen Fällen möglich. Eine definitive präoperative Diagnose der stromalen Magentumoren wurde in keinem der Fälle gestellt. Alle Patienten unterzogen sich einer chirurgischen Resektion. Bei 5 Patienten wurde eine Wedge-Resektion mit tumorfreien Rändern durchgeführt (in einem Fall zusätzlich eine Splenektomie mit distaler Pankreatektomie). Drei Patienten wurden mit einer distalen Gastrektomie und 1 Patient mit einer totalen Gastrektomie mit Splenektomie und partieller Hepatektomie behandelt. Die regionale Lymphknotendissektion wurde in der Regel auf die angrenzenden Lymphknoten beschränkt. Keiner der Patienten verstarb nach der Operation. Drei Patienten unterzogen sich einer adjuvanten Chemotherapie. Der Follow-up-Zeitraum lag zwischen 3 und 46 Monaten (Median 16 Monate). Bis auf 1 Patienten leben alle ohne den Nachweis von lokalen oder Fernmetastasen. Ein Patient wurde nach 3 Jahren wegen eines lokalen Rezidivtumors erneut operiert. Zusammenfassung: Die komplette Resektion der stromalen Magentumoren mit tumorfreien Rändern geht mit einer günstigen Prognose einher, zumindest für eine kurze Follow-up-Periode.