Yvan J. Silva

Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease.

AbstractPURPOSE: The feasibility of laparoscopic colectomy for colon surgery has now been well established. Most of the studies on laparoscopic colectomies include all types of colonic pathologies without discrimination. Our goal was to compare laparoscopic sigmoid colectomy vs. open sigmoid colectomy for simple sigmoid diverticular disease, to assess whether it can be done safely and whether the proposed advantages could be realized. METHODS: We evaluated the differences in outcomes of 66 laparoscopic sigmoid colectomy patients and 88 open sigmoid colectomy patients. We report a five-year outcomes analysis of 154 patients undergoing sigmoid colectomy for diverticular disease. We compared age, gender, history of prior abdominal surgery, estimated blood loss, operative time, total conversions with reason for conversion, time until a liquid diet was started, postoperative complications, hospital length of stay, operation costs, and total hospital charges incurred for both laparoscopic sigmoid colectomy and open sigmoid colectomy. RESULTS: Mean age and gender were similar in the two groups. However, the mean estimated blood loss (143 ml vs. 314 ml), time until a liquid diet was started (2.9 vs. 4.9 days), and hospital length of stay (4.8 vs. 8.8 days) were all significantly less in laparoscopic sigmoid colectomy patients. The mean operative time for laparoscopic sigmoid colectomy was 212 minutes as compared with 143 minutes for open sigmoid colectomy (P < 0.05). Conversion rate of laparoscopic sigmoid colectomy to open procedure was 19.7 percent. All laparoscopic sigmoid colectomy patients received a lighted ureteral stent preoperatively, which was removed at the end of surgery. Relevant complications for laparoscopic sigmoid colectomy vs. open sigmoid colectomy were as follows: anastomotic leak in 1 vs. 3 (1.5 vs. 3.4 percent) patients, hematuria in 64 vs. 6 (97 vs. 6.8 percent) patients, with an average duration for 2.93 vs. 3 days, urinary tract infection in 5 vs. 4 (7.6 vs. 4.5 percent) patients, and ureteral injury in 1 vs. 2 (1.5 vs. 2.2 percent) patients. Although the mean operating room charges were greater in the laparoscopic sigmoid colectomy patients (

Abdominal Wall Endometriomas

9,566 vs.

Do Support Groups Play a Role in Weight Loss after Laparoscopic Adjustable Gastric Banding

7,306) the mean hospital charges (

Calculi complicating a renal transplant

13,953 vs.

Live interactive broadcast of laparoscopic surgery via the Internet

14,863) were less. CONCLUSIONS: We recommend laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease. Laparoscopic sigmoid colectomy seems to be a reliable, safe and efficacious treatment modality with better outcomes for diverticular disease of the sigmoid colon. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.

Surgical significance of the ductus venosus arantii

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our institution was done. The mean age of the patients was 28.4 years. Twelve of these reported cases were secondary to previous surgery. One patient presented primarily with an abdominal wall mass without previous surgical history. The most common presentation was an abdominal wall mass associated with pain during the menstrual cycle. Endometrioma was considered as a differential diagnosis in seven patients. All patients underwent surgery. Along with the literature review on endometrioma, the importance of considering it in the differential diagnosis for patients of child-bearing age is discussed.

Clinical significance of umbilicoportal manometry

Background: Surgical intervention represents the only treatment with long-term efficacy for morbid obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive operation that is increasing in popularity. We hypothesized that attending support groups is beneficial to achieve optimal weight loss after LAGB. Methods: 38 patients who underwent LAGB between Dec 2002 and Aug 2003 were studied retrospectively. Patients were divided into 2 groups; A included 28 patients who did not attend the support groups (surgery without support groups), and B included 10 patients who attended the support groups (surgery with support groups). Weight loss between the 2 groups was compared over a 1-year period. Results: Patients who attended support groups achieved more weight loss (mean decrease in BMI = 9.7 ± 1.9) than patients who did not attend support groups (mean decrease in BMI = 8.1 ± 2.1), P = 0.0437 (unpaired t-test). Conclusion: Support groups appear to be an important adjunct for patients who undergo LAGB, to achieve and maintain improved weight loss.

Preoperative administration of antibodies against tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1) and their impact on peritoneal adhesion formation. Discussion

Four months after a cadaver kidney transplant, kidney stones were found in the renal allograft. Three major predisposing causes of nephrolithiasis were found in the patient, including hyperparathyroidism, renal tubular acidosis, and urinary tract infection. Hypercalcemia was corrected by parathyroidectomy. During the subsequent three years there was no enlargement of the renal stones and adequate kidney function was maintained. Renal tubular acidosis was not severe and seemed to be related to chronic rejection. Urinary tract infection was readily corrected with antibiotics and did not recur after the immediate post-transplant period. Surgical therapy for nephrolithiasis involving a kidney allograft was defferred since urinary flow was not obstructed. This course of management is recommended for use in patients with calculi complicating renal transplantation.

The Implications of Lighted Ureteral Stenting in Laparoscopic Colectomy

AbstractBackground: For the first time in the history of communications, we conducted live interactive broadcasts through the Internet (on August 29, and September 3, 1996). Methods: Successful transmissions were performed from Pontiac, Michigan, to Laguna Hills, California, and Buenos Aires, Argentina, and participants actively interacted in audio and video formats in real time. Results: Video images were transmitted at a rate of 1–2 frame/s and displayed in a 320 × 240 window at the remote sites. The loss of audio packets averaged 17% with a delay of 0.5–2 s. The broadcasting computer station was also able to receive real-time video and sound from the distant computers, allowing complete interaction between both parties over the duration of each transmission session. Average broadcast time was 1.5 h ± 30 min, and the cost of each transmission was equal to that of a regular local phone call. Conclusions: Videoconferencing via the Internet is a viable method for transmitting information in real time allowing surgeons worldwide to work together during surgical procedures.

In-flight continuous vital signs telemetry via the Internet.

Abstract Adult cadaveric dissections and simulated surgical approaches were performed to assess surgical feasibility of re-establishment of this natural portosystemic shunt. Existing anatomic relations and absence of endothelial lining prevent the use of the ductus in surgical treatment of portal hypertension although dilatation is possible.