Achieving the "Minimal Scarring" Concept in Bariatrics by Port-Site Relocation.

BACKGROUND: The aim of single incision laparoscopic surgery (SILS) and other types of trans-umbilical procedures (TU) has been to perform operations with minimal or no visible scars. However, in bariatric surgery, they are in particular demanding and the final esthetic advantage is in question given the long-term abdominal skin alteration, or abdominoplasty. We propose an alternative rationale and approach to achieve the minimal scarring concept in bariatric surgery. METHODS: A retrospective report of a straight forward method using four access ports, where three ports are concealed at either the lower panniculectomy region or the lateral folds of the umbilicus. The technique was performed on a pilot series of 65 female patients who underwent laparoscopic sleeve gastrectomy (LSG). RESULTS: The study sample had a mean age of 40.3 years and a mean BMI of 41.1 ± 4.2 kg/m(2). All procedures were completed laparoscopically. Field ergometry, working angles, and surgeon's convenience were not impaired. Mean operation time was 46 min and mean hospital stay was 2.3 days. Complications were minimal. Postoperative esthetic outcome and the rationale behind port placement were well appreciated by the patients. CONCLUSIONS: Performing LSG with the described approach is feasible, safe, and consistent with basic principles of ergometry including correct working triangulation. Esthetic outcome is up to the minimal scarring concept and future body contouring is not hampered.

Hip Arthroscopy for Femoral-Acetabular Impingement: Do Active Claims Affect Outcomes?

PURPOSE: To compare outcomes of 3 patient groups undergoing hip arthroscopy. METHODS: This study included 138 consecutive hip arthroscopies (106 analyzed) for femoral-acetabular impingement (FAI) with or without labral tear in patients with a minimum 1-year follow-up. Inclusion criteria included patients older than 18 with clinical or radiologic manifestation of FAI with or without labral tear. Exclusion criteria included previous hip surgery and various hip pathologies. Patients were classified into 3 study groups. Group 1 included work-related injuries with active claims ACs (n = 33); mean age, 32 (range, 19 to 63); group 2 included sports injuries with no ACs (n = 35); mean age, 32 (range, 18 to 69); and group 3 included non-sports-related injuries without pending ACs (NAS; n = 38); mean age, 45 (range, 20 to 68). Outcomes were assessed using modified Harris hip scores (mHHS) and hip outcome scores (HOS) preoperatively and during the final evaluation. RESULTS: Baseline score for all groups did not significantly differ (P = .210 for mHHS, P = .176 for HOS). All groups significantly improved from preoperative to final evaluation (group 1: mHHS P = .42, HOS P = .001; group 2: mHHS P < .001, HOS P < .001; group 3 NAS: mHHS P = .001, HOS P = .007). AC patients had the lowest final evaluation scores, while the sports group had the highest. The NAS group did not differ from either group at final evaluation. Preoperative and final evaluation scores inversely correlated with age (r range, -24 to -28; P < .05). CONCLUSIONS: This study has shown that patients may benefit from arthroscopic repair of FAI and labral tears regardless of ACs. The level of improvement, however, is not constant across patients with different characteristics. Moreover, it appears that age may impact perceived improvement after hip arthroscopy. Hip arthroscopy as an intervention in patients with ACs provided positive outcomes, corroborating that an AC is not a contraindication for this procedure. LEVEL OF EVIDENCE: Level III, retrospective comparative study.