Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years.

BACKGROUND: Inguinal hernia repair via multi-trocar laparoscopy (MTL) has gained an increasing popularity worldwide. Single-incision laparoscopy (SIL) has been introduced to reduce the port-related complications and to improve the cosmetic results. The authors report a prospective randomized study comparing SIL versus MTL totally extraperitoneal (TEP) inguinal hernia repair. METHODS: Between January 2013 and May 2015, 113 versus 97 patients were prospectively randomized between SILTEP and MTLTEP. Perioperative, short-term, and mid-term outcomes have been assessed. The primary endpoint was the mid-term outcomes (late postoperative complications, late inguinal hernia recurrence, surgical and cosmetic satisfactions). Secondary endpoints were perioperative outcomes (operative time, mesh fixation, operative complications, postoperative pain, and hospital stay) and short-term outcomes (early postoperative complications, early inguinal hernia recurrence, and days to return to normal activities). RESULTS: After a mean follow-up of 27 ± 8 months, a statistically significant difference was found between the two groups in terms of mean operative time for both unilateral and bilateral inguinal hernia repair (p = 0.016; p = 0.039) and cosmetic satisfaction (p = 0.003). CONCLUSION: Perioperative, short-term, and mid-term outcomes were comparable between the two groups. At 2-year follow-up, a significant shorter operative time after MTLTEP and a greater cosmetic satisfaction after SILTEP have been found.

Single-access transumbilical laparoscopic nissen fundoplication performed with new curved reusable instruments.

INTRODUCTION: The authors report a single-access laparoscopic Nissen fundoplication (SALN) performed with new curved reusable instruments. CASE REPORT: A 21-year-old woman sought care for symptomatic grade B esophagitis and hiatal hernia. A reusable 11-mm trocar was inserted in the umbilicus and a 10-mm, 30° angled, nonflexible, standard length scope was used. Curved reusable instruments (Karl Storz-Endoskope) were transumbilically introduced without trocars. The left hepatic lobe was retracted thanks to the distal curve of the grasper. The cruraplasty and wrap were performed using curved needle holder and intracorporeal sutures. RESULTS: No extraumbilical trocar was necessary. Laparoscopic time was 108 minutes, and umbilical scar length was 16 mm. Discharge was allowed after 48 hours. CONCLUSIONS: SALN is feasible to be performed with curved reusable instruments, which avoid the conflict between the instruments' tips inside the abdomen or between the surgeon's hands outside. Cost of the procedure remains similar to standard laparoscopy because only reusable material is used.

Single-access laparoscopic surgery using new curved reusable instruments: initial hundred patients.

In recent years, laparoscopic surgery underwent a huge investment from both the clinical and research points of view to perform classic procedures through a single (S) incision or single port, resulting in the development of different instruments and ports. The main advantage of the S-access laparoscopy (SAL) is cosmesis. Future investigations will provide other potential advantages, such as improvement in postoperative pain and patient satisfaction. We report our initial experience on 115 patients utilizing a SAL (appendectomy, cholecystectomy, incisional hernia repair, Nissen fundoplication, upper gastrointestinal surgery, diagnostic laparoscopy, hepatic resection, splenectomy), along with the new curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany). The curves of the instruments enable the surgeon to work in an ergonomic position similar to classic laparoscopy, establishing a working triangulation inside the abdomen as well as outside. The cost of SAL is similar to classic laparoscopy as only reusable products are used.

Duodenal duplication cyst in an adult: first simultaneous laparoscopic and endoscopic surgery.

Duodenal duplication cysts are rare congenital anomalies. The symptoms may appear during the neonatal period or later in life, depending on the degree of gastrointestinal outlet obstruction. Classically, symptomatic cases have been treated by surgical resection or endoscopic marsupialization of the cyst. In this paper, we describe a new method of total laparoscopic resection and defect closure after precise localization of the lesion by simultaneous gastrointestinal endoscopy in a 24-year-old woman.

Role of laparoscopy in the management of visceral injuries following abdominal stab wounds.

BACKGROUND: Laparoscopy offers several advantages in the treatment of abdominal stab wounds. In this paper, we report our experience during 2004, where hemodynamically stable patients with stab wounds were managed laparoscopically. PATIENTS AND METHODS: Between January and December 2004, 8 hemodynamically stable patients (7 men, 1 woman) underwent laparoscopy for anterior abdominal stab wounds. Median age was 28.5 years (range, 17-55). All patients underwent an abdominal computed tomography (CT) prior to the laparoscopy. RESULTS: Exploration of the wound under aseptic conditions, carried out as a part of the physical examination, confirmed peritoneal penetration in 7 of the 8 cases. Abdominal CT revealed positive findings in 7 (87.5%) cases. Laparoscopy was performed after a median time of 60 minutes (range 30-90). Laparoscopic exploration evidenced peritoneal penetration in 100% of the cases and visceral lesions in 87.5% of the cases. All visceral injuries were managed laparoscopically. Median operative time was 135 minutes (range, 45-200). Operative mortality was 0% and early morbidity was 12.5%. Median hospital stay was 5 days (range, 1-11). After a median follow-up of 12 months (range, 1-28), 1 patient complained of persistent chest pain and a ventral hernia at the site of the abdominal stab wound was diagnosed in another patient. CONCLUSIONS: Laparoscopy should be included in management algorithms in patients with anterior abdominal stab wounds who are hemodynamically stable. In addition to its diagnostic ability, this study demonstrates that laparoscopy can be an effective management modality with minimal morbidity and no mortality.