Complete Endoscopic Thyroidectomy via Oral Vestibular Approach Versus Areola Approach for Treatment of Thyroid Diseases.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) is gaining interest because it allows operations without skin incisions. The aim of this study was to evaluate the feasibility, safety, and cosmetic results of endoscopic thyroidectomy via the oral vestibular approach (ETOVA) compared with endoscopic thyroidectomy via the areola approach (ETAA) in patients with thyroid diseases. MATERIALS AND METHODS: Eighty-two patients with thyroid diseases were randomized to receive either ETOVA (n=41) or ETAA (n=41). Perioperative and follow-up data were assessed. RESULTS: The surgery was completed in all cases, and all patients were followed up for at least 1 year. There were no differences between the two groups in operation time, blood loss, or postoperative hospital stay. Respective pain scores were 1.7 versus 2.1 and 0.6 versus 0.8 on Days 1 and 3, respectively, postoperatively. The white blood cell counts and C-reactive protein levels were not significantly different between the two groups. Complications were the same in both groups. Oral incision scars were invisible in the ETOVA group. Rates of skin traction sensation on the surgical field were lower in the ETOVA group than in the ETAA group at 3 and 6 months postoperatively (53.7% versus 80.5% and 24.4% versus 46.3%, respectively). The respective satisfaction score was 9.61 versus 9.22 (P=.021). No recurrent cases were observed in the study. CONCLUSIONS: Both the ETOVA and the ETAA procedures are feasible for thyroid diseases. The ETOVA eliminated skin incision scars and gained better cosmetic results in the short-term follow-ups, and the trauma was the same between the two approaches. However, more cases and longer-term follow-ups are needed for confirmation.

The value of routine gastroscopy before laparoscopic Roux-en-Y gastric bypass surgery in Chinese patients.

BACKGROUND: Obesity is closely related to upper gastrointestinal diseases. China has a high incidence of gastropathy. Postoperative examination of the distal stomach becomes extremely difficult after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Whether preoperative routine gastroscopy should be performed at all remains controversial. The objective of this study was to explore the value of routine gastroscopy before performing LRYGB in Chinese patients. METHODS: The preoperative gastroscopy reports of 180 patients who had undergone LRYGB for morbid obesity and/or metabolic syndrome in the Department of Gastrointestinal Surgery of our hospital from January 2009 to August 2013 were retrospectively analyzed. RESULTS: Gastroscopy showed chronic superficial gastritis (n = 159, 88.3%), reflux esophagitis (n = 19, 10.6%), erosion (n = 69, 38.3%), hiatal hernia (n = 5, 2.8%), gastric ulcer (n = 3, 1.7%), duodenal ulcer (n = 32, 17.8%), and gastric polyps (n = 10, 5.6%). CONCLUSION: It is useful to perform gastroscopy before LRYGB. The findings of this investigation can help physicians to develop tailored therapies and procedures and thus improve the prognosis considerably. Gastroscopy should be routinely performed in Chinese patients who are planning to undergo bariatric surgery.