Las lesiones mucosas y submucosas gástricas pueden abordarse por vía endoscópica, laparoscópica o por cirugía abierta. El tamaño, la localización y el tipo de crecimiento son determinantes a la hora de la elección de la técnica. El interés en la cirugía mínimamente invasiva ha llevado a desarrollar nuevos abordajes para suplir las dificultades de la laparoscopia tradicional, como puede ser el caso de la resección de lesiones próximas a la unión esofagogástrica no resecables endoscópicamente, donde la cirugía convencional puede producir estenosis o deformidades posoperatorias y aumento de la morbimortalidad. Presentamos nuestra experiencia en el abordaje de este tipo de lesiones mediante cirugía laparoscópica intragástrica en 3 pacientes consecutivos, con resultado satisfactorio. Este tipo de intervención supone un abordaje más en el arsenal de la cirugía mínimamente invasiva, que puede proporcionar ventajas frente a la cirugía tradicional
Gastric mucosal and submucosal lesions can be resected by endoscopy, laparoscopy or open surgery. Operative methods have varied depending on the location, endophytic growth and size of the lesion. Interest in minimally invasive surgery has increased and many surgeons are attempting laparoscopic approaches, especially in lesions of the stomach near the esophagogastric junction not amendable to endoscopic removal, because conventional surgery can produce stenosis and distort the postoperative anatomy, and increase morbimortality. We report our experience with laparoscopic intragastric surgery in 3 consecutive patients, with no complications. Laparoscopic intragastric surgery extends the surgeons armamentarium to resect complex gastric lesions, while offering patients the benefits of minimal access surgery
Humans , Male , Female , Aged , Minimally Invasive Surgical Procedures/methods , Esophagogastric Junction/injuries , Esophagogastric Junction/surgery , Esophagogastric Junction , Laparoscopy/methods , Endoscopy/methods , Gastrointestinal Stromal Tumors/surgery , Gastrointestinal Diseases/surgery , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures , Hyperplasia/surgery
Gastric mucosal and submucosal lesions can be resected by endoscopy, laparoscopy or open surgery. Operative methods have varied depending on the location, endophytic growth and size of the lesion. Interest in minimally invasive surgery has increased and many surgeons are attempting laparoscopic approaches, especially in lesions of the stomach near the esophagogastric junction not amendable to endoscopic removal, because conventional surgery can produce stenosis and distort the postoperative anatomy, and increase morbimortality. We report our experience with laparoscopic intragastric surgery in 3 consecutive patients, with no complications. Laparoscopic intragastric surgery extends the surgeons' armamentarium to resect complex gastric lesions, while offering patients the benefits of minimal access surgery.
Laparoscopy , Esophagogastric Junction , Gastric Mucosa , Gastroscopy , Humans , Minimally Invasive Surgical Procedures , Stomach Neoplasms
OBJETIVO: La laparoscopia ofrece importantes ventajas clínicas respecto a la técnica abierta en la reparación de las hernias de pared abdominal. Se realiza un estudio coste-beneficio con el objetivo de analizar los resultados clínicos y los costes económicos comparando la técnica abierta y la laparoscopia en la reparación de la hernia de pared anterior abdominal y así determinar el procedimiento más eficiente. MATERIAL Y MÉTODOS: Estudio prospectivo de cohortes sobre 140 pacientes consecutivos con hernias ventrales, con el objetivo de evaluar el coste de ambas técnicas. Se analizan datos clínicos, morbilidad, estancia hospitalaria, complicaciones y costes. RESULTADOS: La vía laparoscópica presentó menor estancia media (p < 0,001), menor morbilidad postoperatoria y complicaciones (p < 0,001) y reducción en la tasa de reingresos. El coste del material laparoscópico fue más alto, aunque el coste total del procedimiento por paciente fue menor (2.865 Euros) vs. reparación abierta (4.125 Euros). CONCLUSIONES: La reparación laparoscópica de las hernias ventrales de pared abdominal aporta beneficios para los pacientes y presenta, además, un coste final del procedimiento sensiblemente menor, evitándose un gasto de 1.260 Euros por cada paciente intervenido por esta vía. Además de ser una técnica eficiente, la reparación laparoscópica es coste-efectiva
OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P < .001) and patient morbidity (P < .001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260 Euros per patient (2,865 Euros vs. 4,125 Euros). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260 Euros for each patient, and so this procedure should be considered a cost-effective approach
Humans , Hernia, Ventral/surgery , Laparoscopy , Herniorrhaphy/methods , Cost-Benefit Analysis , Prospective Studies , Treatment Outcome , Postoperative Complications
OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260 per patient (2,865 vs. 4,125). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260 for each patient, and so this procedure should be considered a cost-effective approach.
Cost-Benefit Analysis , Hernia, Ventral/economics , Hernia, Ventral/surgery , Herniorrhaphy/economics , Herniorrhaphy/methods , Laparoscopy/economics , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies
