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1.
Surg Endosc ; 20(11): 1662-70, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17024541

RESUMO

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) has become the most common surgical treatment for gastroesophageal reflux disease (GERD). Controversies still exist regarding the operative technique and the durability of the procedure. METHODS: A retrospective study of 808 patients undergoing 838 LNF for GERD at a tertiary referral center was undertaken. Demographic, perioperative, and follow-up data had been entered onto the unit database. RESULTS: During a median follow-up period of 60 months (range, 2-120 months), heartburn decreased to 3% of the patients (19/645) and regurgitation to 2% (11/582) (p < 0.01). Respiratory symptoms improved in 69 (85%) of 81 patients (p < 0.01). The incidence of postoperative dysphagia was unaffected by the use of an intraesophageal bougie (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.82-1.64; p = 0.41) or division of the short gastric vessels (OR, 0.84; 95% CI, 0.42-1.07; p = 0.72). In the immediate postoperative period, the incidence of abdominal symptoms increased by 10% (p < 0.01) and dysphagia by 16% (p < 0.01). After 10 postoperative years, only 3% (30/484) were found to have abdominal symptoms, whereas the incidence of dysphagia declined to zero. CONCLUSION: The findings show that LNF is a safe and effective procedure with long-term durability. Abdominal symptoms and dysphagia are the principal postoperative complaints, which improve with time. Personal preference should dictate the use of a bougie, division of the short gastric vessels, or both.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Surg Endosc ; 20(9): 1453-9, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16794782

RESUMO

BACKGROUND: The aim of this study was to evaluate day case laparoscopic herniorraphy (LH) and to ascertain the impact of trainee surgeons on its performance. METHODS: We performed a prospective study of ambulatory laparoscopic transabdominal preperitoneal herniorraphies performed in a dedicated day surgical unit between March 1996 and October 2003. RESULTS: A total of 840 herniorraphies were performed in 706 consecutive patients. Surgery was performed by 15 higher surgical trainees and three consultant surgeons. The mean operating times for trainees were longer for unilateral (48.4 +/- 0.98 vs 41.4 +/- 0.87 min, p < 0.05) and bilateral (69.0 +/- 3.24 vs 53.0 +/- 1.68 min, p < 0.05) repairs than for consultants. Subgroup analysis demonstrated that after an experience of 40 procedures, trainee times approached those of the consultants (41.39 +/- 1.17 vs 41.4 +/- 0.87 min, p= 0.31). LH repair was well tolerated and associated with minimal postoperative pain and nausea. Mean pain scores postoperatively and at 24 h were 2.69 +/- 0.11 and 2.07 +/- 0.09, respectively. Mean nausea scores postoperatively and at 24 h were 0.34 +/- 0.06 and 0.22 +/- 0.06, respectively. Ninety-three percent of patients (n = 657) were discharged within 8 h. There were two conversions to an open procedure (0.1%) and two significant complications (0.1%). Ninety-five percent of patients who responded to our questionnaire (n = 398/419) were satisfied with surgery and would undergo day case laparoscopic herniorraphy again. CONCLUSIONS: Laparoscopic herniorraphy is a safe technique suitable for day case surgery. Operator experience dictates duration of surgery. Trainees' operating times approach those of consultants after 40 procedures. Prolonged operating times and increased cost are not justifiable reasons for not recommending LH.


Assuntos
Assistência Ambulatorial , Educação Médica , Hérnia Abdominal/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Operatórios/educação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Educação Médica Continuada , Feminino , Humanos , Laparoscopia/efeitos adversos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Náusea/etiologia , Dor Pós-Operatória/fisiopatologia , Satisfação do Paciente , Fatores de Tempo , Reino Unido
3.
Surg Endosc ; 19(8): 1082-5, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16021378

RESUMO

BACKGROUND: Even though ambulatory laparoscopic cholecystectomy (ALC) is safe and cost effective, this approach has yet to gain acceptance in the United Kingdom. We report our 5-year experience of ALC with emphasis on its appropriateness for higher surgical training. METHODS: Between July 1997 and July 2002, patients with symptomatic cholelithiasis who met with appropriate criteria underwent ALC. Surgery was performed either by a consultant surgeon or a higher surgical trainee (HST) under direct supervision in our dedicated day surgery unit. Data were recorded prospectively and patients were interviewed postoperatively by an independent researcher. RESULTS: There were 269 patients (231 female and 38 male) with a median age of 46 years (range 17-76). Conversion to open cholecystectomy was necessary in three cases (1%). Of the patients, 79% (213) were discharged within 8 hours of surgery; 95% (256) were discharged on the same day. Thirteen patients (5%) required overnight admission as inpatients. An HST performed 166 (62%) of the procedures. There was a statistically significant difference in operating time between consultants (41 min) and trainees (47 min, P = 0.001) but no significant difference in clinical outcome or patient satisfaction. The mean procedural cost to the hospital was 768 pound sterling for ALC compared with 1430 pound sterling for an inpatient operation. Of patients, 87% expressed satisfaction with the day case operation. CONCLUSION: Our results for ALC compare favorably with published series. In addition, we have demonstrated that the operation can be performed safely by HST under direct supervision without compromising operating lists or safety.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/educação , Adolescente , Adulto , Idoso , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
4.
Clin Radiol ; 59(3): 227-36, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15037134

RESUMO

Morbid obesity is a significant clinical problem in the western world. Various surgical restrictive procedures have been described as an aid to weight reduction when conservative treatments fail. Adjustable laparoscopic gastric banding (LAPBAND) has been popularized as an effective, safe, minimally invasive, yet reversible technique for the treatment of morbid obesity. Radiological input is necessary in the follow-up of these patients and the diagnosis of complications peculiar to this type of surgery. In this review we will highlight the technical aspects of radiological follow-up and the lessons learnt over the last 5 years.


Assuntos
Gastroplastia/efeitos adversos , Gastroplastia/métodos , Laparoscopia/métodos , Obesidade Mórbida/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Dilatação Patológica/etiologia , Desenho de Equipamento , Falha de Equipamento , Seguimentos , Gastroplastia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Radiografia , Infecção da Ferida Cirúrgica/etiologia , Redução de Peso
5.
Surg Endosc ; 17(12): 1905-9, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14577024

RESUMO

BACKGROUND: From November 1993 to May 2002 a total of 172 laparoscopic adrenalectomies were attempted in 152 patients in centers throughout the United Kingdom. RESULTS: The median age was 52 years (18-77 years). Sixty-three percent were female. Indications for resection were Conn's syndrome (60), pheochromocytoma (35), Cushing's disease (24), Cushing's adenoma (8), cortisol-secreting carcinoma (1), other secreting tumor (2), nonfunctioning adenoma (17), congenital adrenal hyperplasia (4), metastatic disease (7), nonsecreting adrenal carcinoma (2), others (12). Median size of the lesions was 3.0 cm (0.5-20 cm). Median operating time was 65 min (30-170 min). Conversion to an open procedure was necessary in 10 patients (7%). Minor morbidity occurred in nine patients (5%). Major morbidity occurred in two patients (pancreatitis, peritonitis). Median hospital stay was 3 days (1-16 days). At median follow-up of 36 months (1-105 months) five patients (4%) had persistent hypertension. No patient had evidence of recurrent hormonal excess. CONCLUSIONS: Laparoscopic removal of the adrenal gland should be considered the surgical procedure of choice in experienced minimally invasive centers.


Assuntos
Adrenalectomia/métodos , Laparoscopia/métodos , Doenças das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/estatística & dados numéricos , Adulto , Idoso , Síndrome de Cushing/cirurgia , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/cirurgia , Hipertensão/epidemiologia , Hipertensão/etiologia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Recidiva Local de Neoplasia , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Reino Unido/epidemiologia
6.
Obes Surg ; 13(1): 136-7, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12630629

RESUMO

A 67-year-old lady presented with anemia and weight loss 15 years after vertical banded gastroplasty. The cancer was confined to the pouch, which is suggestive of a relationship to the anti-obesity surgery. A brief review with possible contributing factors is presented.


Assuntos
Adenocarcinoma Mucinoso/etiologia , Gastroplastia/efeitos adversos , Neoplasias Gástricas/etiologia , Adenocarcinoma Mucinoso/microbiologia , Idoso , Feminino , Helicobacter pylori/isolamento & purificação , Humanos , Fatores de Risco , Neoplasias Gástricas/microbiologia
7.
Obes Surg ; 12(2): 280-4, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11975229

RESUMO

BACKGROUND: The laparoscopically-placed adjustable gastric band (LAGB) is a minimally invasive, adjustable and completely reversible operation. We report 3 years experience. METHODS: Between May 1998 and January 2001, we operated on a consecutive series of 50 patients (8 male/42 female). Mean age of patients was 37 years (30-48). Mean preoperative BMI was 43 kg/m2 (range 38-55). RESULTS: Mean operative time was 130 minutes (range 75-150), and the conversion rate was 6%. Mean hospital stay was 2.8 days (range 2-10). Postoperatively 7/50 (14%) of patients had dysphagia and subsequently 2 (4%) developed gastric pouch dilatation. 2/50 (4%) had non-fatal pulmonary embolism and 2/50 (4%) developed gastroesophageal reflux. Overall morbidity was 32%. There has been no mortality. 6 weeks postoperatively, patients had adjustment of the band by the radiologists. Follow-up has been up to 30 months. Mean excess weight loss at 6 months was 30% (range 26-35%, N = 50), at 12 months 52% (range 44-55%, N = 42), at 24 months 60% (range 55-65%, N = 14) and at 30 months 62% (range 58-64%, N = 8). 5 patients have reached their ideal body weight. CONCLUSIONS: LAGB is safe and effective, even early in the learning curve. The radiologist plays a distinct role. A multi-disciplinary team approach is essential for optimal results. Long-term results are pending.


Assuntos
Bandagens/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/diagnóstico por imagem , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Radiologia , Estômago/diagnóstico por imagem , Estômago/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Tempo , Resultado do Tratamento
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