Surgical endoscopy
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The Enhanced Recovery After Surgery (ERAS) protocol, which is developed to enhance postoperative recovery of patients treated with open colorectal surgery, has been widely adopted. The ERAS protocol has also been introduced in patients treated with laparoscopic colectomy, without data to support its additional value. We investigated whether laparoscopic colectomy in combination with the use of the ERAS protocol leads to a reduction of postoperative length of stay compared to laparoscopic colectomy with conventional care. ⋯ The postoperative length of stay was significantly reduced in the ERAS group without differences in patient outcome. It is suggested that these results are the effect of a combination of the ERAS protocol with laparoscopic colectomy.
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Transvaginal surgery has been performed by gynecologists for decades with abundant literature supporting its efficacy and safety. Recently, several groups reported on the NOTES transvaginal (TV) approach for extrapelvic disease. Nevertheless, repeated TV access for NOTES has never been reported to date. Two cases of "repeated" TV access for NOTES cholecystectomy after TV hybrid sleeve gastrectomy are described. ⋯ This report suggests that, in experienced hands, repeated TV access for extrapelvic surgery is possible and safe, putting forward the intriguing promises of less adhesions formation.
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The objective of enhanced recovery after surgery (ERAS) programs is to incorporate strategies into the perioperative care plan to decrease complications, hasten recovery, and shorten hospital stay. This study was designed to determine which ERAS strategies contribute to overall shortened length of hospital stay in patients undergoing elective colorectal surgery in hospitals. ⋯ In hospitals with variable uptake of ERAS strategies, preoperative counseling, intraoperative fluid restriction, use of a laparoscopic approach, immediate initiation of clear fluids after surgery, and early discontinuation of the Foley catheter are all independently associated with shortened length of stay.
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Randomized Controlled Trial
Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?
Hypocapnia before and during carbon dioxide (CO(2)) insufflation for laparoscopic cholecystectomy may reduce the adverse hemodynamic responses. ⋯ The authors conclude that the use of hypocapnia before and during CO(2) insufflation is effective in attenuating increases in blood pressure after CO(2) pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.
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Randomized Controlled Trial Comparative Study
Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial.
Although symptom outcomes following laparoscopic fundoplication have been adequately evaluated in the past, comparative subjective data of laparoscopic Nissen and Toupet fundoplications are scarce. Multichannel intraluminal impedance monitoring (MII) has not been used so far for comparison of objective data. ⋯ Both procedures equally improve quality of life and GERD symptoms. Bowel symptoms may increase after both procedures at the 3-month follow-up. Manometry and MII data favor Nissen fundoplication, but dysphagia and the inability to belch are more common compared to Toupet fundoplication.