Surgical endoscopy
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Major thoracic or neck surgery or penetrating trauma can cause injury to the thoracic duct and development of a chylothorax. Chylothorax results in metabolic and immunologic disorders that can be life threatening, with a mortality rate reaching 50%. The management of chyle leaks is dependent on the etiology and daily output. Interventions are used to treat only leaks unresponsive to medical management or those with an output exceeding 1,000 ml/day. ⋯ The percutaneous management of chyle leak is feasible, with low morbidity and mortality rates and a high rate of effectiveness. This approach should be considered before more invasive procedures.
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Laparoscopic appendectomy (LA) is not routinely performed for appendicitis because the costs associated with that procedure are higher than those for open appendectomy (OA). However, few studies have investigated the economic influence of LA and OA on specific subpopulations including the elderly, patients with comorbidities, and patients with complicated appendicitis. This population-based study was designed to investigate determinants of costs and hospital length of stay (LOS) for patients undergoing appendectomy. Furthermore, the differences in costs and LOS were compared between LA and OA for various subpopulations. ⋯ Considering costs and LOS, patients older than 65 years, patients with comorbidities, and patients with complicated appendicitis benefit more from the laparoscopic approach for the treatment of appendicitis.
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Comparative Study
Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach.
Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results. ⋯ Laparoscopic left pancreatectomy is a safe procedure for benign and borderline tumors, with similar perioperative outcomes compared with the open procedure. In the long term, the laparoscopic approach is likely to be superior thanks to a more rapid resume of full-time activities and to the lower incidence of incisional hernias and exocrine insufficiency. Clearly, these results have yet to be confirmed in large, randomized trials.
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Comparative Study
Comparison of outcomes for laparoscopically assisted and open radical distal gastrectomy with lymphadenectomy for advanced gastric cancer.
Laparoscopically assisted gastric surgery has become an option for the treatment of early gastric cancer. However, the feasibility and safety of laparoscopically assisted gastrectomy for advanced gastric cancer has rarely been studied. This study evaluated the short- and long-term outcomes of laparoscopically assisted distal gastrectomy (LADG) for advanced gastric cancer. ⋯ Laparoscopically assisted gastrectomy for advanced gastric cancer is safe and effective. In this study, it did not differ significantly from open surgery in terms of survival rate or recurrence after surgery based on long-term follow-up evaluation. It can achieve the same beneficial effects as open surgery, and it has the advantages of a small operation wound, less bleeding, good safety, rapid postoperative recovery, and fewer complications.
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In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic diverticular disease. ⋯ For symptomatic diverticular disease, TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.