Surgical endoscopy
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Recurrent paraesophageal hernia (PEH) repair is performed for symptomatic recurrent hiatal hernia and/or reflux with little understanding as to outcomes related to perioperative and subjective patient variables. The aim of this study was to understand what differences exist between patients undergoing initial paraesophageal hernia (IPEH) repair and those undergoing redo paraesophageal hernia (RPEH) repair. ⋯ Recurrent PEH repair is performed with similar outcomes to IPEH repair with the exception of increased operative time and blood loss. Collis gastroplasty is required more frequently in RPEH patients. Persistent symptoms exist following RPEH repair. Despite recurrent symptomatology, patient satisfaction is high. RPEH repair may be safely performed in patients with recurrent paraesophageal hernias with outcomes similar to IPEH repairs.
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Comparative Study
Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis.
Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses. ⋯ Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.
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Comparative Study
Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study.
Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates. ⋯ Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.
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Randomized Controlled Trial
Quality-of-life scores in laparoscopic preperitoneal inguinal hernia repair.
Published support exists for using lightweight polypropylene mesh (PPM) to repair inguinal hernias with increased biocompatibility and decreased foreign body reaction and pain. However, quality of life (QOL) has not been assessed. We assess QOL in patients undergoing laparoscopic totally extraperitoneal hernia repair (TEP) with lightweight PPM. ⋯ Laparoscopic inguinal hernia repair is associated with initial declines in QOL in the postoperative period. Improvements appear in the long term. General health does not appear to be impacted by laparoscopic TEP. Smaller mesh and unilateral repairs are associated with improved QOL following laparoscopic TEP with PPM. Multiple metrics for QOL are required to reflect patient recovery.
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Comparative Study
Resident participation in laparoscopic Roux-en-Y gastric bypass: a comparison of outcomes from the ACS-NSQIP database.
As clinical outcome data are increasingly tied to hospital reimbursement, balancing quality care with training of surgical residents has become critical. We used the ACS-NSQIP database to determine impact of resident participation in laparoscopic gastric bypass on 30-day morbidity and mortality. ⋯ Resident participation in laparoscopic gastric bypass was associated with statistically significant, but clinically insignificant increase in incidence of superficial site infection, renal failure, readmission rate, and length of stay. Therefore, although resident participation in laparoscopic gastric bypass is associated with significantly increased operative time, it does not lead to increased mortality and has no clinically significant effect on morbidity.