Journal of the American College of Surgeons
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Comparative Study
Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System.
Minimal access surgery techniques have evolved to include complex surgical procedures. Laparoscopic pancreaticoduodenectomy (LPD) is a complex operation that pancreas surgeons have been slow to adopt. This article reviews our experience with patients undergoing LPD and compares their outcomes with those of patients undergoing open pancreaticoduodenectomy (OPD). ⋯ This series demonstrates that LPD appears to be safe and feasible, with benefits over the open counterpart. However, the increased complexity and effort demanded by the technique pose the need for multi-institutional series and standardization in reporting. The goal should be to assess if LPD can result in a better procedure with better outcomes.
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Randomized Controlled Trial Multicenter Study
A prospective multicenter registry of patients with chronic gastroesophageal reflux disease receiving transoral incisionless fundoplication.
This study was undertaken to validate previously reported safety and symptomatic outcomes of transoral incisionless fundoplication (TIF), evaluate the relative benefit of TIF within different gastroesophageal reflux disease (GERD) subgroups, and to determine predictors of success in community settings. ⋯ Transoral incisionless fundoplication is safe and effective in multiple community-based settings in the treatment of medically refractory GERD, as demonstrated by an absence of complications, excellent symptom relief, and complete cessation of PPIs at 6-month follow-up.
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Fibrolamellar hepatocellular carcinoma (FLC) is a rare primary liver tumor presenting earlier in life than nonfibrolamellar hepatocellular carcinoma (NFL-HCC), with distinct epidemiologic and clinical characteristics. Although FLC is believed to have a better prognosis than NFL-HCC, data on treatment and prognosis are scarce. We performed a systematic review to investigate treatment options and clinical outcomes of patients with FLC. ⋯ Patients with FLC treated with partial hepatectomy have excellent long-term survival, with 5-year overall survival reaching 70%. Patients fared worse with the use of other therapeutic options including chemotherapy, intra-arterial therapy, and transplantation, although data directly comparing resection vs transplantation were limited.