Traditional versus single-site placement of adjustable gastric banding: a comparative study and cost analysis

Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors' influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time.

Effectiveness and safety of reduced-port laparoscopic surgery vs conventional multi-port laparoscopic surgery in the treatment of gastric diseases: A meta-analysis

This study aimed to compare the effectiveness and safety of reduced-port laparoscopic surgery (RPLS) and conventional multi-port laparoscopic (CMPLS) surgery in the treatment of gastric diseases.The PubMed, Embase, Cochrane Library, Web of Science, and Chinese Biomedical Literature databases were systematically searched for randomized controlled trials, cohort studies, and case control studies on the use of RPLS vs conventional multi-port laparoscopic surgery in treating gastric diseases from their inception until March 10, 2019. The evaluated outcomes were the operative time, blood loss, length of hospital stay, number of dissected lymph nodes, postoperative complications, and conversions. All of these were compared using Stata software version 12.0.A total of 18 studies were included, which involved 2938 patients. In studies referring to the comparison between RPLS and CMPLS in treating gastric diseases, the former showed significantly inferior in terms of operative time (P = .011) and number of dissected lymph nodes (P = .031); but superior results in terms of the estimated blood loss (P = .000) and length of hospital stay (P = .001) than the latter did; however, the rates of postoperative complications (P = .830) and conversions (P = .102) were not statistically significant between the 2 groups.RPLS and CMPLS showed comparable effectiveness and safety in the treatment of gastric diseases in our meta-analysis. Based on the current evidence, we believe that RPLS is an efficacious surgical alternative to CMPLS in the management of gastric diseases because of the shorter hospital stay and reduced blood loss. However, large-scale, well-designed, multicenter studies are needed to further confirm the results of this study.

What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses

This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven ‘important’ cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended ‘important’ cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

Single-incision or conventional laparoscopic adjustable gastric banding: A systematic review

INTRODUCTION

Single-incision laparoscopic surgery (SILS) in gastric banding (SI-LAGB) has been reported to be a safe and technically feasible procedure among various operating methods. However, there is little evidence with regard to the question whether SI-LAGB has more advantages and should be recommended compared with conventional LAGB (CLAGB). Thus, this study was performed to assess the safety and efficacy of SI-LAGB.

MATERIAL AND METHODS

A computerized search of the electronic databases PubMed and EMBASE was performed. Data regarding operative parameters, postoperative recovery parameters, follow-up time, percentage of excess weight loss, and postoperative complication were pooled and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.

RESULTS

Ten comparative studies including 2,073 patients (1,038 patients who received SI-LAGB and 1,035 patients who received CLAGB) were included and analyzed. Compared with CLAGB, a similar weight loss could be obtained using SI-LAGB. The postoperative complications of SI-LAGB were within the acceptable range, but one study reported one perioperative death. SI-LAGB required a longer operative time. Other outcome variables, such as blood loss, days of hospitalization, pain score, and hospitalization costs, were not significantly different between the two groups.

CONCLUSIONS

SI-LAGB might be a safe and effective alternative to C-LAGB when performed by experienced surgeons, but available data do not allow to give a definitive answer and randomized controlled trials are needed.

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

BACKGROUND

Laparoendoscopic single site (LESS) surgery may have perceived benefits of reduced visible scarring compared to conventional laparoscopic (LAP) totally extraperitoneal (TEP) hernia repairs. We reviewed the literature to compare LESS TEP inguinal hernia repairs with LAP TEP repairs.

METHODS

We searched electronic databases for research published between January 2008 and January 2012.

RESULTS

A total of 13 studies reported on 325 patients. The duration of surgery was 40-98 minutes for unilateral hernia and 41-121 minutes for bilateral repairs. Three studies involving 287 patients compared LESS TEP (n = 128) with LAP TEP (n = 159). There were no significant differences in operative duration for unilateral hernias (p = 0.63) or bilateral repairs (p = 0.29), and there were no significant differences in hospital stay (p > 0.99), intraoperative complications (p = 0.82) or early recurrence rates (p = 0.82). There was a trend toward earlier return to activity in the LESS TEP group (p = 0.07).

CONCLUSION

Laparoendoscopic single site surgery TEP hernia repair is a relatively new technique and appears to be safe and effective. Advantages, such as less visible scarring, mean patients may opt for LESS TEP over LAP TEP. Further studies with clear definitions of outcome measures and robust follow-up to assess patient satisfaction, return to normal daily activities and recurrence are needed to strengthen the evidence.

Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy

BACKGROUND

With the introduction of a new platform, robotic single-site cholecystectomy (RSSC) has been reported as feasible and safe for selected cases. In parallel, the development of real-time near-infrared fluorescent cholangiography using indocyanine green (ICG) has been seen as a help during the dissection, even if the data are still preliminary. The study purpose is to report our experience with ICG RSSC and compare the outcomes to standard RSSC.

METHODS

From February 2011 to December 2011, 44 selected patients underwent RSSC for symptomatic cholelithiasis. Among them, 23 (52.3%) were included in an experimental protocol using the ICG, and the remainder (47.7%) underwent standard RSSC. There was no randomization. The endpoints were the perioperative outcomes. This is a prospective study, approved by our local Ethics Committee.

RESULTS

There were no differences in terms of patients' characteristics, except that there were more male patients in the ICG group (47.8 vs. 9.5%; p = 0.008). Regarding the surgical data, the overall operative time was shorter for the ICG group, especially for patients with a body mass index (BMI) ≤25 (-24 min) but without reaching statistical significance (p = 0.06). For BMI >25, no differences were observed. Otherwise, there were no differences in terms of conversion, complications, or length of stay between both groups.

CONCLUSIONS

A RSSC with a real-time near-infrared fluorescent cholangiography can be performed safely. In addition, for selected patients with a low BMI, ICG could shorten the operative time during RSSC. Larger studies are still required before drawing definitive conclusions.

Laparoendoscopic single-site gastric bands versus standard multiport gastric bands: a comparison of technical learning curve measured by surgical time

BACKGROUND

We aimed to evaluate our learning curve comparing surgical time of laparoendoscopic single-site (LESS) banding with multiport laparoscopy.

METHODS

We performed a retrospective analysis of prospectively collected data comparing our first 48 LESS bands with our first 50 multiport laparoscopic bands at our institution. We then compared the first 24 LESS bands with the last 24 bands.

RESULTS

The average body mass index for the LESS group was significantly lower than for the laparoscopic group (43.19 vs 48.3; P < .0001). The surgical time was much faster toward the second half of our experience performing the LESS procedure (85.34 vs 68.8; P = .0055). LESS banding took significantly longer than our early traditional laparoscopic adjustable gastric banding (76.85 vs 64.4; P = .0015).

CONCLUSIONS

We conclude that in experienced hands, single-incision banding is feasible and safe to perform. Long-term data are needed to prove that LESS banding is as good a surgery as traditional laparoscopic surgery.