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Buselli R, Corsi M, Veltri A, Marino R, Caldi F, Del Guerra P, Guglielmi G, Tanca C, Paoli M, Calabretta VM, Perretta S, Foddis R, Carrozzino MA. Comparison between Standard Expository Cognitive Behavioral Therapy (CBT-E) and Immersive Virtual Reality CBT (CBT-VR) for Rehabilitation of Patients Affected by Occupational Stress Disorders: Study Protocol. Int J Environ Res Public Health 2023; 20:ijerph20095735. [PMID: 37174252 PMCID: PMC10178175 DOI: 10.3390/ijerph20095735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms that can lead to occupational stress diseases, namely Adjustment Disorder and Post-Traumatic Stress Disorder. The literature has evidenced that "exposure therapy" of cognitive-behavioral training (CBT-E) seems to be the most effective technique to manage stress symptoms, including work stress diseases, and several studies have considered Virtual Reality (VR) as an adjuvant tool to exposure-based psychotherapy (CBT-VR) for the treatment of multiple psychiatric disorders. The aim of this study is to evaluate the effectiveness of CBT with exposure to stressful work scenarios in imaginative (CBT-E) and in immersive virtual reality (CBT-VR) scenarios in a group of workers affected by work-related stress disorders and compare the clinical and physiological outcomes between the two exposure techniques. A long-term goal would be to develop an evidence-based rehabilitation program as a treatment for the reintegration into work of patients affected by these psychiatric disorders.
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Affiliation(s)
- Rodolfo Buselli
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Center for Work-Related Stress and Occupational Mental Disorders, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Martina Corsi
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Center for Work-Related Stress and Occupational Mental Disorders, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Antonello Veltri
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Center for Work-Related Stress and Occupational Mental Disorders, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Riccardo Marino
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Center for Work-Related Stress and Occupational Mental Disorders, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Fabrizio Caldi
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Paolo Del Guerra
- Department of Public Health, Azienda USL Toscana Centro, 50053 Empoli, Italy
| | - Giovanni Guglielmi
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Camilla Tanca
- Scuola Superiore Sant'Anna, Institute of Communication, Information and Perception Technologies TECIP, 56100 Pisa, Italy
| | - Massimo Paoli
- Department of Public Health, Sovrintendenza Sanitaria Regionale Inail Toscana, 50144 Firenze, Italy
| | | | - Salvio Perretta
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
| | - Rudy Foddis
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, Cisanello, 56124 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Marcello Antonio Carrozzino
- Scuola Superiore Sant'Anna, Institute of Communication, Information and Perception Technologies TECIP, 56100 Pisa, Italy
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2
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Takeuchi M, Collins T, Ndagijimana A, Kawakubo H, Kitagawa Y, Marescaux J, Mutter D, Perretta S, Hostettler A, Dallemagne B. Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence. Hernia 2022; 26:1669-1678. [PMID: 35536371 DOI: 10.1007/s10029-022-02621-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration. METHODS This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated. RESULTS A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees. CONCLUSION An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.
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Affiliation(s)
- M Takeuchi
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - T Collins
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - A Ndagijimana
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - H Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J Marescaux
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - D Mutter
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
| | - S Perretta
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
| | - A Hostettler
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - B Dallemagne
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
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3
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Buselli R, Corsi M, Veltri A, Baldanzi S, Chiumiento M, Marino R, Caldi F, Perretta S, Foddis R, Cristaudo A, Guglielmi G. Suicidal ideation and suicide commitment in Health Care Workers during COVID-19 pandemic: a review of the literature. Int J Occup Saf Health 2022. [DOI: 10.3126/ijosh.v12i2.40500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Suicide represents an important public health concern since it leads to more annual deaths globally than violence, war and natural disasters combined. It is evident that during this pandemic year the phenomenon acquires even greater importance especially in the categories at risk, such as health care workers (HCWs). The aim of this review is to analyze literature evidence regarding health care providers' suicidal ideation (SI) and suicide commitment during the first year of the COVID-19 pandemic.
Methods: International databases and digital worldwide media reports were screened between March 2020 and March 2021. The authors conducted a systematic review and described evidence using a narrative approach with some focus points based on the PICO framework. Inclusion or exclusion of literature is done according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations.
Results: What emerged is a range of SI that varies from 4 to 8% and the main risk factors seem to be loneliness, not having children and personal history of mental disorders.
Conclusion: SI, and in worst cases suicide commitment, seem mental health outcomes not to be underestimated, especially in an emergency that is protracting. They require monitoring by health surveillance systems with a goal of prevention and support.
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Buselli R, Corsi M, Veltri A, Baldanzi S, Chiumiento M, Del Lupo E, Marino R, Necciari G, Caldi F, Perretta S, Foddis R, Guglielmi G, Cristaudo A. Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2. Workplace Health Saf 2022; 70:43-49. [PMID: 35037513 DOI: 10.1177/21650799211045715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.
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Affiliation(s)
- R Buselli
- Azienda Ospedaliero-Universitaria Pisana
| | - M Corsi
- Azienda Ospedaliero-Universitaria Pisana
| | - A Veltri
- Azienda Ospedaliero-Universitaria Pisana
| | - S Baldanzi
- Azienda Ospedaliero-Universitaria Pisana
| | | | - E Del Lupo
- Azienda Ospedaliero-Universitaria Pisana
| | - R Marino
- Azienda Ospedaliero-Universitaria Pisana
| | - G Necciari
- Azienda Ospedaliero-Universitaria Pisana
| | - F Caldi
- Azienda Ospedaliero-Universitaria Pisana
| | - S Perretta
- Azienda Ospedaliero-Universitaria Pisana
| | - R Foddis
- Azienda Ospedaliero-Universitaria Pisana
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5
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Piantanida E, Boškoski I, Quero G, Gallo C, Zhang Y, Fiorillo C, Arena V, Costamagna G, Perretta S, De Cola L. Nanocomposite hyaluronic acid-based hydrogel for the treatment of esophageal fistulas. Mater Today Bio 2021; 10:100109. [PMID: 33997760 PMCID: PMC8095189 DOI: 10.1016/j.mtbio.2021.100109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Fistulas are abnormal connections between two body parts that can impair the quality of life. The use of biological glues represents the least invasive procedure to fill the fistula; however, it is limited by the need of multiple injections, the persistence of infection and the failure in the treatment of high-output fistulas. We describe herein the use of an injectable nanocomposite hydrogel that is able to form in situ a tissue-mimicking matrix as an innovative material for the treatment of esophageal fistulas. Injectable hydrogels that have the dual advantage of being implantable with a minimally invasive approach and of adapting their shape to the target cavity, while the introduction of mesoporous silica nanoparticles opens the possibility of drug/biomolecules delivery. The hydrogel is based on hyaluronic acid (HA), the crosslinking process occurs at physiological conditions leading to a hydrogel made of >96% by water and with a large-pore micro-architecture. The kinetic profile of the hydrogel formation is studied as a function of HA molecular weight and concentration with the aim of designing a material that is easily injectable with an endoscopic needle, is formed in a time compatible with the surgical procedure and has final mechanical properties suitable for cell proliferation. The in vivo experiments (porcine model) on esophageal-cutaneous fistulas, showed improved healing in the animals treated with the hydrogel compared with the control group.
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Affiliation(s)
- E Piantanida
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
| | - I Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - G Quero
- Digestive Surgery Unit, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
| | - C Gallo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - Y Zhang
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
| | - C Fiorillo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - V Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8 00168, Rome, Italy
| | - G Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8 00168 Roma, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Largo Agostino Gemelli, 1 00168, Italy
| | - S Perretta
- IRCAD, Strasbourg 1 place del'Hȏpital, 67000 Strasbourg, France
| | - L De Cola
- Institut de Science et d'Ingénierie Supramoléculaires, CNRS, UMR 7006, Université de Strasbourg, 8 rue Gaspard Monge, 67000 Strasbourg, France
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6
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Marino R, Bertocci N, Bernabei M, Bonotti A, Mignani A, Fallahi P, Perretta S, Monopoli G, Cristaudo A, Foddis R. Analisi dell’intervento per arresto cardiaco in casi occorsi in ambienti di lavoro nel territorio servito da una centrale operativa del 118 della Toscana. Med Lav 2020; 111:399-403. [PMID: 33124611 PMCID: PMC7809974 DOI: 10.23749/mdl.v111i5.8897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Every year in Italy and all around the world, cardiac arrest hits almost 1 person every 1000 people; a great deal of these events is likely to strike people outside their private houses. OBJECTIVES Analyzing a cohort of cardiac arrest events occurred in various public- and work-places across a territorial area concerning an Emergency Unit related to the national emergency number (118) and assessing the efficacy of a first-aid intervention and the usage of a defibrillator while handling an acute cardiac event. METHODS We analyzed data of 32 sanitary interventions on cardiac arrest events occurred from January 2015 to June 2018 across USL Toscana Centro - Pistoia and Empoli's territory. RESULTS The acute cardiac event occurred in a "strictly speaking workplace" in 28.2% of cases, and in 18.7% during work activity. An AED was present for immediate cardiac arrest treatment in 15.6% of cases with a survival rate of 100% (n=5/5) (p=0.04); in 84.4% of cases the AED was available only after the arrival of national emergency rescuers and the relative survival rate was 40.74% (n=11/27). Regarding cardiopulmonary resuscitation, the survival rate appears to be higher (55.5% Vs 42.8%) when it was started by witnesses. CONCLUSIONS The results of this study suggest that early defibrillation provided by work-related First Aid Emergency Procedure, may be a primary aid and a desirable standard to improve both workers' and private citizens' survival rate after cardiac arrest.
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Affiliation(s)
- Riccardo Marino
- Scuola di Specializzazione in Medicina del Lavoro presso la Azienda Ospedaliera Universitaria Pisana.
| | - Nicola Bertocci
- Centrale Operativa del 118 della USL Toscana Centro-Pistoia.
| | | | - Alessandra Bonotti
- U.O. Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana.
| | - Aldo Mignani
- U.O. Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana.
| | - Poupak Fallahi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Scuola di Specializzazione in Medicina del Lavoro dell'Università di Pisa; Sezione di Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana .
| | - Salvio Perretta
- Sezione di Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana.
| | - Giulia Monopoli
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Scuola di Specializzazione in Medicina del Lavoro dell'Università di Pisa.
| | - Alfonso Cristaudo
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Scuola di Specializzazione in Medicina del Lavoro dell'Università di Pisa; U.O. Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana.
| | - Rudy Foddis
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Scuola di Specializzazione in Medicina del Lavoro dell'Università di Pisa; Sezione di Medicina Preventiva del Lavoro dell'Azienda Ospedaliero Universitaria Pisana..
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7
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Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, Patti MG, Ribeiro U, Richter J, Swanstrom L, Tack J, Triadafilopoulos G, Markar SR, Salvador R, Faccio L, Andreollo NA, Cecconello I, Costamagna G, da Rocha JRM, Hungness ES, Fisichella PM, Fuchs KH, Gockel I, Gurski R, Gyawali CP, Herbella FAM, Holloway RH, Hongo M, Jobe BA, Kahrilas PJ, Katzka DA, Dua KS, Liu D, Moonen A, Nasi A, Pasricha PJ, Penagini R, Perretta S, Sallum RAA, Sarnelli G, Savarino E, Schlottmann F, Sifrim D, Soper N, Tatum RP, Vaezi MF, van Herwaarden-Lindeboom M, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Gittens S, Pontillo C, Vermigli S, Inama D, Low DE. The 2018 ISDE achalasia guidelines. Dis Esophagus 2018; 31:5087687. [PMID: 30169645 DOI: 10.1093/dote/doy071] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Achalasia is a relatively rare primary motor esophageal disorder, characterized by absence of relaxations of the lower esophageal sphincter and of peristalsis along the esophageal body. As a result, patients typically present with dysphagia, regurgitation and occasionally chest pain, pulmonary complication and malnutrition. New diagnostic methodologies and therapeutic techniques have been recently added to the armamentarium for treating achalasia. With the aim to offer clinicians and patients an up-to-date framework for making informed decisions on the management of this disease, the International Society for Diseases of the Esophagus Guidelines proposed and endorsed the Esophageal Achalasia Guidelines (I-GOAL). The guidelines were prepared according the Appraisal of Guidelines for Research and Evaluation (AGREE-REX) tool, accredited for guideline production by NICE UK. A systematic literature search was performed and the quality of evidence and the strength of recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Given the relative rarity of this disease and the paucity of high-level evidence in the literature, this process was integrated with a three-step process of anonymous voting on each statement (DELPHI). Only statements with an approval rate >80% were accepted in the guidelines. Fifty-one experts from 11 countries and 3 representatives from patient support associations participated to the preparations of the guidelines. These guidelines deal specifically with the following achalasia issues: Diagnostic workup, Definition of the disease, Severity of presentation, Medical treatment, Botulinum Toxin injection, Pneumatic dilatation, POEM, Other endoscopic treatments, Laparoscopic myotomy, Definition of recurrence, Follow up and risk of cancer, Management of end stage achalasia, Treatment options for failure, Achalasia in children, Achalasia secondary to Chagas' disease.
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Affiliation(s)
- G Zaninotto
- Department of Surgery and Cancer, Imperial College, London, UK
| | - C Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland, Ireland
| | - G Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - M Costantini
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - M K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - J E Pandolfino
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M G Patti
- Department of Medicine and Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - U Ribeiro
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - J Richter
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - L Swanstrom
- Institute of Image-Guided Surgery, Strasbourg, France; Interventional Endoscopy and Foregut Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - J Tack
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - G Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford Esophageal Multidisciplinary Program in Innovative Research Excellence (SEMPIRE), Stanford University, Stanford, California, USA
| | - S R Markar
- Department of Surgery and Cancer, Imperial College, London, UK
| | - R Salvador
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - L Faccio
- Division of Surgery, Padova University Hospital, Padova, Italy
| | - N A Andreollo
- Faculty of Medical Science, State University of Campinas, Campinas, São Paulo, Brazil
| | - I Cecconello
- Digestive Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - G Costamagna
- Digestive Endoscopy Unit, A. Gemelli Hospital, Catholic University, Rome, Italy
| | - J R M da Rocha
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - E S Hungness
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - P M Fisichella
- Department of Surgery, Brigham and Women's Hospital and Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - K H Fuchs
- Department of Surgery, AGAPLESION-Markus-Krankenhaus, Frankfurt, Germany
| | - I Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - R Gurski
- Department of Surgery, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - F A M Herbella
- Department of Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - R H Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, Australia
| | - M Hongo
- Department of Medicine, Kurokawa Hospital, Taiwa, Kurokawa, Miyagi, Japan
| | - B A Jobe
- Esophageal and Lung Institute, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - P J Kahrilas
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - K S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - D Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - A Moonen
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - A Nasi
- Digestive Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - P J Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; Department of Pathophysiology and Transplantation; Università degli Studi, Milan, Italy
| | - S Perretta
- Institute for Image Guided Surgery IHU-Strasbourg, Strasbourg, France
| | - R A A Sallum
- Department of Gastroenterology, Division of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - G Sarnelli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - E Savarino
- Department of Surgical, Oncological and Gastroenterologica Sciences, University of Padua, Padua, Italy
| | - F Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - D Sifrim
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - N Soper
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - R P Tatum
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - M F Vaezi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - M van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Vanuytsel
- Department of Chronic Diseases, Metabolism and Ageing (Chrometa), Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - M F Vela
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - D I Watson
- Department of Surgery, Flinders University, Adelaide, Australia
| | - F Zerbib
- Department of Gastroenterology, University of Bordeaux, Bordeaux, France
| | - S Gittens
- ECD Solutions, Atlanta, Georgia, USA
| | - C Pontillo
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - S Vermigli
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - D Inama
- ALMA (Association of patients with achalasia, ONLUS), Naples, Italy
| | - D E Low
- Department of Thoracic Surgery Virginia Mason Medical Center, Seattle, Washington, USA
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Dallemagne B, Quero G, Lapergola A, Guerriero L, Fiorillo C, Perretta S. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia 2017; 22:909-919. [PMID: 29177588 DOI: 10.1007/s10029-017-1706-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Giant paraesophageal hernias (GPEH) are relatively uncommon and account for less than 5% of all primary hiatal hernias. Giant Secondary GPEH can be observed after surgery involving hiatal orifice opening, such as esophagectomy, antireflux surgery, and hiatal hernia repair. Surgical treatment is challenging, and there are still residual controversies regarding the laparoscopic approach, even though a reduced morbidity and mortality, as well as a shorter hospital stay have been demonstrated. METHODS A Pubmed electronic search of the literature including articles published between 1992 and 2016 was conducted using the following key words: hiatal hernia, paraesophageal hernias, mesh, laparoscopy, intrathoracic stomach, gastric volvulus, diaphragmatic hernia. RESULTS Given the risks of non-operative management, GPEH surgical repair is indicated in symptomatic patients. Technical steps for primary hernia repair include hernia reduction and sac excision, correct repositioning of the gastroesophageal junction, crural repair, and fundoplication. For secondary hernias, the surgical technique varies according to hernia type and components and according to the approach used during the first surgery. There is an ongoing debate regarding the best and safest method to close the hiatal orifice. The laparoscopic approach has demonstrated a lower postoperative morbidity and mortality, and a shorter hospital stay as compared to the open approach. A high recurrence rate has been reported for primary GPEH repair. However, recent studies suggest that recurrence does not reduce symptomatic outcomes. CONCLUSIONS The laparoscopic treatment of primary and secondary GPEH is safe and feasible in elective and emergency settings, especially in high-volume centers. The procedure is still challenging. The main steps are well defined. However, there is still room for improvement to lower the recurrence rate.
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Affiliation(s)
- B Dallemagne
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. .,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - G Quero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - A Lapergola
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - L Guerriero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - C Fiorillo
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - S Perretta
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
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9
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Ignat M, Vix M, Imad I, D'Urso A, Perretta S, Marescaux J, Mutter D. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg 2016; 104:248-256. [DOI: 10.1002/bjs.10400] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Robust data on quality of life (QoL) after different techniques of bariatric surgery are sparse. This RCT compared excess weight loss (EWL) and QoL after sleeve gastrectomy versus Roux-en-Y gastric bypass (RYGB).
Methods
Obese patients were assigned randomly to RYGB or sleeve gastrectomy. The primary outcome measure was EWL. Secondary outcomes included QoL, co-morbidity, adverse events, vitamin and glycolipid status. QoL was assessed before and annually after surgery, using the Moorehead–Ardelt Quality of Life Questionnaire II (M-A-QoLQII) and Gastrointestinal Quality of Life Index (GIQLI).
Results
One hundred patients were enrolled, 45 in the RYGB group and 55 in the sleeve gastrectomy group. Mean postoperative EWL at 1, 2, 3 and 5 years was 80·4, 79·8, 83·0 and 74·8 per cent respectively after RYGB, and 83·0, 77·8, 66·3 and 65·1 per cent after sleeve gastrectomy (P = 0·017). Mean M-A-QoLQII score before surgery and at 1, 2, 3 and 5 years after operation was 0·5, 1·6, 1·7, 2·1 and 1·4 respectively after RYGB, and 0·3, 1·7, 1·5, 1·5 and 1·2 after sleeve gastrectomy. Mean GIQLI score before and at 1, 2, 3, 5 years after RYGB was 96·4, 113·8, 113·3, 113·4, 111·7, compared with 90·7, 113·9, 114·5, 113·1 and 113·0 for sleeve gastrectomy. The improvement was significant compared with preoperative values (P < 0·001 for M-A-QoLQII and GIQLI), with no difference between groups (P = 0·418 and P = 0·323 respectively). RYGB resulted in higher readmission rates (P = 0·002) and length of hospital stay (P = 0·006) than sleeve gastrectomy.
Conclusion
RYGB and sleeve gastrectomy resulted in equivalent, long-standing QoL improvement. RYGB resulted in more stable weight loss but was associated with higher readmission rates. Registration number: NCT02475590.
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Affiliation(s)
- M Ignat
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - M Vix
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | | | - A D'Urso
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - S Perretta
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - J Marescaux
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - D Mutter
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
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de Ruijter V, Halvax P, Dallemagne B, Swanström L, Marescaux J, Perretta S. The Business Engineering Surgical Technologies (BEST) teaching method: incubating talents for surgical innovation. Surg Endosc 2014; 29:48-54. [PMID: 24993171 DOI: 10.1007/s00464-014-3652-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/26/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Technological innovation in surgical science and healthcare is vital and calls for close collaboration between engineering and surgery. To meet this objective, BEST was designed as a free sustainable innovative teaching method for young professionals, combining surgery, engineering, and business in a multidisciplinary, high-quality, low-cost, and learning-by-doing philosophy. AIMS This paper reviews the initial outcomes of the program and discusses lessons learned and future directions of this innovative educational method. METHODS BEST educational method is delivered in two parts: the first component consisting of live streaming or pre-recorded online lectures, with an interdisciplinary profile focused on surgery, engineering, and business. The second component is an annual 5-day on-site course, organized at IRCAD-IHU, France. The program includes workshops in engineering, entrepreneurship team projects, and in-depth hands-on experience in laparoscopy, robotic surgery, interventional radiology, and flexible endoscopy with special emphasis on the interdisciplinary aspect of the training. A panel of surgeons, engineers, well-established entrepreneurs, and scientists assessed the team projects for potential patent application. RESULTS From November 2011 till September 2013, 803 individual and institutional users from 79 different countries attended the online course. In total, 134 young professionals from 32 different countries applied to the onsite course. Sixty participants were selected each year for the onsite course. In addition, five participants were selected for a web-based team. Thirteen provisional patents were filed for the most promising projects. CONCLUSION BEST proved to be a global talent incubator connecting students to high-quality education despite institutional and economical boundaries. Viable and innovative ideas arose from this revolutionary approach which is likely to spin-off significant technology transfer and lead the way for future interdisciplinary hybrid surgical education programs and career paths.
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Affiliation(s)
- V de Ruijter
- IRCAD-IHU, University Hospital of Strasbourg, Strasbourg, France,
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11
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Mutter D, Dallemagne B, Perretta S, Vix M, Leroy J, Pessaux P, Marescaux J. Innovations in minimally invasive surgery: lessons learned from translational animal models. Langenbecks Arch Surg 2013; 398:919-23. [PMID: 24037252 DOI: 10.1007/s00423-013-1115-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/02/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE Animal models are key elements of surgical research and promotion of new techniques. Inanimate models, anatomical specimens, and living animals are all necessary to solve the various problems encountered by the advent of a new surgical technique. The development of Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures is a representative model. METHODS Over 400 experimental procedures were performed in inanimate models, ex vivo tissues and animals to solve all problems faced by the development of NOTES surgery: peritoneal access, gastrotomy closure, exposure, retraction, dissection as well as education to start this new procedure. RESULTS The successive use of all models allows to identify the ideal solution for each problem and to precisely define the safest and most reliable option to apply the new technique in patients. It allowed to perform the first transvaginal and transgastric cholecystectomy in patients in a safe way. CONCLUSION Animal experimentation remains necessary as even sophisticated computer-based solutions are unable to model all interactions between molecules, cells, tissues, organisms, and their environment. Animal research is required in many areas to validate new technologies, develop training, let alone its major goal (namely to avoid using patients for experimentation) which is to be the first "model" for the surgeon.
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Affiliation(s)
- D Mutter
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, IHU, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France,
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12
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Callari C, Perretta S, Diana M, Dagostino J, Dallemagne B, Marescaux J. Multimedia manuscript. Thoracoscopic management of chylothorax after esophagectomy. Surg Endosc 2011; 26:1160. [PMID: 22083323 DOI: 10.1007/s00464-011-1988-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 09/30/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chylothorax after esophagectomy is a potentially life-threatening complication, with a reported incidence rate of 1-4%. Two cases of postoperative chylothorax successfully managed thoracoscopically are reported. METHODS In case 1, a 61-year-old man presenting with an adenocarcinoma of the lower esophagus underwent laparoscopic transhiatal esophagectomy after neoadjuvant chemotherapy. The thoracic duct was identified, and no obvious leaks were detected. The thoracic drain was removed on postoperative day (POD) 6, and chest X-rays were normal. The patient was discharged on POD 10. On POD 20, he was readmitted for acute cardiopulmonary distress. Computed tomography scan showed a massive right collection. After insertion of a chest tube, 8 l of chylous fluid were drained. Once hemodynamic stabilization had been established, the patient was scheduled for surgery. In case 2, a 54-year-old woman presenting with esophageal stenosis after caustic injury refractory to balloon dilation and stenting underwent esophagectomy. Mediastinal dissection was difficult due to fibrotic reaction. On POD 2, the patient presented with a massive chylothorax. In both cases, three trocars were inserted in the right pleural cavity. An incomplete lateral injury of the thoracic duct was found in case 1, and a complete transection proximal to the cervical anastomosis next to the left subclavian was found in case 2. Clips and sutures were used first to seal the duct. Fibrin glue was applied to reinforce the closure. A chest tube was left in place. RESULTS The operative time was 60 min in case 1 and 55 min in case 2. The chylothorax did not recur, although the postoperative course was longer in case 2 due to associate comorbidities. CONCLUSIONS The thoracic duct is exposed to injuries during esophagectomies, especially in cases of cancer and postcaustic injuries, leading to fibrotic reaction of the surrounding tissue. Early and delayed chylothorax can be managed efficiently by a thoracoscopic approach replicating the sealing techniques used in thoracotomy.
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Affiliation(s)
- C Callari
- IRCAD, Department of Endocrine and Digestive Surgery, University of Strasbourg, Strasbourg, France.
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13
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Dallemagne B, Arenas Sanchez M, Francart D, Perretta S, Weerts J, Markiewicz S, Jehaes C. Long-term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg 2011; 98:1581-7. [PMID: 21710482 DOI: 10.1002/bjs.7590] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND Surgery for failed antireflux procedures is technically more demanding than primary fundoplication. The success rate does not equal that of the primary procedures. This retrospective analysis aimed to assess long-term subjective and objective outcomes in patients who underwent laparoscopic surgery for fundoplication failure. METHODS Objective and subjective outcomes were assessed by radiological and endoscopic methods, symptom questionnaire and quality-of-life index at a minimum follow-up of 12 (mean 75·8) months. RESULTS The study included 129 consecutive patients who had laparoscopic redo surgery after fundoplication had failed. The most frequent patterns of failure were hiatal herniation (50 patients) and slippage (45). Resolution of the symptoms that led to redo surgery was achieved in 27 of 37 and 11 of 16 patients operated for recurrence and for dysphagia respectively. Objective failure was demonstrated in 16 of 39 patients with herniation and six of 22 with slippage. Seven patients underwent an additional surgical procedure. CONCLUSION Long-term assessment of objective and subjective results after laparoscopic repair for failed fundoplication revealed a high failure rate that increased with the length of follow-up. Unexpected and untreated oesophageal shortening may be responsible for this failure rate.
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Affiliation(s)
- B Dallemagne
- Department of Digestive and Endocrine Surgery and Institut de Recherche Contre les Cancers de l'Appareil Digestif, University Hospital of Strasbourg, Strasbourg, France.
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Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux J. Transvaginal specimen extraction in colorectal surgery: current state of the art. Colorectal Dis 2011; 13:e104-11. [PMID: 21564461 DOI: 10.1111/j.1463-1318.2011.02599.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The expected benefit of transvaginal specimen extraction is reduced incision-related morbidity. OBJECTIVES A systematic review of transvaginal specimen extraction in colorectal surgery was carried out to assess this expectation. SEARCH STRATEGY The following keywords, in various combinations, were searched: NOSE (natural orifices specimen extraction), colorectal, colon surgery, transvaginal, right hemicolectomy, left hemicolectomy, low anterior resection, sigmoidectomy, ileocaecal resection, proctocolectomy, colon cancer, sigmoid diverticulitis and inflammatory bowel diseases. SELECTION CRITERIA SELECTION CRITERIA included large bowel resection with transvaginal specimen extraction, laparoscopic approach, human studies and English language. Exclusion criteria were experimental studies and laparotomic approach or local excision. All articles published up to February 2011 were included. RESULTS Twenty-three articles (including a total of 130 patients) fulfilled the search criteria. The primary diagnosis was colorectal cancer in 51% (67) of patients, endometriosis in 46% (60) of patients and other conditions in the remaining patients. A concurrent gynaecological procedure was performed in 17% (22) of patients. One case of conversion to laparotomy was reported. In two patients, transvaginal extraction failed. In left- and right-sided resections, the rate of severe complications was 3.7% and 2%, respectively. Two significant complications, one of pelvic seroma and one of rectovaginal fistula, were likely to have been related to transvaginal extraction. The degree of follow up was specified in only one study. Harvested nodes and negative margins were adequate and reported in 70% of oncological cases. CONCLUSION Vaginal extraction of a colorectal surgery specimen shows potential benefit, particularly when associated with a gynaecological procedure. Data from prospective randomized trials are needed to support the routine use of this technique.
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Affiliation(s)
- M Diana
- IRCAD/EITS, University Hospital of Strasbourg, Strasbourg, France
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15
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Abstract
BACKGROUND Clinical application of natural orifice transluminal endoscopic surgery is under investigation. Preliminary results of transvaginal cholecystectomy in women and associated technical issues have been described. The technique and initial results of hybrid transgastric cholecystectomy are now reported. METHODS Five patients aged 18-60 years with uncomplicated cholelithiasis underwent transgastric cholecystectomy in a prospective intention-to-treat study that included the option of transparietal assistance (hybrid technique) if needed. The gastrotomy was created under laparoscopic guidance through a 5-mm umbilical trocar, which also served to expose the gallbladder, clip the cystic pedicle and close the gastrotomy. Cholecystectomy was carried out using flexible instruments through the endoscope, alone or in combination with laparoscopic instruments. RESULTS The procedure was successful in all patients with a median operating time of 150 (range 120-180) min. Transparietal assistance was necessary in all patients. There were no intraoperative or postoperative complications. CONCLUSION Until technical issues have been resolved, a hybrid procedure with liberal use of transparietal assistance is the safest and most efficient approach for transgastric cholecystectomy. Further studies are essential to evaluate the role of this new approach.
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Affiliation(s)
- B Dallemagne
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
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Affiliation(s)
- B Dallemagne
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, and Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), 67091 Strasbourg, France.
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Perretta S, Allemann P, Dallemagne B, Marescaux J. Natural orifice transluminal endoscopic surgery (N.O.T.E.S.) for neoplasia of the chest and mediastinum. Surg Oncol 2009; 18:177-80. [DOI: 10.1016/j.suronc.2008.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cahill RA, Perretta S, Forgione A, Leroy J, Dallemagne B, Marescaux J. Multimedia article. Combined sentinel node biopsy and localized sigmoid resection entirely by natural orifice transluminal endoscopic surgery: a new challenge to the old paradigm. Dis Colon Rectum 2009; 52:725. [PMID: 19404081 DOI: 10.1007/dcr.0b013e31819a69af0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We demonstrate localized sigmoidectomy with sentinel node biopsy performed entirely via natural orifice transluminal endoscopic surgery in a porcine model (see Video, Supplemental Digital Content 1, http://links.lww.com/A1170). METHODS To perform transluminal endoscopic sentinel node biopsy in the sigmoid mesocolon, a conventional double-channel gastroscope created both the gastrotomy and pneumoperitoneum enabling peritoneoscopy. The sigmoid colon was exposed by an intracolonic magnet under extracorporeal control while intraluminal colonoscopy performed lymphatic mapping via submucosal injection of methylene blue dye. After searching the mesocolon for blue-stained lymph channels, the sentinel nodes were resected and retrieved by the intraperitoneal fiberscope. Immediate thereafter localized sigmoidectomy was performed via an additional transcolonic access just above the rectosigmoid junction. With the circular stapler anvil placed early into the proximal colon, mesenteric dissection and proximal transection were performed using conventional laparoscopic instruments worked through a long standard trocar passed transanally through the colotomy. The specimen was delivered per ano (pull-through technique) and the distal margin cross-stapled extracorporeally, including the colotomy within the specimen. Stapled intestinal anastomosis was fashioned by passing a circular stapler transanally (thus returning the rectal stump to its anatomic position) and mating it with the in situ anvil. The gastrotomy was closed as previously described. RESULTS The operative duration was 31.4 minutes and technical success was readily achieved. Patency and integrity of the anastomosis was confirmed by sigmoidoscopy. CONCLUSION Oncologically propitious surgery for germinal colonic neoplasia may be encompassed by natural orifice transluminal endoscopic surgery. This provocative proposal challenges the conventional treatment paradigm for early stage colonic neoplasia although much further validation of the concepts involved is required.
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Affiliation(s)
- R A Cahill
- Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD/EITS), Strasbourg, France.
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Abstract
Surgery of the adrenal glands has various approaches and remains technically challenging. Many different techniques have been used to decrease morbidity. The most important one is probably laparoscopy which has already quite dramatically improved clinical outcome. The second one is the introduction of posterior endoscopic approach (retroperitoneoscopy), which entirely preserves peritoneal integrity. This concept seems to us to be a fundamental in surgery of the retroperitoneum. Recently, new developments have emerged in the field of abdominal surgery. The most radical concept, known as Natural Orifice Transluminal Endoscopic Surgery (NOTES), consists of the introduction of both endoscope and working instruments through natural orifices in order to eliminate skin incisions and their associated morbidities. Although transperitoneal adrenalectomy has previously been reported in a porcine model, here we report our initial experiences of extra-peritoneal transvaginal NOTES approach of the retroperitoneum, focused on the field of adrenal surgery in both porcine and cadaver models. Whether clinical applications will ultimately be derived of this concept is still not clear certainly it raises new possibilities for interesting developments.
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Affiliation(s)
- P Allemann
- IRCAD-Institute, 1, Place de l'hôpital, 67091 Strasbourg, France.
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Zacharopoulou C, Nassif J, Perretta S, Dallemagne B, Marescaux J, Wattiez A. Exploration of Retroperitoneum by Notes Techniques. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nassif J, Zacharopoulou C, Perretta S, Dallemagne B, Marescaux J, Wattiez A. Retroperitoneal Lymphadenectomy by N.O.T.E.S Technique in Porcine Model: Feasibility and Survival Study. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cahill RA, Asakuma M, Perretta S, Dallemagne B, Marescaux J. Gastric lymphatic mapping for sentinel node biopsy by natural orifice transluminal endoscopic surgery (NOTES). Surg Endosc 2008; 23:1110-6. [PMID: 18813997 DOI: 10.1007/s00464-008-0124-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 06/25/2008] [Accepted: 07/24/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sentinel node biopsy is proposed as sufficiently reliable in determining the lymph node status of early gastric cancer to justify curtailed resection margins if negative. Its performance by natural orifice transluminal endoscopic surgery (NOTES) could therefore expand the patient cohort able to undergo solely endoscopic resection of their primary. METHODS A transvaginal NOTES technique was utilized in six pigs (mean weight 30 kg). The posterior colpotomy and pneumoperitoneum was created by a standard double-channel flexible videoendoscope which was then used to perform peritoneoscopy. Concomitant gastroscopy allowed selection of a site along the greater curvature for lymphatic mapping by submucosal injection of methylene blue (3 ml). Furthermore, torque upon this endoscope allowed the posterior surface of the stomach and retrogastric space to become accessible to the transvaginal endoscope. In surveying the mapping in vivo, the intraperitoneal scope could follow blue-stained efferent lymphatic channels to their first-order draining nodes (i.e., sentinel nodes). Conventional instruments worked down the scope's channels were then used to perform the excisional biopsy. At procedure end, the animals underwent immediate laparotomy to ensure the safety and adequacy of the procedure. RESULTS Each procedure was technically successful. Colpotomy, pneumoperitoneum, and peritoneoscopy were promptly achieved (mean 8 min). Post injection, blue efferent lymphatic channels were immediately appreciable in every animal. Five animals had sentinel nodes in their retropyloric region while the last mapped cephalad towards the esophagogastric junction. Two animals had alternative drainage channels identifying additional sentinel nodes. All blue nodes were dissected cleanly by the intraperitoneal scope and retrieved intact per vaginam. Mean lymphadenectomy time was 19 min. At laparotomy, there was no hematoma, ongoing hemorrhage, or visceral injury in any pig. There were no residual, missed stained nodes or channels. CONCLUSION NOTES sentinel node biopsy for the stomach is technically accomplishable in this experimental model. This proof of concept should encourage serious consideration of its applicability to clinical practice.
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Affiliation(s)
- R A Cahill
- Department of Surgery, IRCAD/EITS, Strasbourg, France.
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Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of most adrenal tumors. LA learning curve (LC) varies among surgeons and may be influenced by factors depending on surgeon, patient, and lesion peculiarities. The aim of this study was to evaluate the LC by multi-dimensional analysis. METHODS Between August 1994 and August 2005, 241 LA were performed in our department. Data were prospectively collected. The pre-operative variables evaluated were patient-related (age, gender, body mass index, co-morbidities) and disease-related (histology, size, and side of lesion). Level of experience of surgical team and surgical approach (anterior, flank, submesocolic routes) were evaluated as well. Flank approached and bilateral procedures were excluded, while submesocolic LA, were collected separately. Operating time (OpT), conversion rate (CR), intra-operative and post-operative complications were evaluated. Patient, surgeon, and procedure-related factors involved in LC were investigated by a multi-factorial logistic regression analysis. RESULTS Body mass index, side, size, histology, technology improvement, and experience of surgical team, evaluated through the progressive series of surgical procedures, were independent predictors of CR and OpT. The CR for right adrenalectomy was 3% (3 cases) compared to 4.2% for left side (6 cases). The submesocolic approach significantly influenced OpT, but not CR. Mean OpT for right and left LA was 83 and 109 min, respectively. Based on surgical experience increase, the OpT and CR flattened their curves, roughly at 30 and 40 procedures for right and left LA, respectively. Post-operative complications did not change considerably throughout the series. Readmission rate within 30 days was negligible. CONCLUSIONS Manifold factors may affect LC and outcome in LA. Their knowledge may support teaching activities as well as reducing conversion and complication rates.
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Affiliation(s)
- M Guerrieri
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, 60121 Ancona, Italy
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Cahill RA, Perretta S, Leroy J, Dallemagne B, Marescaux J. Lymphatic mapping and sentinel node biopsy in the colonic mesentery by Natural Orifice Transluminal Endoscopic Surgery (NOTES). Ann Surg Oncol 2008; 15:2677-83. [PMID: 18491192 DOI: 10.1245/s10434-008-9952-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/20/2008] [Accepted: 04/21/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Although intraluminal and transluminal techniques can achieve localized resection of early-stage alimentary tumours, they do not designate the status of the filtering mesenteric lymph nodes. Natural orifice transluminal endoscopic surgery (NOTES) may however effect sentinel node biopsy from within the peritoneum. METHODS A transgastric NOTES technique was utilized in six pigs. A conventional double-channel gastroscope created both the 12mm anterior gastrotomy and the pneumoperitoneum and enabled peritoneoscopy. The sigmoid colon was fully exposed by an intracolonic magnet under extracorporeal control. Colonoscopy facilitated submucosal injection of methylene blue dye (3 ml) at the apex of the sigmoid loop under direct transgastric vision. The mesocolon was searched for blue-stained lymph channels and nodes, the latter being resected and retrieved by the intraperitoneal endoscope. At procedure end, three pigs underwent immediate laparotomy for scrutiny of the operation site while three were survived for forensic laparotomy on postoperative day 14. RESULTS Each procedure was a technical success. Gastrotomy, pneumoperitoneum, peritoneoscopy and sigmoid exposure were promptly achieved (mean 9.2 min). Post-injection, blue lymphatics identifying specific nodes were immediately appreciable and these could be dissected cleanly and retrieved intact per oram. Mean lymphadenectomy time was 19 (range 12-32) min. All survival animals thrived during convalescence. At laparotomy, there was neither mesentery penetration, bowel ischemia nor mesenteric hematoma/hemorrhage in any pig and no residual blue stained nodes in those sacrificed early. CONCLUSION Sentinel node biopsy can be performed without abdominal wall transgression. Thus potentially the oncological proprietary of local resectional techniques may be augmented while preserving their ideals and dividends.
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Affiliation(s)
- R A Cahill
- Department of Surgery, IRCAD/EITS, Strasbourg, 67000, France.
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Foddis R, Vivaldi A, Filiberti R, Puntoni R, Mutti L, Ambrosino N, Chella A, Guglielmi G, Gattini V, Buselli R, Perretta S, Cristaudo A. [Serum mesothelin dosages in follow-up of previously exposed workers]. G Ital Med Lav Ergon 2007; 29:342-345. [PMID: 18409716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
High dosages of Serum Mesothelin have been demonstrated to be significantly associated to Pleural Malignant Mesothelioma. We recently demonstrated that Serum Mesothelin may be clinically helpful both for diagnostic and prognostic purposes, with the best cut-off corresponding to 1 nM. We also discovered that high levels of Serum Mesothelin are significantly associated to Lung Cancer. The usefulness of this marker in secondary prevention has been suggested, though never demonstrated. We therefore started a long-term prospective cohort study including previously asbestos-exposed workers. These subjects periodically underwent both radiological tests and serum mesothelin dosages. As a mid-term goal of this longitudinal study we decided to check the variability of mesothelin dosages, comparing baseline and follow-up values, as well as the possible correlation with age, duration of exposure, smoking, any abnormality of respiratory functional tests (RFT) and/or radiological tests. At baseline, Mesothelin mean value was 0.66 +/- 0.4 (range 0.08-2.2 nM). Both age (p = 0.04) and abnormal thoracic TC (p = 0.04) were significantly correlated with increased serum mesothelin levels and increasing age. No association was found between baseline mesothelin levels and duration of asbestos exposure (p = 0.5), smoking habits (p = 0.2), abnormal RFT, DLCO (carbon monoxide diffusing capacity) or thoracic X-ray. No significant variation was observed between mesothelin values at baseline and at follow-up (p = 0.2).
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Affiliation(s)
- R Foddis
- Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Università di Pisa.
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Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D'Ambrosio G, Lezoche G, Perretta S, Lezoche E. Thirteen years' experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc 2006; 21:34-40. [PMID: 17111284 DOI: 10.1007/s00464-005-0286-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 04/03/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the effectiveness and long-term results of laparoscopic transcystic common bile duct exploration (TC-CBDE). METHODS Ductal stones were present in 344 of 3212 patients (10.7%) who underwent laparoscopic cholecystectomy (LC). The procedure was completed laparoscopically in 329 patients (95.6%), with TC-CBDE performed in 191 patients (58.1%) who are the object of this study, or with a transverse choledochotomy in 138 cases (41.9%). RESULTS Biliary drainage was employed in 71 of 191 cases (37.2%). Major complications occurred in 10 patients (5.1%), including retained stones in 6 (3.1%). Mortality was nil. No patients were lost to follow-up (median: 118.0 months; range: 17.6-168 months). No signs of bile stasis, no recurrent ductal stones and no biliary stricture were observed. At present 182 patients are alive with no biliary symptoms; 9 have died from unrelated causes. CONCLUSIONS Long-term follow-up after laparoscopic TC-CBDE proved its effectiveness and safety for single-stage management of gallstones and common bile duct stones.
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Affiliation(s)
- A M Paganini
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Via Conca, 60020, Ancona, Italy
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Perretta S, Campagnacci R, Guerrieri M, Paganini AM, De Sanctis A, Sarnari J, Rimini M, Lezoche E. Sub-mesocolic access in laparoscopic left adrenalectomy. Surg Endosc 2005; 19:977-80. [PMID: 15920687 DOI: 10.1007/s00464-004-2233-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2004] [Accepted: 01/17/2005] [Indexed: 01/28/2023]
Abstract
BACKGROUND This article reports an alternative laparoscopic access to left adrenal gland. METHODS From January 1994 to August 2004, 209 laparoscopic adrenalectomies were performed in our Department. Indications were Conn adenoma (55 cases), incidentaloma (64), Cushing adenoma (45), pheochromocytoma (32), adreno-genital syndrome (two), mielolipoma (two), and metastatic mass(nine). Of 209, in 12 cases the left adrenalectomy was performed through a submesocolic access (seven pheochromocytoma, two incidentaloma, two Cushing adenoma, one Conn adenoma,). The identification and closure of the adrenal vein with minimal gland manipulation resulted the main benefit of this approach. Moreover, the adrenalectomy was performed with minimal anatomical dissection. RESULTS No mortality or major complications occurred. During the operation, the blood pressure and cardiac rhythm were significantly more stable, in the group of patients who underwent a left adrenalectomy by the submesocolic approach compared to the anterior or flank lateral transperitoneal group. CONCLUSIONS Left adrenal lesions, as selected cases of pheochromocytoma, can be safely treated by laparoscopic submesocolic access.
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Affiliation(s)
- S Perretta
- Clinica di Chirurgia Generale e Metodologia Chirurgica-Ospedali Riuniti, 60121, Ancona, Italy
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Campagnacci R, Perretta S, Guerrieri M, Paganini AM, De Sanctis A, Ciavattini A, Lezoche E. Laparoscopic colorectal resection for endometriosis. Surg Endosc 2005; 19:662-4. [PMID: 15759190 DOI: 10.1007/s00464-004-8710-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Accepted: 11/16/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND The rectosigmoid colon is affected by deep pelvic endometriosis in 3-37% of cases. In the past, treatment of the affected gastrointestinal tract generally required conversion to conventional surgery. We describe our experience with complete laparoscopic management of deep pelvic endometriosis with bowel involvement. METHODS From March 1995 to March 2003, 29 consecutive patients with endometriosis requiring laparoscopic intervention were evaluated. In seven patients (24%) colorectal involvement was identified prior to the operation. A low anterior resection was performed in four patients (57%) and a sigmoid resection in three (43%). In all cases, colonoscopy showed a normal mucosa. In all cases, treatment consisted of resection of the bowel involved together with the excision of all other implants. Data analysis included age, previous abdominal operations, previous history of endometriosis, operative time, conversion rate, complications, length of stay, and pain relief. RESULTS There were seven patients with colorectal involvement whose median age was 32.8 years (range, 28-40), with a history of previous abdominal operation in two (28%). Preoperative symptoms were as follow: dysmenorrea in four patients (57%), dyspareunia in four (57%), pelvic pain in seven (100%), rectal bleeding in one (14%), and tenesmus in five (71%). Mean operative time was 190 min (range, 165-230). Length of stay was 8.3 days (range, 7-11). There were no anastomotic leak and no major postoperative complication. One patient had temporary urinary retention. At a median follow-up of 38.7 months (range, 1-84), complete relief of pelvic symptoms was achieved in five patients (71%), and there was improvement in one patient. In one patient complaining of persistent pain, a new colonic implant was diagnosed two years after the surgery requiring reoperation. CONCLUSIONS The results show that provided that the surgeon is highly skilled in laparoscopy, laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement is feasible and effective in nearly all patients.
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Affiliation(s)
- R Campagnacci
- Department of General Surgery, University of Ancona, Umberto I Hospital, Largo Cappelli 1, 60121, Ancona, Italy. f.feliciotti@ popcsi.unian.it
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Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, D'Ambrosio G, Lezoche E. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 2003; 17:1530-5. [PMID: 12874687 DOI: 10.1007/s00464-002-8874-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2002] [Accepted: 03/05/2003] [Indexed: 01/03/2023]
Abstract
BACKGROUND Controversy continues to surround laparoscopic rectal resection for malignancy. A longer follow-up period is required to evaluate the long-term efficacy of the procedure and its impact on survival. Furthermore, no data from ongoing randomized controlled trials are yet available. The aims of this study were to compare long-term outcomes for unselected patients undergoing either laparoscopic or open rectal resection for cancer. METHODS A series of 124 unselected consecutive patients with rectal cancer, who underwent surgery by the same surgical team, have been included in this study. Patients with T1N0 tumors underwent local excision, and emergency cases were excluded from the study. Written consent was submitted by each patient, and inclusion in either group (laparoscopic or open) was left to the patient's choice. The laparoscopic approach was chosen by 81 patients, and 43 patients chose open surgery. All the patients underwent preoperative radiotherapy (5,040 cGy), performed in selected cases with chemotherapy (for patients younger than 70 years). The following parameters were compared between the two groups: length of the surgical specimen, clearance of the margins of the specimen, number of lymph nodes identified, local recurrence rate, incidence of distant metastases, and survival probability analysis. The mean follow-up period for both groups was 43.8 months (range, l-9 years). RESULTS We performed 60 laparoscopic and 27 open anterior resections, as well as 21 laparoscopic and 16 open abdomino perineal resections, respectively. No mortality occurred in either group. The mean length of the resected specimens was 24.3 cm in the laparoscopic group and 23.8 cm in the open group ( p = 0.47). The mean tumor-free margin was 3.0 cm in the laparoscopic group and 2.8 cm in the open group ( p = 0.57), and the mean number of lymph nodes identified was 10.3 in the laparoscopic group and 9.8 in the open group ( p = 0.63). Of the 124 patients, 86 (52 laparoscopic and 34 open) were included in out study. We excluded patients who underwent a palliative resection (6 laparoscopic and 6 open patients) or conversion to open surgery ( n = 10) and patients who had undergone surgery in the past year ( n = 16). One laparoscopic patient was lost to follow-up evaluation, whereas three laparoscopic patients and one open patient died of causes not related to cancer. No wound recurrence was observed. The local recurrence rate after laparoscopic resection was 20.8%, as compared with 16.6% after open resection ( p = 0.687). Distant metastases occurred in 18.2% of the patients in the laparoscopic group, as compared with 21.2% in the open group ( p = 0.528). Cumulative survival probability was 0.709 after laparoscopic resection after LR and 0.606 after open resection ( p = 0.162), whereas for Dukes' stages A, B, and C in the laparoscopic group versus the open group, it was 0.875 vs 0.889 ( p = 0.392), 0.722 vs 0.584 ( p = 0.199), and 0.500 vs 0.417 ( p = 0.320), respectively. At this writing 20 laparoscopic patients (62.5%) and 20 open patients (60.6%) are disease free ( p = 0.623). CONCLUSIONS Oncologic surgical principles were respected. Long-term outcome after laparoscopic resection of rectal cancer was comparable with that after conventional resection. We should wait to draw conclusive scientific statements until the completion of ongoing international randomized controlled trials.
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Affiliation(s)
- F Feliciotti
- Department of General Surgery, University of Ancona, Umberto I Hospital, Via Conca, 60020 Ancona, Italy
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Patti MG, Perretta S, Fisichella PM, D'Avanzo A, Galvani C, Gorodner V, Way LW. Laparoscopic antireflux surgery: preoperative lower esophageal sphincter pressure does not affect outcome. Surg Endosc 2003; 17:386-9. [PMID: 12436239 DOI: 10.1007/s00464-002-8934-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2002] [Accepted: 08/09/2002] [Indexed: 12/17/2022]
Abstract
BACKGROUND Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. METHODS We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22%); group B (LES pressure, 7-13 mmHg; 178 patients; 64%); group C (LES pressure, >or=14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 +/- 22 months. RESULTS There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C. CONCLUSIONS We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.
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Affiliation(s)
- M G Patti
- Department of Surgery and Swallowing Center, University of California, 533 Parnassus Avenue, Room U-122, San Francisco, CA 94143-0788, USA.
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Patti MG, Molena D, Fisichella PM, Perretta S, Way LW. Gastroesophageal reflux disease (GERD) and chest pain. Results of laparoscopic antireflux surgery. Surg Endosc 2002; 16:563-6. [PMID: 11972188 DOI: 10.1007/s00464-001-8220-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2001] [Accepted: 11/08/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopic fundoplication cures heartburn and regurgitation in patients with gastroesophageal reflux disease (GERD) but its effect on the chest pain that is also experienced by some patients is less clear. Confusion stems from the fact that it is difficult to determine preoperatively whether the chest pain is actually caused by the reflux. Therefore, we designed a study in patients with GERD and chest pain that would assess the value of pH monitoring in establishing a correlation between the symptom and the disease, the predictive value of pH monitoring on the results of surgical treatment, and the outcome of laparoscopic fundoplication on chest pain in patients with GERD. METHODS Of 487 patients who underwent laparoscopic fundoplication for GERD at our institution between October 1992 and July 2000, 165 (34%) complained of chest pain in addition to heartburn and regurgitation. Their symptoms had been present for an average of 118 months. The pH monitoring tracings were analyzed for a correlation between episodes of reflux and chest pain. The mean length of follow-up was 13 months. RESULTS Among the 165 patients with chest pain, the relationship between pain and reflux during pH monitoring was as follows: 39 patients (group A) experienced no chest pain during the study; in 28 patients (group B), chest pain correlated with reflux in <40% of instances; in 98 patients (group C), chest pain correlated with reflux in ?40% of instances. Chest pain improved postoperatively in 65% of group A patients, 79% of group B patients, and 96% of group C patients (group C vs A and B: p <0.05). Heartburn and regurgitation resolved or improved in 97% and 95% of patients, respectively. CONCLUSIONS These data show that pH monitoring helped to identify a relationship between chest pain and reflux; and when the two coincided, the chest pain was relieved by antireflux surgery.
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Affiliation(s)
- M G Patti
- Department of Surgery, University of California-San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143-0788, USA
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Feliciotti F, Campagnacci R, Perretta S, Paganini AM, Guerrieri M, Tamburini A, De Sanctis A, Lezoche E. Laparoscopic resection of a juxtaglomerular cell tumor of the right kidney. Surg Endosc 2002; 16:539. [PMID: 11928050 DOI: 10.1007/s00464-001-4177-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2001] [Accepted: 07/03/2001] [Indexed: 11/27/2022]
Abstract
Juxtaglomerular cell tumor is an extremely rare neoplasm of the kidney that causes blood hypertension. A 45-year-old man with persistent hypertension was referred to our department because of a solid mass of unclear origin (kidney? colon?) located in the right mesorenal region that had been detected by Computed tomography (CT) scan, ultrasonography, and colonoscopy. Serum levels of renin, plasma renin activity (PRA), and aldosterone were all normal. Operatively, four 10/12-mm ports were placed, ultrasonography confirmed a well-encapsulated lesion of the kidney. Ultrasonic shears and cautery were used to resect the lesion, including 5 mm of free renal tissue. Postoperatively, a prompt normalization of blood pressure was observed. The pathological findings showed a juxtaglomerular cell tumor. The definitive diagnosis of juxtaglomerular cell tumor is made on the basis of laboratory findings, and imaging studies, Its definitive treatment is surgical excision which can be accomplished successfully with minimally invasive surgery.
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Affiliation(s)
- F Feliciotti
- Department of General Surgery, University of Ancona, "Umberto I" Hospital, Largo Cappelli 1, 60121 Ancona, Italy
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Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli M, Bonjer J, Miccoli P. Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 2002; 16:96-9. [PMID: 11961614 DOI: 10.1007/s004640090043] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2000] [Accepted: 11/23/2000] [Indexed: 10/28/2022]
Abstract
BACKGROUND Three approaches are currently used for endoscopic adrenalectomy-the lateral (transperitoneal), the posterior (retroperitoneal), and the anterior (transperitoneal). Both the lateral and posterior approaches are performed with the patient placed in the flank decubitus position; in the anterior approach the patient is supine. This study was designed to compare these three types of access in a relatively large series of patients undergoing adrenalectomy at three different institutions. METHODS Laparoscopic adrenalectomy was performed in 216 patients with a variety of adrenal disorders, including 66 patients with Conn's syndrome, 55 with incidentaloma, 58 with Cushing's syndrome, 33 with pheochromocytoma, two with virilizing adrenogenital syndrome, and two with other lesions. Seventy-two adrenalectomies were performed using the lateral access, 67 via the posterior approach, and 77 via the transperitoneal anterior approach. There were 111 right and 105 left lesions. RESULTS One patient in the lateral access group and three patients in the posterior group required conversion to open surgery. No conversions were needed in the anterior group. The learning curve was statistically significant only in the anterior access group. In both of the transperitoneal approaches (lateral and anterior), a statistically significant correlation was found between the operative time and the patient's body mass index (BMI). The postoperative hospital stay and time needed to return to normal activities were similar for the three groups. One patient who underwent retroperitoneal adrenalectomy for Cushing' disease died in the postoperative period of Candida sepsis and peritonitis. CONCLUSIONS The anterior access route requires that the surgeon be skilled in advanced laparoscopic surgery. Both of the transperitoneal approaches (anterior and lateral) are suitable to remove larger adrenal masses. The posterior access may represent a better option in obese patients or in cases with small lesions.
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Affiliation(s)
- E Lezoche
- II Clinica Chirurgica, Universita "La Sapienza", Policlinico Umberto I, Viale del Policlinico, 00161 Roma, Italy.
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Abstract
All patients who are candidates for laparoscopic fundoplication for the treatment of gastroesophageal reflux disease (GERD) should have a symptom review, barium swallow imaging, endoscopy, esophageal manometry, and ambulatory pH monitoring. The presence of a typical primary symptom, an abnormal 24-hour pH score, and a good response to acid-suppression therapy are predictive of a successful surgical outcome. The surgeon should be particularly wary of the following types of patients who may be referred for fundoplication but not have GERD: those who do not respond to proton pump inhibitors, those without esophagitis, those with only atypical symptoms, those in whom pH monitoring was done without previous manometry, and those with a borderline reflux score, severe vomiting, severe dysphagia and heartburn, unusual symptoms, severe depression, or morbid obesity.
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Affiliation(s)
- M G Patti
- Department of Surgery and Swallowing Center, University of California-San Francisco, 94143-0788, USA.
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Fisichella PM, Perretta S, Di Stefano A, Di Carlo I, La Greca G, Russello D, Latteri F. Chronic liver herniation through a right Bochdalek hernia with acute onset in adulthood. Ann Ital Chir 2001; 72:703-5. [PMID: 12061222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Congenital right diaphragmatic hernia of Bochdalek rarely occurs in adults and usually is asymptomatic. We report a right Bochdalek hernia with chronic liver herniation and intestinal malrotation in a 55-year old woman who presented with acute intestinal occlusion. The diagnosis required definitive confirmation by CT scan. With impending strangulation, emergency surgery through a thoracoabdominal approach resulted in an easy hernia repair and reduced the technical difficulties due to the intestinal malrotation.
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Affiliation(s)
- P M Fisichella
- Divisione Clinicizzata di Chirurgia d'Urgenza e Pronto Soccorso, Azienda Ospedaliera Catanizzaro, Catania.
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Patti MG, Albanese CT, Holcomb GW, Molena D, Fisichella PM, Perretta S, Way LW. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. J Pediatr Surg 2001; 36:1248-51. [PMID: 11479868 DOI: 10.1053/jpsu.2001.25786] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/PURPOSE In the past, surgical treatment in achalasia usually has been reserved for patients whose dysphagia does not respond to pneumatic dilatation. The success of minimally invasive myotomy, however, has resulted in a shift in practice in adult patients, whereby laparoscopic surgery is becoming preferred as primary treatment by most gastroenterologists and surgeons. The aim of this study was to assess the efficacy of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. METHODS Thirteen patients with esophageal achalasia (median age, 15 years; 6 boys and 7 girls; median duration of symptoms, 24 months) underwent laparoscopic Heller myotomy and Dor fundoplication between 1996 and 1999. Two patients had been treated previously by pneumatic dilatation, and 1 patient had received intrasphincteric Botulinum toxin injections. RESULTS Median duration of the operation was 130 minutes. The patients were fed after an average of 33 hours, and they all left the hospital within 2 days. At a median follow-up of 19 months, there was no residual dysphagia in any patient. CONCLUSIONS Laparoscopic Heller myotomy and Dor fundoplication were effective and safe for children with esophageal achalasia. Hospital stay and recovery time was short, and the functional results were excellent. These data support the notion that laparoscopic Heller myotomy should become the primary treatment of esophageal achalasia in children.
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Affiliation(s)
- M G Patti
- Department of Surgery, University of California, San Francisco, CA 94143-0788, USA
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Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 2001; 136:870-7. [PMID: 11485521 DOI: 10.1001/archsurg.136.8.870] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In the treatment of achalasia, surgery has been traditionally reserved for patients with residual dysphagia after pneumatic dilatation. The results of laparoscopic Heller myotomy have proven to be so good, however, that most experts now consider surgery the primary treatment. HYPOTHESIS The outcome of laparoscopic myotomy and fundoplication for achalasia is dictated by technical factors. SETTING University hospital tertiary care center. DESIGN Retrospective study. PATIENTS AND METHODS One hundred two patients with esophageal achalasia underwent laparoscopic Heller myotomy and Dor fundoplication. Fifty-seven patients had been previously treated by pneumatic dilatation or botulinum toxin. The design of the operation involved a 7-cm myotomy, which extended 1.5 cm onto the gastric wall, and a Dor fundoplication. Esophagrams, esophageal manometric findings, and video records of the procedure were analyzed to determine the technical factors that contributed to the clinical success or failure of the operation. MAIN OUTCOME MEASURE Swallowing status. RESULTS In 91 (89%) of the 102 patients, good or excellent results were obtained after the first operation. A second operation was performed in 5 patients to either lengthen the myotomy (3 patients) or take down the fundoplication (2 patients). Dysphagia resolved in 4 of these patients. The remaining 6 patients were treated by pneumatic dilatation, but dysphagia improved in only 1. At the conclusion of treatment, excellent or good results had been obtained in 96 (94%) of the 102 patients. CONCLUSIONS These data show that a Heller myotomy was unsuccessful in patients with an esophageal stricture; a short myotomy and a constricting Dor fundoplication were the avoidable causes of residual dysphagia; a second operation, but not pneumatic dilatation, was able to correct most failures; and that the identified technical flaws were eliminated from the last half of the patients in the series.
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Affiliation(s)
- M G Patti
- Department of Surgery, University of California, 533 Parnassus Ave, Room U-122, San Francisco, CA 94143-0788, USA.
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