20 research outputs found
Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia
Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures
Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia
Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures
Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry
Aims: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). Materials and Methods: Forty-six patients with typical symptoms of GERD, from March 2001 to November 2009, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by ourselves and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen′s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient′s evaluation of outcome and quality of life after surgery. Results: Relief of the primary symptom responsible for surgery was achieved in 85% of patients at a mean follow-up of 28 months. Thirty-nine patients were asymptomatic, 2 had minor gastrointestinal symptoms not requiring medical therapy, 3 patients had gastrointestinal symptoms requiring medical therapy/ Proton Pump Inhibitors and in 2 patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in 6 patients. Median hospital stay was 3 days, decreasing from 6 in the first 10 patients to 3 in the last 10 patients. Conclusions: Preoperative oesophageal manometry is not mandatory for laparoscopic fundoplication done in selected patients with typical symptoms of GERD and upper GI endoscopy suggestive of large hiatus hernia
Retrospective evaluation of patients of gastroesophageal reflux disease treated with laparoscopic Nissen's fundoplication
Aims: To evaluate retrospectively the outcome of laparoscopic
fundoplication in a cohort of patients with typical symptoms of
gastroesophageal reflux disease (GERD). Materials and Methods:
Forty-two patients with typical symptoms of GERD, who were operated for
laparoscopic Nissen's fundoplication from March 2001 to August 2008,
were studied. The study was limited to patients with positive findings
on upper gastrointestinal (GI) endoscopy done by us and "typical"
symptoms (heartburn, regurgitation, and dysphagia) of GERD.
Laparoscopic Nissen's fundoplication was performed when clinical
assessment suggested adequate oesophageal motility and length. Only one
patient who had negative endoscopic findings underwent a 24-h pH
monitoring before surgery. Outcome measures included assessment of the
relief of the primary symptom responsible for surgery in the early
postoperative period; the patient's evaluation of outcome, and quality
of life after surgery. Results: Relief of the primary symptom
responsible for surgery was achieved in 95.24% of patients at a mean
follow-up of 28 months. Thirty-five patients were asymptomatic, two had
minor gastrointestinal symptoms not requiring medical therapy, three
patients had gastrointestinal symptoms requiring medical therapy/Proton
Pump Inhibitors (PPI) and in two patients the symptoms worsened after
surgery. There were no deaths. Clinically significant complications
occurred in six patients. Median hospital stay was 3 days, decreasing
from 6 days in the first 10 patients to 3 days in the last 10 patients.
Conclusions: Laparoscopic Nissen's fundoplication is the choice of
operation for clinically symptomatic GERD patients
Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia
Although the advent of laparoscopic fundoplication has increased both
patient and physician acceptance of antireflux surgery, it has become
apparent that the laparoscopic approach is associated with an increased
risk of some complications and as well as the occurrence of new
complications specific to this approach. One such complication occurred
in our patient who had intra-operative left hepatic vein injury during
laparoscopic floppy Nissen fundoplication for large para-oesophageal
rolling hernia. With timely conversion to open procedure, the bleeding
was controlled and the antireflux and the procedure were completed
uneventfully. However, this suggests that even with an experience in
advanced laparoscopy surgery, complications can occur. Clear
understanding of the normal and pathologic anatomy and its variations
facilitates laparoscopic surgery and should help the surgeon avoid
complications. The incidence of some of these complications decreases
as surgeons gain experience; however, new complications can arise due
to the increase in such procedures
Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry
Aims: To evaluate retrospectively the outcome of laparoscopic
fundoplication in a cohort of patients with typical symptoms of
gastroesophageal reflux disease (GERD). Materials and Methods:
Forty-six patients with typical symptoms of GERD, from March 2001 to
November 2009, were studied. The study was limited to patients with
positive findings on upper GI endoscopy done by ourselves and "typical"
symptoms (heartburn, regurgitation, and dysphagia) of GERD.
Laparoscopic Nissen′s fundoplication was performed when clinical
assessment suggested adequate oesophageal motility and length. Only 1
patient, who had negative endoscopic findings, underwent a 24-hour
pH-monitoring before surgery. Outcome measures included assessment of
the relief of the primary symptom responsible for surgery in the early
postoperative period; the patient′s evaluation of outcome and
quality of life after surgery. Results: Relief of the primary symptom
responsible for surgery was achieved in 85% of patients at a mean
follow-up of 28 months. Thirty-nine patients were asymptomatic, 2 had
minor gastrointestinal symptoms not requiring medical therapy, 3
patients had gastrointestinal symptoms requiring medical therapy/
Proton Pump Inhibitors and in 2 patients the symptoms worsened after
surgery. There were no deaths. Clinically significant complications
occurred in 6 patients. Median hospital stay was 3 days, decreasing
from 6 in the first 10 patients to 3 in the last 10 patients.
Conclusions: Preoperative oesophageal manometry is not mandatory for
laparoscopic fundoplication done in selected patients with typical
symptoms of GERD and upper GI endoscopy suggestive of large hiatus
hernia