IS AGE A CONTRAINDICATION FOR LAPOROSCOPIC ANTI-REFLUX SURGERY IN

Introduction: The aim of this study is to assess the safety of laparoscopic anti-reflux surgery (LARS) in the elderly.Materials and Method: A total of 1000 patients underwent a LARS procedure between May 2004 and November 2009. Patients over 60 years were defined as group A (A) and under 60 years were defined as group B (B). All data, including demographics, operative details, operative/ postoperative complications and outcomes were recorded in a prospective database.Results: There were 48 paients in A and 952 patients in B. The mean age of A and B was 64, and 39 respectively.(p0.05) Hiatal hernia was more common in A(81%) opposed to B (77%)(p=0.001). Toupet was performed more frequently in A (52%) opposed to B (31%) (p=0.002). There was no mortality and conversion. Esophageal perforation, jejunal perforation and pulmonary emboli were the major complications and were seen only in B(p>0.05). All other minor complications and postoperative dysphagia, bloating and reflux recurrence were similiar among the groups.(p>0.05)Conclusion: LARS is a safe procedure in patients over 60 years old. Age should not be a contraindication to LARS

Is age a contraindication for laporoscopic anti-reflux surgery in elderly

Introduction: The aim of this study is to assess the safety of laparoscopic anti-reflux surgery (LARS) in the elderly.Materials and Method: A total of 1000 patients underwent a LARS procedure between May 2004 and November 2009. Patients over 60 years were defined as group A (A) and under 60 years were defined as group B (B). All data, including demographics, operative details, operative/ postoperative complications and outcomes were recorded in a prospective database.Results: There were 48 paients in A and 952 patients in B. The mean age of A and B was 64, and 39 respectively.(p0.05) Hiatal hernia was more common in A(81%) opposed to B (77%)(p=0.001). Toupet was performed more frequently in A (52%) opposed to B (31%) (p=0.002). There was no mortality and conversion. Esophageal perforation, jejunal perforation and pulmonary emboli were the major complications and were seen only in B(p>0.05). All other minor complications and postoperative dysphagia, bloating and reflux recurrence were similiar among the groups.(p>0.05)Conclusion: LARS is a safe procedure in patients over 60 years old. Age should not be a contraindication to LARS

Is laparoscopic antireflux surgery safe and effective in obese patients?

Background It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS.Methods Patients undergoing primary LARS were divided into three groups: BMI 30 (obese). All perioperative data, operative and postoperative complications, and follow-up data were recorded prospectively. All patients were seen 2 months postoperatively and yearly thereafter.Results One thousand patients underwent LARS from May 2004 to August 2009. There were 484, 384, and 132 patients in normal, overweight, and obese groups, respectively. The incidence of Barrett's metaplasia (8.5% for the entire series) increased with BMI, although this difference was not statistically significant. 684 patients had Nissen and 316 had Toupet fundoplication. Mean follow-up was 53.33 +/- A 17.21 months. There was no mortality or conversion to open surgery. Mean operating times were 48.04 +/- A 21.20, 53.54 +/- A 23.42, and 61.33 +/- A 28.47 min for normal, overweight, and obese groups, respectively (P = 0.0001). Esophageal perforation, jejunal perforation, and pulmonary emboli were the three major complications in separate patients. Dysphagia occurred in 18.4, 13.1, and 9.9% of normal, overweight, and obese patients, respectively (P = 0.122). Bloating occurred in 18, 14.1, and 20.5 % of normal, overweight, and obese patients, respectively (P = 0.150). Rehospitalization for any reason, excluding redo surgery or dilatation, occurred less in overweight subjects (4.8, 1, and 3.8% respectively, P = 0.008). All other minor complications were distributed evenly among the groups with the exception of hiccups, which occurred more frequently in normal weight patients. Recurrence of reflux was observed in 0.6, 3.6, and 2.3% of the normal, overweight, and obese patients, respectively (P = 0.007).Conclusion LARS is a safe but more demanding procedure in obese patients and a significant increase in complications should not be anticipated. Long-term control of reflux by LARS in higher-BMI patients is slightly worse than that in normal-weight subjects

Operative Outcomes

Background: This study was designed to analyze the outcomes of Nissen fundoplication (NF) versus Toupet fundoplication (TF) in patients undergoing laparoscopic antireflux surgery (LARS).Methods: All perioperative data, operative/postoperative complications, and follow-up data were prospectively recorded. All patients were seen on the 2nd month postoperatively and by yearly intervals thereafter. All patients have at least 12-month follow-up. Using SPSS software, groups were compared by t-test and chi-square tests as appropriate.Results: One thousand consecutive patients underwent primary LARS from May 2004 to August 2009. Six hundred eighty-four patients had NF and 316 had TF fundoplication. The mean follow-up of the NF (51.26 months) group was slightly longer than the TF group (43.53 months) (P = .018). There was no mortality and conversion. Esophageal perforation, jejunal perforation, and pulmonary emboli were the sole three major complications in separate patients. Dysphagia occurred in 15.4% and 9.9% in NF and TF, respectively (P = .001). Corresponding numbers for bloating were 19.6% and 10.8% in NF and TF, respectively (P = .001). Seventeen patients underwent reinterventions such as dilatation and re-do surgery and all 17 were in the NF group (P < .05). All other minor complications were similar except hiccups, which were seen in 30 patients and all were in the NF group (P < .05). Recurrence of reflux was observed in 1.8% and 2.2% of the NF and TF, respectively (P = .620).Conclusion: Both NF and TF are effective procedures in controlling the acid-reflux symptoms. The functional side effects appear more often in the NF group. These side effects can be minimized and reinterventions for severe/prolonged dysphagia can be avoided with TF

Is laparoscopic antireflux surgery safe and effective in obese patients?

BACKGROUND: It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS. METHODS: Patients undergoing primary LARS were divided into three groups: BMI 30 (obese). All perioperative data, operative and postoperative complications, and follow-up data were recorded prospectively. All patients were seen 2 months postoperatively and yearly thereafter. RESULTS: One thousand patients underwent LARS from May 2004 to August 2009. There were 484, 384, and 132 patients in normal, overweight, and obese groups, respectively. The incidence of Barrett's metaplasia (8.5% for the entire series) increased with BMI, although this difference was not statistically significant. 684 patients had Nissen and 316 had Toupet fundoplication. Mean follow-up was 53.33 ± 17.21 months. There was no mortality or conversion to open surgery. Mean operating times were 48.04 ± 21.20, 53.54 ± 23.42, and 61.33 ± 28.47 min for normal, overweight, and obese groups, respectively (P = 0.0001). Esophageal perforation, jejunal perforation, and pulmonary emboli were the three major complications in separate patients. Dysphagia occurred in 18.4, 13.1, and 9.9% of normal, overweight, and obese patients, respectively (P = 0.122). Bloating occurred in 18, 14.1, and 20.5 % of normal, overweight, and obese patients, respectively (P = 0.150). Rehospitalization for any reason, excluding redo surgery or dilatation, occurred less in overweight subjects (4.8, 1, and 3.8% respectively, P = 0.008). All other minor complications were distributed evenly among the groups with the exception of hiccups, which occurred more frequently in normal weight patients. Recurrence of reflux was observed in 0.6, 3.6, and 2.3% of the normal, overweight, and obese patients, respectively (P = 0.007). CONCLUSION: LARS is a safe but more demanding procedure in obese patients and a significant increase in complications should not be anticipated. Long-term control of reflux by LARS in higher-BMI patients is slightly worse than that in normal-weight subjects

Affinity of Staphylococcus epidermidis to various prosthetic graft materials

yerdel, mehmet ali/0000-0002-4044-076XWOS: 000169838100010PubMed: 11421606Background. Abdominal wall hernias have always been a major problem for general surgeons. The techniques of repairing primacy, recurrent, and incisional hernias have evolved throughout the years at an accelerating trend, especially after production of prosthetic graft materials. Although looked upon with suspicion due to infection, fistula formation, and foreign body reaction, prosthetic graft materials are used deliberately in primary and recurrent hernias. The present study was,designed to evaluate bacterial adherence to frequently used prosthetic graft materials. Materials and methods. The study was carried out in five different groups with each group consisting of 10 identical samples of the same kind of prosthetic graft material. The prosthetic graft materials used in the study were polypropylene, polyglactin 910, polyester fibers, steel, and polytetrafluoroethylene (PTFE). These prosthetic graft materials were incubated in vitro with a Staphylococcus epidermidis strain which was ++++ adhesion positive. The degree of adhesion of S. epidermidis to prosthetic graft materials was assessed by the ELISA. method. Results. Vicryl grafts showed significantly minimal bacterial adhesion whereas PTFE grafts tended to have more adhesion but this did not reach a statistical significance. Other graft materials did not show any difference for bacterial adhesion (Table 3). Conclusion. These results suggest that in vitro S. epidermidis adhesion to Vicryl grafts is less than other types of prosthetic graft materials (P 2001 Academic press