Minimally invasive techniques in the management of benign surgical salivary problems

Sialolithiasis is considered as the commonest underlying pathology for sialadenitis, commonly affecting submandibular salivary glands, to lesser extent parotid glands and rarely sublingual or minor salivary glands. Stenosis of secondary and tertiary ducts of the salivary ductal system can also precipitate suppuration of the salivary glands. Patients with history of sialadenitis were best investigated by ultrasound and/or sialography. Patient should be informed by a written consent that if the endoscopic trial failed, the procedure should be shifted to external sialoadenectomy. Interventional sialoendoscopy is a new procedure to visualize the salivary ductal system followed by stone extraction, fragmentation of big stones then extraction or dilatation of stenosed duct by metallic dilator or balloon catheter. The surgical duration ranged between 10-20 minutes, with limited complications as duct perforation requiring sialoadenectomy or duct stenosis with fibrosis that was detected in the routine postoperative ultrasound and/or sialograms. Being a simple outpatient ambulant procedure, sialoendoscopy avoids the risk of general anesthesia and the need to do maximum neck extension in patients suffering of neck problems

Pulmonary functions, pain and metabolic response after laparoscopic banding versus open gastroplasty in morbid obesity

The present study compares postoperative pulmonary functions, pain and stress responses between laparoscopic group [n = 15] and open surgical groups [n = 15] in morbidly obsess patients. Pulmonary functions [forced vital capacity FVC, forced expiratory volume in 1 second FEV1% and peal expiratory flow rate PEFR] were performed and Spo2 was measured preoperatively [control], 4h after surgery and on days 1, 2 and 3 after the operation. Postoperative pain measured using a 100-mm visual analogue scale VAS and narcotic consumption were recorded every 8 hours for the first three days after operation. Also, endocrine metabolic response was measured via assay of serum cortisol and serum glucose levels preoperatively, 30 min, after induction, 2h and days 1,2 and 3 postoperatively. Pulmonary function showed that 4 h post surgery, a significant difference between the two groups being less for laparoscopic group. This difference continued over day 1,2 and 3 where the same results were still obtained for Spo2. Pain intensity at rest, during mobilization and on coughing was significantly less after laparoscopy. Requirements for postoperative opioid were 50% less in laparoscopic group. In both groups, plasma glucose and cortisol increased after surgery compared with baseline reaching the peak at 4 h without significant difference between both groups. This continued postoperatively but with significant difference between the two groups being less in laparoscopic group