A laparoscopic versus open adrenalectomy in Ramathibodi Hospital.

OBJECTIVE: To compare the results of laparoscopic adrenalectomy with those of open adrenalectomy in Ramathibodi Hospital. MATERIAL AND METHOD: Medical charts of 41 laparoscopic and 39 open adrenalectomy patients were reviewed Baseline characteristics and outcomes of treatment were compared between these two patient groups, using univariable statistical tests and multivariable statistical procedures. RESULTS: There were significant baseline differences between the two groups in terms of gender, body mass index, ASA class, and preoperative diagnosis. The outcomes operative time, estimated blood loss and length of hospital stay were also significantly different. After adjusting for the effects of baseline differences, laparoscopic adrenalectomy was associated with a significant reduction of length of hospital stay by 40%. CONCLUSION: Laparoscopic adrenalectomy is a safe and effective procedure and should help hasten postoperative recovery and may save the costs of hospitalization.

Laparoscopic Heller myotomy with dor antireflux for achalasia.

BACKGROUND: The ideal antireflux procedure following laparoscopic Heller myotomy for achalasia is controversial. The authors present a laparoscopic technique of partial anterior fundoplication to bolster the myotomy. MATERIAL AND METHOD: Between August 2002 and March 2006, 11 patients (eight females and three males; median age, 33 years) underwent a laparoscopic Heller myotomy with bolstering partial anterior fundoplication. The results of the barium swallow and manometry studies were consistent with achalasia. Failed medical treatments included balloon dilation, botulinum injection, and calcium channel blockers, were indications for surgery. RESULTS: The pre-operative weight loss was 9 Kg (range, 3-16) with a mean duration of symptoms of 29 months (range, 12-72). Sixty-three percent (7 of 11) of the patients had undergone pneumatic balloon dilation before surgery. Myotomy was confirmed with endoscopic guidance. Partial anterior fundoplication was performed with the edges of the myotomy on the right and left sides sutured to the stomach, which covered the myotomy. No conversion was required. The mean operative blood loss was 70 mL (range, 30-150). The mean operative time was 3 hours. Patients resumed solids at 2.5 days (range, 2-5). None of the patients had any perioperative or postoperative complications. Follow-up ranged up to 4 years (median, 2). Postoperatively, symptoms of dysphagia (to both solids and liquids), heartburn, odynophagia, regurgitation, and cough were significantly reduced in all patients. CONCLUSION: Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity.

Initial experience and result of a Swedish adjustable gastric banding by laparoscopic approach in Thai cohorts.

BACKGROUND: Morbid obesity is a growing problem in Thailand. Several surgical procedures are available for weight reduction. The laparoscopic gastric banding has been shown to be an effective weight loss with a low post or perioperative complication. OBJECTIVE: The aim of this report was to evaluate the early preliminary outcome of the laparoscopic Swedish adjustable gastric banding operation in Thai cohort patients. MATERIAL AND METHOD: From November 2003 until March 2005, ten patients with a median age of 31 (range, 18-61) underwent laparoscopic Swedish adjustable gastric banding for morbid obesity at Ramathibodi Hospital. Demography, clinical course and outcome including excess weight loss and peri-operative complications were reviewed and studied. Descriptive statistics were used for data summary. RESULTS: There were 3 men and 7 women with a median preoperative body weight of 142.5 kg (range, 98-164 kg), and median body mass index (BMI) of 49.2 kg/m2 (range, 40.3-62.4 kg/m2). The operations were successful in 9 out of 10 patients with median operative time of 195 minutes (range, 125-275 minutes). One patient with a BMI of 62.4 had a failed operation due to poor operative exposure from a very large left lobe of the liver. None of the remaining patients required conversion to the opened technique. The mean hospital stay was 4 days with no perioperative mortality. There was no major post operative complication except one minor wound infection. The excess weight loss was within the range of 33.5% to 62.1% during the short-term follow-up (range, 1-15 months) CONCLUSION: The presented early preliminary result of the laparoscopic Swedish adjustable gastric banding showed a good technical success with a significant short-term weight loss. The authors believe this minimally invasive operation is appropriate for morbidly obese Thai patient. However a longer follow-up study is needed.

Preminary report: initial experience of endovascular laser therapy for varicose veins due to greater saphenous vein incompetence in Thailand.

BACKGROUND: Surgical venous stripping (SVS) is a standard treatment for varicose veins (VV) due to greater saphenous vein incompetence (GSVI) but there are some disadvantages to and risks. Endovascular laser (EVL) has been introduced to overcome these disadvantages. The present study was designed to determine the effectiveness of EVL treatment for these patients. MATERIAL AND METHOD: The patients with VV due to GSVI diagnosed by duplex scan were recruited in the present study. The EVL-procedure was percutaneously approached guiding by ultrasound under monitor anesthetic care (MAC). Postoperative clinical and imaging assessment was assessed. RESULTS: There were 17 limbs with symptomatic VVs in 11 patients. Two patients were admitted for a reason not related to surgery. The others were day cases. There was no postoperative complication except a large echymosis in one case. At 3-month follow-up, no recanalization or recurrence was detected. CONCLUSION: The authors' early results demonstrated that EVL could obliterate VVs due to GSVI and further showed some benefits over SVS. More studies with a longer period of follow-up are needed to further confirm the efficacy of EVL.