Slippage after adjustable gastric banding according to the pars flaccida and the perigastric approach

To evaluate laparoscopic adjustable gastric banding and the 'pars flaccida' techniques for treating morbidly obese patients. Between May 1999 and July 2002, 64 patients underwent laparoscopic adjustable gastric banding. The 'perigastric' technique was performed in the first 31 patients. From September 2000 the band was positioned according to the 'pars flaccida' technique in the remaining 33 patients. The patients were divided into three groups: group 1 - 'perigastric' technique using Lap-Band size 9.75 and 10 cm [31 patients]; group 2 - 'pars flaccida' technique using Lap-Band size 10 cm [12 patients], and group 3 - 'pars flaccida' technique using the Swedish band [21 patients]. There were 58 females and 6 males with a mean age of 36.6 years [range 17-56]. The preoperative mean body mass index was 46.2 kg/m2. Band slippage occurred in 10/31 patients [32.2%] of group 1, 3/12 patients [25%] of group 2 and none in group 3 patients [p < 0.01]. The 'pars flaccida' technique significantly reduces the incidence of postoperative slippage after gastric banding. This complication is further reduced in the Swedish band group. Furthermore, we do not recommend using the 10-cm Lap-Band in the 'pars flaccida' technique

Laparoscopic splenectomy for hematological disorders

The aim of this prospective study was to evaluate the safety and feasibility of laparoscopic splenectomy [LS] in patients with hematological disorders of the spleen. Subjects and Between 1999 and 2001, 15 patients [11 female and 4 male], with a mean age of 30 years, underwent LS after preoperative evaluation. If difficulties were encountered in LS, one trocar site incision was enlarged to 7-8 cm to engage the left hand for hand-assisted laparoscopic splenectomy [HALS] and the procedure was completed. Various parameters were reported, including spleen size as assessed by ultrasound scan, postoperative mortality and morbidity rates, accessory spleen removal, conversion rate, operative times and length of hospital stay. LS was successfully completed in 9 patients [60%] and HALS was performed in 4 patients [26.6%]. Two patients required conversion to open splenectomy. The mean operative time was 209 min and the mean hospital stay was 8.1 days. The hospital stay was significantly longer among HALS patients than LS patients. The mean age of patients and splenic size were associated with a significantly higher conversion rate. No deaths were attributed to the procedure. Complications occurred in 2 of 15 patients. Accessory spleens were identified in 2 patients. Conclusions: LS is both a safe and feasible procedure, but it requires great technical care to avoid serious complications

Pain during mammography: impact of breast pathologies and demographic factors

The aim of this study was to systematically assess the pain experienced by patients undergoing mammography for various clinical presentations. Subjects and Two hundred and twenty-five patients aged 25-85 years [45.43 +/- 8.25 years] presenting for mammography were included in the study. Presenting symptoms and clinical diagnosis were provided by the referring physicians and demographic information was obtained from self-reported questionnaires. Mammography results were recorded by the radiologist. Two different but reliable and valid measures of pain - Visual Analog Scale [VAS] and Pain/Discomfort Rating Scale [DRS] - were used to assess pain during mammography and data were statistically analyzed to examine the possible predictors of pain. Forty-nine% of the patients reported pain during mammography when cut-off level of VAS score was 40; however, when the cut-off level was raised to 60 [considering the preexisting pain as presenting symptom in some patients] only 23% reported pain. With DRS, 7% reported pain, 27% discomfort and 66% neither pain nor discomfort. Biserial correlation between the VAS and DRS scores suggested strong positive agreement between the two measures of pain [r = 0.56, d.f. = 90, p < 0.01]. Patients presenting with coexisting breast lumps and preexisting breast pain and those diagnosed with inflammatory conditions of the breast and fibrocystic changes experienced more pain during mammography. Preexisting breast pathologies and demographic factors such as age and educational level of the patient were important in reporting pain during mammography. This finding indicates that proper assessment of pain using standard measures and its association with breast pathologies and demographic factors is important for planning pain management in women undergoing mammography

introduction of laparoscopic appendectomy in a teaching hospital

A retrospective study of laparoscopic appendectomy [LA] versus open appendectomy [OA] was performed on patients with suspected acute appendicitis. Patients were selected for OA or LA according to the clinical evaluation, and preference of the surgeon. Over a 2-year period 180 patients were included, of whom 94 patients underwent OA, and 86 patients underwent LA. LA was successfully completed in 76 patients [88.3%]. The mean hospital stay in OA was 3.2 days versus 2.7 days in LA. The mean operative time was shorter in OA than in LA [51.6 versus 59.8 min]. There was no significant difference in convalescence between both the groups, however, there was a tendency towards less narcotic requirement among the LA group. Postoperative complications in patients who underwent OA included: chest infection [3 patients], wound infection [4 patients], thrombophlebitis [1 patient]. Complications after LA included: pelvic collection [1 patient], chest infection [1 patient], ileus [1 patient]. There was no wound infection in the LA group. There was no death in either groups. LA is a safe procedure comparable to OA, however, it requires skills in laparoscopy and prospective randomized trials are needed to confirm its advantages over conventional appendectomy