Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

PURPOSE: Single-incision laparoscopic surgery (SILS) for colorectal surgery is widely performed for many disease entities. However, there are few reports about the role of repeat single-incision laparoscopic surgery (R-SILS). The aim of this study is to analyze R-SILS data to evaluate the feasibility and safety of the occurrence and review its outcomes. METHODS: This is a retrospective review of the prospectively collected SILS database in Samsung Medical Center, Seoul, Korea, between April 2009 and December 2015. A retrospective review of 38 patients who underwent R-SILS from 2,207 patients who underwent primary SILS for colorectal surgery was performed. RESULTS: The indications of R-SILS were 23 primary SILS-related complications, 10 cancer-related, and 5 other surgical indications. Of the 38 repeat surgeries, 24 were emergent operations, and 14 were elective operations. Fecal diversion for anastomotic leakage after rectal surgery was the most common reason for reoperation. There were 2 cases of conversions: one case was converted to conventional multi-port, and the other case was converted to open surgery. Mean operative time was 137.9±64.1 min, estimated blood loss (EBL) was 105±98 ml, and length of hospital stay was 10.1±8.1 days. Post-operative complication was noted in 5 (13.2%) of 38 R-SILS cases, and there was no 30-day postoperative mortality. CONCLUSION: Repeat single-incision laparoscopy surgery is feasible and safe in select patients when performed by an experienced surgeon.

The Efficacy of Repeated Radiofrequency Medial Branch Neurotomy for Lumbar Facet Syndrome

OBJECTIVE: Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. METHODS: A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. RESULTS: There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. CONCLUSION: Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects. Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.