Initial learning experience of laparoendoscopic single site (LESS) gastric banding: finding predictors of success.

Single-incision laparoscopic adjustable gastric banding (SI-LAGB) is a promising technique with potential to decrease pain and improve cosmesis. It is challenging and potentially time-consuming. We aimed to identify preoperative patient characteristics predictive of a successful SI-LAGB. Demographic and anthropometric data were prospectively collected. Primary endpoint was operating time. Adequate operating time (AOT) was determined using a historic consecutive of 100 subjects undergoing multi-port LAGB. The cutoff for AOT was defined as mean + 1 SD of the historic cohort. Binary logistic regression analysis was used in univariate and multivariate modeling to identify independent preoperative variables associated with AOT. From February 2009 to October 2010, 79 patients (71 female) underwent SI-LAGB, with no conversions to multi-port laparoscopy. Mean operating time was 61 ± 27 min. The cohort was divided into two groups: AOT (n = 53) and excessive operating time, (EOT, n = 26) based on cutoff value of 69 min. On univariate analysis, preoperative BMI had significant (p = 0.03) counterintuitive effect on operative time (AOT 44.2 ± 6.2 kg/m(2) versus EOT 42.1 ± 4.2 kg/m(2)). Hiatal hernia was also significant predictor of EOT (19.2% versus 3.7%; p = 0.001) and remained an independent predictor of EOT in multivariate logistic regression after adjusting for covariates, increasing the chance for EOT by 5.9 times (odd ratio 5.9; 95% CI 1.1-31.1; p = 0.04). SI-LAGB can be performed safely and timely. Concomitant hiatal hernia could be successfully repaired during a SI-LAGB but at the cost of significant additional operating time.

Predicting relapse in ductal carcinoma in situ patients: an analysis of biologic markers with long-term follow-up.

BACKGROUND: The incidence of ductal carcinoma in situ (DCIS) of the breast is increasing. Optimal treatment remains controversial and, because of a long natural history, may not be evident for many years. We undertook this study to identify markers of disease recurrence. METHODS: We studied 131 pure DCIS patients with a 100-month mean follow-up. We performed a complete histologic review, immunohistochemical staining for p53 and vascular endothelial growth factor expression, and enumerated microvessel density/mm2 using factor VIII-Ab. Statistical analysis was performed by using an SAS software package (Cary, NC). RESULTS: Eleven patients (8%) developed ipsilateral recurrence at a mean of 55 months (11-137 months) after initial treatment. Three were DCIS, and 8 were invasive cancer. Recurrence was significantly predicted by p53 overexpression (in 55% of tumors that recurred versus 22% of those that did not, P = .02) but not other factors. CONCLUSIONS: These data suggest that biologic factors may have an important role in predicting recurrence in DCIS patients.