Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair.

BACKGROUND: Primary or incisional ventral hernia repair is one of the most common surgical procedures, addressed to general surgeons. The enhanced view-totally extraperitoneal technique (eTEP) was first described by Deas for inguinal hernias, but lately it has been applied to ventral hernias by Belyansky et al. So far, results are promising and data about the procedure are rising. METHODS: Retrospective comparative analysis of 27 recruited eTEP procedures and 27 IPOM operations for the period between April 2017 and June 2018 at the department of Endoscopic surgery of Military Medical Academy, Sofia. Baseline characteristics, operative records and perioperative data are provided and compared for both groups. RESULTS: Fifty-four patients were included. There were no differences between age, sex, BMI, primary or incisional hernias, co-morbidity, active smoking, EHS-classification and immunosuppression through the patients in different groups. Mean defect area-eTEP is 71 cm2 with no statistical difference, compared to IPOM-76 cm2. Operative time in eTEP is significantly longer with mean time of 186 min and 90 min in IPOM patients. Mean length of stay did not differ between the groups, with 2.9 days after eTEP and 3.4 after IPOM. Median pain score from the intraoperative (the day of surgery) to the seventh postoperative day is lower in the eTEP group. No surgical site infections and/or mesh infections were present. There was one readmission in the IPOM group with ASBO, and it was managed conservatively. There were no reinterventions and perioperative mortality in the sample. CONCLUSION: We found out that the eTEP/eRS approach is feasible and safe. Our study shows comparable results of eTEP/eRS to the IPOM procedure with reduced video analogue scale pain score to the 7th postoperative day and increased operative time. The study contributes to the upcoming evidence in the field of new minimally invasive techniques for ventral hernia repair.

Laparoscopic vs open resection for rectal carcinoma--a prospective analysis.

UNLABELLED: In the recent years, laparoscopic surgery has established itself worldwide as a method of treatment for colorectal cancer. Several prospective randomized trials comparing laparoscopic with open resection of the colon, showing the advantages of laparoscopic surgery in terms of a shorter hospital stay, faster recovery of intestinal transit and physical activity in equivalent survival and recurrence rate. However, in many of the studies the data on laparoscopic resection for rectal cancer are scarce and it is still controversial. AIM: In this report, we aimed to make a comparative analysis of the clinical and oncological outcomes after laparoscopic and open rectal resection in patients with a rectal cancer. MATERIAL AND METHODS: We compare and analyze prospectively data from two groups of patients with rectal cancer--66 undergoing laparoscopic and 47 undergoing open rectal resection respectively. Both groups were selected with comparable demographic characteristics (gender, age, body mass index), ASA class (American Society of Anesthesiologists), tumor stage, type of neoadjuvant radiochemotherapy and operations. The data were statistically processed. RESULTS: The mean age was 61, body mass index ranged from 18 to 42. The frequency of conversion was 6.06%. Postoperative complications were similar in both groups, except for wound infection was lower for the laparoscopic group (p = 0.02). The laparoscopic group had a shorter hospital stay (7 and 5 days respectively p < 0.01), faster recovery of intestinal motility (3 and 4.5 days respectively, p < 0.001) compared with the open group. Three-year survival rate and the rate of local and late recurrences were identical in both groups. CONCLUSIONS: Laparoscopic surgery is applicable in the treatment of rectal cancer with similar oncologic outcomes compared with conventional surgery and has all the advantages of miniinvasive methods. There is a need for further randomized studies to refine the applicability of laparoscopic rectal resection for cancer.

Surgical treatment of benign diseases of the gastroesophageal junction in clinic of endoscopic surgery at MMA during the period 2005-2012: pathophysiology, surgical techniques and trends of their use.

UNLABELLED: Treatment of the diseases of the gastroesophageal junction is one of the serious problems faced by gastroenteorologist and surgeons. In contrast to the proton pump inhibitors (PPI) surgery achieves a long symptoms free period. Laparoscopic surgery has its advantages as an alternative to conventional surgery. The purpose of this study was to compare the obtained results from patients treated with laparoscopic surgical methods to the results of the patients treated with conventional surgery and conservative treatment with PPI. MATERIALS AND METHODS: The present study includes 99 patients: 90 patients with diaphragmatic hernia and gastroesophageal reflux disease (GERD), 8 patients with achalasia and a benign stricture of the lower third of the esophagus. All patients were operated by laparoscopic techniques. 72% of the 99 patients were women and 28% men. The average age of patients was 62 years. RESULTS: The majority of our patients had mixed hiatal hernia--55.5%, followed by axial (23.3%) and hiatal (13.3%). The most common method we used was anterior fundoplication (85.5%), we used the Nissen fundoplication in 7.8% of the patients, crurorhaphy with mesh in 4.4% and plain crurorhaphy in 2.2%. All patients had a mild postoperative period. Analgesia with prophenid is done only in the first 24 hr. The average hospital stay of the patients was 3 days. CONCLUSIONS: Partial laparoscopic fundoplication is a method of choice for the anti-reflux surgery compared to conventional surgery and drug therapy. Dysphagia is rare in patients with anterior fundoplication and is easily influenced by conservative treatment, that's why is our preferred method.