The Comparison of Balloon and Camera Dissection of the Preperitoneal Space in Totally Extraperitoneal Repair Hernia Repair. Our Initial Experience!

Purpose. To perform totally extraperitoneal repair of a hernia, it is essential to create a working space for the placement of instruments. In this study, we aimed to compare balloon dissection (BD) and camera or telescopic dissection (CD) with respect to the surgical outcomes, without considering the cost-effectiveness. Methods. Forty consecutive, healthy, unilateral inguinal hernia patients who underwent Totally Extraperitoneal Repair hernia repair were randomized into 2 groups according to whether they received BD or CD. The perioperative demographic characteristics were recorded. All the operations were video recorded from the beginning to the end of each procedure. The virtually constructed periods of the procedures were evaluated by another surgeon who watched each video. The time spent for each period, the severity score assigned by the surgeon, the total operation time, the peritoneal laceration rate, the presence of early and late postoperative pain, the number of postoperative visits, the total analgesic requirements, and the complications were recorded. Results. The demographic properties of the patients, the perioperative and postoperative complications, and the severity scores in the BD and CD groups were statistically similar. The total operating time and the time from the dissection of the peritoneum to the reduction of the hernia sac were significantly longer in the CD group. Post-discharge analgesic consumption, Visual Analog Scale scores, and the number of visits were similar between the groups. Conclusions. The dissection of the working space in the preperitoneal area can be achieved using camera dissection without the risk of common complications associated with balloon dissection, particularly balloon rupture.

Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic Patients.

BACKGROUND: Bariatric surgical techniques are based on mechanical restriction rather than functional restriction. Our purpose is to analyze the outcomes of diverted sleeve gastrectomy with ileal transposition (DSIT) as a mode of functional restrictive therapeutic option for class II and class III obese type 2 diabetes mellitus patients. METHODS: A retrospective analysis was performed on data derived from 159 patients with type 2 diabetes mellitus who underwent DSIT between October 2011 and January 2014. Postoperative changes in body mass index (BMI), HbA1c, cholesterol indexes, and triglycerides, as well as complications and mortality rates, were noted and analyzed. RESULTS: The study group consisted of 88 females and 73 males, with a mean age of 51.8 years. Mean duration of hospital stay was 6.4 (range, 4 to 42) days; mean follow-up was 18.3 months, and no mortality was detected. Mean BMI decreased from 39.33 to 25.51 kg/m(2) (excess BMI loss rate was 75.4 %, p < 0.001). Mean fasting glucose level decreased from 189.8 to 123.5 mg/dl (p < 0.001), and mean postprandial glucose level decreased from 246.1 to 179.4 mg/dl (p < 0.01). Mean HbA1c decreased from 9.24 to 6.14 % 1 year after surgery (p < 0.001). Overall, 88.68 % of patients were off antidiabetic medications at the end of 1 year. Hypertension was diagnosed in 121 of 161 patients preoperatively and resolved in 114 cases (94.2 %, p < 0.001). Triglycerides decreased from a mean of 210.07 to 125.24 mg/dl, and cholesterol decreased from a mean of 208.34 to 163.23 mg/dl (p < 0.001 for each). CONCLUSION: Our results demonstrate that DSIT provided effective remission rates in all components of metabolic syndrome in obese type 2 diabetic patients with acceptable complication and mortality rates.

Laparoscopic diverted resleeve with ileal transposition for failed laparoscopic sleeve gastrectomy: a case report.

Laparoscopic sleeve gastrectomy (LSG) recently gained popularity for the treatment of obesity and related co-morbidities. With the increasing number of bariatric operations, the requirement for redo or revision bariatric surgery seems to be increasing. In the present case, a 50-year-old female patient with failed LSG who underwent laparoscopic resleeve, duodenal diversion, and ileal transposition is presented. Her metabolic and biochemical parameters were found to be improved significantly after 18 months. To the best of our knowledge, this is the first report of a case treated with this method in the literature.

Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT).

BACKGROUND: In this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM). METHODS: A total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011-2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed. RESULTS: The participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6-31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy. CONCLUSIONS: Our data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.