ABSTRACT
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is increasingly recommended to women of reproductive age. For continued use, LAGB needs to be proven to be safe and well-tolerated during pregnancy. Maternal obesity is a well-recognized risk factor for gestational diabetes, maternal hypertension and is more likely to result in instrumental delivery or caesarean section. Weight control with the LAGB may reduce the incidence of these complications. METHODS: An observational study was conducted of the LAGB in pregnancy, including a study comparing outcomes of LAGB pregnancies with previous non-LAGB pregnancies. Women who had had successful LAGB pregnancies were identified from a computerized database. A telephone questionnaire was used to collect the additional outcome data needed and was administered by an independent medical practitioner. RESULTS: 49 LAGB and 31 previous non-LAGB pregnancies were included. 2 LAGBs (4%) required removal during pregnancy. Mean maternal weight gain was significantly reduced in the LAGB group, 3.7 kg vs 15.6 kg (P <0.0001), with no effect on fetal weight, 3.31 vs 3.53 kg, or neonatal complications, 4% and 3%. The incidence of gestational diabetes, 8 and 27% (P =0.048), and hypertension, 8 and 22.5% (P =0.06) was significantly reduced in the LAGB group. The overall complication rate during pregnancy for LAGB was 20.4% and 52% for non-LAGB (P =0.0037) CONCLUSION: LAGB is safe and well-tolerated during pregnancy with a lower incidence of gestational diabetes and maternal hypertension. LAGB can be safely recommended to morbidly obese women of childbearing age.
Subject(s)
Gastroplasty/adverse effects , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Pregnancy Complications/surgery , Pregnancy Outcome , Adolescent , Adult , Body Mass Index , Case-Control Studies , Female , Humans , Observation , Pregnancy , Weight LossABSTRACT
BACKGROUND: The aim was to assess the acceptability and safety of day-case laparoscopic fundoplication for gastro-oesophageal reflux disease (GORD). METHODS: This prospective study commenced in December 1999 and lasted for 18 months. All patients had proven symptomatic GORD. Inclusion criteria were American Society of Anesthesiologists grade I or II with adequate home support. A standard anaesthetic, analgesic and antiemetic protocol was used. Patients were contacted by telephone on the night of discharge and arrangements were made for a nurse to visit the following day. Postoperative pain and nausea were assessed using visual analogue scores (scale 0-10) on a self-completion questionnaire. RESULTS: Twenty patients were included. There were no postoperative complications. All patients were discharged on the day of surgery. Median time to discharge was 6 h 30 min (range 4.5 to 9 h). One patient reattended casualty the following morning but none required readmission. There was no significant difference in median pain or nausea scores the evening after surgery or the next morning. All patients were satisfied with the information given and aftercare provided. All would recommend it to a friend and 19 of 20 would undergo the procedure as a day case again. CONCLUSION: This study suggests that day-case laparoscopic fundoplication is feasible. Patients find it acceptable and it appears safe.
Subject(s)
Ambulatory Surgical Procedures/methods , Fundoplication/methods , Gastroesophageal Reflux/surgery , Laparoscopy , Adult , Aged , Ambulatory Surgical Procedures/standards , Feasibility Studies , Female , Fundoplication/standards , Humans , Laparoscopy/standards , Length of Stay , Male , Middle Aged , Pain, Postoperative/etiology , Patient Satisfaction , Prospective Studies , Treatment OutcomeABSTRACT
We present the case of a 50-year-old man with situs inversus who underwent laprascopic colonic resection for diverticulitis. The patient, who had right-sided pain due to inversion of the viscera mimicking appendicitis, initially presented a diagnostic challenge. A barium meal confirmed situs inversus and the diagnosis of diverticulitis. We present an overview of the operative technique of what is the first documented laparoscopic colectemy in a patient with situs inversus. We then discuss the benefits of the laproscopic approach to colectomy, with reference to this interesting case with unusual anatomy.
Subject(s)
Colectomy/methods , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Laparoscopy/methods , Situs Inversus/complications , Humans , Male , Middle AgedABSTRACT
BACKGROUND: The totally extraperitoneal technique (TEP) is a well-established method for repairing inguinal hernias laparoscopically. It has a low recurrence rate with minimal morbidity. Good training is necessary to decrease the length of the learning curve. Laparoscopic training courses at the Guildford Minimal Access Therapy Training Unit (MATTU) include lectures, live demonstrations, and practical training. In the absence of a commercially available TEP hernia model, the Guildford MATTU, along with Limbs and Things, has developed a realistic artificial model. OBJECTIVE: The aim was to develop a model that would familiarize course participants with the different anatomical perspective and the steps needed to complete the TEP repair, in an effort to shorten their learning curve. EVALUATION: The MATTU model has been evaluated in terms of anatomic accuracy, realism, versatility, cost effectiveness, and ease of use. CONCLUSIONS: The MATTU model accurately replicates TEP repair. It is robust, easy to use, cost effective, and easy to maintain. It will be widely available.
