Carotid angioplasty and stenting versus redo endarterectomy for recurrent stenosis.

BACKGROUND: Carotid angioplasty and stent (CAS) is an alternative to redo carotid endarterectomy (RCEA) for recurrent carotid stenosis (RCS). The purpose of this study was to evaluate the outcomes of CAS in the treatment of RCS. METHODS: In an 8-year period, all patients presenting for treatment of RCS were followed-up prospectively. Logistic regression analysis was performed to identify variables associated with unfavorable outcomes. RESULTS: There were 45 CAS and 46 RCEA procedures performed in 75 patients. One patient in each group suffered a stroke. There were no deaths. The hospital length of stay was significantly shorter for CAS. Secondary recurrence was higher after RCEA (14% vs 6.1%) and failure to take beta-blockers was an independent predictor for multiple recurrences. CONCLUSIONS: CAS is a safe and effective method to treat patients with RCS and may become the procedure of choice for this disease.

A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Intraperitoneal local anesthetics have been investigated in several laparoscopic procedures that demonstrate improved postoperative pain control and reduced length of hospital stay. No published studies to date address the effectiveness of IP local anesthetics in laparoscopic gastric bypass patients (LRYGB). STUDY DESIGN: Between October 2004 and March 2005, 133 patients were prospectively studied to evaluate the efficacy of IP bupivacaine (IPB) in LRYGB. Patients were randomized to receive either bupivacaine (study group) or saline (control group), which was administered over the esophageal hiatus before dissection and bypass. All procedures were performed in a University-affiliated community-based hospital by three experienced laparoscopic gastric bypass surgeons. Outcomes variables included postoperative pain and narcotic use, length of stay, antiemetic use, cost, and pulmonary function. RESULTS: There were 65 patients within the study group and 68 control patients, with equivalent patient demographics (p > 0.05). A statistically significant decrease in oral narcotic (hydrocodone/acetaminophen, Lortab Elixir, UCB) use was seen in the experimental group relative to the control group (23.8 +/- 2.2 mL versus 33.7 +/- 3.0 mL). Material cost was greater by $0.36 per patient in the study group. All other outcomes variables (ie, length of stay, postoperative IV narcotic use, incentive spirometer volumes, visual analog pain scale, and antiemetic use) showed no considerable differences. CONCLUSIONS: IPB use during LRYGB revealed a statistically significant difference only in postoperative oral narcotic use. Possibly, the IPB can limit or prevent peritoneal irritation and reduce the need for longer narcotic use. Clinical significance was not demonstrated by our outcomes variables.