The use of an improved intragastric balloon technique to reduce weight in pre-obese patients--preliminary results.

BACKGROUND: In this study, a new safer and faster intragastric balloon procedure was also employed to treat pre-obese patients (body mass index (BMI) < 30). METHODS: From June 2006 to June 2009, 20 such patients were submitted to the Silimed Gastric Balloon treatment, as a part of a multidisciplinary program involving clinical, psychological, and behavioral approaches. For the 16 patients who had completed the 5-6-month treatment, the initial mean weight and mean BMI were 74 kg and 27.5 kg/m(2), respectively. RESULTS: After the treatment, the mean weight and BMI values decreased significantly to 65.9 kg and 24.5 kg/m(2), respectively. There were only minor complications--nausea and vomiting--with the exception of two cases of spontaneous deflation of the devices which were successfully removed by gastric endoscopy. CONCLUSIONS: Thus, preliminary data suggest that this new intragastric balloon procedure might also be a safe and effective treatment for weight loss in pre-obese patients.

Needlescopic clipless cholecystectomy as an efficient, safe, and cost-effective alternative with diminutive scars: the first 1000 cases.

BACKGROUND: The advent of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), surgery without skin scarring, is now challenging every surgeon to improve the esthetic results for patients. Minilaparoscopic cholecystectomy (MLC) represents a refinement in laparoscopic surgery, potentially as cosmetically effective as NOTES. Nevertheless, because of the increased cost and difficulty in managing the equipment, it has not been widely accepted among surgeons. OBJECTIVE: To report modifications of the minilaparoscopic technique that make it possible to conduct needlescopic procedures safely and effectively, thereby, considerably reducing costs and promoting the dissemination of this operation. METHOD: One thousand consecutive patients who underwent MLC were analyzed, from January 2000 to May 2009 (78.7% women; average age 45.9 y). SURGICAL TECHNIQUE: after performing the pneumoperitoneum at the umbilical site, 4 trocars were inserted; 2 of 2 mm, 1 of 3 mm, and 1 of 10 mm in diameter, through which a laparoscope was inserted. Neither the 3-mm laparoscope, nor clips, nor manufactured endobags were used. The cystic artery was safely sealed by electrocautery near the gallbladder neck and the cystic duct was sealed with surgical knots. Removal of the gallbladder was carried out, in an adapted bag made with a glove wrist, through the 10-mm umbilical site. RESULTS: The operative time was 43 minutes. The average hospital stay was 16 hours. There was no conversion to open surgery; 2.8% of patients underwent conversion to standard (5 mm) laparoscopic cholecystectomy because of difficulties with the procedure; there were 1.9% minor umbilical site infections and 1.0% umbilical herniations. There was no mortality; no bowel injury, no bile duct injury, and no postoperative hemorrhage, only 1 patient with Luschka's duct bile leakage needed a reoperation. CONCLUSIONS: The MLC technique shows no differences in risks as compared with other laparoscopic cholecystectomy procedures. It also entails a considerable reduction in cost, and, as it does not use the 3-mm laparoscope or disposable materials, it is possible to perform MLC on a larger number of patients. Owing to the near invisibility of scars, MLC may also be considered as cosmetically effective as NOTES and SILS.

An improved intragastric balloon procedure using a new balloon: preliminary analysis of safety and efficiency.

BACKGROUND: The authors developed a new intragastric balloon procedure with the objective of making it safer, faster, and less expensive than the established ones. The proposed procedure uses a new gastric balloon with technical improvements in the placement and removal procedures. METHODS: From June 2006 to July 2007, 52 patients were submitted to the new treatment with the Silimed Gastric Balloon (SGB), as part of a multidisciplinary program involving clinical, psychological, and behavioral approaches. RESULTS: The new placement and removal procedures of the SGB were effective and safe in all the cases. Due to simplicity and shortened duration of the procedures, all the patients left the outpatient clinic in less than 1 h after the placement or removal of the SGB. For the 14 patients who had completed the 6-month treatment, the initial mean weight, mean body mass index (BMI), and mean excess of weight (EW) were, respectively, 100.7 kg, 35.7 kg/m(2), and 30.0 kg. After the 6-month treatment, these values decreased significantly: 89.4 kg, 31.8 kg/m(2), and 19.6 kg. CONCLUSIONS: Preliminary data suggest that the procedure with the new balloon comes forth as a safe and effective alternative to the treatment of weight loss in patients with appropriate indication of use.