UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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242 Updated Topics in Minimally Invasive Abdominal Surgery is predisposed to infection and it reduces the quality of life. Endoscopic transpapillary drainage was introduced as a more attractive approach in this subset of patients. The technique utilizes the ERCP endoscope to cannulate the billiary tree and the cystic duct followed by placement of cystic duct stent or a nasocholecystic catheter in the gallbladder [59, 60]. The outcome of this endoscopic approach was evaluated retrospectively in 35 surgically high-risk patients with acute cholecystitis. Nasocholecystic catheter was inserted in 21 patients, plastic stent in 6 patients and combined approach in 2 patients. The procedure was not successful in 6 of the 35 patients (17 %). Among the 29 patients with successful gallbladder drainage, 24 patients clinically improved within 3 days, while 4 patients died of septic complications. Although this technique was successful in 83 % of the patients, longterm follow-up showed a 20% relapse rate for acute pancreatitis which emphasizes the role of this approach as a bridge until the patient is surgically fit [61]. 5.2 Endoscopic treatment of GERD Endoscopic treatment of GERD has been an attractive topic for the last 15 years. Hope for a successful cure of GERD with endoscopy has been a rollercoaster. In this section we will briefly discuss various endoscopic modalities currently available for GERD treatment. One of the earliest devices to treat GERD by endoscopic approach is the “Stretta Device”. This device uses thermal coaogulation of the mucosa of the lower esophageal sphincter (LES) in order to narrow the esophagus and prevent GERD. Although the device showed modest success, its clinical use was hindered by the higher rate of complications such as esophageal perforation and aspiration pneumonia. Currently this system is not commercially available [62, 63]. Other devices utilize suturing techniques to produce endoscopic plication of the LES in an effort to decrease GERD. There are more than five plicator devices available in the market. There are multiple cases series and non-randomized trials investigating the effectiveness of this technique. In summary, it showed a modest decrease in acid reflux but the procedure is lengthy and there is an increased risk of complication [64-66]. Based on the available data, it is premature to support incorporating these devices in clinical practice. A third technique that involves injecting bulking agents at the LES to prevent GERD has been recently introduced. The injected materials are either plexigal microsphere or ethylene vinyl alcohol (biodegradable microsphere) as in the Enteryx device. Although the technique is easy to use, the Enteryx device was recalled by the United States’ Food and Drug Administration due to the associated complications such esophageal abscess, polymer migration and death [67-69]. Although many of the above mentioned results are disappointing, there are other devices currently being researched which could alter the current grim look for use of endoscopy in GERD. 5.3 Endoscopic myotomy for esophageal achalasia Traditionally, the endoscopy role in achalasia was limited to endoscopic dilation and endoscopic injection of BOTOX [70]. A new technique involving creating a submucosal tunnel in the lower esophagus followed by advancing the endoscope in the new created space to the lower esophageal sphincter (LES) and electrocautery disruption of circular muscle of LES was proven feasible in an animal model [71]. This technique was proven successful in 17 patients with achalasia who underwent endoscopic myotomy in a tertiary referral center in Japan. Patients had significant improvement of their dysphagia and in the resting LES pressure. No major complications were reported [72]. The first case of
Role of Endoscopy in Laparoscopic Procedures endoscopic myotomy in the United States was reported in December 2010 by Stavropoulos et al; the procedure was successful with improvement in dysphagia in the follow-up period [73]. This technique has many advantages including the minimally invasive nature of the procedure, the lower incidence of reflux since only an incision of the circular muscle is done and the option of performing laparoscopic myotomy if needed. However, long-term data are not yet available for this new approach. 6. References [1] Feingold, D.L., et al., Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg, 2004. 8(5): p. 543-6. [2] Lane, K.L., et al., Endoscopic tattoo agents in the colon. Tissue responses and clinical implications. Am J Surg Pathol, 1996. 20(10): p. 1266-70. [3] Price, N., et al., Safety and efficacy of India ink and indocyanine green as colonic tattooing agents. Gastrointest Endosc, 2000. 51(4 Pt 1): p. 438-42. [4] Yeung, J.M., C. Maxwell-Armstrong, and A.G. Acheson, Colonic tattooing in laparoscopic surgery - making the mark? Colorectal Dis, 2009. 11(5): p. 527-30. [5] Nizam, R., et al., Colonic tattooing with India ink: benefits, risks, and alternatives. Am J Gastroenterol, 1996. 91(9): p. 1804-8. [6] Askin, M.P., et al., Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc, 2002. 56(3): p. 339-42. [7] Shatz, B.A., et al., Long-term safety of India ink tattoos in the colon. Gastrointest Endosc, 1997. 45(2): p. 153-6. [8] Singh, S., et al., Complication after pre-operative India ink tattooing in a colonic lesion. Dig Surg, 2006. 23(5-6): p. 303. [9] Lennon, A.M., et al., EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc, 2010. 72(5): p. 1089-94. [10] Newman, N.A., et al., Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal pancreatectomy. Surgery, 2010. 148(2): p. 371-7. [11] Vezakis, A., et al., Intraoperative cholangiography during laparoscopic cholecystectomy. Surg Endosc, 2000. 14(12): p. 1118-22. [12] Clayton, E.S., et al., Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg, 2006. 93(10): p. 1185-91. [13] Kharbutli, B. and V. Velanovich, Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg, 2008. 12(11): p. 1973-80. [14] Enochsson, L., et al., Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience. Surg Endosc, 2004. 18(3): p. 367-71. [15] ElGeidie, A.A., G.K. ElEbidy, and Y.M. Naeem, Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc, 2011. 25(4): p. 1230-7. [16] Grunhagen, D.J., et al., Laparoscopic-monitored colonoscopic polypectomy: a multimodality method to avoid segmental colon resection. Colorectal Dis, 2010. [17] Franklin, M.E., Jr., et al., Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience. Dis Colon Rectum, 2000. 43(9): p. 1246-9. 243
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VI Contents Chapter 9 Appendicitis
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Part 1 Laparoscopic Biliary-Pancrea
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1. Introduction 5 Laparoscopic Live
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Laparoscopic Liver Resection 2.2.1
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Laparoscopic Liver Resection conver
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Laparoscopic Liver Resection (Bruix
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Laparoscopic Liver Surgery 5 mm por
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Laparoscopic Liver Surgery Fig. 7a.
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Laparoscopic Liver Surgery or later
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Laparoscopic Liver Surgery non rand
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Laparoscopic Liver Surgery With rap
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Laparoscopic Liver Surgery [19] Tro
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Laparoscopic Hernia Repair defect.
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Laparoscopic Hernia Repair LeBlanc,
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UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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