2005 SAGES Abstracts

POSTER ABSTRACTS
and GERD symptom scale scores are presented.
RESULTS: The table bellow presents the early surgical outcomes:
Outcomes n=100
OR time (min) 104 (60-235)
30 d mortality 1%
Morbidity 7%
Mean LOS
1.87 days
Conversion rate 0%
Outcomes n=100 OR time (min) 104 (60-235) 30 d mortality
1% Morbidity 7% Mean LOS 1.87 days Conversion rate 0%
Six patients presented with dysphagia following the surgery
and were treated conservatively (two patients required dilatation).
The median follow-up for this series is 22.6 months with
a mean satisfaction score of 10 ± 2.98 on a visual scale of 0 to
10. Eighty five percent of patients would undergo the surgery
again and 86% estimated that surgery had improved their
quality of life.
CONCLUSION: Community surgeons can safely develop a
laparoscopic Nissen fundoplication practice in their local hospital
with outcomes similar to larger tertiary centers.
P278–Esophageal/Gastric Surgery
THE LEARNING CURVE OF LAPAROSCOPIC NISSEN FUNDO-
PLICATIONS PERFORMED BY A COMMUNITY SURGEON,
Herawaty Sebajang MD, Laurent Biertho MD,Mehran Anvari
PhD,Craig McKinley MD, Centre for Minimal Access Surgery,
McMaster University Hamilton Ontario Canada; North Bay
District Hospital, North Bay Ontario Canada
PURPOSE: The learning curve of laparoscopic Nissen fundoplications
performed by academic surgeons is reported to be 20
to 50 cases. The aim of this study was to assess a community
surgeon?s learning curve with this procedure.
METHODS: Between January 2001 and June 2003, data was
collected prospectively on the initial fifty laparoscopic Nissen
fundoplications performed in a community hospital by a single
surgeon with no fellowship training in advanced laparoscopic
surgery.
RESULTS:
There was no symptom recurrence noted in all 50 patients at a
mean follow-up of 25 months. At 6 weeks postoperative, four
patients (8%) had dysphagia and were managed conservatively.
The community surgeon involved in this series attended
laparoscopic courses early in the learning curve and after the
17th case received mentoring, telementoring and telerobotic
assistance.
CONCLUSION: There is a significant drop in morbidity, mortality
and operating time after the first 20 cases. A number of factors
including mentoring, telementoring, telerobotic assistance
and dedicated operating room nursing staff may have impacted
on reducing this learning curve.
P279–Esophageal/Gastric Surgery
A NOVEL CONCEPTUAL MODEL OF THE CURRENT SURGICAL
CLASSIFICATION OF PARAESOPHAGEAL HERNIAS USING
DYNAMIC THREE-DIMENSIONAL RECONSTRUCTION, Ross D
Segan MD, Stephen M Kavic MD,Ivan M George,Patricia L
Turner MD,Adrian E Park MD, University of Maryland
Baltimore
The existing classification system of hiatal and paraesophageal
hernias has been described throughout the literature.
Currently, there is no satisfactory comprehensive graphic representation
of this system for the surgeon. Multiple modalities
have been used to illustrate these hernias, most relying on
artists? renderings or 2-dimensional radiographic studies. The
ambiguity of existing illustrations, along with a lack of a current
standard, promotes miscommunication among clinicians.
Polygonal mesh surface modeling techniques were utilized to
render dynamic 3-dimensional CT-based models of the four
recognized types of paraesophageal hernias. The resulting
images allow near-real time navigation by the surgeon in an
intuitive and clinically relevant fashion.
This model should clarify the existing classification system
and will ultimately improve management of paraesophageal
hernias.
P280–Esophageal/Gastric Surgery
LAPAROSCOPIC HAND-ASSISTED NISSEN FUNDOPLICATION,
Kazuyuki Shimomura MD, Tatsuo Yamakawa MD, Dept. of
Surgery, Mizonokuchi Hospital, Teikyo-University
Although laparoscopic surgery is being widely accepted by
surgeons, some drawbacks of this procedure, mainly from that
laparoscopic procedures are 2-D remote surgery without tactile
sensation, are being recognisied. Hand-assited laparosopic
surgery (HALS), which started in recent years to improve these
situations, provides surgeon tactile sensation and good organ
handlings. Usually the indications of HALS are supposed to be
associated with large resected specimen like colectomy,
gasterectomy, and nephrectomy. However in selected cases
like in complicated or high risk patients, HALS is also useful in
functional diseases like GERD (gastro-esophageal reflux disease)
even without surgical specimen. We would demonstrate
the procedures and usefulness of Hand-assisted Laparoscopic
Nissen Fundoplication (HALS Nissen) for GERD. The procedures
of HALS Nissen is almost similar to pure laparoscopic
access, but these procedures can be performed by the surgeon’s
finger guide. The advantages of HALS Nissen are mainly
in the phase of blunt dissection around lower esophagus
with surrounded adhesion by severe esophagitis. And it also
contributes for the better results in avoiding intraoperative
injury in the area of esophago-gastric junction. As for the procedure
of suture for fundoplication, HALS is useful to build the
wrapping around fundus with appropriate pressure to fundus
by finger knotting. We performed 3 cases of HALS Nissen so
far, and the operation time is around 1 hour 30 min. All the
patients discharged in 3 to 7 post portative days without complications
or recurrence. HALS Nissen procedure is considered
to be a safe and useful option to GERD to promote surgical
safety.
P281–Esophageal/Gastric Surgery
HAND-ASSISTED LAPAROSCOPIC SURGERY FOR A HUGE
GASTROINTESTINAL STROMAL TUMOR OF THE
STOMACH:REPORT OF TWO CASES, Hitotoshi Takemoto MD,
Hiroshi Yano MD,Takushi Monden MD, Department of
Surgery,NTT West Osaka Hospital
Gastrointestinal stromal tumor (GIST) of the stomach is difficult
to diagnose preoperatively no matter whether it is malignant
or benign. Although recent advances in imaging techniques,
such as US, CT, and MRI have aided in the identification
of space-occupying lesions of the stomach, these techniques
do not permit preoperative diagnosis of these lesions.
Therefore, the resection of the tumor is generally necessary
from both diagnostic and also therapeutic aspects in patients
with GIST of the stomach. There are variable operative
approaches, and most surgeons expect that the laparoscopic
procedure will be better than open surgery because it carries
low complications, faster recovery, less pain and better cosmetics.
We report two cases of a huge GIST of the stomach
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