2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
cumulative estimation of the remote results does not differ
from well-known and makes 47 % of a ulcer relapses.
However, after studying patients in view of their division into
the groups it becomes obvious, that the most part of relapses
directly connected to inadequacy of an ulcer disease treatment.
In group “ A “ good and satisfactory results are marked
in 81 %, bad results in 19 %. In group “ B “ good and satisfactory
results are marked in 38 % of patients, bad in 62 %.
Conclusions:We can state that treatment of patients with perforated
ulcer must consist of combinated surgical and therapy
treatment. It allows in most cases to perform operation of simple
closer of perforation, on the indications laparoscopy is preferred.
P289–Esophageal/Gastric Surgery
LAPAROSCOPIC REDO NISSEN FUNDOPLICATION,
Constantine T Frantzides MD, Tallal M Zeni MD, John G
Zografakis MD,Mark A Carlson MD, Evanston Northwestern
Hospital
Objective: To evaluate the mechanisms of failure after laparoscopic
fundoplication, and the operative techniques necessary
to reduce failure.
Methods and Procedure: A retrospective review of 42 patients
with failed laparoscopic fundoplication was done. Pre- and
postoperative symptoms and testing (endoscopic, radiologic
and manometric) were analyzed. Operative techniques to correct
the etiologies of failure were documented.
Results: Hearburn (69%) and dysphagia (12%) were the most
common presenting symptoms; both symptoms were present
in 10% of patients. Preoperative testing revealed the presence
of reflux (76%), esophagitis (67%), hiatal hernia (45%), stenosis
(14%), and dysmotility (5%). The most common intraoperative
finding was a combination of ?slipped? fundoplication and
hiatal hernia (24%). Other intraoperative findings included isolated
slippage or malpositioning (17% each); combined malpositioning
with hiatal hernia (12)%; isolated hiatal hernia or tight
fundoplication (10% each); loose fundoplication (7%); and tight
cruroplasty (5%). Redo fundoplication alone was performed in
45% of patients, and another 45% underwent redo fundoplication
with hiatal hernia repair; 68% of the hiatal hernia repairs
were done with mesh. Suture removal from a tight cruroplasty
(5%) and additional suture placement on a loose fundoplication
(5%) occasionally were employed. Complications included
four gastric perforations, which were all recognized and
repaired during the redo procedure. Open conversion occurred
in one patient. Length of stay was 3.5 +/- 1.0 days. Long-term
failure occurred in 7/42 patients (17%). Four of these patients
had a recurrent hiatal hernia, while three had a failed fundoplication.
Conclusion: Redo fundoplication can be successfully accomplished
laparoscopically in nearly all patients. Hiatal hernia
repair (with mesh reinforcement) and secure anchorage of the
fundoplication appear to be essential components of longterm
success. The recurrence rate following reoperation is
higher than after primary fundoplication.
P290–Flexible Diagnostic &
Therapeutic Endoscopy
ENDOSCOPE DIAGNOSIS AND TREATMENT OF SEVERAL
PEDIATRIC GASTROINTESTINAL DISEASES :A SINGLE CEN-
TER EXPERIENCE, Merab Buadze MD, Ramaz Kutubidze
MD,George Adamashvili MD,Zaza Chagelishvili MD,Levan
Labauri MD, Dept. of Gastrointestinal Endoscope Surgery of
Pediatric Clinic. Tbilisi State Medical University.Georgia.
Introduction: Endoscopy is a common procedure for diagnosis
and treatment of various gastrointestinal and colonic disorders
in children.
Methods: We report our experience 1985 ? 2003 of 14911
(11504 diagnostic and 3407 therapeutic) upper and lower
endoscopies in children from newborn to 16 years. There were
used concisions sedations with repeated doses of midazolam
(0.025mg/kg) up to summary dose (0.4 mg/kg). The surgical
endoscopies were performed under general anesthesia.
Results:
1.Peptic Ulcer Disease ? 685; Doudenal ulcer ? 598 (87%),
Gastric ulcer ? 87 (13%). Study of speciments was done by
202 http://www.sages.org/
PCR to evaluate H.pylori specific CagA and VacA genes in 24
patients.
2.Endoscope treatment of gastroduodenal bleeding of ulcerous
genesis 296 cases, among them DU ? 244 (82%), GU ? 52
(18%). Bleeding due to esophageal varices ? 27 cases, sclerotherapy
? 12.
3.Endoscope polypectomy of single (84%) or multiple (16%)
colon polyps ?2250 cases. 91% of the polyps were juvenile.
4.Removal of foreign bodies from upper GI ? 570 cases
(esophageal ? 392, gastric ? 160, duodenal ? 18).
5.Endoscope treatment of accidental chemical burns of esophagus
with repeated endoscope control and dilatation ? 180
cases.
6.Endoscope diagnosis and successful dissolution of gastric
phytobezoars using white turnip ? 87 cases.
7.Endoscope investigations among the new-born such diseases
as congenital hypertrophic pyloric stenosis?239.
8.Endoscope balloon dilatation of esophageal stenosis ? in 26
patients: among them after esophageal atresia-9.
9.Eosinophilic esophagitis ? 25, treatment with Kromolin-
Natrium and corticosteroidis.
10.Endoscope diagnosis and treatment by colonoileoscopy of
ileocolic intussusception in children under 2 years ? 73 cases.
Endoscope treatment was done totally in 68 from 73 (93,1%)
cases. The valve of Baugin and 10-15 cm in length terminal
ileum were observed usually after endoscope pneumatic
reduction.
Conclusions: Hence in some surgical diseases of intestinal
tract in children the use of endoscope treatment is primary
safe method. Also it decreases the number of laparatomies
and complications.
P291––Flexible Diagnostic &
Therapeutic Endoscopy
THE USEFULNESS OF INTRAOPERATIVE ENDOSCOPY, John
M Cosgrove MD, George Denoto MD,Jeremy Goverman MD,
North Shore University Hospital/North Shore-Long Island
Jewish Health Care System
The usefulness of intraoperative endoscopy as an adjunct to
general surgery procedures cannot be overstated. The performance
of upper endoscopy, colonoscopy and sigmoidoscopy
can be accomplished with minimal setup and preparation,
little difficulty and essentially no morbidity. Also, the
procedure can be performed without adding much time to the
operative case. The experience of one surgical endoscopist
and a busy laparoscopic surgeon at a large academic medical
center is chronicled. A two-year period(September 2002-
September 2004) was chosen for review. All intraoperative
endoscopies, colonoscopies and sigmoidoscopies were included.
Those procedures performed outside the operating
room(i.e.; endoscopy suite and SICU) were excluded.
There were 95 intraoperative endoscopies performed during
the study period. There were 23 endoscopies to evaluate open
gastric bypass(RYGBP), 14 colonoscopies for evaluation of
colonic anastomoses, 16 colonoscopies for evaluation of rectal
stumps or lower gastrointestinal hemorrhage, 5 endoscopies
for upper gastrointestinal hemorrhage or small bowel obstruction,
9 tracheostomies/PEGs, 13 sigmoidoscopies, 6 endoscopies
for laparoscopic assisted myotomies, 4 colonoscopies
for laparoscopic assisted colectomies, 3 endoscopies for
laparoscopic assisted partial gastrectomies and 3 endoscopies
for therapeutic reasons status post gastric bypass procedures.
The endoscopies were therapeutic in 5 cases(3RYGBP, 2 foreign
bodies). Furthermore, our policy of intraoperative
endoscopy picked up three anastomotic defects(1RYGBP, 2 colorectal
anastomoses) that were easily corrected at the same
setting. The endoscopic procedures have an excellent predictive
value as there were no postoperative leaks. The average
time for each endoscopy was less than two minutes.
The performance of intraoperative endoscopy is an invaluable
adjunct to the surgical armamentarium. It can be performed
easily and safely and the information obtained is very useful
and therapy will be altered in a subgroup of patients. The
endoscopy allows the entire team to visualize the anastomosis
on the monitor and photographs can be taken for inclusion in
the medical record. We advocate the widespread application of