2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
24 of the patients were male and 22 were female in LigaSure
group and 30 of the patients were male and 20 were female in
endoclip group. The median age was 29 years (range 16-75) in
LigaSure group and 26 years (range 15-58) in endoclip group.
There was no difference in mean hospital stay, postoperative
pain and return to work between the groups. The mean operative
time was 41 minutes (range 23-93) in LigaSure group and
53 minutes (range 20-120) in endoclip group and the difference
was found to be statistically significant (p< 0.01).
Conlusions:
LA is a safe and easily performed method, along with having
the advantages of laparoscopic surgery. The use of ligasure in
LA facilitates the dissection of mesoappendix and shortens the
operation time.
P371–Minimally Invasive Other
LAPAROSCOPIC REPAIR OF MORGAGNI HERNIA, Nihat Yavuz
MD, Rafet Yigitbasi MD,Oguzhan Sunamak MD,Abdullah As
MD,Ceyhun Oral MD,Sabri Erguney MD, Istanbul
University,Cerrahpasa Medical School,General Surgery
Department
Introduction:
Morgagni hernia is a rare type of diaphragmatic hernia which
represents less than 5% of all congenital diaphragmatic hernias.
Patients are generally asymptomatic and are diagnosed
incidentally.When symptomatic,it generates symptoms due to
the compression of thoracic organs or compression of herniated
intraabdominal organs. Once diagnosed, the condition
requires prompt surgical correction .The defect is repaired
either by primary suture or by the use of a prosthetic mesh. In
adults,prosthetic mesh repair is preferred. Recently laparoscopic
repair of Morgagni hernia has been introduced and
gained wide acceptance.
Materials and Methods:
Between Jan 2002 and May 2004 ,5 patients with Morgagni
hernia were treated laparoscopically at our department.
Female/male ratio was 3/2. Mean age was 56 years (range 41
to 69 years). Diagnosis were made by chest x-ray and CT scan.
Herniation was on the left in two patients, and on the right in
three. The content of hernial sac was transverse colon and
stomach. There were two separate defects in a patient with left
sided hernia. All cases were laparoscopically treated using
prosthetic material.
Results:
All operations were completed laparoscopically. The postoperative
hospital stay was 3 to 5 days with a mean of 4 days.
None of the patients developed any complication in the early
postoperative period. The mean follow-up period is 7 months
(range 3 to 24 months). All patients are actually in good health
and without recurrence.
Conclusion:
Laparoscopic repair of Morgagni hernia is a safe ,simple and
reliable procedure which presents all the advantages of the
minimally invasive surgery.
P372–Minimally Invasive Other
LAPAROSCOPIC REPAIR OF VENTRAL AND INCISIONAL HER-
NIAS:OUR EXPERINCE IN 150 PATIENTS, Nihat Yavuz MD,
Turgut Ipek MD,Abdullah As MD,Metin Kapan MD,Erhun
Eyuboglu MD,Sabri Erguney MD, Istanbul
University,Cerrahpasa Medical School,General Surgery
Department
Introduction: Incisional hernias develop in 2 to 20% of laparotomy
incisions. Approximately 100.000 ventral hernias are
operated each year in the United States. Recurrence rate of
open repair is 25 to 52% for primary and 12.5 to 19% for mesh
repair. Compared to open technique, laparoscopic repair has
low complication and recurrence rates, greater patient acceptance
and shorter hospital stay.
Materials and Methods:. Between April 1999 and April
2004,150 patients with ventral and incisional hernias were
treated laparoscopically. Data concerning the age and sex of
patients, the location, number and size of fascial defect(s), the
type of hernias and their contents, the size and type of meshes
used in repair,the operative time,the length of hospital stay,
and postoperative complications were collected.
Results: Among 150 patients, 111 were female, 39 were male.
92 patients had incisional; 58 had umbilical hernias. In 85
cases, polypropylene, in 40 cases, Dual, in 25 cases, Composix
meshes were used. Mean age was 56.0 years (33 to 81 years).
Mean operative time was 63 minutes (30 to 125 minutes).
Mean postoperative hospital stay was 2.5 days (1 to 15 days).
Postoperative complication rate was 8.6% (seroma, paralytic
ileus, small bowel injury, and suture-site neuralgia). Mean follow-up
period was 32 months (4 to 60 months). Recurrence
rate was 3%. Three subileus cases detected during follow-up.
Conclusion: Laparoscopic approach to ventral and incisional
hernias is safe, feasible and a good alternative to open
approach. Our results are comparable with those of other
reports in the literature.
P373–New Techniques
ARE ANTROPOMETRIC AND VOLUME MEASUREMENT PRE-
OPERATIVE PREDICTORS OF OPERATIVE DIFFICULTY AND
CONVERSION NEED DURING LAPAROSCOPIC APPROACH TO
RECTAL DISEASES?. PRESENTATION OF PROTOCOL AND
PRELIMINAR RESULTS., Eduardo M Targarona PhD, Carmen
Balague PhD, Jaun Carlos Pernas PhD,Jose Monill
PhD,Carmen Martinez PhD,Jorge Garriga PhD,Manuel Trias
PhD, Service of Digestive Surgery. *Service of Radiology.
Hospital Sant Pau. Univ of Barcelona.
In rectal cancer, factors as the pelvic characteristics and tumor
size can determine the degree of technical difficulty to perform
the surgery by laparoscopic approach.
Objective: - To identify the anthropometric and pathologic features
that posses predictive value of operative difficulty or
conversion need to open surgery in the laparoscopic approach
to rectum cancer. - To identify through volumetric measurements
the relation between the pelvic and rectal or tumoral
volume that could permit to predict the degree of technical difficulty,
or the risk or need to convert to open surgery during
laparoscopic approach to rectum cancer.
Design: Prospective study of all patients diagnosed of rectum
cancer and submited to laparoscopic approach in our Dep of
Lap Dig Surgery of Hospital de Sant Pau, Univ of Barcelona.
The radiological study is performed by Abdominal CTScan
with CT Siemens SOMATON plus 4. Axial scans since iliac
crests to ischiatic tuberosities, 5 mm wide. Multiplanar reconstruction
in a in SIEMENS Magic View 1000 workstation measuring
in an axial and sagital and oblique planes the net axis: -
promontorium-retropubic, -subsacral-retropubic, -lateral (axial
oblique), -maximum and minimal lateral and ant-post pelvic
diameter in tumoral location, craneal-caudal, lateral and antpost
tumor diameter, and prosthetic craneal caudal, lateral and
ant-post diameter in men.
Volumetric analysis is performed by Volumetric analysis of
minor pelvis, rectal ampulla, rectal tumor and prostate with an
specific software (3D Doctor, Able Software Corp., 5 Appletree
Lane, Lexington, MA 02420-2406, USA). 3D reconstruction is
done from a DICOM file obtained during CT scan.
Statistics analysis: Univariate and Multivariate analysis.
Factors evaluated as predictive variables: BMI, previous
abdominal surgery, prosthetic and tumoral volume, tumoral
location, the different pelvic axis (refered in design), neoadjuvant
RT-QT. As dependent variables will be evaluated operative
time, technical difficulty (4 degrees), peroperative blood
loss, conversion rate, postop complications and hospital stay.
We present the basis of protocol and preliminar results.The
protocol began on Jan/04 and 20 patients (6 w and 14 m)
(mean age 74 &#61617;7 y) have been included. First statistical
study will be performed on Dec/04-Jan/05 in order to evaluate
and present the results of the first year of the study.
We expect to obtain statistical differences on depending of volumetric
paramethers.
P374–New Techniques
ADVANTAGES OF A NEW MANUAL SUTURING SYSTEM
INCLUDING ADDITIONAL DEGREES OF FREEDOM, Gerhard F
Buess 1,2 PhD, Jens Burghardt 1,Marc O Schurr 2 PhD,Marcus
Braun 2, 1. Helios Klinik Muellheim, Germany 2. Tuebingen
Scientific, Germany
Description of the methods
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