2005 SAGES Abstracts
2005 SAGES Abstracts
2005 SAGES Abstracts
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
POSTER ABSTRACTS<br />
<strong>SAGES</strong> <strong>2005</strong><br />
P104–Colorectal/Intestinal Surgery<br />
PRELIMINARY EXPERIENCE OF LAPAROSCOPY-ASSISTED<br />
EXPLORATION OF OBSCURE INTESTINAL BLEEDING AFTER<br />
CAPSULE ENDOSCOPY; THE KOREAN EXPERIENCE, MINY-<br />
OUNG CHO MD, JIN KIM MD,JEOUNG WON BAE,JONG SUK<br />
KIM,YOUNG CHUL KIM,CHEONG WUNG WHANG,SUNG OCK<br />
SUH, Surgery, College of Medicine, Korea University<br />
Background: Obscure intestinal bleeding (OGB) is generally<br />
defined as recurrent acute or chronic bleeding for which no<br />
source has been identified by routine radiologic and endoscopic<br />
examination. The aim of this study was to report our<br />
early experiences detecting small bowel bleeding by capsule<br />
endoscopy (CE), and the results of laparoscopy-assisted operations<br />
for OGB.<br />
Materials and Methods: 75 patients with obscure gastrointestinal<br />
bleeding were examined by CE. Twelve patients of the<br />
active bleeding group underwent laparoscopy-assisted operation,<br />
and we carried out intra-operative enteroscopy to find the<br />
focus of the bleeding.<br />
Results: Laparoscopic localization of the lesion was successful<br />
only for 4 patients?those with Meckel’s diverticulum, gastrointestinal<br />
stromal tumor, lymphoma, and ischemic necrosis. In 3<br />
cases in which there was no natural passage of the capsule<br />
endoscope, lesions were identified by small bowel exploration<br />
through simple palpation. Intra-operative enteroscopy was<br />
performed in 5 cases, in order to localize the lesions. The<br />
lesions that were identified by CE pre-operatively were resected<br />
successfully, via laparoscopic or laparoscopy-assisted operation.<br />
The gastrointestinal bleeding has not recurred during<br />
the post-operative follow-up period (mean 10.6 months).<br />
Conclusion: Intraoperative enteroscopy needs to identify small<br />
mucosal lesions that cannot be detected by laparoscopy, or by<br />
conventional small bowel exploration. Our results suggest that<br />
laparoscopic or laparoscopy-assisted surgery is a feasible<br />
method for managing OGB patients whose lesions are identified<br />
by pre-operative CE. The laparoscopy-assisted operation<br />
is effective in explorations of the intra-abdominal cavity and<br />
the identification of some lesions. It can also be performed as<br />
an adequate ?mini-laparotomy?<br />
P105–Colorectal/Intestinal Surgery<br />
LONG-TERM SURVIVAL AFTER LAPAROSCOPIC COLECTOMY<br />
FOR ADENOCARCINOMA, Tom Paluch MD,Michael J Clar<br />
MD,Jon Greif DO, Amy L Day MD, Kaiser Foundation Medical<br />
Center, San Diego<br />
Controversy regarding the oncologic efficacy of laparoscopic<br />
colectomy (LC) for colorectal carcinoma (CRC) has precluded<br />
its widespread application. The greatest concern remains<br />
availability of long-term survival data. Few series extend to<br />
five years and almost none beyond. We reviewed the records<br />
of 134 patients who underwent attempted LC for CRC at our<br />
institution between 1992 and 1998. In 114 of 134 (85%), the<br />
operation was completed laparoscopically. Operations performed<br />
were right hemi-colectomy (n = 54; 47%), sigmoid<br />
colectomy (n = 35%), left hemi-colectomy (n = 11), and other (n<br />
= 9). Mean operating time for those procedures was 142 mins<br />
(range 75 - 308 mins). Peri-operative mortality was 0.9%.<br />
Pathologic stages were Stage A: 17 (15%), Stage B1: 16 (14%),<br />
Stage B2: 37 (32%), Stage C1: 3 (3%), Stage C2: 34 (30%),<br />
Stage D: 7 (6%). There was no significant difference in stage<br />
between cases completed closed and those converted to open.<br />
Follow-up ranged from 72 to 139 mos (mean: 84 mos; median:<br />
78 mos). Overall 80/114 (70%) are alive and NED. Crude survival<br />
at 6 through 10 years post-op were 75%, 73%, 66%, 63%,<br />
and 58% respectively. 34 pts (30%) had recurrent disease.<br />
Mean time to recurrence was 29.5 mos (range 2 - 75 mos). The<br />
mean survival of pts with recurrent disease was 40.7 mos<br />
(range 0 - 101 mos). There was 1 (0.9 %) port site/ incisional<br />
recurrence. We conclude that LC for CRC is a safe and oncologically<br />
sound operation and should be offered to all pts with<br />
CRC.<br />
P106–Colorectal/Intestinal Surgery<br />
COST COMPARISON OF LOOPED VERSUS STAPLED LAPARO-<br />
SCOPIC APPENDECTOMY, Erika Fellinger MD, Alexander Perez<br />
MD,Neal Seymour MD,David Earle MD, Baystate Medical<br />
152 http://www.sages.org/<br />
Center<br />
Objective: There is variability in technique when performing<br />
laparoscopic appendectomy, particularly for uncomplicated<br />
cases. We hypothesized that the use of relatively high cost<br />
items such as disposable staplers does not add clinical or<br />
financial value to the procedure.<br />
Methods: All patients with uncomplicated appendicitis (defined<br />
by a length of stay of 2 days or less) undergoing laparoscopic<br />
appendectomy between 10/1/01 and 6/1/04 (N= 326) were identified<br />
and stratified into one of two groups according to the<br />
use of a commercially available, pre-tied Roeder?s knot (EL),<br />
or use of selected, high cost, disposable items (SS = staplers<br />
and reloads, Ligasure?, ultrasonic coagulating shears). Total<br />
hospital cost, OR time in minutes, and supply cost for each<br />
group were compared using ANOVA and Cox proportional<br />
hazards tests.<br />
Results: The total OR supply cost was less for EL compared<br />
with SS laparoscopic appendectomy ($790 vs. $1070, p
Change language