Introduction: Critics of minimally invasive methods sometimes argue that the sum of lengths of all trocar sites are similarly morbid to a “conventional” incision of equal length. This argument assumes correctly that pain and scarring are proportional to total tension normal to a linear incision. But the argument also assumes that total tension sums linearly […]
INTRODUCTION: A 59 year old male with a long history of barrett’s esophagus and previous nissen fundoplication underwent a laparoscopic, thoracoscopic Ivor Lewis Esophagectomy for esophageal carcinoma. Upper GI on POD # 9 showed a contained mediastinal leak measuring 3 x 4 cm.METHODS: Endoscopy confirmed an anastamotic disruption. A pig tail drain was endoscopically placed […]
INTRODUCTION: Endoscopic pseudocyst drainage is well documented, but few series describe endoscopic drainage of pancreatic abscesses. Abscesses are complications of pancreatitis, presenting with sepsis and/or peritonitis. We report the feasibility and efficacy of natural orifice translumenal endoscopic surgery for pancreatic abscesses. METHODS: We reviewed consecutively treated patients (1994-2007). Approaches alone or in combination were: (1) […]
INTRODUCTION: The patient is an 18 year-old female with severe ulcerative colitis refractory to medical management. At presentation her hematocrit was 15 and her albumin was 2.1. Our practice is perform a total abdominal colectomy with end ileostomy as the initial procedure in ulcerative colitis patients who are malnourished and immunocompromised. This is followed by […]
INTRODUCTION: Intraoperative endoscopy (IOE) has gained wider clinical acceptance as a useful adjunct in advanced laparoscopic surgery. One known drawback of IOE, however, is prolonged distension of downstream bowel which compromises the subsequent surgical exposure/procedure, resulted in open conversion in worst case scenario. The use of rapid absorptive carbon dioxide (CO2) instead of air, has […]