After completing 200 cases, Katada et al. (The Gastroenterologist, June 1995) report that laparoscopic Nissen fundoplication is a safe and effective treatment for gastroesophageal reflux disease (GERD), a condition in which stomach acids surge upward into the esophagus causing severe heartburn and other symptoms.

Although medical therapy is generally considered the treatment of choice for chronic reflux, a significant number of GERD patients on long-term medical therapy still experience severe symptoms and risk developing complications. Researchers attribute these persistent cases to an anatomical defect in the lower esophageal sphincter (LES), the valve between the esophagus and the stomach. In these cases, surgical intervention is needed to repair the defect.

The authors conclude that laparoscopic Nissen fundoplication -- a minimally invasive procedure that strengthens the LES -- is the "preferred method" for managing patients with severe GERD who have failed medical therapy. Their patients typically leave the hospital in one or two days, experience less pain, fewer side effects, better cosmetic results and an earlier return to normal activities. They note that the laparoscopic procedure has shown the same good early results as the traditional "open" procedure while offering all of the advantages of minimally invasive surgery.

 

BEDSIDE LAPAROSCOPY: FASTER DIAGNOSIS, LESS STRESS FOR CRITICALLY ILL

Doctors at the Cleveland Clinic can now diagnose critically ill patients faster and spare them the stress of going to the operating room (OR) by performing "bedside laparoscopy" in the intensive care unit (ICU), according to a report in Laparoscopic Surgery Update , (June 1995).

Like open exploratory surgery, diagnostic laparoscopy is employed when the cause of a disorder can't be determined from test results or physical exams. Bedside laparoscopy is essentially the same as diagnostic laparoscopy performed in the OR. The hospital maintains a cart in the ICU containing a television monitor, trocars (entry ports) and other standard instruments. When a diagnostic procedure is required, the cart is brought to the patient's bed along with sterile linens and a camera borrowed from the OR.

The bedside technique was developed by staff surgeon Matthew Walsh, MD, and his colleagues because speedy diagnoses are often needed for ICU patients, but doctors are reluctant to subject the critically ill to the stress of an OR visit. Dr. Walsh performs about one bedside procedure a month with minimal expense and effort and with excellent results.

 

LAPAROSCOPY OFFERS COST-EFFECTIVE TREATMENT FOR ECTOPIC PREGNANCY

A recent study by Gray et al. (The Lancet, May 1995) found that laparoscopic surgery is more cost-effective than traditional "open" surgery for treating ectopic pregnancy, a condition in which fetal tissue implants itself in the fallopian tube, ovary or cervix, instead of the uterus, and begins to grow outside the womb.

The study compares the costs of inpatient and follow-up care for 109 women treated at Sahlgrenska University Hospital (Goteborg, Sweden) from 1987 to 1989. The study reports that while laparoscopic and traditional surgery had equal success rates (100%), women who underwent laparoscopic surgery (48) saved an average of SEK 4641 (approximately $642). Although instrumentation costs were higher in these cases, researchers attribute their cost savings to a shorter average operating time (88 minutes vs. 105 minutes) and an average hospital stay of 2 days vs. 5 days with traditional surgery. The researchers conclude that the overall savings are likely to be greater because the cost analysis did not consider non-medical economic costs (such as lost wages, sick leave benefits and child care costs) that may be higher after traditional surgery. "Cost saving which might be realized from a variety of perspectives would make laparoscopy even more attractive," the study concludes.

 

LAPAROSCOPIC STAGING OF PANCREATIC CANCER REDUCES UNNEEDED SURGERY

Surgeons in Boston report that using laparoscopic techniques to stage (determine the severity) pancreatic cancer before choosing a course of treatment helps patients with inoperable cancer avoid exploratory surgery and enables doctors to use medical and surgical resources more effectively (Laparoscopic Surgery Update, June 1995).

While laparoscopy cannot provide full treatment, doctors at New England Deaconess Hospital and Massachusetts General Hospital have used laparoscopic techniques in 123 patients with pancreatic cancer to stage the progress of the disease and determine the next phase in treatment. These patients had previously shown no evidence of metastatic disease (spreading of the cancer to surrounding areas).

Laparoscopic staging, however, revealed that the cancer had spread within the abdominal cavity in 28 patients, who were then ruled out as surgical candidates. Subsequent tests found that radiation therapy was the most appropriate treatment for 42 patients, while exploratory surgery was necessary for the remaining 53 patients, or just 43% of the original group who underwent laparoscopic staging.

 

PATIENT INFORMATION ON MINIMALLY INVASIVE INTESTINAL SURGERY NOW AVAILABLE

An informational brochure on minimally invasive intestinal surgery is now available from United States Surgical Corporation. To order, call Kathy O'Brien at 203-845-1735.

For more information, contact Steve Rose, editor, at 203-845-1732 or E-mail to [email protected].

Items marked by an * and The Laparoscopy Report are trademarks of USSC.




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