Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy

Beger, H.G.; Schwarz, A.; Bergmann, U.
February 2003
Surgical Endoscopy;Feb2003, Vol. 17 Issue 2, p342
Academic Journal
journal article
Background: Gastrointestinal (GI) tract surgeons were challenged with the development of two revolutionary surgical specialities: laparoscopic and endoscopic surgery. Minimal access surgery currently is the surgical speciality with the greatest impact on patient care. Regarding the competitive treatment methods (open, laparoscopic, and intraluminal endoscopic management), each new treatment must be evaluated on the evidence of the patient's benefit, surgical morbidity, short- and long-term outcome, cost effectiveness and maintenance of quality of life.Methods: On the basis of randomized clinical trials, minimal access surgery results in reduced postoperative pain, reduced early postoperative analgetic medication, reduced frequency of systemic inflammatory response syndrome and systemic complications, early restoration of normal bowel function, and minimalization of wounds and skin scars. Among the well-established laparoscopic procedures, laparoscopic cholecystectomy has been convincingly demonstrated as superior to open cholecystectomy on the basis of controlled clinical trials. Superior benefit in favor of laparoscopic hernia repair has been demonstrated only regarding a lower level of pain, a higher level of physical activity, and earlier return to work. However, in terms of operating time and costs, open repair without mesh has benefits. Laparoscopic appendectomy offers benefits in terms of pain reduction, faster postoperative recovery, and lower incidence of wound infections, but has major drawbacks with regard to longer operating time, higher local complication rates, and significantly higher costs for total hospitalization. A cost study group concluded from a randomized clinical trial that only minimal short-term quality-of-life benefits were found for laparoscopically assisted colon resection, as compared with standard open colectomy, for colon cancer. On the basis of controlled clinical trials, there is only a little doubt that the laparoscopic approach is currently the operative treatment of choice for gastroesophageal reflux compliance. Endoscopic intraluminal techniques are increasingly important for minimalization of surgical treatment. For ulcer bleedings, endoscopic treatment is the established first choice. A major old and new challenge for GI tract surgeons is the intraluminal endoscopic approach to lesions. For neoplastic lesion in the esophagus (> 2 cm, mucosa restricted), Barrett's epithelium, early gastric cancer, adenoma of the ampulla of Vater, T1+, TIM lesion of the large bowel, T1 cancer of the rectum, intraluminal endoscopic treatment methods are increasingly replacing open surgical resection or even a laparoscopic technique. The surgeon must be aware that many of the local surgical complications, particularly those of GI tract anastomoses, are managed by endoscopic techniques.Conclusions: The GI tract surgeon must accumulate competent endoscopic experience. His responsibility for GI diseases focuses on surgical treatment using minimal access surgical techniques including surgical endoscopy in preoperative, intraoperative, and postoperative settings. This major assignment is a challenge not only for GI tract surgeons in the near future.


Related Articles

  • Transgastric pure-NOTES peritoneoscopy and endoscopic ultrasonography for staging of gastrointestinal cancers: a survival and feasibility study. Donatsky, Anders; Vilmann, Peter; Meisner, Søren; Jørgensen, Lars; Rosenberg, Jacob // Surgical Endoscopy;Jun2012, Vol. 26 Issue 6, p1629 

    Background: Human natural orifice transluminal endoscopic surgery (NOTES) has mainly been based on simultaneous laparoscopic assistance (hybrid NOTES), forgoing the theoretical benefits of the NOTES technique. This is due to a lack of NOTES-specific instruments and endoscopes, making pure-NOTES...

  • Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans. Narula, Vimal K.; Happel, Lynn C.; Volt, Kevin; Bergman, Simon; Roland, Jason C.; Dettorre, Rebecca; Renton, David B,; Reavis, Kevin M.; Needleman, Bradley J.; Mikami, Dean J.; Ellison, E. Christopher; Melvin, W. Scott; Hazey, Jeffrey W. // Surgical Endoscopy;Jun2009, Vol. 23 Issue 6, p1331 

    Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report...

  • Incisional gastropexy. Watson, Kara; Tobias, Karen M. // Veterinary Medicine;Apr2006, Vol. 101 Issue 4, p213 

    Presents information on incisional gastropexy. Indications for gastropexy; Types of gastropexies; Technique for incisional gastropexy.

  • Intestinal biopsy. Brandt, Laura; Tobias, Karen M. // Veterinary Medicine;Apr2006, Vol. 101 Issue 4, p220 

    Presents information on intestinal biopsy. Indications and methods; Surgical technique for incisional biopsy of the intestines; Complications of intestinal biopsy.

  • Omentalization. Anderson, Erik; Tobias, Karen M. // Veterinary Medicine;Apr2006, Vol. 101 Issue 4, p230 

    Presents information on omentalization, the placement of omentum around organs or within cavities to improve vascularization or drainage. Indications for omentalization; Technique for omentalization of gastrointestinal surgery sites; Complications of omentalization.

  • Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck. Werner, Jochen; Sapundzhiev, N.R.; Teymoortash, A.; Dünne, A.A.; Behr, T.; Folz, B.J. // European Archives of Oto-Rhino-Laryngology;Oct2004, Vol. 261 Issue 9, p463 

    Sentinel lymphadenectomy was developed to reduce the extent of surgical interventions in cancer patients. The sentinel node (SN) concept was first established for melanoma and breast cancer; within some years, it also became increasingly popular for head and neck cancer. As soon as the required...

  • The Natural Orifice Simulated Surgical Environment (NOSsEâ„¢): Exploring the Challenges of NOTES Without the Animal Model. Clark, James; Sodergren, Mikael; Noonan, David; Darzi, Ara; Yang, Guang-Zhong // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2009, Vol. 19 Issue 2, p211 

    In this paper, we introduce an inexpensive, realistic, and robust simulator model for training and requirement assessment of natural orifice transluminal endoscopic surgery (NOTES). A laparoscopic box trainer is converted into an effective NOTES environment, in which many of the challenges...

  • Nitrous oxide for monitoring fluid absorption in volunteers†Declaration of interest. Following completion of the study, the sponsors (AGA-AB) gave the patent of the N2O method to the corresponding author. R. G. Hahn // BJA: The British Journal of Anaesthesia;Jan2007, Vol. 98 Issue 1, p53 

    Background. We studied whether nitrous oxide (N2O) added to a fluid allows the infused volume to be quantified by measuring N2O in the expired air during normal breathing. If so, N2O might serve as a tracer of fluid absorption during endoscopic surgery.Methods. Twelve male volunteers received...

  • Endoskopische Nukleotomie - Renaissance eines Verfahrens. Leu, H. // Der Orthopäde;Feb2011, Vol. 40 Issue 2, p126 

    Since the introduction of percutaneous nucleotomy two lines of development have been followed. On the one hand the blindly driven intradiscal tissue active methods and on the other hand endoscopically controlled minimally invasive tissue methods. The first group diminished the acceptance of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics