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George S Ferzli

Publications and source records attributed to George S Ferzli.

5 recordsLinked to original sources
PubMed2006

Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis.

HYPOTHESIS: Outcome following laparoscopic adjustable gastric banding (LAGB) in super morbidly obese patients is significantly worse compared with the standard laparoscopic Roux-en-Y gastric bypass (LRYGB). DESIGN: Prospective case series. SETTING: Community teaching hospital (490 beds). PATIENTS: A prospectively maintained database identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004. The study group included super morbidly obese patients (body mass index >50 [calculated as weight in kilograms divided by the square of height in meters]) following LAGB and LRYGB. INTERVENTIONS: Among 106 patients with super morbid obesity, 60 (57%) and 46 (43%) underwent LAGB and LRYGB, respectively. MAIN OUTCOME MEASURES: Patient demographics, weight loss, percentage of excess weight loss, change in body mass index, early (<30 days) and late (> or =30 days) complications, reoperations, medical comorbidity, and patient satisfaction were studied. Analysis was performed using the t test and Pearson chi 2 analysis. RESULTS: Overall median follow-up was 16.2 months (range, 1-40 months). Preoperative factors of patient age, sex, weight, body mass index, and medical comorbidity were similar between the 2 groups. Compared with LRYGB, patients who underwent LAGB experienced a greater incidence of late complications (P < .05), reoperations (P < .04), less weight loss (P<.001), and decreased overall satisfaction (P < .006). Likewise, patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus (P < .05) and sleep apnea (P<.01) compared with the LAGB group. Furthermore, postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations. Our single mortality was in the LAGB group. CONCLUSIONS: In super morbidly obese patients, LAGB is significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity, and patient dissatisfaction compared with LRYGB. Further evaluation of LAGB in this patient population appears warranted.

Adolescent↗
PubMed2004

Mesh infection in the era of laparoscopy.

BACKGROUND: The incidence of mesh infection during open hernia repair has been reported to be as high as 3%. With the introduction of laparoscopy, the rate of infection is still a matter of debate. METHODS: All 1182 laparoscopic inguinal hernia repairs performed at our institution from September 1991 to June 2002 were retrospectively reviewed to identify both mesh and wound infections. RESULTS: There were two mesh infections (0.17%) during that period, and one wound infection. CONCLUSION: The incidence of mesh infection in laparoscopic repair is considerably lower than in the open procedure. The two main reasons for this are the introduction of mesh through trocars to avoid skin contact, and the mesh is placed far from the trocar incisions, again avoiding contamination. The rate of wound infection is not related to that of mesh infection, and depends mainly on aseptic prepping techniques prior to surgery.

Aged↗
PubMedDate not supplied

Intracorporeal suturing and knot tying broadens the clinical applicability of laparoscopy.

OBJECTIVE: As surgeons become more experienced with basic laparoscopic procedures like cholecystectomy, they are able to expand this approach to less common operations. However, without laparoscopic suturing skills, like those obtained with Nissen fundoplication, many operations cannot be completed laparoscopically. We present a series of 10 patients with less common surgical illnesses who were successfully treated with minimal access techniques and intracorporeal suturing. METHODS: Over a 6-month period at 2 medical centers, 10 patients underwent operations with laparoscopic intracorporeal suturing and knot tying. Diagnoses included bowel obstruction due to gallstone ileus (n=1), perforated uterus from an intrauterine device (n=1), urinary bladder diverticulum (n=1), bleeding Meckel's diverticulum (n=3), and perforated duodenal ulcer (n=4). RESULTS: Each patient was treated with standard surgical interventions performed entirely laparoscopically with intracorporeal suturing. No morbidity or mortality occurred in any patient due to the operation. CONCLUSIONS: Although each of these operations has been previously reported, as a series, they point out the importance of mastering laparoscopic suturing. Although devices are commercially available to facilitate certain suturing scenarios, we encourage residents and fellows to sew manually. We believe that none of these operations could have been completed as effectively by using a suture device. The ability to suture laparoscopically markedly broadens the number of clinical scenarios in which minimal access techniques can be used.

Adult↗