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Abdominal Surgery May Become Easier for Patients

Advanced technique is said to reduce post-op pain and scarring

WEDNESDAY, June 3 (HealthDay News) -- A scarless surgical technique shows promise in procedures such as weight-loss surgery and gallbladder and appendix removal, suggest several studies.

The technique, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), causes less pain than conventional laparoscopic surgery and offers a much faster recovery time, experts say. Doctors pass an endoscope through a natural opening in the body and then through an internal incision in the stomach, vagina, bladder or colon. This eliminates external incisions and scars.

A study from the University of California, San Diego, suggests that the technique might offer a far less painful and dangerous option for weight-loss surgery. It was used to perform transvaginal sleeve gastrectomy in morbidly obese patients, creating two small incisions in the abdomen and one in the vagina to remove 70 percent of the patients' stomachs, the study reported.

The findings were to be presented this week at the Digestive Disease Week conference in Chicago.

Standard laparoscopic gastrectomy requires five to seven larger incisions in the abdomen that can cause major scarring and increase the risk for infections and hernias.

"Compared to traditional laparoscopic techniques in which patients experience a high incidence of infections and hernias, the results so far indicate this procedure accelerates weight loss while minimizing adverse events," Dr. Santiago Horgan, professor of surgery, said in a new release from a conference sponsor.

In another study, Horgan and colleagues were the first to perform transvaginal appendectomies. The procedure involved just a small incision in the abdomen and another in the vagina, fewer than the incisions needed for appendix removal with traditional laparoscopy.

"Our initial results suggest when appendectomies are performed transvaginally, patients experience less pain, fewer complications and are on their feet in three to four days," Horgan said. "While we have enough data to prove that the procedure is safe, the question now is to see if it can be duplicated successfully in a larger sample of patients."

In a third study, researchers at the University of Buenos Aires used the procedure transvaginally to successfully remove the gallbladders of 21 of 22 people. The procedure could not be completed in one patient because of pelvic lesions.

The 21 people who had the procedure healed successfully with no complications and were able to resume sexual activity without pain after a brief recovery period. Two of the 21 became pregnant after the procedure, and one has had a normal delivery with no complications. The other women is not yet full term.

"Gallbladder removal using the NOTES procedure is remarkably safe and effective," Dr. Oscar M. Laudanno, chief of gastroenterology at Hospital Bocalandro, said in the news release. "We can eliminate the pain and recovery time of traditional surgery without introducing complications, either gynecological or sexual, for the patient."

In another study, Cedars-Sinai Medical Center researchers used the procedure for a new incision-free weight-loss surgery, called transoral gastroplasty, that involves using a vacuum to bring together the sides of the stomach and then stapling them together to reduce food intake. Because the study is a U.S. Food and Drug Administration clinical trial, the researchers could not reveal the results, but they planned to show a video of the procedure at the conference.

"The potential of NOTES and near-NOTES procedures is being demonstrated," Dr. Michael L. Kochman, of the Hospital of the University of Pennsylvania, said in the news release. "These latest studies show that surgeries that once subjected patients to significant pain and recovery time may become a thing of the past."

More information

The American Academy of Family Physicians has more about gallbladder removal.

-- Robert Preidt

SOURCE: Digestive Disease Week, news release, June 2, 2009

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