Background Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centres. Patients and methods Patients with FAP and histologically confirmed gastric adenomas were identified between 1997-2018. Patient demographics, adenoma characteristics management/surveillance outcomes were collected. Results One hundred and four (49 female) of 726 patients (14%) were diagnosed with gastric adenomas at a median age of 47 years (range 19-80). The median size of gastric adenoma was 6mm (range 1.5-50mm); 64 (62%) patients had adenomas located distal to the incisura. Five (5%) patients had gastric adenomas demonstrating high grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (p=0.04). Of adenomas larger than 20mm, 33% contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. Sixty-three (61%) patients underwent endoscopic therapy for gastric adenomas. Complications occurred in three (5%) patients and two (3%) had recurrence, all following piecemeal resection of large (30-50mm) lesions. Three patients were diagnosed with gastric cancer during follow-up, a median of 66 months (range 66-115) after initial diagnosis. Conclusions In this series, we observed gastric adenomas in 14% of patients with FAP. Five per cent contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but does not completely eliminate the cancer risk.
Patients with small bowel CD undergoing strictureplasty alone may have fewer postoperative complications than those undergoing a concomitant bowel resection. However, surgical recurrence maybe higher following strictureplasty alone than with a concomitant small bowel resection. Patients may require appropriate preoperative counselling regarding the pros and cons of each operative technique.
Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.
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