Weight loss resulting from LRYGBP significantly reduces obesity-related morbidities, resulting in a substantial reduction in medication needs in patients over the age of 54. The projected cost savings realized in the 78 patients in this study amounts to approximately $240,566.04 annually.

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The increased morbidity and cost of RLOC to avoid symptomatic residual BDS is not justified. All other reasons given for RLOC are either flawed or indicate that the procedure can be safely employed selectively. SLOC is an effective method of verifying suspected BDS and is safer and less expensive than RLOC.

Laparoscopic transperitoneal fusion of the L5-S1 spinal interspace has become a common procedure. Retroperitoneal retraction and laparoscopic instrumentation without insufflation also allows visualization of the upper lumbar spaces, but this procedure is much more difficult to accomplish. We review and compare our results using each of these techniques for the treatment of mechanical instability and chronic back pain. A total of 35 selected patients underwent intervertebral fusion between February 1996 and August 1998. Their mean age was 48 years. There were 22 female and 13 male patients. Standard CO2 insufflation was used in 10 patients with L5-S1 fusions. Retractional gasless technique was used in nine patients with fusions at L5-S1, 16 patients at L4-L5, one patient at L3-L4, three patients at L2-3, and one patient at L1-L2. Thus, we performed a total of 40 lumbar fusions in 35 patients. In the 19 patients with the gasless technique, a balloon dissector and retractor facilitated the retroperitoneal exposure. Seven of these 19 patients were converted to open procedures, most commonly due to lacerations of the peritoneal lining that prohibited visualization. None of the L5-S1 patients with insufflation were converted to open. Mean operative time in the insufflated patients was 152 min vs. 181 min for the retractional technique. There were seven complications in the transperitoneal group: one fusion device migration, one postoperative UTI, one intracerebral hemorrhage, one severe postoperative pancreatitis, and three iliac vein lacerations. There were 16 complications in the retroperitoneal group: one deep vein thromboses, one serosal bowel injury, one small tear in the spleen, one cage migration, one postoperative pulmonary atelectasis, one postoperative hydrocele, four postoperative ileus, and six peritoneal tears. The mean postoperative stay was three days for both groups. There were no deaths. The L5-S1 interspace is best approached transperitoneally for anterior fusion. Although the retroperitoneal retractional technique is much more difficult and has a longer and steeper learning curve, it does allow laparoscopic anterior fusion of the upper lumbar spine.

This paper presents the technique and results of an operation that restores normal anatomical and physiological antireflux mechanisms for the treatment of gastroesophageal reflux disease (GERD). The Hill procedure was modified beginning in 1973, evolving into an operation that has been standard in our practice since 1987. Major changes included total fixation of the abdominal esophagus and elimination of phrenoesophageal bundle plication. We began performing the procedure laparoscopically in 1991 and simultaneously began a study to look at our results. This is the first report of the first 44 patients operated on from October 1991 through March 1994. There was one operative complication. Mean follow-up was 14 months. One patient was lost to follow-up and one patient died. There were no long-term side effects. A Visick grading scale was designed to categorize results. Forty graded satisfactory (95%) and two unsatisfactory.