Papers by Maurice Arregui
Problems in General Surgery, 2002
Surgical Clinics of North America, 2004
Surgical endoscopy, 1994
Although the laparoscopic technique is a new approach to groin hernia, it is becoming more widely... more Although the laparoscopic technique is a new approach to groin hernia, it is becoming more widely accepted as an alternative to traditional open techniques. This study is a preliminary review of complications and recurrences. A questionnaire specific for complications was sent to each investigator. From 12/89 to 4/93, 1,514 hernias were repaired; 119 (7.8%) were bilateral and 192 (12.7%) recurrent. There were 860 indirect, 560 direct, 43 pantaloon, 37 femoral, and 6 obturator hernias, and 8 were not specified; 553 were repaired using a transabdominal preperitoneal mesh technique (TAPP), 457 with a total extraperitoneal technique (TEP), 320 with intraperitoneal onlay mesh (IPOM), 102 by ring closure, and 82 involved plug and patch technique. Eighteen intraoperative and 188 postoperative complications were seen. The total complication rate was 13.6%, of which 1.2% were intraoperative. Of the intraoperative complications, 12 were related to the laparoscopic technique, three were relate...
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 1991
The safety of laparoscopic cholecystectomy has been demonstrated through its increased use, and w... more The safety of laparoscopic cholecystectomy has been demonstrated through its increased use, and we have performed 114 of these operations as outpatient procedures. These patients have done well and hospitalization charges have been reduced substantially. Of 622 laparoscopic cholecystectomies performed from November 1989 to March 1991, 114 were done on an outpatient basis if the patients were generally healthy, lived nearby, and the operative procedure was uneventful. Other patients were admitted as 23-h observation or as inpatients. Records of 106 outpatients were reviewed and hospital charges obtained. These charges were then compared with those of 337 patients who underwent standard open cholecystectomy as morning admissions and who had no comorbid conditions nor complications. Comparisons are also made with 23-h observation and inpatient laparoscopic cholecystectomies as well as with all standard open cholecystectomy patients. The technique employed is with three punctures using electrocautery and a minimum of disposable products. Of the 106 outpatients, one required admission for postoperative ileus and pain control; 21 (19.8%) experienced nausea and 14 (13.2%) experienced vomiting but were treated successfully with antiemetics; none required admission. One patient required outpatient catheterization for urinary retention. Of the last 100 laparoscopic cholecystectomies performed by three surgeons (M.E.A., C.J.D., A.A.), 43 were performed as outpatients using the above selection criteria. 44 were held for 23-h observation, and 13 were inpatients. The average hospital charge for 377 uncomplicated morning-admitted inpatient standard cholecystectomy patients was $4,250.00, compared with $2,293.02 for 106 outpatient laparoscopic cholecystectomy patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 1994
Minimally Invasive Cancer Management, 2009
Ultrasound is an indispensable tool for the minimally invasive oncologic surgeon. The tactile sen... more Ultrasound is an indispensable tool for the minimally invasive oncologic surgeon. The tactile sense which surgeons rely so much upon in cancer surgery is limited during laparoscopy, but that deficit can be filled, and frankly exceeded, by utilizing laparoscopic ultrasound (LUS) techniques. In addition, preoperative endoscopic ultrasound (EUS) provides the clinician with information for staging, delineates anatomic relationships to guide
The Sages Manual, 2006
There are indications and applications for laparoscopic ultrasound during numerous laparoscopic p... more There are indications and applications for laparoscopic ultrasound during numerous laparoscopic procedures. These situations include evaluation of the biliary tree during laparoscopic cholecystectomy, evaluation of the pancreas and surrounding vasculature ...
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 1994
Surgical endoscopy, Jan 16, 2014
The altered anatomy of Roux-en-Y gastric bypass presents a challenge when duodenal access is requ... more The altered anatomy of Roux-en-Y gastric bypass presents a challenge when duodenal access is required for ERCP. One technique, laparoscopic transgastric ERCP, was first described in 2002. Since that time, a total of 77 laparoscopic or percutaneous transgastric ERCPs have been reported. The largest case series includes 26 ERCPs, and no reports specifically address complications. We reviewed our experience with 85 transgastric ERCPs and report the limitations and complications associated with access and ERCP. Retrospective review was conducted of gastric bypass patients who underwent transgastric ERCP in our practice from 2004-2014. Forty-one patients underwent 85 transgastric ERCPs during the study period. Conversion from laparoscopic to open procedure occurred in 4.8Â %, and selective cannulation rate was 93Â %. Forty-seven percent of cases were repeat ERCPs performed through a gastrostomy tube tract. During 15-month median follow-up, the overall complication rate was 19Â %, with 88Â % ...
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2000
Pancreatic islet cell tumors represent a diverse group of neuroendocrine lesions. These tumors ma... more Pancreatic islet cell tumors represent a diverse group of neuroendocrine lesions. These tumors may be singular or multiple, benign or malignant, sporadic, or part of the constellation of multiple endocrine neoplasia type 1. Tumors such as insulinomas and gastrinomas produce gastrointestinal peptides that lead to diagnosis. Nonfunctioning lesions may be found incidentally or by screening patients at high risk for such tumors. Successful management of patients with pancreatic islet cell tumors relies on accurate localization and sound operative technique. With proper preoperative localization, advanced laparoscopic methods can be used to manage patients with these pancreatic neoplasms. Preoperative localization of pancreatic islet cell tumors was difficult in the past. Standard imaging and localizing modalities, such as computed tomography scanning, magnetic resonance imaging, angiography, transabdominal sonography, and portal venous sampling, yield only 24% to 75% accuracy. Consequently, many biochemically suspected lesions cannot be imaged with current techniques. Decreased tactile sensation of laparoscopy adds complexity to intraoperative identification. Endoscopic sonography and laparoscopic sonography provide accurate preoperative and intraoperative localization to enhance laparoscopic and open resection. The authors treated two patients with islet cell neoplasms using endoscopic sonography to preoperatively visualize the tumors and laparoscopic sonography to guide laparoscopic enucleation. Their approach and difficulties are discussed.
World Journal of Surgery, 1999
The use of minimally invasive techniques in surgery for inguinal hernias has become an establishe... more The use of minimally invasive techniques in surgery for inguinal hernias has become an established approach to inguinal hernia repair. A brief history of laparoscopic hernia surgery is presented, including evolution of techniques. Several prospective randomized trials comparing open repairs with laparoscopic procedures are reviewed, and the results of the experience at the authors' institution are presented. Studies on the advantages of laparoscopic hernia repair vary, many showing advantages of the laparoscopic approach over open techniques. With continuing refinement of technique and efforts to minimize the cost differential, there should be a continuing role for minimally invasive hernia repair.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2011
Gastrointestinal (GI) lipomas are rare, benign, slowly growing, submucosal tumors, which can eith... more Gastrointestinal (GI) lipomas are rare, benign, slowly growing, submucosal tumors, which can either be incidentally found as silent tumors of the GI tract or be the cause for GI bleeding, anemia, intussusception, and bowel obstruction. Endoscopic removal is a valid alternative to surgical resection of these tumors. In the recent past, many submucosal lipomas were for the most part resected surgically due to the risk of perforation using endoscopy. There are newer techniques available to allow safe endoscopic removal of these lesions. We present 3 successful techniques tailored to the location of the lipoma and size. In our unit, 3 symptomatic GI lipomas were referred to us for surgical resection, 2 originating from the duodenum and 1 from the cecum were diagnosed and resected under endoscopic ultrasound and endoscopy. We performed 3 different techniques to remove these lipomas. One of the lipomas in the duodenum was in the duodenal bulb. It was mobile and 3 cm in size. We attempted to remove this broad-based lipoma by snare and cut technique after its borders were elevated with injection of saline and epinephrine. The second duodenal lipoma was 1.5 cm. This pedunculated lipoma was located in the second portion, on the pancreatic side of the duodenum proximal to ampulla. This lipoma was lifted up with a snare and its base was cauterized resulting in successful removal. The third GI lipoma was 3.5 cm in size pedunculated and located in the cecum. The base of this pedunculated lipoma was ligated with poly loop device and endoclip resulting in ischemia and spontaneous separation of the lipoma from the colonic wall. All cases were revisited with follow-up endoscopy. All 3 methods, when used selectively, were found to be very safe and effective. All 3 lesions were successfully removed and histopathologically confirmed to be lipomas. After endoscopic removal, no complications were observed. Carefully selected GI lipomas, which in the past have required surgical resection due to high risk for perforation can be endoscopically removed with great success.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2001
Sphincter of Oddi (SO) dysfunction as a potential cause of chronic acalculous cholecystitis (CAC)... more Sphincter of Oddi (SO) dysfunction as a potential cause of chronic acalculous cholecystitis (CAC) has not been studied in cases for which intraoperative SO manometry was used during laparoscopic cholecystectomy. In this study, we evaluated the effects of carbon dioxide pneumoperitoneum on laparoscopic transcystic SO manometry. In 27 patients with CAC, transcystic SO manometry had been attempted during laparoscopic cholecystectomy. The mean age of the patients was 46 years (range, 22-71). Complete manometric data sets were obtained in 18 patients. The mean SO pressure, phasic SO pressure, and phasic frequency were 35.4 +/- 29.1 mm/Hg versus 30.8 +/- 23.8 mm/Hg, 104.8 +/- 63.0 mm/Hg versus 73.6 +/- 34.6 mm/Hg, and 2.1 +/- 1.8 contractions/min versus 2.8 +/- 3.4 contractions/min with and without pneumoperitoneum, respectively. All differences were nonsignificant (P > 0.05). Two complications (7.4%) were observed: pancreatitis and jaundice. SO manometry is not affected by CO2 pneumoperitoneum. It may be used to study SO motility in patients with CAC.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2009
The need for acquisition of specific laparoscopic skills has emphasized the role of a preclinical... more The need for acquisition of specific laparoscopic skills has emphasized the role of a preclinical laboratory-training program. However, for laparoscopic inguinal hernia repair with a steep learning curve, especially for totally extraperitoneal repair, preclinical skill training remains a challenge. A standardized preclinical resident training program in endoscopic surgery is described. Also, a standardized clinical training program is proposed with systematic dissection in 10 different consecutive steps for totally extraperitoneal inguinal hernia repair. Continuous mentoring by an expert is an absolute prerequisite to the success of this training program. In this way, the learning period may be drastically reduced to approximately 30 procedures, in whom the resident progressively performs more and more of the different steps, and ultimately the complete procedure. Validation studies at different institutions are starting up to demonstrate the additional value of this training program.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2002
Surgical Endoscopy, 1995
The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been... more The incidence and reasons for early recurrences following laparoscopic hernioplasty have not been studied. Because the incidence is small and the follow up is short, a multi-institutional study was performed among the pioneers in the field. The incidence figures were obtained by survey of surgeons who had significant experience (over 100 cases) and kept concurrent records. Fifty-four recurrences (1.7%) occurred after 3229 laparoscopic hernia repairs. There were 1944 transabdominal preperitoneal (TAPP) repairs with 19 recurrences (1%) and 578 preperitoneal repairs with no recurrences. There were 345 onlay mesh (IPOM) repairs with seven recurrences (2%), and 286 plug and patch repairs with 26 recurrences (9%). Simple closures were performed 76 times with two recurrences (2.6%). Fifty-seven patients (three cases were referred to the author without incidence data but complete records for analysis) had 60 recurrent hernias. Recurrences were noted, on average, 5.1 months postoperatively (range 0-30 months). The most common reason for recurrence was that the mesh was too small - 36 (60%). The mesh was never stapled in 19 instances (32%), and the hernia was never repaired in three cases (20%). The clips pulled through the tissue in six cases (8%), and in 10 cases (15%) the repair has not yet been undertaken because the etiology was unclear. There was more than one reason in 19 patients. Technical factors were responsible for nearly all recurrences.
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Papers by Maurice Arregui