772 Two-Hundred Consecutive Laparoscopic Liver Resections

10 times an easy, a medium and a difficult task with endoscopic equipment on a NOTES skillsbox. Time and errors were meassured, an overall score allocated and evaluated statistically. RESULTS: Group 3 performed all 3 of their allocated tasks significantly worse when compared to group 1 and 2 (p<0,05). No differences were detected between the performances of group 1 and 2 for the easy and the medium task (p>0,05). Group 1 performed the difficult tasks significantly better than group 2 (p<0,05). Group 2 demonstrated a very rapid learning curve between the first and tenth performance with a significantly better result for the tenth time of performance when compared to the first (p<0,05). CONCLUSION: The data support the conclusion that endoscopically inexperienced laparoscopic surgeons learn very quickly the handling of endoscopic equipment. Their initial performance is superior when compared to individuals without any surgical training. Furthermore, intitial performance is similar when compared to trained endoscopists for easy and tasks of moderate difficulty. However, endoscopists are still superior in handling endoscopic material for complex tasks when compared to endoscopically untrained surgeons. The data therefore suggest that laparoscopic surgeons are not severely disadvantaged by their lack of endoscopic experience and - due to their surgical experience - should perform NOTES. 50% of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis of NAFLD in patients with GD. Moreover, the fact that NAFLD is highly prevalent in patients with GD may justify routine liver biopsy in all patients undergoing laparoscopic cholecistectomy. Laparoscopic liver biopsy is a safe and effective method to establish the diagnosis and stage of NAFLD in patients with GD. 682 Reinterventions for Specific Technique-Related Complications of Stapled Haemorrhoidopexy (SH): A Critical Appraisal Pierpaolo Sileri, Vito M. Stolfi, Antonio Chiaravalloti, Achille Lucio Gaspari Introduction: Stapled haemorrhoidopexy (SH) is an attractive alternative to conventional haemorrhoidectomy (CH) because of reduced pain and earlier return to normal activities. However complications rates are as high as 31%. Although some complications are similar to CH, most are specifically technique-related. In this prospective audit we report our experience with the management of some of these complications. Methods: Data on patients undergoing haemorrhoidectomy at our unit or referred to us are prospectively entered in a database. The onset/duration of specific SH-related complications as well as reinterventions for failed/complicated SH were recorded. Results: from 1/03 to 10/07, 110 patients underwent SH, while 17 patients were referred after complicated/failed SH. Among SH performed in our group, we observed 21 specific complications in 17 patients (15.5%): urgency (12), tenesmus (5), severe persistent anal pain (2), haemorrhoidal thrombosis (2). Urgency resolved within 4 months in all patients but one in which lasted 8 months. Three patients (2.7%) had tenesmus up to 3 months. One patient with anal pain underwent exploration under anaesthesia (EUA) and retained stapled removal with complete symptoms resolution. The haemorrhoidal thrombosis occurred 4 and 12 days after SH and were treated medically. Six patients developed haemorrhoidal recurrence after 16+/-5 months after SH (range 9-26 months). Four symptomatic patients underwent further CH. Two patients (1,8%) developed symptomatic anorectal stenosis with urgency and frequency and responded to anal dilatation with dilators. Overall reinterventions rate for this group was 5.5%. Among the referred SH-group, 1 patient underwent Hartmann's procedure because of rectal perforation. The remaining 16 patients experienced at least one of the following: recurrence (6), urgency (6), severe anal pain (4), tenesmus (4), colicky abdominal pain (1), anal fissure (1) and stenosis (1). Recurrences where observed after 16+/-6 months from surgery (range 9-36 months). Four patients underwent CH with regular postoperative recovery. Two patients underwent EUA because of persisting pain after SH (7+/-6 months). Anorectal manometry and ultrasound were performed in both and pelvic MRI in one. In one patients the US showed a small submucosal abscess at the stapled line. The abscess was not seen at the MRI and it was not found at EUA. In both patients, surgical removal of retained staples resolved the pain. One patient underwent anoplasty. Conclusions: SH presents unusual and challenging complications. Abuses should be minimized and longer-term studies are needed to further clarify its role. 680 To Prepare or Not the Colon for Elective Surgery with Primary Intraperitoneal Anastomosis. There Is No Question María Jesús Peña-Soria, Julio M. Mayol, Rocio Anula, Ana M. Arbeo-Escolar, Jesus A. Fernandez-Represa Introduction: The definitive analysis of a prospective single-blinded randomized trial to investigate whether preoperative mechanical bowel preparation decreases the incidence of surgical site infection and anastomotic failure after elective colorectal surgery by a single surgeon is presented. Patients and Methods: All patients scheduled to undergo an elective colorectal procedure with a primary anastomosis by the same surgeon from October 2001 until January 2007 were enrolled and randomized to receive either oral polyethylene glycol (PEG) lavage solution (Group A) or no mechanical bowel preparation whatsoever (MBP)(Group B). Dietary restrictions were limited to 12 hours prior to surgery. A standard intravenous antibiotic prophylaxis scheme was used. Exclusion criteria included immunosupression, preoperative chemoradiotherapy, diverting stoma and perforated and/or obstructing tumor. Patients were followed by an independent observer for wound infection, intrabdominal sepsis and anastomotic failure within 30 days after surgery. Student's T and Chi square tests were used for statistical analysis. Statistical significance was defined as p<0.05. The number of patients needed to treat (NNT) was calculated as the inverse of the absolute risk reduction. The study was approved by Hospital Clinico San Carlos ethics committee. Results: One hundred and forty five patients were enrolled. Three patients (2.06%) were preoperatively excluded because of active immunosupression. One hundred and forty two patients were randomized but 13 of them (8.9%) were excluded from analysis (diverting stoma in 10 cases, contained perforation in 1 patient and unresectable tumor in 2 patients). Of the remaining 129 patients, 64 were assigned to Group A and 65 to Group B. The mean age was 67.39 ± 15.9 years in Group A and 67.2 ± 12.6 years in Group B (NS). There was no difference in sex distribution between groups. Overall, 27 patients (20.9%) developed postoperative wound infection, 16 (24.6%) patients in Group A vs. 11 (17.2%) in Group B (NS). There were 3 cases of intrabdominal sepsis and all of them occurred in Group A (6.3%). The SSI rate was 29.7% (19/64) for Group A vs. 17.2% (11/ 65) for group B (NS). The overall rate of anastomotic failure was 5.4% (n = 7), 4 patients in Group A (6.2%) vs. 3 patients in Group B (4.6%) (NS). The overall complication rate (SSI+ anastomotic failure) in Group A was 35.9% vs., 21.5% in Group B (NS). The NNT was 7. Conclusion: the NNT in our definitive analysis suggests that better outcomes in terms of SSI and anastomotic failure rates would be achieved by a single surgeon if preoperative MBP with PEG is routinely omitted. 772 INTRODUCTION Since the first report of a laparoscopic liver resection in 1992, laparoscopic resection of peripheral hepatic segments has become increasingly more common in the surgical treatment of both benign and malignant tumors. The minimally invasive approach to resections of the entire liver, however, is still only being performed in highly specialized centers do to lingering concerns about feasibility and efficacy. METHODS Patients who underwent minimally invasive techniques were compared to results in the literature of patients treated at other European referral centers who were approached with open techniques. Our data was collected retrospectively, including our first cases of advanced laparoscopic resections. Five-year Kaplan-Meier curves of patients with hepatocellular carcinoma (HCC) and non-neuroendocrine metastatic disease were calculated to ascertain disease free and overall survival. RESULTS Over a 12-year period from January 1995 until June 2007, a total of 357 liver procedures were performed. Of these a total of 200 laparoscopic liver resections were performed. The average OR time, estimated blood loss and length of stay was 192 minutes (+/- 106), 324 mL (+/-365) and 10 days (+/- 9). Conversions occurred in 13 patients (7%). Complications occurred after laparoscopic resection for primary liver cancer in 23% and in 24.2% after resections of non-neuroendocrine hepatic metastases compared to 31% and 25% as reported in the open European literature, respectively. Overall 5-year survival in patients with primary liver cancer is 66% and 55% in patients with nonneuroendocrine secondary hepatic tumors in the laparoscopic group compared to 36% and 32%, respectively, in the open group. Thirty day mortality occurred in 1% in the laparoscopic group compared to 2% in the open group. CONCLUSIONS Minimally invasive techniques for hepatic resections of the entire liver are feasible and safe, and high volume centers that specialize in these procedures can have results similar to historical open series. Five year overall survival may be superior when minimally invasive techniques are used, however, larger randomized-controlled trials are necessary to ascertain this. 681 Routine Liver Biopsy to Detect Non-Alcoholic Fatty Liver Disease (NAFLD) During Laparoscopic Cholecystectomy for Symptomatic Gallstone Disease (GD). Is It Justified? Antonio Ramos-De la Medina, Federico B. Roesch, Alfonso Perez Morales, Silvia CidJuarez, Jose M. Remes-Troche Background: Non-alcoholic fatty liver disease (NAFLD) and its inflammatory and progressive subtype non-alcoholic steatohepatitis (NASH) have emerged as a major health burden. NAFLD and Gallstone disease (GD) share common pathophysiologic and risk factors. Currently there are no recommendations regarding screening of NAFLD in patients at increased risk. Moreover, non invasive methods to diagnose NAFLD are unreliable and liver biopsy is the only method for assessing the presence and extension of this condition. Firm recommendations of when to perform a liver biopsy in the routine clinical evaluations have not been developed. In this study our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and to evaluate the usefulness of routine liver biopsy as a screening method. Methods: We prospectively evaluated 95 consecutive patients referred for cholecystectomy due to symptomatic GD between January 1st 2005 and June 30th 2006. All patients had a liver biopsy performed at the end of a standard laparoscopic cholecystectomy. Demographics, anthropometric measurements, family history, risk factors, laboratory tests and abdominal ultrasound were registered and analyzed. Patients with a positive serology for hepatitis B or C virus, those with a history of alcohol ingestion greater than 150 gr/day, autoimmune hepatitis or other liver disease where excluded. Results: Twenty-nine patients (30.5%) were male and 66 (69.4%) were female. Mean age was 52.15 ± 16.82 years (range 2- 84 years) Forty-three patients (45%) had normal biopsies (Group A) while 52 patients (55%) had histological findings compatible with NAFLD (Group B). The patients in the later group where further classified according to the system proposed by Brunt as follows: stage I 51.93%, stage II 28.84%, stage III 19.23% and cirrhosis 3.15%. Patients in group B were older, had a higher body mass index, higher prevalence of diabetes, higher glicosilated hemoglobin levels, serum cholesterol and serum triglycerides than those in group A although they were not statistically significant. There were no complications secondary to the liver biopsies. Discussion: In our series, our findings show that more than 773 Long-Term Quality of Life Is Similar After Hepatic Resection for Malignant and Benign Diseases Vanessa Banz, Regula Fankhauser, Peter Studer, Beat Gloor, Daniel Inderbitzin, Daniel Candinas Background: Morbidity and mortality are continuously decreasing after major hepatic surgery due to more advanced operative methods and perioperative care. The extent and indications of liver resections (LR) are being pushed to the limits. As survival increases post-hepatectomy, quality of life (QOL) becomes a leading issue. Up until now, no studies address potential differences in long-term QOL in patients necessitating LR for benign or malignant conditions. Our aim was to see how postoperative diagnosis affected long-term self estimated QOL and A-853 SSAT Abstracts SSAT Abstracts Two-Hundred Consecutive Laparoscopic Liver Resections Andrew A. Gumbs, Brice Gayet