Laparoscopically assisted bowel surgery in an era of double-balloon enteroscopy: from inside to outside.
BACKGROUND
This report describes an integrated therapeutic method of double-balloon enteroscopy (DBE) and laparoscopically assisted bowel surgery (LABS) for small bowel diseases.


METHODS
In this study, 34 patients with obscure gastrointestinal bleeding (OGIB, n=25) and abdominal pain (n=9) who underwent DBE and LABS were analyzed. Demographics, patient characteristics, diagnostic tests, DBE and LABS findings, surgical results, and long-term outcome were reviewed.


RESULTS
All 34 patients underwent DBE without significant complications. Biopsy was performed for 16 patients, ink mark for 25 patients, and temporary homeostasis during DBE for 5 patients. Laparoscopically assisted bowel resection was performed for 27 patients, converted laparotomy for 6 patients, and laparoscopic diagnosis alone for 1 patient. The pathologic diagnoses included gastrointestinal stromal tumor (GIST) for eight patients, primary adenocarcinoma for three patients, lymphoma for three patients, Meckel's diverticulum for three patients, angiodysplasia for three patients, ulcer for two patients, lipoma for four patients, metastasis for three patients, jejunal diverticulosis for two patients, and tuberculosis ileitis, ileal varix, and lymphangioma for one patient each. No surgical mortalities or significant morbidities were noted. After a follow-up period of 14+/-3 months, 29 patients were well without disease recurrence. Two patients had symptomatic recurrence, and three patients died of cancerous progression.


CONCLUSIONS
The combination of DBE and LABS represents an ideal therapeutic method, especially for OGIB caused by small bleeding neoplasms or vascular lesions.
Yeh
Ta-Sen
TS
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. tsy471027@adm.cgmh.org.tw
Liu
Keng-Hau
KH
Su
Ming-Yao
MY
Lin
Cheng-Hui
CH
Chiu
Cheng-Tang
CT
Tseng
Jeng-Hwei
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002404:Catheterization / Q000295:instrumentation*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult