SAGES/ALACE Symposium: Integrating New Technologies, Old Tricks, and Operative Approaches

In earlier days, surgeons had more functionality and flexibility with separate individual ports instead of multi-hole platforms for single-port surgery

Current multi-hole platforms have improved functionality compared to earlier versions

Multiple puncture holes in fascia was a concern and issue with separate trocar approach

Most current platforms have a skin barrier protector sleeve for specimen extraction

The mass population is probably not going to adopt the robot for single-site surgery

Different types of myotomy have been tried for achalasia, starting from the Levatiti one circular or spiral

Circular or spiral myotomies that left both longitudinal and circular layers with only mucosa had complications such as out-pouching

Total circular myotomy gives length but the esophagus loses strength

Bilateral myotomy is capable of elongating the esophagus while keeping good compliance

LINX is a potential in-between therapy, maybe more effective than current endoluminal therapies but maybe not as much of a barrier as Nissen, but more physiologic

The LINX device is a rosary of magnets that slide along so when you swallow, the bolus pushes the magnets apart and they lose some attraction force, making it more physiologic

If you are already suffering what is believed to be a complication of gastroesophageal reflux disease (Barrett's), we should be aggressive about managing that and not just treat it expectantly, similar to a colon polyp

It's not clear whether it's necessary to do radiofrequency ablation for non-dysplastic Barrett's in some people's minds

Buried glands is actually a natural state of Barrett's esophagus

Radiofrequency ablation definitely decreases buried glands and does so more than acid suppression and placebo

If we know ahead of time that there are stones in the common bile duct, we don't send to ERCP but explore the common duct directly, either transcystic or via choledochotomy

In a review of 500 ERCPs from 10 different endoscopists, only 68% were able to clean the biliary tree

In many countries in Latin America, an endoscopist does 100 cases in 10 years as it's not everyday routine

It's possible to do exploration of the common bile duct with decreased cost, same morbidity, and probably even less morbidity than ERCP

Gastric leaks and biliary leaks have very common closure rates and usually close in about 2 to 3 weeks

Most surgeons leave stents in place until about 4 to 6 weeks because it's not a big deal to remove them

Chronic fistulas, especially tracheoesophageal fistulas managed for months through drainage procedures, clips, and glues, are left with stents for a much longer period and have lower success rates