***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Hypothermia during and after major abdominal surgery decreases host defenses , increases the incidence of coagulopathy and may alter blood pressure , cardiac contractility and myocardial stability . Methods : We design ed a prospect i ve r and omized study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass .  Results : Patients in the forced air warming group ( n = 32 ) had significantly higher perioperative body core temperature , lower central venous pressure and blood pressure readings , lower incidence of shivering , less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those patients in the warmed blanket group ( n = 32 ) . Conclusion : The forced air warming system is safe , cost effective and beneficial in minimizing the undesirable consequences of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass BACKGROUND The magnitude of the systemic stress response is proportional to the degree of operative trauma . We hypothesized that laparoscopic gastric bypass ( GBP ) is associated with reduced operative trauma compared with open GBP , result ing in a lower systemic stress response . STUDY DESIGN Forty-eight patients with a body mass index of 40 to 60 were r and omly assigned to laparoscopic  ( n = 26 ) or  open  ( n = 22 ) GBP Blood sample s were measured at baseline and at 1 , 24 , 48 , and 72 hours postoperatively . Metabolic ( insulin , glucose , epinephrine , norepinephrine , dopamine , ACTH , cortisol ) , acute phase ( C-reactive protein ) , and cytokine ( interleukin [IL]-6 , IL-8 , tumor necrosis factor [TNF]-alpha ) responses were measured . Catabolic response was also measured by calculating the nitrogen balance at 24 and 48 hours postoperatively . RESULTS The two groups of patients were similar in terms of age , gender , and preoperative body mass index . The mean operative time was longer for laparoscopic GBP than for open GBP ( 229 + /- 50 versus 207 43 minutes ) . After laparoscopic and open GBP , plasma concentrations of insulin , glucose , epinephrine , dopamine , and cortisol increased ; IL-8 and TNF-alpha remained unchanged ; and negative nitrogen balances occurred at 24 and 48 hours . There was no significant difference in these parameters between groups . Concentrations of norepinephrine , ACTH , C-reactive protein , and IL-6 levels also increased , but these levels were significantly lower after laparoscopic GBP than after open GBP ( p < 0.05 ) . CONCLUSIONS Systemic stress response after laparoscopic GBP is similar to that after open GBP , except that concentrations of norepinephrine , ACTH , C-reactive protein , and IL-6 are lower after laparoscopic than after open GBP . These findings may suggest a lower degree of operative injury after laparoscopic GBP The benefits of laparoscopic appendectomy appear to be controversial . Since 1994 , several abdominal procedures have been completed by using the needlescopic technique , but there appear to be no prospect i ve studies to demonstrate the perceived benefits of needlescopic appendectomy . The authors compared open , laparoscopic , and needlescopic appendectomy in a r and omized fashion with regard to duration of surgery , length of hospitalization , analgesic dosage , and surgery-associated complications . From March to July 1998 , 75 patients admitted at the emergency station of the authors ' hospital with a final diagnosis of acute appendicitis without tumor formation were r and omized to receive one of the three treatment categories : open ( OA ) , laparoscopic ( LA ) , and needlescopic ( nLA ) appendectomy . Laparoscopic and needlescopic appendectomy were performed by using a three-port technique , although the size of the trocar used varied . There were 26 patients in the OA group , 23 in the LA group , and 26 in the nLA group . The mean operation duration s for the OA , LA , and nLA groups were 55.4 ± 28.0 minutes , 69.1 ± 48.8 minutes , and 62.3 ± 26.3 minutes , respectively , and these were not significantly different from one another . The mean number of the analgesic doses ( Pethidine 1 mg/kg ) required was 1.3 ± 1.2 mg/kg , 0.5 ± 0.8 mg/kg , and 0.2 ± 0.6 mg/kg , respectively . Significant differences were noted when comparing the OA with the LA or nLA groups ( OA vs. LA , P = 0.02 ; OA vs. nLA , P = 0.0002 ; LA vs. nLA , P = 0.06 ) . The mean oral intake duration s were 32.2 ± 16.9 hours , 21.0 ± 14.6 hours , and 20.8 ± 16.4 hours , respectively , after surgery for the OA , LA , and nLA groups , and the between-group differences were statistically significant for the OA versus LA group ( P = 0.004 ) and for the OA versus nLA group ( P = 0.003 ) . The mean duration s of hospitalization for the OA , LA , and nLA groups were 3.6 ±1.8 days , 2.8 ± 1.4 days , and 2.4 ± 0.9 days , and difference was detected between the OA and the nLA groups ( P = 0.02 ) . The OA group rendered a greater wound-complication rate and ileus than did the other two groups , but the differences were not detected between the three categories ( P = 0.065 , 0.6935 ) . The result of the current study confirmed that the nLA procedure is a feasible and safe one . The nLA procedure provided substantial advantages over the OA procedure in the context s of diminished postoperative pain and shorter hospital stay without significant increases in postoperative complication rate or surgical time HYPOTHESIS  Laparoscopic gastric bypass ( GBP )  induces a postoperative hypercoagulable state that is similar or reduced compared with open GBP . SETTING University hospital . PATIENTS Between May 1999 and June 2000 , 70 patients were r and omly assigned to laparoscopic ( n = 36 ) or open ( n = 34 ) GBP .  Deep venous thrombosis ( DVT ) prophylaxis consisted of antiembolism stockings and sequential pneumatic compression devices . MAIN OUTCOME MEASURES Plasminogen , thrombin-antithrombin complex ( TAT ) , prothrombin fragment 1.2 ( F1.2 ) , fibrinogen , D-dimer , antithrombin III ( AT ) , and protein C levels were measured at baseline and at 1 , 24 , 48 , and 72 hours postoperatively . A venous duplex examination of both lower extremities was performed preoperatively and between the third and fifth day postoperatively . RESULTS The 2 groups were similar in age , weight , and body mass index . Plasminogen levels decreased , and TAT , F1.2 , and fibrinogen levels increased after laparoscopic and open GBP . There was no significant difference in these levels between groups . D-dimer levels increased in both groups , but the levels were significantly higher after open GBP than after laparoscopic GBP ( P<.01 ) . Antithrombin III and protein C levels decreased in both groups . The reduction of AT ( at 1 hour ) and protein C ( at 72 hours ) was significantly less after laparoscopic GBP than after open GBP ( P<.05 ) . Postoperative venous duplex examination revealed DVT in 1 ( 2.9 % ) of 34 patients after open GBP but in none of 36 patients after laparoscopic GBP . One patient developed pulmonary embolism after open GBP . CONCLUSIONS Laparoscopic GBP induces a hypercoagulable state similar to that of open GBP . Our findings suggest that DVT prophylaxis should be used during laparoscopic GBP as in open GBP BACKGROUND Impairment of pulmonary function is common after upper abdominal operations . The purpose of this study was to compare postoperative pulmonary function and analgesic requirements in patients undergoing either laparoscopic or open Roux-en-Y gastric bypass ( GBP ) .  STUDY DESIGN Seventy patients with a body mass index of 40 to 60 kg/m2 were r and omly assigned to undergo laparoscopic ( n = 36 ) or open ( n = 34 ) GBP .  The two groups were similar in age , gender , body mass index , pulmonary history , and baseline pulmonary function . Pulmonary function studies were performed preoperatively and on postoperative days 1 , 2 , 3 , and 7 .  Oxygen saturation and chest radiographs  were performed on both groups preoperatively and on postoperative day 1 . Postoperative pain was evaluated using a visual analog scale and the amount of narcotic consumed was recorded . Data are presented as mean + /- st and ard deviation . RESULTS Laparoscopic GBP patients had significantly less impairment of pulmonary function than open GBP patients on the first three postoperative days ( p < 0.05 ) . By the 7th postoperative day , all pulmonary function parameters in the laparoscopic GBP group had returned to within preoperative levels , but only one parameter ( peak expiratory flow ) had returned to preoperative levels in the open GBP group . On the first postoperative day , laparoscopic GBP patients used less morphine than open GBP patients ( 46 + /- 31 mg versus 76 + /- 39 mg , respectively , p < 0.001 ) , and visual analog scale pain scores at rest and during mobilization were lower after laparoscopic GBP than after open GBP ( p < 0.05 ) . Fewer patients after laparoscopic GBP than after open GBP developed hypoxemia ( 31 % versus 76 % , p < 0.001 ) and segmental atelectasis ( 6 % versus 55 % , p = 0.003 ) . CONCLUSION Laparoscopic gastric bypass result ed in less postoperative suppression of pulmonary function , decreased pain , improved oxygenation , and less atelectasis than open gastric bypass BACKGROUND To perform a prospect i ve , r and omized comparison of laparoscopic adjustable gastric b and ing ( LAGB ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) .  METHODS LAGB , using the pars flaccida technique , and st and ard LRYGB were performed . From January 2000 to November 2000 , 51 patients ( mean age 34.0 + /- 8.9 years , range 20 - 49 ) were r and omly allocated to undergo either LAGB ( n = 27 , 5 men and 22 women , mean age 33.3 years , mean weight 120 kg , mean body mass index [ BMI ] 43.4 kg/m(2 ) ; percentage of excess weight loss 83.8 % ) or LRYGB ( n = 24 , 4 men and 20 women , mean age 34.7 , mean weight 120 kg , mean BMI 43.8 kg/m(2 ) , percentage of excess weight loss 83.3 ) . Data on the operative time , complications , reoperations with hospital stay , weight , BMI , percentage of excess weight loss , and co-morbidities were collected yearly . Failure was considered a BMI of > 35 at 5 years postoperatively . The data were analyzed using Student 's t test and Fisher 's exact test , with P < .05 considered significant . RESULTS The mean operative time was 60 + /- 20 minutes for the LAGB group and 220 + /- 100 minutes for the LRYGB group ( P < .001 ) . One patient in the LAGB group was lost to follow-up . No patient died . Conversion to laparotomy was performed in 1 ( 4.2 % ) of 24 LRYGB patients because of a posterior leak of the gastrojejunal anastomosis . Reoperations were required in 4 ( 15.2 % ) of 26 LAGB patients , 2 because of gastric pouch dilation and 2 because of unsatisfactory weight loss . One of these patients required conversion to biliopancreatic diversion ; the remaining 3 patients were on the waiting list for LRYGB . Reoperations were required in 3 ( 12.5 % ) of the 24 LRYGB patients , and each was because of a potentially lethal complication . No LAGB patient required reoperation because of an early complication . Of the 27 LAGB patients , 3 had hypertension and 1 had sleep apnea . Of the 24 LRYGB patients , 2 had hyperlipemia , 1 had hypertension , and 1 had type 2 diabetes . Five years after surgery , the diabetes , sleep apnea , and hyperlipemia had resolved . At the 5-year ( range 60 - 66 months ) follow-up visit , the  LRYGB  patients had significantly lower weight and BMI and a greater percentage of excess weight loss than did the LAGB patients . Weight loss failure ( BMI > 35 kg/m(2 ) at 5 yr ) was observed in 9 ( 34.6 % ) of 26 LAGB patients and in 1 ( 4 
    Output:
    
Recent r and omized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures .
However , evidence -based medicine has failed to show major advantages in SILS , and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology .