摘要:

MIS continues to evolve with the introduction of new techniques and technology. This report discusses the use of “needlescopic” technology in the surgical management of achalasia. Heller myotomy procedures performed between January 1, 1997, and July 1, 2000, were analyzed and the results of 14 needlescopic procedures were compared with 15 laparoscopic procedures. Demographic and short-term outcome data were compared for each group using &khgr;2, Fisher exact, and Studentttests where appropriate. Both groups were similar in age and gender. However, the needlescopic group weighed less (72.2 vs. 83.5 kg;P= 0.05). Intraoperatively, the needlescopic procedures were shorter (98.2 vs. 131.9 minutes;P= 0.03). There were no conversions to open surgery or differences in the number of intraoperative complications for either group. Postoperatively, the groups had similar complications, time to normal diet, and analgesia requirements. Nonetheless, the needlescopic group had a shorter length of stay in hospital (1.1 vs. 2.0 days;P= 0.04). Needlescopic Heller myotomy appears to be a safe treatment option, resulting in a decreased length of stay and improved wound cosmesis.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Treatment of acute cholecystitis is still under debate. The aim of this study was to evaluate the efficacy of early laparoscopic cholecystectomy (ELC) in comparison with conservative treatment followed by delayed laparoscopic cholecystectomy (DLC) in the management of acute cholecystitis. This prospective comparative study involved two groups of patients presenting with acute cholecystitis within 72 hours of the onset of symptoms. ELC was performed in 82 consecutive patients, whereas DLC was performed in 87 patients who previously underwent medical treatment. Surgical variables, hospital stay, and postoperative morbidity were evaluated in both groups. Time of surgery and conversion rate were lower in the ELC group. Postoperative morbidity was similar in both groups. Overall hospital stay was shorter in the ELC group. ELC within 72 hours of the onset of acute cholecystitis is a safe procedure with better results than DLC in terms of surgical timing, conversion rate, and hospital stay.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The long-term results of laparoscopic unroofing for symptomatic solitary nonparasitic hepatic cysts have not been well demonstrated. During the last 8 years, five patients with symptomatic solitary nonparasitic hepatic cysts underwent laparoscopic unroofing. Their symptoms were right-upper-quadrant pain (in three patients) and epigastric pain (in two). Accompanying the hepatic cysts were acute cholecystitis in one case and adenomyomatosis of the gallbladder in another. Perioperative data, including operation time, estimated blood loss, complications, hospital stay, and mortality rate, were evaluated. There were no conversions to open laparotomy. Cysts were located in segments 4 and 5 in three patients, segment 3 in one, and segment 8 in another, and the mean size of the cysts was 10.4 cm in diameter (range: 7–18 cm). In four cases cholecystectomy was performed simultaneously. Mean operation time, estimated blood loss, and postoperative hospital stay were 182 minutes (range: 72–270), 168 mL (range: minimal to 800 mL), and 9.4 days (range: 7–12), respectively. There were no deaths or instances of major morbidity. During a mean follow-up period of 66 months (range: 35–102), one patient had a recurrent lesion requiring reoperation. Laparoscopic unroofing is a feasible and safe procedure for patients with symptomatic solitary nonparasitic hepatic cysts. Strict patient selection, accurate location of the cyst within the liver, and a sufficiently wide unroofing technique are needed for the outcome to be successful.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors introduce a new instrument functioning as both perforator and aspirator in the laparoscopic management of hepatic hydatid cysts. Between January 1998 and January 2002, 11 laparoscopic cystotomy + partial cystectomy + drainage procedures were performed for eight consecutive patients. Eight of the cysts were located in the right lobe, and the remaining three in the left. The average diameter (±SD) of the cysts was 9.6 ± 3.66 cm, and the mean age of the patients was 31.3 ± 7.24 years. The diagnosis was confirmed by ultrasonography and/or computerized tomography. The procedure was performed with the help of three ports. The “perfore-aspirator” instrument (Bahadir Tibbi Aletler A. S., Samsun, Turkey) was introduced through the 10-mm trocar at the subcostal area, and the cystotomy procedure was done with success. Then, a partial cystectomy procedure was performed with the use of a grasper and scissors attached to an electrocautery device. The average hospitalization period was 5 ± 1.69 days. No major morbidity or mortality was seen. All patients were treated with albendazole preoperatively and postoperatively.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Our goal was to analyze the results obtained with the surgical treatment of gallstone ileus using a new video-assisted laparoscopic technique. Six patients with gallstone ileus were admitted to the Hospital de Clínicas José de San Martín of Buenos Aires between March 1996 and April 1998. The patients' charts were retrospectively studied. Five of the six patients were women, with an average age of 71.2 years. Enterolithotomy was performed in four patients, laparoscopic enterolithotomy in one, and diagnostic laparoscopy with no need of further surgical treatment (because the calculus migrated to the colon) in the remaining patient. The postoperative complication rate was 33%. In one patient, acute pulmonary edema and sepsis developed, and death occurred in the immediate postoperative period (mortality rate, 16.6%). The average hospital stay was 6.6 days. The average follow-up was 16 months. No patient required treatment of the enterovesical fistula; all of them remained asymptomatic. One patient died as the result of evolution of vesicular adenocarcinoma. This approach represents a safe and feasible technique that may reduce the morbidity associated with the surgical treatment of gallstone ileus by guiding the surgical incision, preventing unnecessary laparotomies, and improving abdominal exploration.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Laparoscopic adhesiolysis for chronic abdominal pain is subject for criticism. In this prospective study, we analyze factors that encourage or discourage the indication for therapeutic laparoscopic adhesiolysis. Two hundred twenty-four consecutive patients with chronic abdominal pain underwent diagnostic laparoscopy, and in case of adhesions, they underwent adhesiolysis. Pain relief was assessed, and the individual impact of variables on pain relief was determined. Laparoscopy was performed in 224 patients. Two hundred patients had only adhesions and underwent primary laparoscopic adhesiolysis. Three months after adhesiolysis, 74% of patients were pain-free or had less pain. The remaining 26% of the patients felt no change (22%) or had more pain (4%). Gender, age, and bowel perforation leading to a laparotomy appear to be individual factors significantly influencing pain relief. Laparoscopic adhesiolysis can be done (almost) completely in 92% of patients with adhesions. After laparoscopic adhesiolysis, 74% of patients had good results and 4% had more pain. The complication rate is high.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study was undertaken to evaluate the short-term surgical outcomes of laparoscopic surgery for colonic carcinoma in octogenarians and compare them with those for a younger group of patients who underwent the same surgical procedures. This matched case–control study involved 17 octogenarian patients with colonic carcinoma who underwent laparoscopic surgery between 1996 and 2001. The results were compared with those for 34 matched patients aged 60 years or less who underwent the same surgical procedures during the same period. Both groups were well matched for clinical characteristics. However, the American Society of Anesthesiology status was significantly higher in the octogenarian group (P= 0.001). There were no significant differences between the two groups in terms of the incidence of complications, the interval before resumption of liquid or solid food intake, or length of hospitalization. There were no deaths in either group. Advanced age should not be regarded as a contraindication for laparoscopic colonic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Laparoscopic repair of ventral abdominal wall hernias involves intraperitoneal placement of a mesh, which may lead to adhesion formation and bowel fistulation. The first series of selected patients with ventral abdominal wall hernias treated laparoscopically by extraperitoneal placement of a polypropylene mesh is presented. Thirty-four patients (24 women and 10 men; median age, 52 years [range, 34–70]) were selected from among 122 patients undergoing laparoscopic ventral hernia repair. Of these patients, 18 had a primary ventral abdominal wall hernia and 16 had an incisional hernia. After reduction of sac contents and adhesiolysis intraperitoneally, a large flap of peritoneum (with extraperitoneal fat, fascia, and posterior rectus sheath where present) was raised to accommodate a suitably sized polypropylene mesh, which was then covered again with the peritoneal flap at the end of the procedure. Intraoperatively, apart from circumcision of the hernial sac at the neck, a total of 24 iatrogenic peritoneal tears occurred in 20 patients, mainly at the site of the previous scar. In two patients, it was observed that greater than 25% of the mesh was exposed after the procedure. The median (±SD) duration of hospitalization postoperatively was 1 day (±0.56). One patient's hernia recurred 4 months after surgery, and one patient's infected mesh was removed 8 months after surgery. Laparoscopic extraperitoneal placement of a mesh is feasible and appears to be an advance over laparoscopic intraperitoneal mesh placement for ventral abdominal wall hernias in selected patients. However, longer follow-up and controlled clinical trials will be necessary before any firm conclusions can be drawn.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Laparoscopic adrenalectomy (LA) is a preferred method for the removal of small adrenal masses. However, the role of LA for surgical treatment of large adrenal masses is less established. We evaluated the outcomes of LA for large (≥5 cm) adrenal masses. We retrospectively reviewed 24 consecutive patients who underwent LA for large adrenal masses at a tertiary care university hospital. The average age of the 24 patients was 49 years, and each underwent laparoscopic resection of a large adrenal mass. All LAs were performed via a lateral transperitoneal approach. The average (± standard deviation) size of the masses was 6.8 ± 1.5 cm (range, 5–11). Pathologic diagnoses included adrenal cortical adenoma (10 cases), pheochromocytoma (7), cyst/pseudocyst (3), myolipoma (2), and adrenal cortical hyperplasia (2). Statistical analysis was performed with a two-samplettest. The average operating time was 178 ± 55 minutes (range, 120–300), and average blood loss was 87 ± 69 mL (range, 20–300); the averages were nonsignificantly greater in the right LA group than in the left LA group (203 vs. 166 minutes,P= 0.89; 124 vs. 77 mL,P= 0.14). The average duration of nothing-by-mouth (NPO) status was 0.7 days (range, 0–4), and the average time until return to a regular diet was 1.74 ± 0.9 days (range, 1–5). The average length of stay was 2.5 ± 1.9 days (range, 1–10). One patient had a transient episode of pseudomembranous colitis. There were no conversions to open adrenalectomy and no major morbidities or mortalities. LA is safe and effective for surgical treatment of large adrenal masses. Both right and left large adrenal masses can be approached laparoscopically with equal success. The role of minimally invasive approaches to adrenal malignancies necessitates further investigation.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The surgical management of juxtarenal aneurysms necessitates suprarenal aortic clamping and control of the renal arteries. We attempted to reproduce this procedure laparoscopically. Five female piglets were submitted to a totally laparoscopic approach of the aortoiliac segment. After laparoscopic control of the renal arteries and suprarenal clamping, a 6-mm Dacron tube graft was anastomosed to the juxtarenal aorta. After the procedure, a midline laparotomy allowed verification of the patency of the renal arteries and the quality of the anastomosis. Mean operative time was 198 minutes (range, 170–240 minutes). The dissection took an average of 92 minutes (range, 75–110 minutes). The mean suprarenal aortic cross-clamp time was 46.3 minutes (range, 29.1–81.5 minutes), and the mean anastomotic time was 28.9 minutes (range, 16.5–68.1 minutes). This study demonstrates in this animal model the feasibility of juxtarenal aortic anastomosis using a laparoscopic technique. Newly designed instruments should allow a shorter clamping time in the future.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID