摘要:

The aim of this study was to assess the outcome of a continuous series of 30 patients with perforated duodenal peptic ulcers treated by a laparoscopic approach. Between January 1996 and December 1998, 30 patients (24 males, 6 females) with a mean age of 69.2 years were operated on with a laparoscopic approach. Laparoscopic treatment included peritoneal lavage, suture of the perforation, and omental patching in 24 cases. A conversion to laparotomy was necessary in five patients (16.6%). Mean operative time was 92 minutes (range: 58–114) and mean hospital stay was 6 days (range: 4–16). Mortality and morbidity rates were 6.6% (n = 2) and 16.6% (n = 5). With a median follow-up of 12 months, 96% of the patients were in good condition; one patient had recurrent duodenal ulceration. The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A laparoscopic choledochoduodenostomy (LCDD) may be performed when the common bile duct (CBD) is obstructed by primary or secondary stones or strictures. A biliary bypass procedure has two goals in view. The short-term goal is complete removal of stones and bypass of obstruction and stricture to restore biliary drainage. The long-term goal is preventing a recurrence of the problem. There is debate over the superiority of any one procedure to achieve both goals. Therefore, it may help the practicing clinician to be aware of the success (or failure), on a case-by-case basis, of these procedures. This awareness may help in the choice of technique. To date, since 1991, we have performed 16 LCDDs; however, in this report, we describe our results with LCDD over the last 4 years to emphasize the usefulness of this procedure. We find that it is a safe and effective procedure for treating patients with benign bile duct obstruction, even for those whose condition may be described as complicated or difficult. Evidence is slowly accumulating that LCDD is also successful in promoting long-term biliary drainage. We reviewed our LCDDs done over the past 4 years, documenting our preoperative, intraoperative, and postoperative experience. A successful LCDD was performed on all six patients. None of the patients had postoperative leaks. There was only one death, which was due to the patient's comorbidities and not the procedure itself. The hepatobiliary enzyme levels returned to normal in all of the surviving patients. The average postoperative length of stay was 6 days. With proper selection and adequate laparoscopic experience, LCDD can be performed in a safe and effective way.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Since the introduction of laparoscopic cholecystectomy (LC), an increase in accidental common bile duct (CBD) injuries of up to 1.2–1.6% has been reported. In the present prospective study of 1,710 patients undergoing cholecystectomy (1,241 LC procedures and 469 open cholecystectomies [OC]), we tested the predicative value of routine intraoperative cholangiography (IOC). The IOC was feasible in 92.4% of the cases in the LC group and in 83% of cases in the OC group and presented a complete depiction of the extrahepatic bile system in 98.3%. Anatomic variations of the bile duct system, which influenced the operative management, were found in 13.2% of cases (13.4% LC versus 12.8% OC). In 2.5% of the patients, preoperatively undetected CBD stones were also found. Method-specific complications did not occur in any of the patients. Additionally, in a controlled subgroup analysis of 163 patients, we evaluated preoperative intravenous cholangiography (IVC) and IOC. Intravenous cholangiography showed only 72.4% of the operation-relevant anatomic variations (vs. 100% by IOC); in 6.1% of the cases, there were reactions to the dye (vs. none in IOC), and in only 28.6% of the patients, CBD stones were detected (vs. 71.4% IOC). There were four bile duct injuries (0.29%) during LC and two (0.4%) during OC. All injuries were detected intraoperatively and fixed in the same setting without postoperative complications. In conclusion, we recommend the use of routine IOC during cholecystectomy. By this technique, anatomic variations of the bile duct system will be visualized and therefore accidental injuries will be avoided.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ultrasound-guided radiofrequency thermal ablation has been performed for liver tumors by percutaneous, laparoscopic, or open surgical approaches. Each approach has specific advantages and disadvantages. Herein we describe a new technique for hand-assisted laparoscopic ultrasound-guided radiofrequency thermal ablation of liver tumors. A hand-access device is placed at the right or central portion of the abdomen, in addition to standard trocars. A conventional intraoperative ultrasound probe, with an ultrasound guidance system attached, is inserted into the peritoneal cavity together with the surgeon's hand. After pneumoperitoneum is established, an electrode-cannula for thermal ablation is introduced subcostally or intercostally, and advanced into a liver tumor under direct guidance by intraoperative ultrasound. We have used this technique in eight patients with unresectable liver tumors. Precise guidance of the cannula into tumors was possible. All tumors were well ablated. The postoperative recovery of patients was of shorter duration compared with that of an open surgical approach. A hand-assisted laparoscopic ultrasound-guided method has advantages of both laparoscopic and open surgical approaches for radiofrequency thermal ablation treatment of liver tumors. Accurate cannula insertion is possible with the ultrasound guidance system. The hand-assisted laparoscopic approach can become an additional useful technique, particularly as a valuable alternative to an open surgical method, for performing radiofrequency thermal ablation.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6–39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Laparoscopic repair of ventral and incisional hernias is still a controversial therapeutic option. The purpose of this article is to evaluate the results of laparoscopic surgery on ventral hernias in an outpatient surgery unit of a university hospital. Fifty-five patients consecutively underwent laparoscopic surgery for ventral/incisional hernias in the outpatient unit. The patients' clinical features, hernia type, intraoperative, and postoperative complications and reasons for hospital admission are studied. Forty-two patients (76%) were discharged on the day of the surgery. Thirteen (24%) required hospital admission; 9 admissions were predictable (5 for intraoperative occurrences and 4 for associated surgery) and 4 were unpredictable (all for uncontrolled pain; 31%). We found no case of hospital admission for vomiting, urinary retention, or dizziness. Statistical analysis of the patients requiring admission showed no significant correlation with their clinical features or with the site, size, or recurrence of the abdominal wall defect (P> 0.05). Laparoscopic repair of ventral and incisional hernias can be done as a highly efficient ambulatory procedure, and morbidity and hospital admission with this technique do not depend on the type of hernia.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Significant advances in fiberoptic and digital technology for laparoscopic surgery have been made over the past decade. One area that appears to be overlooked in this field is the advancement in the display of the image during laparoscopic surgery. The authors describe the use of digital video-cinema equipment as a simple and effective technique that enhances the projection of the surgical view. This method has been found to be visually more comfortable, aiding the surgical procedure, and extremely useful as a teaching tool.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A simple modification for securing the omental patch during laparoscopic oversewing of perforated duodenal ulcers is presented. This new concept uses color coding of sutures to prevent confusion and suture “cut-out” during the tie-over of the omental patch. The concept of suture color-coding may be applicable to other laparoscopic procedures where identification of “suture pairs” is difficult.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report a case of an acute strangulated gastric volvulus in a hernia of Bochdalek in an adult female patient that was repaired successfully via the laparoscopic approach. A left-sided diaphragmatic hernia contained a strangulated but viable gastric volvulus and a noncompromised colon. The contents of the hernia were reduced, and the 4-cm congenital diaphragmatic defect was primarily repaired with nonabsorbable sutures. The patient was discharged on the second postoperative day and remained symptom-free at 7 months. Unlike the very few previous reports of elective laparoscopic repair of uncomplicated Bochdalek hernias, this appears to be the first report of an urgent laparoscopic repair of a complicated hernia of this type.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

When we remove bile duct stones in endoscopic retrograde cholangiopancreatography, we sometimes encounter the complication of basket impaction. In most cases, bile duct stones can be crushed with a mechanical lithotriptor. An endotriptor also is commonly used to resolve the problem of basket impaction. An endotriptor is more powerful than a mechanical lithotriptor in crushing stones. We report a case of basket impaction that was not resolved by means of an endotriptor. When abdominal radiography shows apparent calcified bile duct stone, it should be cautioned that the stone is sometimes too hard to be crushed, even with use of the endotriptor as well as a mechanical lithotriptor.

ISSN:1051-7200    

出版商:OVID    

年代:2002

数据来源: OVID