摘要:

&NA;Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search wordspancreaticandpseudocystsand all relevant articles in English Language or with English abstracts were retrieved. In addition, cross‐references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The laparoscopic approach to PEH, in use for close to a decade, shows promising results. However, data on the long‐term follow‐up of patients who undergo this procedure are still lacking, and the use of mesh is debatable. We retrospectively investigated 33 patients who underwent this procedure over a 30‐month period. In 10 patients, the repair was performed using a mesh prosthesis. There was one (3%) intraoperative and four (12%) early postoperative complications, with one mortality (3%). The average postoperative stay was 3 days. During a 58‐month follow‐up period, 18% of the patients developed small, sliding recurrent hernias, with a higher rate in the primary repair group (18% vs. 10%). Surgical outcome was scored good‐to‐excellent on a questionnaire by 84.5% of the patients. Laparoscopic repair of PEH is feasible and safe. While small recurrences do occur, functional results remain good. The use of mesh should be tailored to the specific patient.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;It is well known that several patient‐related factors are able to affect the surgical outcome such as quality of life or symptom relief after laparoscopic antireflux surgery. The aim of the current study was to evaluate and compare surgical outcome up to 1 year after laparoscopic antireflux surgery in relation to patients' subjective degree of compliance with former antireflux medication. Based on a three‐level grading of subjective compliance with primary antireflux medication, a total of 140 patients undergoing antireflux surgery were divided into three subgroups: group 1/TC (totally compliant; n = 60), group 2/PC (partially compliant; n = 49); and group 3/NC (noncompliant; n = 31). Gastrointestinal Quality of Life Index (GIQLI), satisfaction with surgery, and the subjective degree of dysphagia as well as traditional outcome data (e.g., DeMeester score, lower esophageal sphincter pressure, side effects) were evaluated in all patients. As a result of surgery, only patients out of group 1/TC (GIQLI, preoperative 86.3 + 9.3 vs. 1 year postoperatively 123.1 + 7.2 points) and group 2/PC (GIQLI, preoperative 94.2 + 8.6 vs. 1 year postoperatively 120.8 + 7.8 points) showed a significant quality of life improvement that remained stable for at least 1 year (P< 0.05‐0.01). In contrast, group 3/NC (GIQLI, preoperative 100.2 + 6.1 vs. 1 year postoperatively 117.2 + 9.8 points) patients had no significant quality of life improvement and patient satisfaction with surgery was less good when compared with that of the other groups. In these patients, also the subjective degree of postoperative dysphagia was significantly (P< 0.05‐0.001) higher during the 1‐year follow‐up when compared with patients from group 1/TC or group 2/PC. A total of 42% of group 3/NC patients reported surgical side effects, whereas only 3% from group 1/TC and 10% from group 2/PC stated to be affected by any new symptoms (P< 0.0001). None of group 1/TC or group 2/PC patients suffered from recurrent symptoms or underwent laparoscopic reoperation. Of group 3/NC, a total of four patients (13%) needed any kind of additional intervention in relation to antireflux surgery (reoperation, n = 3; pneumatic dilatation, n = 1). There were no significant differences between the three groups when postoperative values of esophageal manometry and 24‐hour pH monitoring were compared. What the current study does show is that the efficacy and the surgical outcome after laparoscopic antireflux surgery partly depends on the subjective degree of patient compliance with primary antireflux medication. Patients with no compliance in relation to former antireflux medication should generally not be refused antireflux surgery. But these patients should be evaluated with great care before surgery and should also be informed that surgical outcome may be affected in several aspects.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;One of the goals of antireflux surgery (ARS) is to lower medications usage for heartburn symptoms. There has been some controversy as to whether this is accomplished by surgery. In addition, there is little comparative data of medical usage in patients suffering from gastroesophageal reflux disease (GERD) treated nonoperatively with those treated with surgery, and no data on additional esophageal procedures, such as upper endoscopy or dilation. The purpose of this study was to determine these differences in a matched group of medically and surgically treated patients with at least 1 year of follow‐up. All patients who underwent ARS with at least 1 year of follow‐up were included. These patients were matched to a group of medically treated patients for gender, age, and month of surgery to month of gastroenterologic clinic visit. Information was gathered through the medical record or direct contact for the present use of medications and additional esophageal procedures related to GERD. One hundred twenty‐two patients in each group were studied. Medication usage consisted of 13% of ARS patients versus 95% of medical patients (P< 0.0001). ARS patients had used 359 patient‐months of medications versus 3578 in the medical group (P< 0.0001). Only 25% of ARS patients prescribe medications actually responded to their use. Additional procedures consisted of 9% of ARS patients versus 64% of medical patients (P< 0.0001). In conclusion, ARS leads to decreased medication use and to decreased use of subsequent esophageal procedures. In addition, most postoperative ARS patients placed on medications do not respond, and therefore require an objective evaluation for their symptoms.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;A retrocolic submesocolic approach was used for creating the gastroenteroanastomosis in 42 consecutive patients who underwent laparoscopic biliopancreatic diversion for obesity. The surgical technique is described in detail. The laparoscopic gastroenteroanastomosis was successfully performed on all the operated patients, with no intraoperative complications requiring conversion to open surgery and no immediate or late postoperative morbidity related to the anastomosis.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;&bgr;‐Thalassemia, which results from a reduced production of &bgr;‐globin chain of hemoglobin, is a common single gene disorder with an extremely heterogeneous clinical picture. Its presentation may vary from mild anemia in &bgr;‐thalassemia minor to severe and life‐threatening anemia in &bgr;‐thalassemia major. Recent advances in supportive treatment of &bgr;‐thalassemia major have resulted in substantial increase in survival in these patients, and an increasing number of these patients reach adolescence and adulthood. The incidence of cholelithiasis is reported to be increased in these patients. Although laparoscopic cholecystectomy (LC) has become the gold standard treatment of symptomatic gallstone disease, its experience in adult &bgr;‐thalassemic patients has been limited. From May 1992 through April 2000, 10 consecutive adult &bgr;‐thalassemic patients with symptomatic gallstone underwent LC at our institution. Data were obtained on the type of &bgr;‐thalassemia, presentation, preoperative laboratory findings, history of preoperative transfusion, postoperative complications, postoperative analgesic requirement, length of hospital stay, and follow‐up. All operations were completed laparoscopically. The mean operative time was 98.5 minutes. The postoperative analgesic requirement was minimal. There was no mortality. One patient developed fever postoperatively due to lung atelectasis that was managed conservatively. The mean hospital stay was 3 days. Laparoscopic cholecystectomy is feasible, safe, and effective in the treatment of adult &bgr;‐thalassemic patients with symptomatic gallstone disease. Technical adjustments are required when operating on patients with &bgr;‐thalassemia major.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;This multicentric national registry reports the experience of 16 Brazilian surgical teams in laparoscopic colorectal surgery. Between 1992 and 2001, 1966 patients (941 men [47.8%] and 1025 women [52.1%]) were operated on, with ages ranging from 1 to 94 years (average, 55.9 years). Benign diseases were diagnosed in 1170 patients (59.5%). There were 82 (4.2%) reported intraoperative complications (range, 2.0‐9.8%), 209 (10.6%) conversions to laparotomy (range, 1.4‐23.5%), and 383 (19.4%) postoperative complications (8.0‐29.6%). Mortality occurred in 29 patients (1.5%). During the early experience (first 50 operated patients in each surgical team), there were more intraoperative complications (8.1% × 1.7%), conversions (16.6% × 6.8%) and postoperative complications (25% × 16%). After an average follow‐up of 26.5 months, 91 tumor recurrences (13.8%) were reported (0.45% parietal recurrences). There was no incisional recurrence in the ports used to withdraw the pathologic specimen. The Brazilian experience is significant, with complication and mortality rates similar to those reported in literature. The results indicate that experience reduces complication and mortality rates. Oncological results are satisfactory and the incidence of parietal recurrence is low and similar to other series.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Omental entrapment of the peritoneal dialysis catheter remains a common cause of flow dysfunction. Prophylactic omentectomy during catheter implantation is still followed with an incidence of flow obstruction as high as 10%. We describe indications and a technique for selective performance of omentopexy during laparoscopic catheter implantation that resulted in only a 0.7% obstruction rate in 153 consecutive patients as compared with a 12.8% rate in a preceding group of 78 consecutive patients. Laparoscopic omentopexy was performed during 9.2% of implant procedures and only when the omentum was found to extend to the retrovesical space. The procedure is simple, quick, and inexpensive to perform. Employing selective criteria for omentopexy eliminates the performance of unnecessary procedures. Actuarial analysis demonstrates that an operative strategy of selectively performing omentopexy for redundant omentum significantly improves catheter survival free of flow dysfunction (P< 0.0001).

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;We performed a prospective study to evaluate the feasibility of performing endoscopic total extraperitoneal repair of groin hernia (TEP) under epidural anesthesia in selected patients considered to be at high risk or unfit for general anesthesia. Fifty‐eight endoscopic total extraperitoneal hernia repairs were performed in 36 patients between January 1997 and December 1999 under epidural anesthesia since they were considered a high risk or unfit for general anesthesia. All patients received intramuscular diclofenac sodium for preemptive analgesia. Intraoperatively, all were sedated with intravenous midazolam and fentanyl. Endoscopic TEP repair was successful under epidural anesthesia in 33 of 36 patients. In the remaining three patients, the procedure had to be converted to Lichtenstein's repair due to shoulder discomfort experienced by the patients as a result of pneumoperitoneum, which was produced by incidental peritoneal tears during extraperitoneal dissection. Intraoperatively, one patient had bleeding from the inferior epigastric artery, which was controlled with clipping of the artery. The mean operative time was 48 minutes (range, 28‐72 minutes) in the TEP group and 94 minutes (range, 84‐102 minutes) in the converted group. All the patients received an epidural top‐up dose at the end of surgery for postoperative analgesia. All patients were ambulatory the same day. Postoperative pain was assessed by a visual analogue scale (VAS). The mean pain score was 1.2 (± 0.8) on discharge in the TEP group. During follow‐up, seven patients developed scrotal swelling with cord induration, which was treated conservatively with scrotal support and analgesics. In all patients, resolution was observed within 6 weeks. One patient was detected to have a recurrence 4 months after surgery. Endoscopic TEP repair under epidural anesthesia appears to be safe, technically feasible, and an acceptable alternative in patients who are at high risk or unfit for general anesthesia.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The aim of this study was to compare laparoscopic totally extraperitoneal approach (TEP) repair with tension‐free open mesh repair in inguinal hernia. One hundred thirty‐four patients were allocated randomly to undergo TEP repair (n = 67) or open mesh repair (n = 67). Operative and postoperative outcomes were determined. The mean of operating time (49.67 ± 14.11 vs. 56.64 ± 12.32;P= 0.001), visual analog scale score (2.73 ± 1.69 vs. 4.61 ± 1.77;P= 0.001), hospital stay (1.8 ± 0.7 vs. 2.7 ± 1.6;P= 0.001), and duration of recovery (10.8 ± 7.4 vs. 15.2 ± 8.5;P= 0.001) was significantly less for TEP repair when compared with open mesh repair. The incidence of complications (13.4% vs. 16.4%;P= 0.631) and recurrence (2.9% vs. 5.9%;P= 0.407) was approximately equal in each group. Our results showed that laparoscopic TEP repair is superior to open mesh repair.

ISSN:1051-7200    

出版商:OVID    

年代:2003

数据来源: OVID