摘要:

Since laparoscopic cholecystectomy was introduced, the treatment of choledocholithiasis has been modified. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) has been performed selectively in elderly patients and in those with a strong suspicion of biliary duct stones (jaundice, demonstrated at ultrasound). Intraoperative discovery of common duct stones at cystic duct cholangiography signifies that they must be removed intraoperatively [or postoperatively by ERPC and endoscopic sphincterotomy (ES)]. As ES has a failure rate of 3–23%, laparoscopic common duct exploration emerges as the treatment of choice. Since November 1990, we have performed 59 laparoscopic common bile duct explorations. In our experience, the transcystic technique (18 patients) with choledochoscopy appears easier to perform than with fluoroscopy without choledochoscopy. Since, during our early experience, we encountered some difficulty with the transcystic technique, we elected to evaluate common duct exploration through a choledochotomy (41 patients). The main advantage of this technique is that it provides complete access to the ductal system without damage to the papilla. This procedure seems more difficult to perform than the transcystic technique and can be used when there are contraindications to the latter.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A method is described of using a “flared patch” of woven polypropylene mesh (Marlex or Prolene) to laparoscopically repair inguinal hernial defects. The technique has been used in >150 patients with indirect (60%) and direct (25%) inguinal hernias. Operating time was reduced from 45 min when the hernial sac was dissected to 25 min using the current technique. All procedures were performed in the outpatient department or during 23-h hospital observation. In the short-term follow-up time of a mean of 12 months (range, 4–23), there has been a 0.67% recurrence rate. The advantages of the laparoscopic approach, which places the operator at the site of the defect, are emphasized by the simplicity of this method. The specific patient benefits include less pain and an earlier return to normal activity, including work. It also allows for the repair of some bilateral hernias.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Since the first laparoscopic cholecystectomy in 1987 by Mouret, the scope of biliary surgery available to a laparoscopic surgeon has increased. In the early days of the procedure there were several accepted contraindications. Some of these were acute cholecystitis, morbid obesity, adherent gallbladder, jaundiced patients, ductal calculi, and biliary tract anomalies. In a series of 300 laparoscopic cholecystectomies we encountered five cholecystoduodenal fistulae. It was possible to deal with four fistulae laparoscopically. Two patients underwent a laparotomy, one for a failed laparoscopic repair of cholecystoduodenal fistula and the other for several common bile duct (CBD) stones, which could not be removed laparoscopically via the cystic duct. We maintain that with increasing expertise and improved instrumentation, most cases of cholecystoduodenal fistula could be dealt with laparoscopically.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report a new, simple, and effective technique for closing the fascial openings following laparoscopic surgery utilizing a straight lowsley retractor.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A new technique to access the lesser sac in gastric cancer staging by laparoscopy is described. The posterior surface of the stomach is approached through the gastrocolic ligament after lifting the stomach by means of a transparietal suture.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The 212th Mobile Army Surgical Hospital was deployed from a United States military base in Germany to the former Yugoslavia to provide medical support for more than 25,000 United Nations soldiers. This medical unit was the first mobile hospital ever to deploy with a capability for laparoscopic surgery. During a 2-month trial period, seven laparoscopic procedures were performed for various abdominal emergencies. There were no complications, and all patients returned to full duty within 1 week. No equipment problems or other logistical obstacles were identified. This preliminary report suggests that laparoscopic surgery is quite feasible in a forward-deployed field hospital, allowing combat soldiers to return to full duty in a much shorter time than after conventional surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thoracoscopically assisted esophagectomy with gastric pull-up was done in a 56-year-old man with esophageal cancer. The thoracoscopic technique, including the use of intraoperative ultrasound, is discussed. The addition of thoracoscopy offers safer and more complete esophageal dissection than transhiatal blunt esophagectomy and is less invasive than conventional thoracotomy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We describe a case of spontaneous delayed peritoneal-cutaneous sinus formation from unretrieved gallstones during laparoscopic cholecystectomy. Complete healing required excision of the sinus tract and evacuation of intraperitoneal stones.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We describe an intraoperative complication of laparoscopic cholecystectomy and make recommendations to avoid its occurrence. We describe a case in which the liver was lacerated during a routine laparoscopic cholecystectomy. The laceration occurred when the gallbladder was retracted into the suprahepatic space, causing a traction injury of the quadrate lobe, 2 cm lateral to the falciform ligament. The placement of the epigastric trocar through the falciform ligament fixed the liver to the abdominal wall, facilitating the injury. When placing the epigastric trocar, care should be taken to avoid placement through the falciform ligament. If this is not possible, retraction of the gallbladder into the suprahepatic space should be accomplished while observing the liver edge. If the liver edge seems to be under tension, division of the falciform ligament to allow for easy retraction of the liver is recommended.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We present a case report of a 48-year-old woman with intractable prepyloric ulcers treated with laparoscopic bilateral truncal vagotomy, antrectomy, and Billroth I anastomosis. The patient was discharged from the hospital on the 5th postoperative day, eating a regular diet. Her postoperative recovery has been uneventful and without complications. Laparoscopic bilateral truncal vagotomy, antrectomy, and Billroth I may be the procedure of choice for intractable prepyloric and pyloric ulcers.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID