ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Twelve patients presenting with symptomatic esophagitis associated with hiatal hernia and gastroesophageal reflux underwent operative management under laparoscopic guidance. The antireflux procedure employed was the Nissen fundoplication. The authors completed the operation laparoscopically in nine patients. Postoperatively, patients were evaluated with repeat fiberoptic endoscopy, esophageal manometry, and barium contrast studies. Postoperative results were considered excellent on the basis of these studies and complete control of symptoms. The mortality rate was 0%. The only major operative complication was a pneumonia that occurred in one patient. At 1 month follow-up, six patients were totally asymptomatic. The authors conclude that laparoscopic treatment of gastroesophageal reflux associated with a hiatal hernia is feasible by a procedure that has already proven its value during open surgery

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The Toy-Smoot laparoscopic hernioplasty was performed in 10 patients with excellent short-term results. This laparoscopic hernioplasty utilizes the principles of high ligation of the sac, a tension-free repair, and the advantages of an expanded PTFE patch over other prosthetic patch materials with-out groin dissection. The Toy-Smoot laparoscopic hernioplasty is a safe and effective repair of both direct and indirect inguinal hernias. The patients experience only minimal pain and return to full activity by the second postoperative day

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic cholecystectomy is rapidly becoming the preferred therapy for symptomatic cholelithiasis. It was our impression that the necessary traction exerted on the gallbladder during this procedure would frequently lead to intraoperative perforation with bile leak. We sought to determine prospectively the incidence of gallbladder perforation during laparoscopic cholecystectomy and to ascertain whether or not intraoperative bile leak resulted in overt complications. Laparoscopic cholecystectomy was performed success-fully on 250 patients between November 1989 and December 1990. Gallbladder perforation occurred in 80 patients (32%). Compared with those without a bile leak, there was a larger percentage of men (p < 0.05), and the average weight was greater (p < 0.01) in those developing a bile leak. Operating time was significantly longer in patients with gallbladder perforation (mean ± SEM, 104 ± 4 min) than in those without a bile leak (94 ± 3 min, p < 0.01), presumably because of the increased time spent irrigating the abdomen and retrieving gallstones. There was no difference in postoperative serum liver enzymes, amount or type of analgesia administered, interval to return to work or to full activity, or the development of postoperative infections. A wound infection requiring antibiotic therapy developed in only one patient who had not suffered a bile leak. The incidence of bile leak during the performance of laparoscopic cholecystectomy is therefore appreciable, occurring in approximately a third of our patients. Gallbladder perforation does not lead to any other adverse complications and should not cause the surgeon to convert to an open cholecystectomy

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We describe a new technique of biliary cyst fenestration using a videolaparoscopic approach. From June 1989 to October 1990, laparoscopic fenestration was performed for four symptomatic solitary cyst and one polycystic liver disease patients, without any morbidity. Mean hospital stay was short: 6.8 days (range of 3–14 days). No recurrence was observed on ultra-sound controls with a mean follow-up of 6.4 months (range of 2–15 months). Laparoscopic fenestration for symptomatic biliary cysts is a simple, effective, and minimally invasive procedure

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The authors present a retrospective analysis of 465 pediatric laparoscopic appendectomies. The ages of these patients ranged from 3 to 16 years, with a mean age of 10 years. The diagnosis of acute appendicitis was based on one or more of the following: the initial or repeated physical examination, abdominal radiographs, leukocyte blood count, and ultrasonography. On gross examination, 90% of appendices appeared inflamed, while on microscopic examination, 93% showed evidence of acute inflammation. There was a 3.6% incidence of minor intraoperative incidents and a 3.0% postoperative complication rate with 1.3% of patients requiring a subsequent laparotomy or repeat laparoscopic procedure. There were no deaths. The advantages of laparoscopic appendectomy include easy and rapid localization of the appendix, regard-less of its location, the ability to explore the entire abdominal cavity through the same laparoscopic portals used for appendix removal, the ability to lavage completely the contaminated peritoneal cavity, a reduction in the incidence of intraperitoneal abscesses, and a probable reduction in postoperative adhesions. In addition, laparoscopic appendectomy is associated with less cutaneous scarring and a more rapid return of intestinal function and normal activities. In our experience, these results are better than those obtained with classical surgery

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Although laparoscopic cholecystotomy is gaining worldwide acceptance, it is associated with some nonsurgical complications. We report the occurrence of massive subcutaneous emphysema, bradycardia, malfunctioning oximeters, pulmonary edema, endobronchial intubation, and the patient falling from the table with change in position during this surgical procedure. Choice of anesthetics, commonly occurring anesthetic complications, and management of these problems during laparoscopic surgery are discussed

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Continuous ambulatory peritoneal dialysis is commonly used for the maintenance of patients with chronic renal failure. A common complication associated with this treatment is outflow obstruction of the catheter. Noninvasive approaches to outflow obstruction such as enemas, infusions of saline, and body position changes are rarely successful in the management of these complications (1). Herein we report a review of our experience with the use of laparoscopy for the evaluation and management of peritoneal dialysis catheters with outflow obstruction

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic cholecystectomy has been widely accepted, and because of its many benefits, other intra-abdominal operations are now being done laparoscopically. We felt the next step in the evolution of laparoscopic surgery could be bowel resection. This paper presents two cases of laparoscopic sigmoid resection and a detailed description of the technique. Included in the technique is the use of prototype endoscopic stapling devices to divide the mesentery and bowel. The two most difficult technical decisions involved the methods for specimen removal and for completing the anastomosis. The specimen was removed through a muscle splitting incision in the left lower quadrant, positioned as a mirror image of a standard appendectomy incision. The anvil of the CEEA (end-to-end) stapler was also position in the proximal colon through this incision; the anastomosis was completed with the CEEA stapler

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID