摘要:

SummaryLaparoscopic fundoplication is being performed with increasing frequency. The learning curve for the operation is long, and we herein discuss some of the problems we have experienced with this surgery. We also discuss changes we have made in our technique as the result of our experiences.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe incidence and severity of dysphagia before and 6 months after laparoscopic Nissen fundoplication without routine division of short gastric vessels are presented. Laparoscopic Nissen fundoplication was undertaken in 195 patients over 32 months with 116 patients who had prospective follow-up longer than 6 months. Patients underwent a 24-h pH recording, esophageal manometry, and symptom score assessment before and 6 months after surgery. There was a significant (p < 0.0001) improvement in the percent of reflux in 24-h (8.61 ± 0.74 to 0.68 ± 0.12), lower esophageal pressure (8.53 ± 0.51 to 23.11 ± 1.1 mm Hg), and reflux symptom scores (40.97 ± 1.13 to 12.11 ± 1.1) at 6 months. A similar improvement (p < 0.0001) was also observed in the dysphagia symptom score (4.58 ± 0.38 to 1.96 ± 0.32), with more than half the patients reporting improvement after surgery. No correlation was observed between the change in dysphagia score and the postoperative lower esophageal pressure or esophageal motor function. These data suggest that the incidence of clinically significant dysphagia after laparoscopic Nissen fundoplication, even without division of short gastric vessels, is low. Improvement in the dysphagia score after surgery is interesting and warrants further investigation.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryUsing retrospective chart review, the authors evaluated the results of laparoscopic Nissen fundoplication in their first 100 patients. All patients were diagnosed with gastroesophageal reflux disease. More than 90% of the patients in this series were symptomatically improved, and 92% of those studied endoscopically had healed esophagitis and intact fundoplication. No deaths, esophageal injuries, or splenic injuries occurred. Laparoscopic fundoplication can be performed safely and efficiently. Using a linear stapler enables rapid and safe fundi mobilization. Selective manometrics and ambulatory pH monitoring provide excellent results. Laparoscopic Nissen is safe and as effective as the open procedure. Research centers have noted some differences in postoperative function of the lower esophageal sphincter, but symptomatically patient satisfaction is comparable.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummarySixty-one patients with gastroesophageal reflux who did not respond to conventional medical treatment were treated in a prospective study, 29 by conventional surgery and 32 by laparoscopic methods. All underwent manometry and pH measurement preoperatively and at a follow-up of four months. There was no mortality, and the morbidity of the two groups was not significantly different at 3% and 5%. Hospital stay was significantly reduced (5.4 versus 8.9 days; p – 0.02) following laparoscopic treatment, and time off from work was 21.3 days versus 38.2 days (p = 0.02). The satisfaction index ex-pressed by the patients was 65% at 1 month and 95% at 3 months. Dysphagia was observed in 30% of the patients at 1 month and in 3% at 4 months in both groups. The results of manometry and pH measurements at 4 months are comparable between open surgery and laparoscopy. There was one failure (3%) in the laparoscopic group caused by disruption of the valve. The mean pressure in the esophageal segment (expressed in mm Hg) changed in the two groups from 3.6 to 18.1 (p = 0.001). The results of this series show laparoscopic management of gastroesophageal reflux to be justified.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummarySince the advent of laparoscopic cholecystectomy, there has been concern about its efficacy in the pregnant patient. This article reports the largest series to date and adds to the growing evidence that the procedure can be safely performed and has the potential to decrease morbidity and mortality. At the Phoenix Indian Medical Center, we performed laparoscopic cholecystectomy in eight women in the second trimester and one in the first trimester of pregnancy, and we attempted it in one patient in her late second trimester. Intra-abdominal pressure was maintained at or below 15 mm Hg. Subsequently, all 10 patients had term vaginal deliveries. In the pregnant patient, laparoscopic cholecystectomy appears to be safe with no morbidity or mortality seen in this series. Early mobilization has the potential to decrease post-operative complications and shorten hospital stay.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe report a case of an anomalous junction of the cystic duct with the left hepatic duct found during laparoscopic cholecystectomy. Only five other patients with this anatomy have been reported. Two of these five patients had left-sided gallbladders, and the remaining patients (including ours) had their gallbladder in its normal location. Alhtough the prevalence of this anomaly associated with left-sided gallbladders is 5.6 to 14.3%, this anomaly appears to be quite rare in patients with gallbladders in the normal position. In four cases, it was accompanied by left-sided gallbladder or low bifurcation of the common hepatic duct. This rare condition may accompany other biliary anomalies and should be kept in mind when performing cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryEighty-three patients (108 repairs) with inguinal hernias underwent laparoscopic transabdominal preperitoneal repair in the community hospital setting. The patients included 82 men and one woman, ranging in age from 15 to 82 years. Concomitant procedures included umbilical hernia repairs, lysis of adhesions, and varicocoelectomy. Ninety-four percent of these patients were discharged the same day, with only one patient requiring more than an over-night stay. Postoperative complications included five cases of urinary retention requiring overnight catherization (4.6%) and one case each of labile hypertension (0.9%), vasovagal reaction (0.9%), dizziness (0.9%), and ileus (0.9%); there were 12 cases of groin swelling with ecchymosis (11%). With follow-up of almost 2 years, there has been one known recurrence (0.9%). This study demonstrates that laparoscopic hernia repair can be performed safely and success-fully in the community hospital setting and can be a sound alternative to the standard open hernia repair.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummarySelective use of transcystic bile duct exploration during laparoscopic cholecystectomy is a safe and highly effective approach for treatment of most common duct stones. The technique obviates the need for selective endoscopic retrograde cholangiopancreatography-sphincterotomy prior to cholecystectomy and is a more cost-effective approach.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe purpose of this study was to describe the development of the laparoscopic technique for anterior lumbar fusion and to evaluate the clinical results of a first case series of patients. The in vivo porcine model was used first to develop the technique of transperitoneal laparoscopic interbody fusion. Afterwards, operative time, blood loss, perioperative complications and length of stay were recorded for the first 34 patients who underwent laparoscopic fusion of L4–5 or L5–S1 at two medical centers in 1994. Laparoscopic lumbar fusion was successful in 30 of 34 patients. Four patients early in the series successfully were converted to an open procedure because of poor visualization (two cases) or iliac venous injury (two cases). Transfusion was required in one patient; average blood loss was 128 ml. Operative time averaged 218 min, hospitalization 3.67 days. Laparoscopic fusion is feasible and has minimal complications when a skilled laparoscopic surgeon is present for exposure. Minimal excisional trauma associated with this technique should result in de-creased hospitalization and earlier recovery compared with standard open techniques. Preliminary results indicate an earlier discharge and return to work (3 weeks) than that expected for standard open techniques.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe developed a hook suture carrier for closure of trocar wounds, making use of the vertical rather than the horizontal space, which is limited in small wounds. The technique is simpler than all the laparoscopically assisted devices currently available, and it has no learning curve. No complications developed in 6 months of use.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID