ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This report deals with the first 350 laparoscopic cholecystectomies performed at Creighton University, beginning in October 1989, by one of the authors (R.J.F., Jr.). An open technique was used for initial access to the abdominal cavity in 343 patients (98%). Patients included 274 females and 76 males, with an average age of 45.5 years. Weight ranged from 72 to 316 pounds (32–142.2 kg). The laparoscopic procedure was successfully completed in 338 (96.6%). Operative cholangiography was performed in 113 (32.3%), and 52 (14.7%) had acute cholecystitis as determined by the final pathological report. Median operating time was 80 min. There was no operative mortality. Bile duct injury was not seen. Postoperative complications occurred in 21 patients (6%), only two of which were directly related to the open technique (cellulitis of the umbilical wound requiring antibiotics). A third patient (0.3% of 343 successful laparoscopies) required reoperation on postoperative day 4 for a small bowel perforation; the exact cause could not be determined, but conceivably it was related to the umbilical minilaparotomy. We conclude that the open technique is safe and effective method for initial peritoneal access prior to laparoscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Two sets of experiments were conducted to determine whether the potential hazards of secondary sparking and distal tissue burns are a serious risk for surgeons using monopolar electrosurgery during laparoscopy. The results indicate that secondary sparking poses little threat, whereas distal burns are very likely, given certain tissue parameters that force the entire electric current through narrow structures.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Intraoperative cholangiography was successfully performed in 98% of 300 consecutive laparoscopic cholecystectomies, including 290 chronic, 44 acute, 33 fibrotic, 16 gangrenous, and 17 hydropsed cases. Unsuspected common duct stones were identified in 16 patients (4%). The presence of two surgeons and the ability of routine cholangiography to clarify the biliary anatomy produced excellent results with no injuries to the common duct in this series.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

For many centers, laparoscopic cholecystectomy (LC) has become the treatment of choice in cholecystolithiasis. Sometimes, however, bile stones with a diameter of 1.5 cm and above can only be removed if the periumbilical incision is enlarged or the stone is crushed with a forceps intraoperatively. To keep the incision as small as possible, to be able to work with the smallest available trocars, and to shorten the operative procedure, patients in our center with stones larger than 1.5 cm are submitted to preoperative extracorporeal shock wave lithotripsy (ESWL). LC is performed the same or the next day. We have used this procedure in eight patients, and LC could be performed in all cases without enlargement of the periumbilical incision. Macromorphological changes of the gallbladder following ESWL, such as hematoma and edema, were not seen.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A variety of complications are associated with fiberoptic colonoscopy. Life-threatening complications such as perforation and hemorrhage may require surgical intervention. The records of all patients who underwent fiberoptic colonoscopy, with or without biopsy, polypectomy, electrocoagulation, or laser therapy at St. Luke's-Roosevelt Hospital Center were reviewed. Thirteen of 21 perforations occurred during polypectomy, laser therapy, or difficult diagnostic colonoscopy. Eight patients developed a perforation after an uneventful diagnostic colonoscopy. Three patients required operative control of hemorrhage following polypectomy and one after multipolar electrocoagulation (BICAP) therapy for a cecal arteriovenous malformation. Two patients had benign pneumoperitoneum and one a retained polyp snare. Of the 28 patients in this entire series, 26 underwent operative resection or repair. Seventeen (65%) of the latter group underwent primary resection or closure of performation without protective fecal diversion. Only one (5.9%) septic complication occurred in this group. Twelve patients in the perforation group (57%) underwent primary resection with anastomosis or closure of perforation without fecal diversion. One (8.3%) developed a septic complication. In this entire series, four deaths (14.3%) occurred, all of which were in the perforation group. Delay in diagnosis of perforation was the main factor contributing to death. No patient died of hemorrhage, benign pneumoperitoneum, or retained polyp snare. The key to successful outcome in perforation is early diagnosis and prompt operative intervention.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The safety of laparoscopic Cholecystectomy has been demonstrated through its increased use, and we have performed 114 of these operations as outpatient procedures. These patients have done well and hospitalization charges have been reduced substantially. Of 622 laparoscopic cholecystectomies performed from November 1989 to March 1991, 114 were done on an outpatient basis if the patients were generally healthy, lived nearby, and the operative procedure was uneventful. Other patients were admitted as 23-h observation or as inpatients. Records of 106 outpatients were reviewed and hospital charges obtained. These charges were then compared with those of 337 patients who underwent standard open cholecystectomy as morning admissions and who had no comorbid conditions nor complications. Comparisons are also made with 23-h observation and inpatient laparoscopic cholecys-tectomies as well as with all standard open cholecystectomy patients. The technique employed is with three punctures using electrocautery and a minimum of disposable products. Of the 106 outpatients, one required admission for postoperative ileus and pain control; 21 (19.8%) experienced nausea and 14 (13.2%) experienced vomiting but were treated successfully with antiemetics; none required admission. One patient required outpatient catheterization for urinary retention. Of the last 100 laparoscopic cholecystectomies performed by three surgeons (M.E.A., C.J.D., A.A.), 43 were performed as outpatients using the above selection criteria. 44 were held for 23-h observation, and 13 were inpatients. The average hospital charge for 377 uncomplicated morning-admitted inpatient standard cholecystectomy patients was $4,250.00, compared with $2,293.02 for 106 outpatient laparoscopic cholecystectomy patients. The reduction in cost seems related to length of hospital stay as well as technique employed. Controllable charges approach $1,726 per procedure. In selected patients, outpatient laparoscopic cholecystectomy can be safely performed, with a substantial reduction in hospitalization charges, which seems to be directly related to length of hospital stay as well as to technique.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Gallstones are commonly lost into the peritoneal cavity during cholecystectomy. We investigated the effect of this occurrence using a rabbit model and also by a postal questionnaire of patients in whom gallstones were lost at the time of laparoscopic cholecystectomy. No deleterious effects could be demonstrated, and it is concluded that there is no indication for a laparotomy to retrieve “escaped” gallstones during laparoscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. The recent introduction of an endoscopic linear stapling device has made possible thoracoscopic pulmonary resection. A 28-year-old woman with a history of recurrent pneumothorax, diffuse interstitial fibrosis, and left apical microblebs underwent thoracoscopic lung resection using this new stapling device. A 3 x 5 cm segment of involved lung tissue was removed. Postoperatively, the patient manifested no evidence of air leak and was discharged 48 h after surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic gastrostomy was performed successfully on six consecutive patients after the procedure was developed using a porcine model. These patients were unable to undergo percutaneous endoscopic gastrostomies because of obstruction from cancer or anatomical blockage. Operative time averaged less than 18 min. Three patients underwent the procedure under local anesthesia with intravenous sedation, and two patients were operated on in a strictly outpatient setting. No complications or deaths occurred. Laparoscopic gastrostomy appears to be a safe alternative to open gastrostomy in patients who cannot undergo percutaneous endoscopic gastrostomy.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID