摘要:

SummaryLaparoscopically assisted intestinal surgery has been described in a variety of different intestinal diseases but not in inflammatory bowel disease. The study shows that laparoscopically assisted ileocolectomy is feasible in patients with Crohn's disease with low morbidity.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWe present 20 cases of laparoscopically assisted colon resection. Ten patients were operated on for various benign lesions of the large bowel, and the remaining 10 for malignancy. Three fourths of the patients were over 65 years of age. The operative technique described herein involved laparoscopic mobilization of the colon and then its delivery through a relatively small incision through the anterior abdominal wall. Direct mobilization of the segment of bowel containing the malignant lesion was usually accomplished via the accessary incision made directly over the lesion. After eviscerating the specimen onto the abdominal wall, the involved segment of large intestine was resected along with its accompanying mesentery. The anastomosis was done by conventional linear stapling devices. No operative-related mortality occurred. Postoperative nasogastric tube suction was required in only one patient. Return of gastrointestinal function occurred an average of 2.5 days after the surgery. Average postoperative hospital stay was less than 5 days.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryNearly three of four hysterectomies are performed by abdominal incision. When laparoscopically directed dissection of the uterus adnexae and development of the bladder flap are coupled with a Doderlein vaginal hysterectomy, most of these abdominal procedures can be converted to vaginal procedures. Experience with 167 procedures has demonstrated that this new procedure can be performed safely, effectively, and efficiently. The benefits of less postoperative discomfort, resulting in shorter hospital stays and quicker return to normal activity, coupled with a reduced cosmetic defect, have been clearly demonstrated.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWe compared the first year's experience in performing laparoscopic cholecystectomy in a university hospital and a community hospital to deter-mine the impact of postgraduate surgical training on outcome. Laparoscopic cholecystectomy was attempted on 446 patients. The conversion rate to open cholecystectomy was 8.3% and did not differ between institutions. Surgical house staff performed 43% of the cases at the university hospital compared with 8% at the community hospital. The greater use of laser and cholangiograms resulted in significantly longer mean operative time at the university hospital (141 ± 26 min) than at the community hospital (114 ± 52 min). The overall complication rate did not differ significantly (p = 0.15). Complications included common duct injury (three cases), bile leak (five cases), bleeding or hematoma (six cases), epigastric artery hematoma (one case), and death (one case). Operative inexperience during this first year may be a major determinant for the complication rates at both hospitals. It is too early to determine the impact of graduate surgical education on complications. Intense education and supervised instruction is requisite to minimizing the morbidity associated with laparoscopic cholecystectomy regardless of whether it is performed at a university or community hospital.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummarySince November 1990, 50 laparoscopic herniorrhaphies have been done in 47 patients (three patients with bilateral repairs), including 31 indirect and 19 direct inguinal hernias, three of which were recurrent. The 47 patients included 42 men and five women. Small indirect hernias were treated by plugging the hernia orifice with a tightly rolled polypropylene mesh plug. Large indirect, all direct, and combined hernias were treated by creating a peritoneal flap and stapling a polypropylene mesh screen preperitoneally over the defect. The mesh was stapled to Cooper's ligament, iliopubic tract, and transversus abdominous arch. Forty-five patients were discharged on the day of surgery and the other two within 24 h. The average return to full activity has been two days. The only intraoperative complication was an easily controlled trocar site bleeder. Postoperatively one minor trocar site infection occurred. One persistent and one recurrent hernia were among the group, both large indirect hernias done early in our experience (by the plug technique) before stapling instruments were available. The technique of laparoscopic herniorrhaphy is in its infancy and still evolving as our understanding of anatomy and technology improves. Even if long-term follow-up shows an acceptable recurrence rate and less patient disability, surgeons must weigh the wisdom of converting a procedure from local to general anesthesia and an inexpensive procedure into a more expensive procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic femoral herniorrhaphy using a preperitoneal plug and patch appears to be a feasible laparoscopic approach to femoral hernia. A modified preperitoneal femoral hernia repair with mesh and resection of incarcerated small bowel has been successfully completed under laparoscopic guidance in a 64-year-old patient with incarcerated femoral hernia. To our knowledge, this is the first such case reported in the United States. With further experience, laparoscopic femoral herniorrhaphy could provide a viable alter-native to the standard treatment of femoral hernia.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe development of a lymphocele is an uncommon but well-known complication following a kidney transplantation. In case of recurrence after puncture and aspiration, a laparoscopic procedure seems to be the treatment of choice. For the preoperative workup ultrasound is essential; CT scan is to be favored if available. A large fenestration is easy to perform laparoscopically and thus the lymphocele is drained into the abdominal cavity. Because of the immunosuppressive treatment, adhesions hindering a laparoscopic approach are unusual. The conclusion is that surgeons trained in laparoscopic techniques have an important role in these infrequent abdominal problems.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWith the recent popularization of video laparoscopic cholecystectomy comes a renewed interest in thoracoscopy and its clinical applications in intrathoracic disease. Successful video thoracoscopic dorsal sympathectomy was accomplished in a patient with causalgia of the right upper extremity with immediate and complete resolution of pain and vasomotor symptoms. Standard operative approaches to dorsal sympathectomy are technically difficult, having risks of major nerve injury and Horner's syndrome. Video thoracoscopic dorsal sympathectomy obviates these risks and should become the procedure of choice in the future.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryA technique is described for laparoscopic abdominoperineal resection (APR). Three of four such cases could be successfully completed laparoscopically. One major complication was directly related to the laparoscopic approach, an enterotomy caused by the Babcock clamp, which was discovered at the time of conversion to laparotomy for bleeding. A minor complication related to the laparoscopic procedure, subcutaneous emphysema, required no treatment. There was one postoperative death unrelated to the laparoscopic technique. The intraoperative advantage was enhanced visualization; the intraoperative disadvantages were increased operative time and cost. Postoperative advantages were earlier mobilization, oral intake, and discharge; de-creased pain; and improved cosmesis. Laparoscopic APR is both feasible and safe and with more experience should prove to be cost effective.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic anterior resection of the rectum was performed in the porcine model. Colorectal anastomosis was accomplished with a closed triple staple technique using a circular stapler. The anvil and shaft were passed beyond the level of resection and retrieved through the proximal transverse linear cutter staple line. The stapler post was passed through the distal rectal staple line transanally. The resulting stapled anastomosis contained portions of three staple lines. There were no anastomotic leaks or strictures at one month follow-up autopsy. The triple-stapled anastomosis via a laparoscopic approach after an anterior resection of the rectum in a pig is a safe, reliable technique.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID