摘要:

SummarySixty-five patients with symptomatic pancreas divisum were treated by endostents, surgery, or observation. In 35 patients, endoscopic stenting either alone (20) or followed by surgery (15) was the primary therapy. Of 30 patients not stented, 10 underwent elective surgery and 20 were followed. Treatment was based on symptoms and biochemical and radiologic tests. The results of surgical decompression correlated favorably with endoscopic drainage. In untreated patients, the natural history of pancreas divisum was benign. Surgery is safe and effective in symptomatic patients, although multiple operations may be required for recurrent symptoms or progressive disease.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThree patients with biliary leakage following coelioscopic cholecystectomy after percutaneous drainage of abdominal collection underwent 99m Tc TRIMETHYL-BROMO IDA biliary scintigraphy. In all cases, scintigraphy showed the site of the leak with a good dynamic evaluation of tracer confirming the adequacy of percutaneous drainage. Two patients were treated conservatively; one underwent surgical repair of a common bile duct lesion because of the high output of bile despite nasobiliary drainage. Biliary scintigraphy provides useful information in case of suspicious biliary leakage after coelioscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryBetween November 1989 and September 1992, the author performed 1,000 laparoscopic cholecystectomies. Three common bile duct injuries occurred (0.3%). Selective cystic duct cholangiograms were performed for diagnosis and management of common bile duct stones. A total of 102 cholangiograms (10%) were done. Only eight of these cholangiograms were done for anatomical verification in the face of severe chronic or acute cholecystitis. Five were cystic duct cholangiograms, resulting in two common bile duct injuries. To avoid the problem of common bile duct injury in cases of obscure anatomy where clarification was needed, a cholecystocholangiogram was done for duct identification in three subsequent cases without event. The third common bile duct injury occurred early in the learning experience without benefit of the cholangiogram.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryPatients undergoing laparoscopic cholecystectomy had celiotomy either by a blind (Veress needle) approach (n = 781) or by fascial and peritoneal incision with insertion of a 10-mm sheath under direct vision (n = 247). The blind approach was associated with three small bowel injuries and one tear of the left common iliac artery. No intestinal or vascular injuries occurred in the open insertion group. The difference was not statistically significant. The mean duration of surgery was 81.4 ± 1.3 min in the blind group compared with 72.6 ± 2.0 min in the open group (p < 0.001). There was no significant difference in postoperative stay or in return to normal activity between the two groups. It is recommended that blind access to the peritoneal cavity for laparoscopy be abandoned in favor of an open approach because the blind approach confers no advantages and places the patient at risk for unrecognized visceral or vascular injury even though these injuries may not occur at a statistically significant frequency.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic approaches to adrenalectomy have been limited by the retroperitoneal (RP) location of the adrenal glands and their relative inaccessibility transabdominally. We developed a technique for endoscopic adrenalectomy in a domestic swine model using insufflation of the RP space with CO2and retroperitoneoscopy. The technique for retroperitoneal endoscopic adrenalectomy was first developed in an acute study of three animals. A chronic survival study was then undertaken in six pigs. Unilateral right (n = 3) or left (n = 3) adrenalectomy was performed. Mean RP insufflation time was 14.5 min (range, 7–30 min), and mean dissection time after insufflation was 100 min (range, 80–120 min). Two additional animals died under anesthesia after RP insufflation and placement of the trocars for retroperitoneoscopy but before dissection of the adrenal gland. One death was unexplained at autopsy. The other death was associated with a right-sided pneumothorax attributable to penetration of the diaphragm by a trocar. The remaining six pigs recovered uneventfully from the procedure. Autopsies performed 37 to 51 days postoperatively showed minimal scarring of the adrenalectomy bed. The results suggest that posterior adrenalectomy using RP CO2insufflation and direct retroperitoneoscopy is potentially applicable to the treatment of small adrenal lesions in humans.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryVery large gallstones sometimes render laparoscopic cholecystectomy time consuming and difficult. In addition, several advantages of laparoscopy, namely decreased postoperative pain and minimal abdominal scarring, could be compromised by the need to enlarge the umbilical incision. Besides the solution of the mechanical or electrohydraulic fragmentation of such large gallstones, as described by several authors, we propose a posterior colpotomy as a simple technique for removing very large gallbladders in women.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryTwo women, both aged 76 years, with several days of clinical symptoms of mechanical intestinal obstruction were diagnosed laparoscopically and found to have gallstone ileus. In one patient, pneumobilia was demonstrated preoperatively on plain abdominal radiography. Neither patient had had previous abdominal surgery. After searching through the small intestine laparoscopically, the stones were found. The site of obstruction was in both cases the ileum. The nondistended small intestine was visualized in the videoendoscope and lifted toward the anterior wall. Through very small lower midline and right lower quadrant muscle-splitting incisions, respectively, the ileum, including the gallstone, was brought out extracorporally, and the stone was removed by a simple enterolithotomy. Both patients recovered rapidly and returned to their homes on the fourth and fifth postoperative days, respectively. One patient returned after 3 weeks and was successfully treated for a wound infection. Four months after surgery, neither patient had any abdominal complaints. Laparoscopic diagnosis, and if possible treatment for mechanical intestinal obstruction, especially in elderly nonoperated patients, is suggested to minimize operative trauma, facilitate postoperative mobilization and hopefully reduce the high operative morbidity and mortality in this group of patients.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe rapid amplification of indications and areas of application of laparoscopic or thoracoscopic techniques leads to increasing problems and needs in surgical training. Pulsatile perfusion of organs (POP) and organ groups in laparoscopic training devices (pelvitrainers) aids in creating optimum conditions for the simulation of difficult intraoperative situations and complications. Simple applicability, low cost, and the possibility of a noticeable reduction of the currently required animal experiments render POP an ideal training method for minimally invasive surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy has become the “gold standard” in the therapy of noncomplicated cholelythiasis. Gallbladder perforation with bile and calculi spreading in the abdominal cavity is one of the most frequent intraoperative complications of laparoscopic cholecystectomy. When not recognized during surgery or unproperly treated, it may lead to intraperitoneal abscess formation and may require a reoperation. We report a case of an intraperitoneal abscess with a cutaneous fistula, a site of a mucopurulent exudate, and stone spillage after an unrecognized gallbladder perforation and residual lithiasis in the peritoneal cavity found 3 months after laparoscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLysis of infrahepatic adhesions during laparoscopic cholecystectomy was attempted by using monopolar electrocautery. The flow of current was seen to follow an unpredictable pathway and almost causing a thermal injury to an adjacent small bowel loop. A brief discussion of pertinent bioelectrical principles is also presented.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID