摘要:

SummaryIn this study, laparoscopic transabdominal preperitoneal inguinal hernia repair and traditional open inguinal hernia repair were compared in relation to operative time, hospital stay, pain medication use, recovery time, complications, and costs. Elective hernia repairs, 126 in 106 patients, were prospectively followed from January 1991 through September 1993. Seventy-five procedures were performed by laparoscopy and 51 by traditional open approach. Time off work, pain medication use, surgical complications, and hospital stay were all significantly less (p< 0.001) with the laparoscopic approach. Patients in the laparoscopic group returned to work on average 5.5 weeks earlier than patients who underwent traditional herniorrhaphy. The difference in operative times was not statistically significant; however, the difference in the cost of the operations was. In conclusion, laparoscopic inguinal hernia repair offers significantly decreased postoperative pain, shorter hospital stays, faster return to work, fewer complications, and comparable operative times, but at an increased expense for the cost of laparoscopic instrumentation and technology.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryThis study examines the role of intravenous cholangiography in the preoperative assessment of the first 100 patients considered for laparoscopic cholecystectomy at this institution. Intravenous cholangiography detected common bile duct (CBD) stones in 10 patients, of whom only five had a dilated CBD (> 8 mm). There were no cases of inadequate visualisation of the CBD using IVC and no allergic reactions to the contrast medium. All CBD stones were confirmed by either endoscopic retrograde cholangiopancreatography (ERCP) or exploration of the CBD. There have been no cases of missed CBD stones during a follow-up period of 8 to 18 months. In contrast, ultrasound scanning was only able to detect one CBD stone, and there was a 14% incidence of inadequate visualisation of the CBD. Intravenous cholangiography is a safe, inexpensive, and highly accurate technique for assessing the CBD in patients undergoing laparoscopic cholecystectomy, with false-positive and false-negative rates of 0 in this study. The timing of the investigation permits preoperative clearance of the duct by ERCP and, should this fail, the option of a single procedure of open exploration of the CBD.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryPreoperative embolization of the right portal vein branch before extended right hepatectomy for hepatocellular carcinoma or hilar cholangiocarcinoma has been recommended for the prevention of postoperative liver failure. Percutaneous transhepatic insertion into the intrahepatic portal vein and insertion into the ileocolic vein at open laparotomy are used for inserting a catheter introducer into the portal vein. We devised a new technique for the laparoscopic insertion of a catheter introducer into the ileocolic vein and used it for right portal embolization in three patients. Measurement of hepatic volume by computed tomography 3 weeks after right portal embolization showed a 28.6 to 66.0% increase in the volume of the predicted remnant liver. This minimally invasive procedure has three advantages: reduction of postoperative pain, avoidance of hepatic injury, and the opportunity for a laparoscopic observation of the liver and the intra-abdominal organs before right portal embolization and hepatectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryWith the worldwide acceptance of laparoscopic cholecystectomy (LC) as the treatment of choice for symptomatic gallbladder disease, great concern has grown over the spectrum of complications associated with this new procedure. The nature, causes, frequency, as well as ways to avoid these complications have been the subject of many articles and studies. Although it is established that the frequency of the major complications decreases with increased experience, there will still be new surgeons performing the procedure with limited experience in the early stages of their surgical practice. Therefore, continuous efforts should be exerted to bring to a minimum the number of serious morbidities, especially common bile duct injuries. Review of each institution's experience and sharing it with other medical centers may be a valuable approach to achieve this important goal. In this report, we will analyze the spectrum of complications we encountered during our experience with LC as well as some recommendations to avoid some of the serious morbidities related to this procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy has rapidly replaced open cholecystectomy as the preferred surgical treatment of symptomatic cholelithiasis. Although the indications are similar for both procedures, some surgeons believe that pregnancy is a contraindication for the laparoscopic approach. Several recent reports in the literature have shown that laparoscopic cholecystectomy can be performed safely in the pregnant patient. A review of all patients who underwent laparoscopic cholecystectomy from January 1991 to January 1993 at Scott Air Force Base (AFB) and Edwards AFB was performed. Of 248 patients reviewed, four procedures were performed in the gravid patient. All patients were operated on during the second trimester of pregnancy. Laparoscopic cholecystectomy was successful in all four. Cholangiogram was performed in two patients. No postoperative morbidity was encountered (maternal or fetal). Twenty-one cases of laparoscopic cholecystectomy in the pregnant patient, with no fetal or maternal morbidity or mortality, have been reported in the literature to date. We conclude that in selected cases, laparoscopic cholecystectomy can be performed safely during pregnancy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryLaparoscopic appendectomy represents another challenge for residency training. This retrospective study was conducted to determine the efficacy of this operation, to contrast it to conventional appendectomy, and to describe experience in teaching residents. We examined the case records of 151 patients who underwent appendectomies performed by residents between September 1990 and September 1992. Surgery was performed laparoscopically in 26% of the cases, by conventional means in 65%, and converted to an open procedure in 9% of the total patients. Acute appendicitis was confirmed in 56% of laparoscopic patients, 85% of conventional patients, and 86% of converted patients. Age, sex, signs and symptoms, complications, and operative times were similar in laparoscopic and conventional groups. Mean hospital stay was 3.5 days in the laparoscopic group, 4.5 days in the conventional group, and 8.5 days in the converted group. Operating room charges were highest in the laparoscopic group. Surgical procedure depended on the experience and bias of the attending surgeon. Laparoscopic appendectomy appears to be easily learned by surgical residents and to be associated with an outcome similar to that of conventional appendectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryIn 1991, because of the international emphasis on laparoscopic surgery, a large contingency of surgeons took on the task of introducing laparoscopy to the People's Republic of China. This trip was a technological feat, since all of the equipment and instrumentation had to be carried into the country. This necessitated a major coordinated effort among professional teaching staff and industry representatives with their transported equipment. This unique educational opportunity is detailed in this article, which highlights, in particular, the contrast between the new “high-tech” surgery and the reality of a developing country.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryDouble gloving may blunt perception of excessively warm instruments. We describe a case where this might have contributed to a cutaneous burn in a patient undergoing laparoscopic cholecystectomy. To test the role of two gloves in blunting temperature perception, we performed two experiments. In the first, 250 ml of water at 70°C were placed in one glove or two gloves, and the rate of change of temperature after submersion in a bath at 18°C was measured. The use of two gloves was associated with a marked decrease in rate of change in temperature (temperature at 5 min 37 ± 2.3°C [double gloves] versus 24 ± 2.6°C [single glove]; p < 0.001). In the second experiment, a thermometer covered with no gloves, one glove, or two gloves (group 5; n = 5) was submerged in a water bath at 90°C. After 5 s, the temperature without gloves was 85.2 ± 2.2°C compared with 61.3 ± 0.8°C with one glove and 45.6 ± 1.1°C with two gloves (p < 0.001). After 15 s, the temperature without gloves was 90.2 ± 1.6°C compared with 76.5 ± 0.5°C with one glove, and 64.4 ± 0.8°C with two gloves (p < 0.001). We conclude that the use of two gloves significantly decreases heat transmission, thus altering temperature perception.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryAdvances in laparoscopic surgery have drastically modified not only the thinking of most general surgeons, but have also helped to change the approach to many disease processes. The tremendous success of the laparoscopic approach to biliary tract disease as well as to appendicitis, trauma, and even colonic disease led us to consideration and evaluation of laparoscopy as a tool in the management of patients with acute and chronic intestinal obstruction. Forearmed with laparoscopic skills gained performing laparoscopic cholecystectomy, common bile duct exploration, appendectomy, and laparoscopic colon resection and cognizant of the many patients with simple adhesions, internal herniae, and volvulus, we included all patients with suspected intestinal obstruction who did not have resolution of signs and symptoms with conservative treatment in this study. Patients were treated initially with intravenous fluids, nasogastric suction, and correction of electrolyte disturbances. Laparoscopy was performed on 23 patients during the period of May 1991 through April 1993 with resolution of the problem laparoscopically in 20. Details of pathological processes, operations performed, technique, and guidelines for laparoscopy are included.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryLaparoscopic gastrostomy (LG) and laparoscopic jejunostomy (LJ) were performed successfully on 22 consecutive patients after development of the procedure on a porcine model. Patients did not undergo percutaneous endoscopic gastrostomies (PEG) due to obstruction from head and neck, esophageal cancer, gastropexy for gastric volvulus, perforated esophagus, failed PEGs, or surgeon's preference. Operative time averaged < 20.5 min. Five patients underwent the procedure under local anesthesia with intravenous sedation and three patients were operated on in a strictly outpatient setting. There was one postoperative death. LG and LJ are safe alternatives to open enterostomy in patients who cannot undergo PEG.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID