ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Bleeding continues to be a significant cause of morbidity and mortality for patients with peptic ulcer disease. Recent advances have changed the management of this disease. Upper endoscopy with or without endoscopic therapy is the preferred procedure during the initial evaluation of upper gastrointestinal bleeding. With its excellent success rates, many patients are being cured with endoscopic therapy followed by eradication ofHelicobacter pylori.H. pyloriis now thought to have an important role in the pathogenesis of a majority of gastric and duodenal ulcers. This finding has led to the recommendation that patients with peptic ulcer disease be treated with regimens effective against this organism. Currently, patients who are older and who have more severe underlying medical conditions present a challenge. This review will address the options for treatment of peptic ulcer bleeding. In addition, knowledge gained regardingH. pyloriinfection and use of nonsteroidal anti-inflammatory drugs will be discussed.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Vertical banded gastroplasty (VBG) is an effective treatment for morbid obesity. Recent advancement in laparoscopic surgery has made laparoscopic VBG possible. The authors compared retrospectively the outcomes of laparoscopic VBG versus open VBG in patients with morbid obesity. From June 1998 to April 1999, 100 patients (18 men, 82 women; average age, 32.6 years) underwent laparoscopic VBG, and 40 patients (7 men, 33 women; average age, 28.8 years) underwent conventional open VBG. The two groups were similar regarding sex, age, and body mass index distribution. Mean surgical time, blood loss estimate, duration of postoperative recovery, analgesic usage, complications, and weight reduction were compared among the two groups. Laparoscopic VBG was successful in 99 (99%) of the 100 patients. Mean surgical time was longer in duration for the laparoscopic VBG group than it was for the open VBG group (173 vs. 101 minutes,P< 0.01). The laparoscopic VBG group had earlier flatus passage (1.9 vs. 2.6 days;P< 0.01), less usage of analgesics (meperidine 50 mg/unit; 0.9 vs. 2.3 units;P< 0.01), and a shorter postoperative hospital stay (3.7 vs. 6.0 days;P< 0.01). Estimated blood loss, surgical complication rate, and weight reduction were similar among the two groups. Although laparoscopic VBG required a longer surgical time and was technically more demanding, it resulted in shorter recovery time, less analgesic use, and less severe physical discomfort. The authors' findings show that the two methods were approached safely equally.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Hepatic hydatid cysts are a common surgical problem that is encountered in many tropical countries, including India. Open surgical exploration and excision had been the mainstay of treatment until the advent of laparoscopy. In 1998, we successfully managed six cases of large hepatic hydatid cysts using the videoendoscope, with excellent postoperative follow-up results. Four men and two women participated in this study, with patient ages ranging from 28 to 42 years. The duration of the disease ranged from 1.3 to 2.8 years. All patients had undergone preoperative albendazole therapy for more than 2 months. Complete evacuation of the cyst contents, including all daughter cysts and laminated membrane, along with a subtotal excision of the extrahepatic part of the cyst wall, was accomplished without any spillage into the peritoneal cavity. The saucerized cavity was drained. The drains were removed 6 to 9.4 days after a check ultrasound. Postoperative follow-up ranged from 3 to 9 months and revealed no evidence of a recurrence in the abdomen. It is possible with carefully planned placement of trocars to completely eliminate the risk of spillage, and therefore not compromise the standard principles of hydatid surgery.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Laparoscopic surgery recently has been conducted to repair colonic perforation that is associated with colonoscopy. The authors describe their laparoscopic repair of perforation using passing sutures and an endoscopic linear stapler. One 12-mm and several 5-mm trocars were inserted in the lower abdomen under general anesthesia. Observing with a laparoscope, passing sutures were threaded transversely through all layers of the margin of defect and pulled up with forceps to hold the margin straight, along which the defect was stapled with an endoscopic linear stapler. The authors applied this method for five patients, where the perforation occurred in the sigmoid colon or in the cecum (perforation size ranging from 10 mm to 50 mm). Perforation was successfully repaired in all patients, with no complications because of perforation or the procedures. The current method is beneficial because the perforated lesion is safely and easily closed and postoperative colonic stenosis is avoided.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis. Clinical studies have shown this approach to be a reasonable alternative to open appendectomy. The objective of the current study was to assess the outcome of laparoscopic appendectomy using three different techniques. The study sample consisted of 150 children with acute appendicitis who underwent surgery at Al-Azhar University Hospitals, Cairo, Egypt, and at Al Mishary Hospital in Riyadh, Saudi Arabia, between October 1997 and October 1999. The patients were allocated to undergo extracorporeal laparoscopic appendectomy, Endoloop laparoscopic appendectomy, or EndoGIA (Ethicon Endo-surgery, Inc., Cincinnati, OH, USA) laparoscopic appendectomy. All patients were assessed for the severity of the disease at baseline using clinical and hematologic indicators. The ages of the children ranged from 7 to 14 years, with a mean of 10 years (SD, 2.14 years). Of the children, 55.3% were female. The results showed that children who underwent laparoscopic appendectomy using the EndoGIA had statistically significant shorter operating times, did not have complications, and had the shortest duration of hospital stay (although duration of hospital stay did not reach the statistically significant level ofP> 0.05). Therefore, the study showed that laparoscopic appendectomy using the EndoGIA is the procedure that is most recommended, except for the relatively high cost of the disposable materials. Endoloop laparoscopic technique was the second most preferable procedure, and the least preferred procedure was extracorporeal laparoscopically assisted appendectomy. The major drawback of the last technique is the high frequency of complications. Endoloop laparoscopic appendectomy with a purse-string suture can be performed safely if the EndoGIA is not available.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Several researchers have documented less postoperative pain and a quicker return to daily activities after laparoscopic herniorrhaphy. However, little objective data that validates this hypothesis exists. This study compares the rate of postoperative physical work capacity with return to preoperative levels, which is measured by a standard treadmill test in patients who underwent laparoscopic and conventional open hernia repair. Patients completed a 6-minute walking test preoperatively and 1 week postoperatively using a nonmotorized treadmill. The distance walked was recorded. If the distance that a patient achieved at 1 week was not within 0.02 miles of the preoperative values of the patient, the patient was asked to return at 1 month for repeat testing. Patients were enrolled prospectively in this study from October 1997 to February 1999. Sixty-six patients participated in the study (27 laparoscopic herniorrhaphies and 39 open herniorrhaphies were performed). There was no significant difference in age, body mass index, or preoperative distance achieved among the two groups. At 1 week, patients who underwent laparoscopic repair demonstrated a mean increase of 18 meters from preoperative distance (P= 0.07). In the open group, patients demonstrated a mean decrease of 90 meters at 1 week (P= 0.001). The change in distance at 1 week between the laparoscopic and the open groups was statistically significant (P= 0.001). However, at 1 month, there was no significant difference among the two groups. Measured using treadmill walking, laparoscopic hernia repair seems to offer an early advantage to open repair in return-to-physical-work capacity.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In patients with severe pulmonary disease, laparoscopic techniques are not advised. The authors report their preliminary experience with laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair for inguinal hernia during spinal anesthesia in patients with chronic obstructive pulmonary disease. Spinal anesthesia was performed using hyperbaric bupivacaine (3–3.5 mL) injected at L2–L3. If necessary, additive opioid therapy was administered. Under low-pressure pneumoperitoneum (10 mm Hg), polytetrafluoroethylene mesh was stapled securely on the posterior inguinal wall to spare epigastric and iliac vessels. Fifteen patients underwent surgery. Median age was 62 years. All patients were classified American Society of Anesthesiologists physical status III/IV. Mean forced expiratory volume in the first second was 1.1 L/s. Median operating time was 20 minutes. Postoperative recovery was uneventful for all patients. The average duration of hospital stay was 1.5 days. Seroma or hematoma was not noted. Six-month follow-up did not show recurrence or infection. This technique is an effective method of repair of inguinal hernia in patients with severe chronic obstructive pulmonary disease, and it provides a maximum of comfort.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this study was to evaluate intra-and postoperative outcome after endoscopic axillary lymphadenectomy without liposuction. One hundred patients with early stage breast cancer were treated by breast conserving therapy and endoscopic technique. The median duration of operation was 75 minutes (30–130 minutes). Switching from endoscopy to an open technique was necessary for two patients. The median number of removed lymph nodes was 16. Postoperatively, seroma developed in four patients, temporal winged scapula developed in three patients, and a wound infection in one patient. On postoperative day 5, arm mobility was not restricted for 89 patients. After a median follow-up of 14 months, 14 patients reported persistent impairment of sensibility, and two patients did not have full shoulder mobility. Axillary recurrence has not developed in any patient. Endoscopic axillary lymphadenectomy can be performed safely without previous liposuction.

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-7200    

出版商:OVID    

年代:2001

数据来源: OVID