ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Despite the phenomenal growth of laparoscopic surgery since 1987, surgical residency training programs are failing to train residents in advanced laparoscopic procedures. Data were obtained from the operative registry maintained by the Department of General Surgery, Naval Medical Center San Diego and included all operations performed during the course of a 5-year general surgery residency by residents graduating in 1992 (group 1) and those graduating in 1996 (group 2). Each of the group 1 residents averaged 18 laparoscopic cholecystectomies and 68 open cholecystectomies, whereas the group 2 residents averaged 95 laparoscopic cholecystectomies and 18 open cholecystectomies. Group 1 residents averaged <1 advanced laparoscopic procedure during their residency, whereas group 2 residents averaged 46. Although there was no significant difference in total open cases between groups 1 and 2 (1,233 vs 1,197 respectively; p > 0.99), group 2 performed a significantly greater proportion of laparoscopic cases (12% vs 1%; p < 0.001). The teaching of advanced laparoscopic procedures can and should be incorporated into the surgical residency.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

An observational prospective cohort study was made to evaluate the results of laparoscopic colorectal cancer resection, in terms of recurrence and patient survival. Fifty consecutive patients were analyzed, subjected to abdominoperineal amputations of the rectum (n = 10), anterior rectal resection (n = 13), rectosigmoidectomy (n = 18), and other colectomies (right, left, segmentary) (n = 9). Mean follow-up was 21 months (maximum, 42 months). The tumors corresponded to stage I (TNM classification of the International Union Against Cancer) in 6 cases, stage II in 17, stage III in 18, and stage IV in 9 cases. Survival in stages I-IV was 100, 92, 79, and 18%, respectively, with a disease-free survival rate of 100, 70, and 49% in stages I-III, respectively. Recurrence was pelvic in four cases, with multiple growths, peritoneal carcinomatosis, lung metastases, and implantation in the port scar in one case each. To conclude, survival after a maximum follow-up period of 42 months was found to be acceptable and similar to the percentages reported in the literature for open surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Previous studies have utilized different regimens of laparoscopic surgery for treatment of both acute and chronic diverticular diseases. Our aims were to assert that laparoscopic-assisted sigmoid resection and anastomosis for sigmoid diverticulitis after acute attacks is safe and feasible, provided the inflammatory process has subsided. A chart review was undertaken of patients who underwent laparoscopic sigmoid resection after resolution of the acute attack of diverticulitis at hospitals affiliated with the University of Miami. Thirty-eight patients, median age 52 years, were identified. Laceration of the spleen was the only intraoperative complication (one patient). Seven patients (18%) were converted due to severe adhesions. Regular diet was tolerated on the third postoperative day, and the length of hospital stay was 4 days. No major complications or deaths occurred. In conclusion, laparoscopic surgery for sigmoid diverticulitis after resolution of the acute process seems safe and feasible and provides excellent immediate postoperative recovery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In laparoscopic extraperitoneal herniorrhaphy, there have been no static calculations for nonfixed prostheses with regard to the ideal size of the prosthesis, mesh overlap on the hernial orifice, friction coefficient, and shear forces. The aim of the present study was to perform these static analyses. The friction coefficient of a polypropylene mesh was measured in an experimental setting. Based on the distribution of adhesive force and load on the mesh, we calculated the required mesh overlap over the hernial opening.The friction coefficient was determined as μ0= 0.3. The friction surface required to immobilize the prosthesis is 4.16 times the stress surface. Assuming a safety factor of 2.5, the minimum distance between the margin of the prosthesis and that of the hernial opening should be equal to the diameter of the hernial opening.For smaller lesions we recommend a minimum mesh overlap of 2 cm over the hernial orifice. From a hernia size 2 cm and larger, the distance between the margin of the prosthesis and the hernial opening should be equal to the diameter of the orifice. From 4 cm and larger, the prosthesis should be secured with a stapler (or a similar mode of fixation) to prevent recurrence.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In laparoscopic herniorrhaphy, an alternative to mesh fixation with a stapler is now offered by the helical fastener. The helical fastener was used in 46 patients (39 men and 7 women) with 30 unilateral and 15 bilateral inguinal hernias and 1 femoral hernia. We also used a 5-mm optical system, with which we were able to reduce the size of the trocar incisions. Two 5-mm incisions and one 7-mm incision were used. The fixation elements could easily penetrate bone; therefore, the mesh was easily fixed in the public bone. Laterally, the mesh was fixed in the iliopubic tract. The peritoneum was closed by continuous, extracorporeal knotted sutures. Complications included a wound hematoma in two cases and a small bowel obstruction secondary to inadequate closure of the peritoneum in another case. This was treated by the laparoscopic technique, and the peritoneum was closed with staples.All patients were available for follow-up after 6 to 12 months and were free of recurrence at that time. Patients started to stress the groin after 2 weeks (range 1 to 3). In view of the 40% reduction in incision size and the greater stability of mesh fixation, we prefer the helical fastener over stapler fixation.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The results of laparoscopic repair of 281 recurrent inguinal hernias in 260 patients are presented. One hundred sixty-eight totally extraperitoneal (TEP) and 113 transabdominal preperitoneal (TAPP) procedures were performed. Four major complications occurred in the early postoperative period, three of them in the TAPP group. After 2-4 years, the results were controlled by questionnaires and clinical reexaminations, if necessary. Eleven percent of the TAPP patients and 2% of the TEP patients experienced a recurrence. About 20% of the patients reported occasional discomfort and pain in the operated groin. We conclude that laparoscopic herniorrhaphy provides acceptable results in reoperative hernia surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Recovery of gallstones from the stool demonstrates that gallstones pass into the duodenum due to antegrade sphincter of Oddi (SO) activity. However, retrograde SO peristalsis occurs in three-fourths of patients with bile duct stones as shown by SO manometry. The aim of this study was to investigate, by comparing patients with and without bile duct stones, whether reversed SO activity would retain even small stones. Thirty-nine patients with gallbladder stones ≤3 mm in diameter underwent cholecystectomy, 22 of them with concomitant biliary stones. The remaining 17 patients served as controls. The diameters of the cystic duct and the small stones in the gallbladder and bile duct were measured. The case histories of the controls indicated previous passage of gallstones into the duodenum, i.e., a normal antegrade SO activity. Biliary stones ≤3 mm in diameter were recovered in three-fourths of the patients with ductal stones, a sign of retrograde SO activity. SO dysfunction seems to occur in three-fourths of patients with bile duct stones and should be suspected when stones ≤3 mm are present, as, under these circumstances, it is necessary to retrieve even such small stones.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We retrospectively evaluated the role of intraoperative cholangiography (IOC) combined with laparoscopic intraoperative ultrasonography (LIOU) for detection of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy. We reviewed 184 patients with biliary stones. Preoperatively, all patients underwent ultrasonography (US); 183 of the patients were investigated by cholangiography (oral and intravenous cholangiography in 145 and endoscopic retrograde cholangiography in 44). LIOU was carried out in all patients and IOC was done in 183. LIOU visualized the bile duct in 94.6% of the patients and IOC was successful in 95.6%. CBD stones were detected in a total of 17 patients, 9 (52.9%) of whom were positive on preoperative investigations. The sensitivity for detecting CBD stones was 29.4% with US, 22.2% with oral and intravenous cholangiography, 50.0% with endoscopic retrograde cholangiography, 82.4% with LIOU, and 93.3% with IOC. The diameter of the stones visualized intraoperatively (4.4 ± 1.2 mm) was smaller than that of the stones detected preoperatively (6.9 ± 2.6 mm). The stones were removed during laparoscopy in 15 patients and after conversion to laparotomy in 2. None of the patients had residual CBD stones after follow-up for 6 to 50 months. Intraoperative examination using both LIOU and IOC was useful for prevention of residual CBD stones.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A prospective study of laparoscopic ultrasound (LUS) for evaluation of the common bile duct during laparoscopic cholecystectomy was started in October 1993. LUS during cholecystectomy was performed routinely to preoperatively identify unsuspected stones. Three-hundred thirty patients with symptomatic cholelithiasis were included in the study. The preoperative work-up included endoscopic retrograde cholangiopancreatography in 49 patients. Common bile duct (CBD) stones were found in 22 cases; in 19 cases the stones were removed successfully by endoscopic sphincterotomy. LUS successfully visualized the CBD in all but 10 patients (3%). CBD stones were found in 17 patients and confirmed by preoperative cholangiography and/or CBD exploration. There were two false-negative and one false-positive result for LUS. In 47 patients (14.2%) LUS detected CBD sludge as low-amplitude echoes without acoustic shadowing. The presence of CBD sludge was correlated with some biochemical and clinical variables. A significant correlation was identified between the absence or presence of CBD sludge and endoscopic retrograde cholangiopancreatography, acute pancreatitis, gallbladder sludge, age, and the levels of serum bilirubin and alkaline phosphatase. A significant difference was recorded between CBD diameter and the presence or absence of stones or sludge (p = 0.00001). In our experience, LUS allowed good diagnosis of CBD stones during laparoscopic cholecystectomy. The clinical significance of CBD sludge remains to be elucidated.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID