摘要:

ABSTRACTTo determine if laparoscopic inguinal herniorrhaphy can be performed safely in unselected patients, the authors' first 100 consecutive laparoscopic inguinal hernia repairs were reviewed. All patients with inguinal hernias who were candidates for general anesthetic were accepted for the study. Their ages ranged from 18 to 84 years. One hundred and six hernias were laparoscopically repaired in 95 males and 4 females. One male patient required an open hernia repair.The first 14 patients were repaired with a preperitoneal patch and plug technique, and the next 85 with the double-buttress transabdominal preperitoneal approach. Two pieces of polypropylene mesh were stapled to the transversalis fascia, ileopubic tract, and Cooper's ligament after the preperitoneal dissection of the hernia was completed. The first piece was placed over the indirect space, with a slit for the cord medially, and the second piece was placed over the entire direct and indirect area.Patients have been followed from 8–18 months. To date, no recurrence has developed. Complications have included seroma, inferior epigastric bleeding, trocar hernia, and neuralgia. Patients have returned to work and normal activity in 2 days to 2 weeks, with an average of 1 wee

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.1

年代:1993

数据来源: MAL

摘要:

ABSTRACTEvaluation of the role of staples, clips, and sutures for laparoscopic ligation of the renal artery revealed that occluding the renal artery with three, 9 mm titanium clips is as secure as occluding the renal artery with standard 2-0 and 0-silk ligatures. However, a triple staggered line of 2.5 mm staples placed across the renal artery was not as secure as either clips or silk sutures. The authors also studied eight female farm pigs who underwent laparoscopic nephroureterectomy with en masse stapled occlusion of the renal hilum. In one animal, an arteriovenous fistula was documented 6 months postoperatively. Currently, when laparoscopically occluding the renal hilum, the authors recommend a thorough dissection of the renal artery and renal vein; each should then be separately occluded so that three individually placed titanium clips remain on the stump of the renal artery and on the renal vein.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.9

年代:1993

数据来源: MAL

摘要:

ABSTRACTFrom November 1989 to December 1990, 474 elective laparoscopic cholecystectomies were performed. This study analyzes the first year's experience with regard to complications, postoperative response in terms of pain and nausea, and time back to activity and work.There were 369 females and 105 males in the group. The average age was 51.5 years. Of these, 394 were discharged within 23 h and 80 required admission postoperatively.Of the group requiring hospitalization, there were 10 (2.1%) major complications, 37 (7.8%) minor complications, 14 (3.0%) aborted laparoscopic cholecystectomies, and 19 (4.0%) others. Major complications occurred early in the surgeon's experience, all but two within the surgeons' first 25 cases.Patients in the short stay group were followed-up with a phone questionnaire. In this group, most patients experienced minimal abdominal pain following surgery, with an average score of 2.4 (SD = 1.38) on a scale of 1 (absent) to 5 (extreme). At home, 48.6% of patients experienced some form of postoperative discomfort. Of these, 38.2% experienced abdominal pain, 18.7% shoulder pain, and 32.7% nausea. The average postoperative time to resume normal daily activity was 7.9 days (SD = 8.2) and to return to work was 11.6 days (SD = 9.9)

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.13

年代:1993

数据来源: MAL

摘要:

ABSTRACTThe widespread use of laparoscopic cholecystectomy for the treatment of symptomatic gallstones has been associated with an increased use of diagnostic and therapeutic biliary endoscopy to treat common bile duct stones and postoperative complications. In 250 patients with successful laparoscopic cholecystectomy, 35 were selected for preoperative ERCP evaluation after fitting the criterion of clinical evidence with common bile duct stones (ultrasound and biochemical data). Stones were found in 16 of 35 patients (45.7%). Endoscopic sphincterotomy with stone removal was successfully carried out during the procedure. Laparoscopic cholecystectomy was performed 1 or 2 days after endoscopic sphincterotomy with good result. Only one patient without clinical evidence of common bile duct stones developed postoperative retained stone; he was successfully treated by endoscopic sphincterotomy. Three patients with postoperative bile leakage were successfully treated with endoscopic nasobiliary drainage. Diagnostic and therapeutic ERCP procedures should incorporate the newly developed method of laparoscopic cholecystectomy in order to provide a more safe and minimal invasive therapy.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.19

年代:1993

数据来源: MAL

摘要:

ABSTRACTAs laparoscopic cholecystectomy evolves into the "standard" method for gallbladder removal, it has become necessary for surgical residents to safely acquire the necessary skills to perform the procedure. To determine the safety of this procedure in the hands of residents, the authors evaluated the first 100 attempted laparoscopic cholecystectomies performed by a resident in the role of "surgeon." Ninety-one of the 100 procedures were successfully completed laparoscopically and 9 required conversion to laparotomy: 5 technically difficult cases, 2 common duct explorations, and 2 for intraoperative complications. At Cooper Hospital in New Jersey, essentially all patients requiring cholecystectomy are first attempted laparoscopically. Seventy-seven patients had chronic cholecystitis and 23 had acute disease. Twenty-two patients had intraoperative cholangiograms and two had laparoscopic common bile duct exploration. For the laparoscopically-completed procedures, average operative time was 91 min and showed a downward trend as each resident gained experience. Three (3%) major complications occurred: one colon laceration, one common bile duct injury, and one postoperative bile collection. For the 91 laparoscopically-completed procedures, 53 patients were discharged on postoperative day 1 and 20 on postoperative day 2. Average postoperative hospitalization was 1.7 days. Overall, these results were comparable to those reported in the literature by attending and private surgeons. The authors conclude that laparoscopic cholecystectomy can be performed safely by supervised residents acting as primary surgeon with outcomes similar to those obtained by trained attending surgeons.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.23

年代:1993

数据来源: MAL

摘要:

ABSTRACTThe routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.27

年代:1993

数据来源: MAL

摘要:

ABSTRACTPregnancy has generally been considered a contraindication to laparoscopic cholecystectomy. The authors present a case of laparoscopic cholecystectomy in a 37-year-old patient who was 18 weeks pregnant. Laparoscopic cholecystectomy can be safely accomplished during pregnancy, provided that the open technique of insertion of the first cannula is used, and all subsequent trocars be inserted under direct vision.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.35

年代:1993

数据来源: MAL

摘要:

ABSTRACTRuptured duodenal peptic ulcer is a serious complication of ulcer disease that occurs in approximately 5% of cases and accounts for over 70% of deaths associated with peptic ulcer disease.1This case report details the management of a 67-year-old male with a ruptured duodenal peptic ulcer who presented to the emergency room with acute onset of severe abdominal pain. There was no past history of ulcer disease. An abdominal x-ray suggested the presence of free air, and diagnostic laparoscopy was performed. The superior exposure afforded by this minimally invasive technique not only permitted an exact diagnosis to be made, but also afforded a means to expeditiously correct the pathologic defect.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.41

年代:1993

数据来源: MAL

摘要:

ABSTRACTThe authors report a case in which an 87-year-old woman underwent diagnostic laparoscopy for abdominal pain of unknown etiology. Jejunal diverticulosis was discovered with diverticulitis and perforation into the mesentery. Visualization of the appendix, ovaries, uterus, colon, and liver ruled out additional pathology. The disease was serious enough that resection of the involved jejunum was necessary. With the aid of the laparoscope, the incision was directed nearer to the area of the disease. A 5 cm left upper quadrant transverse incision was made, allowing removal of perforation and the diseased bowel. Primary resection and anastomosis were performed. This case sets a precedence for use of exploratory diagnostic laparoscopy and particularly small bowel resection for symptomatic diverticulitis. The authors believe that this technique results in less postoperative pain, allowing for a prompt recovery with minimal morbidity and mortality, particularly in the elderly population.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.47

年代:1993

数据来源: MAL

摘要:

ABSTRACTMany procedures that were once approached exclusively through large abdominal incisions are now accomplished using operative laparoscopic techniques with shorter, less expensive hospital stays and significantly reduced convalescence. This report describes a laparoscopic orchiectomy in a patient with complete androgen insensitivity and discusses the indications for gonadectomy in phenotypic females with an XY karyotype.

ISSN:1052-3901    

DOI:10.1089/lps.1993.3.51

年代:1993

数据来源: MAL