ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic laser cholecystectomy (LLC) is a less morbid alternative to open cholecystectomy. The advantages of laparoscopic techniques associated with advances in laser technology have heralded a dramatic advancement in the surgical treatment of biliary disease. Earlier return to work, lower morbidity, and lower medical expense are known advantages of laparoscopic surgery. We present the findings of our initial 500 procedures. The outcome of the first 200 procedures is compared to the following 300 procedures. Operating time averaged 88 min, and cholangiograms were achieved in 79%. Thirty-two percent were performed as outpatients and average hospital stay was 0.98 days. Conversion to open cholecystectomy occurred in 1.8% of cases and there were 5 major complications related to the procedure. No wound infections and no respiratory complications were encountered. There were no mortalities. Management of common bile duct stones with combined surgical and endoscopic modalities are discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Invented in 1982 by Semm, a gynecologist, laparoscopic appendectomy began to be used in operative surgery in 1987. Since then, we have modified and performed this promising procedure in > 700 patients. The data of the first 625 cases indicate that laparoscopic appendectomy is safe and practicable. With regard to patient age as well as the acuteness of the inflammation, the patients represent a cross section of the normal appendicitis population. The major benefits and possible problems of the method are presented and discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Retrospective review of the first 210 patients treated by laparoscopic cholecystectomy revealed 55 patients (26%) with acute cholecystitis diagnosed preoperatively or intraoperatively. Average age was 52 years amongst 38 women and 17 men. Cardiac history was present in 4%, pulmonary disease was noted in 9%, and other significant medical history was found in 10%. Abnormal preoperative laboratory values (white blood cell count, liver function) were seen in 80%. Operations averaged 104 minutes. Dissection was performed with the potassium titanyl phosphate (KTP) laser in 9%, neodymium-doped yttrium aluminum garnet (Nd Yag) laser in 20%, and electrocautery alone in 71%. Average body habitus was 5 ft 9 in, 178 lb for men and 5 ft 5 in, 155 lb for women. Average length of stay was 2.6 days. Thirty-eight patients (69%) left the hospital in < 2 days. Postoperative complications included one case each of urinary retention, pneumonia, myocardial infarction, and three cases of postoperative fever. Drains were placed in 10 patients (18%). There was no mortality. Suggestions are made for technical considerations that make laparoscopic cholecystectomy a safe and efficient approach to acute cholecystitis.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Recent reports suggest that laparoscopic laser cholecystectomy may become the preferred therapy for symptomatic cholelithiasis. To assess the efficacy and safety of this technique, using monopolar electrocautery instead of laser for the gallbladder dissection, laparoscopic cholecystectomy was performed on 11 pigs. Under general anesthesia, a pneumoperitoneum was established, and four sheaths were placed into the abdomen for introduction of instruments. Using video laparoscopic guidance, the cystic duct and artery were isolated, clipped, and divided. Monopolar electrocautery was used to dissect the gallbladder from its fossa. Five animals were sacrificed immediately, without visible evidence of injury to the bile ducts, liver, or intestine. The remaining six pigs were allowed to recover. One animal died 10 days postoperatively due to adhesive small bowel obstruction. The remainder survived in good health until sacrifice at 1 month. Histologic examination of the gallbladder bed and liver revealed no evidence of ongoing local hepatocyte destruction or chronic cholestasis. Cholangiography demonstrated the bile ducts to be intact. Mean (±SEM) total serum bilirubin (TB), alkaline phosphatase (AP), and glutamic oxalacetic transaminase (SGOT) at the time of sacrifice were similar to nonoperated swine (n = 10): TB, 0.12 ± 0.02 versus 0.11 ± 0.01 mg/dl; AP, 175 ± 23 versus 162 ± 10 IU/L; SGOT, 37 ± 4 versus 55 ± 7 IU/L, respectively (p > 0.05). We conclude that laparoscopic cholecystectomy can be performed using monopolar electrocautery without significant acute injury to the liver, bile ducts, or surrounding viscera. Furthermore, the porcine model can be utilized by surgeons to attain competence in this technique prior to instituting clinical application in humans.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic herniorrhaphy is compared with conventional herniorrhaphy in 20 patients, who underwent laparoscopic herniorrhaphy utilizing a Mersilene plug and patch graft, and high ligation of the neck of the sac with an Endo-GIA. Patients were pain-free and returned to normal activity the first postoperative day. There was one recurrent direct inguinal hernia in an indirect repair. Laparoscopic herniorrhaphy appears to be a safe, effective way to repair indirect inguinal hernias and certain direct inguinal hernias. There is a marked reduction of pain and rapid return to normal activity. The disadvantage of this procedure is the lack of long-term follow-up.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Common bile duct stones were present in sixteen of our first two hundred cases of laparoscopic cholecystectomy. Treatment included flushing into the duodenum, catheter drainage of the duct for cholangiographic and percutaneous access, open choledochotomy with stone removal and E.R.C.P., or combinations thereof. A technique for open choledocholithotomy with suture closure of the duct is presented.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic cholecystectomy has revolutionized the surgical approach to gallbladder pathology. Since it was first introduced in France in 1987, and then subsequently in the United States in 1988, thousands of operations have been performed successfully. Less frequently, laparoscopic evaluation of the biliary ductal system, either by cholangiography or choledochoscopy, has been performed. Laparoscopic common duct exploration presents the next challenge for the biliary tract surgeon. This article reviews the author's early experience with laparoscopic biliary ductal evaluation, choledochoscopy, and removal of common duct stones. A suggested approach to ductal pathology is proposed.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Difficulties can be experienced trying to retrieve gallstones during laparoscopic cholecystectomy. We present three cases and describe three techniques to securely grasp large, free peritoneal calculi. The need to recover such stones is discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Laparoscopic surgery offers distinct advantages to traditional surgery, including decreased hospitalization and recovery periods, decreased postoperative discomfort, and improved cosmesis. A feasible laparoscopic approach to the treatment of peptic ulcer disease might confer similar patient benefits. A modified highly selective vagotomy (in combination with cholecystectomy for symptomatic cholelithiasis) has been successfully completed under laparoscopic guidance in a patient with intractable ulcer disease. The patient was discharged on the second postoperative day, tolerating a regular diet. The patient's dyspeptic symptoms disappeared during the immediate postoperative period and further endoscopic evaluation revealed resolution of active ulcer disease. Although experience is still limited in the United States, initial clinical results from Europe would indicate that laparoscopic vagotomy is not only feasible but effective. With further experience, laparoscopic vagotomy may provide a viable alternative to the standard treatment of peptic ulcer disease.

ISSN:1051-7200    

出版商:OVID    

年代:1991

数据来源: OVID