摘要:

SummaryThe purpose of this study was to compare laparoscopic to open colectomy with respect to: 1) morbidity and mortality, 2) adequacy of resection for cancer (margins and number of nodes), 3) operative time, 4) postoperative time for tolerating diet and discharge, and 5) total hospital charges. A historical control group of open colon surgery patients was used. Laparoscopic colectomy was completed in 18/24 patients and 6 were converted to open colectomy. There were no operative or perioperative mortalities. In procedures for cancer, all margins were free of tumor. The average number of nodes in the laparoscopic group (LC) was higher than in open colectomy (OC) group. The average operative time was slightly longer in the LC group compared to the OC group. Postoperative length of stay was shorter in the LC group, and considerably shorter in the elective LC group. Corrected average total hospital cost was lower in the LC group than in the OC group. Laparoscopic colectomy has acceptable morbidity and mortality, is cost-efficient and seems to provide ad-equate resection for cancer, although long-term data will be crucial to this issue.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryThe authors performed Heller's myotomy using an endothoracoscopic technique on two patients with swallowing difficulties that were clinically demonstrated to be oesophageal achalasia. At 12 and 18 months' follow-up, respectively, both patients were asymptomatic. Extramucosal cardiomyotomy, as reported by Heller in 1913, is the most common approach to repair achalasia of the oesophagus. The advantages of the laparoscopic technique (less pain, small scars, reduced hospital stay) are given, as well as the disadvantages (possible mobilization of left lateral liver segment, possible splenic damage, difficulty retracting abdominal contents). More studies are needed to determine the rate of pulmonary complications caused by the extended degree of pulmonary collapse in the thoracoscopic approach and to compare the laparoscopic and thoracoscopic approaches to Heller's myotomy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryThe use of routine cholangiography during laparoscopic cholecystectomy is still under debate. Previous reports have suggested that intraoperative sonography can replace cholangiography in the evaluation of common duct lithiasis during open cholecystectomy. The present study was performed to evaluate the possible role of sonography during laparoscopic cholecystectomy. Thirty patients underwent intraoperative sonography of the biliary tree during laparoscopic cholecystectomy. In cases with a diagnosis of common bile duct lithiasis, intraoperative cholangiography was performed. In 26 cases, sonography did not show the presence of stones; in three cases, stones were identified at both sonography and cholangiography; in one case, stones were diagnosed by sonography alone. In this last case, stones were confirmed on later review of cholangiogram. No complications related to the method were observed. We suggest that intraoperative sonography can represent an adequate substitute for intraoperative cholangiography as a screening procedure for stone identification during laparoscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryWe evaluated the usefulness of methyltert-butyl ether in gallbladder extraction during laparoscopic cholecystectomy when large stones are present. Five patients with symptomatic gallbladder stones larger than 30 mm under-went laparoscopic cholecystectomy according to the standard procedure. Extraction of the gallbladder without enlarging the 10-mm orifice was not possible because of the large stones. We infused MTBE in the gallbladder through a 9-French polyethylene catheter passed into its neck already pulled out of the umbilical port. The solvent was injected, aspirated after 10 to 15 s, and then immediately reinjected. This procedure continued until the stones softened and it became possible to crush and to remove them easily with a forceps or aspirator. The mean duration of the entire procedure was 7.7 ± 1.57 min. Methyltert-butyl ether infusion should be considered during laparoscopic cholecystectomy because it is a cheap and fast method to allow gallbladder extraction when large stones are present.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryTo determine the extent of surgical stress induced by open (n = 20) and laparoscopic (n = 20) cholecystectomy, postoperative serum cortisol, growth hormone, and insulin responses were determined for each group. The groups were similar regarding age, sex distribution, and duration of the surgical procedures. The open cholecystectomy group had significant elevations of serum cortisol, growth hormone, and insulin levels 8 h after surgery (p< 0.05). The increased cortisol and growth hormone levels returned to preoperative control values 48 h after surgery. In the laparoscopically operated group, although all hormones increased after surgery, only the increase in growth hormone was statistically significant (p< 0.05). Serum cortisol and growth hormone levels gradually returned to control values 48 h after surgery, but the increased serum insulin levels remained significantly high in both groups 24 and 48 h after surgery (p< 0.05). It is concluded that acute surgical stress indi ed by open cholecystectomy is more severe than that induced by laparoscopic surgery as reflected by serum hormone determinations. However, the hormonal convalescence rate was similar for both groups. It appears that laparoscopic cholecystectomy is “minimally invasive” concerning the hormonal responses.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryA questionnaire survey was conducted in April 1992, 2 years after the first laparoscopic cholecystitis (LC) was performed in Singapore. The aim was to evaluate the safety and efficacy of this new procedure. Twenty surgeons performed 1,066 LC, of which 93% were done electively, mainly for biliary colic and chronic cholecystitis. Acutely inflamed gallbladders accounted for 6.5% of cases. Fifty-seven (5.4%) patients had to be converted to open surgery, 108 (10.1%) patients required preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis, and 57 (5.4%) intraoperative cholangiograms were done. Common bile duct injuries occurred in 10 (0.9%) patients, of which six (0.6%) were transections. Seven (0.6%) patients developed bile leakage. Minor complications occurred in another 10 (0.9%) patients. There was one (0.09%) death.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryTo date, 14 patients have undergone laparoscopic or laparoscopically assisted colon resections for malignant disease. Margins of resection and lymph nodes (LNs) recovered were compared with those of 20 consecutive controls treated over the preceding 6-month period at the same institution. Of these 14 procedures, one was completed entirely via laparoscopy, 13 were laparoscopically assisted (a small transverse incision was used to deliver the colon and lesion after laparoscopic mobilization). One other patient required conversion to open colectomy. An average of 10.5 LNs (range 0–32) were recovered via the laparoscopic technique per case; 0.4 LNs showed positive signs of metastatic disease (range 0–4). Average margins of resection were 11.1 cm proximally and 10.0 cm distally (range 3–34 cm proximally, 2–23 cm distally). In no case did the margins contain tumor. These results compare favorably with those for the 20 concurrent controls, among whom an average of 7.6 LNs were recovered per case, 0.5 LNs with positive signs of metastatic disease (range 2–19 LNs total, 0–4 positive). Similarly, proximal margins averaged 7.4 cm, and distal margins averaged 14.2 cm (range 1.5–20 cm and 2–30 cm, respectively). Only one postoperative complication was directly related to the surgical procedure—a herniation of small bowel into a trocar site. One anastomotic stricture occurred 6 weeks after surgery, and one partial small-bowel obstruction was noted at 4 weeks. Both were treated nonoperatively. The procedure took only 10 min longer than the conventional open technique, hospitalization was shorter, resumption of regular diet took place significantly sooner (p = 0.01), and postoperative analgesic requirements were significantly lessened (p = 0.002). These preliminary results suggest that in experienced hands, laparoscopically assisted colon resections yield adequate surgical specimens and may be preferable to an open technique in terms of comfort and recovery.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryTo assess the impact of raised intra-abdominal pressure associated with laparoscopy on venous return, we have used an animal model (pig) to study the effect of progressive increases in insufflation pressure on femoral venous blood outflow. As a second variable, the effect on flow of the reverse Trendelenburg position was also assessed. Evidence of any adaptation in venous blood flow to the increased intra-abdominal pressure was assessed during a prolonged surgical procedure. These studies have shown that femoral venous blood outflow in the pig is markedly depressed at insufflation pressures of 10 to 20 mm Hg. The reverse Trendelenburg position accentuates this reduction in flow, and there was no sign of adaptation to this depressed flow during a laparoscopic Nissen fundoplication. These findings have clear implications for the potential of deep venous thrombosis/pulmonary embolism (DVT/PE) following prolonged therapeutic laparoscopy.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryWith the development of the transabdominal preperitoneal secured prosthetic mesh repair, many laparoscopic surgeons feel not only that they have a procedure with a low recurrence rate, but that the procedure also has historic academic credibility. This repair emulates well-established open procedures. Shortcomings of this repair include a demand for more precise identification of structures, more careful dissection, and a higher risk of injury to important anatomical entities. There have been anecdotal reports of injuries to nerves such as the lateral femoral cutaneous nerve, the femoral nerve, and the genital branch of the genital-femoral nerve. This article reviews inguinal anatomy from the laparoscopic vantage point and identifies the areas where injury to nerves can occur.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

SummaryThe use of a small rod (5-mm diameter, 20-cm length, code no. BN320, Aesculap Ltd., Sheffield, England) inserted extraperitoneally has been a useful tool in aiding peritoneal dissection during laparoscopic hernia repair. Experience gained in 100 such repairs using this instrument has helped to reduce the operating time in most instances.

ISSN:1051-7200    

出版商:OVID    

年代:1994

数据来源: OVID