共查询到20条相似文献,搜索用时 750 毫秒
1.
M. R. P. Van Den Bossche G. Leman K. E. W. Ballaux J. Himpens 《Surgical endoscopy》1999,13(2):166-167
Pulmonary hernias are extremely rare. They are usually treated with open surgical procedures. We describe a case in which
a large, spontaneously acquired intercostal pulmonary hernia was successfully repaired by video-assisted thoracoscopic surgery
(VATS).
Received: 12 August 1996/Accepted: 26 November 1996 相似文献
2.
Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy 总被引:3,自引:2,他引:1
Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt
to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty
during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux
and a large (≥8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty
was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (≤11 months) the patients are
doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement
of the repair with PTFE mesh.
Received: 5 March 1996/Accepted: 3 June 1996 相似文献
3.
The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients
who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations
were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could
be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels
from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other
three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal
during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one
patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found
to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic
reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided.
Received: 9 February 1996/Accepted: 20 May 1996 相似文献
4.
Laparoscopic repair of a paraduodenal hernia 总被引:1,自引:1,他引:0
T. Uematsu H. Kitamura M. Iwase K. Yamashita H. Ogura T. Nakamuka H. Oguri 《Surgical endoscopy》1998,12(1):50-52
Paraduodenal hernias have traditionally been treated by conventional laparotomy. We report the first case of a left paraduodenal
hernia treated laparoscopically. A 44-year-old man was admitted with abdominal pain and nausea. Computed tomography and an
upper gastrointestinal series with small-bowel followthrough showed accumulation of the small bowel on the left side of the
abdomen. A laparoscopic repair was performed. The small bowel was observed beneath a thin hernia capsule. Approximately 1.5
m of jejunum was easily reduced into the abdominal cavity. The hernia orifice (5-cm diameter) was closed intracorporeally
with five interrupted sutures. Good exposure of the operative field is critical to this procedure; poor exposure may limit
the applicability of the laparoscopic approach. This minimally invasive operation is currently indicated in nonobstructive
paraduodenal hernias, especially on the left.
Received: 7 October 1996/Accepted: 11 April 1997 相似文献
5.
Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic
gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared
to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal
cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery.
Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy
was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach,
and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated
medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric
bypass was performed.
Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of
the stomach and surrounding upper abdominal organs.
Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to
decrease operation time.
Received: 18 September 1996/Accepted: 26 December 1996 相似文献
6.
Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair 总被引:6,自引:1,他引:5
A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent
inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and
small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy
has remained intact. This complication needs to be added to the differential diagnosis in patients who present inflammation,
abscess formation, or cutaneous fistula following laparoscopic hernia repair.
Received: 7 October 1996/Accepted: 14 October 1996 相似文献
7.
Short-term outcome of laparoscopic paraesophageal hernia repair 总被引:5,自引:0,他引:5
T. R. Huntington 《Surgical endoscopy》1997,11(9):894-898
Background: The purpose of this study is to determine the morbidity, mortality, and short-term outcomes associated with laparoscopic
paraesophageal hernia repair (LPHR).
Methods: A series of 58 consecutive LPHRs performed by the author were reviewed with an average 1-year follow-up. Morbidity and mortality
rates were compared with historical series of open repairs. Anatomy and technical considerations pertinent to LPHR were reviewed.
Results: There were no procedure-related or perioperative deaths in this series of patients undergoing LPHR. Four major complications
occurred (7%), two of which required reoperation, all in urgently repaired patients. One patient required conversion to laparotomy
(1.7%). Based on symptoms, there were no reherniations. No patients had long-term dysphagia worse than preoperatively. Preoperative
symptoms of chest pain, esophageal obstruction, hemorrhage, and reflux were resolved in all patients.
Conclusions: LPHR is safe, effective, and compares favorably to historical series of open paraesophageal hernia repair.
Received: 24 July 1996/Accepted: 20 November 1996 相似文献
8.
Laparoscopic management of lumbar hernia 总被引:1,自引:1,他引:0
We describe (for the first time) a laparoscopic approach to repair an acquired superior triangle lumbar hernia in a morbidly
obese woman by using prosthetic mesh. Such a technique provides an excellent anatomic view, thus avoiding injury to structures
in proximity to the hernia during repair; eventually the well-known advantages of such approach result.
Received: 10 November 1996/Accepted: 20 December 1996 相似文献
9.
Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence,
the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated
laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter.
Methods: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair
with (n= 17) or without (n= 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both
repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis,
PTFE mesh with a 3-cm ``keyhole' was positioned around the gastroesophageal junction with the esophagus through the keyhole.
The PTFE was stapled to the diaphragm and crura with a hernia stapler.
Results: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every 6 months thereafter.
Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the
repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention)
in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE
was notable for three (16.7%) recurrences within the first 6 months of surgery.
Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence
in patients with large hiatal hernia defects.
Received: 1 May 1998/Accepted: 22 December 1998 相似文献
10.
Background: The laparoscopic repair of inguinal hernia is still controversial. Transabdominal preperitoneal repair violates the peritoneal
cavity and may result in visceral injuries or intestinal obstruction. The laparoscopic extraperitoneal approach has the disadvantage
of being technically demanding and requires extensive extraperitoneal mobilization. The Lichtenstein repair gives good long-term
results, is easy to learn, can be performed under local anesthesia, but requires a larger incision.
Methods: We describe a novel percutaneous tension-free prosthetic mesh repair performed through a 2-cm groin incision. The inguinal
canal is traversed with the aid of a 5-mm video-endoscope and the canal is widened using specially designed balloons. Spermatic
cord mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic
guidance.
Results: Between October 1993 and July 1995, 85 primary inguinal hernia repairs (48 indirect and 33 direct) were performed on 81 patients
(80 men, one woman) by the author (A.D.). The mean age was 41 years (range 17–83 years). Six repairs were performed under
local anesthetic. Mean operative time was 42 min (range 25–74). Mean hospital stay was 1.2 days (0–3 days). The mean return
to normal activity was 8 days (2–10 days). Eight complications have occurred: a serous wound discharge, two scrotal hematomas,
a scrotal swelling that resolved spontaneously, wound pain lasting 2 weeks, an episode of urinary retention, and two recurrences
early in the series (follow-up 1–22 months).
Conclusion: The endoscopically guided percutaneous hernia repair avoids the disadvantages of laparoscopy (i.e., lack of stereoscopic
vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation
allows operation through a 2-cm incision. The minihernia repair thus combines the virtues of an open tension-free repair with
minimal access trauma.
Received: 21 May 1996/Accepted: 8 August 1996 相似文献
11.
A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that
had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of
the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect
was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene
mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative
course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding
the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair.
Received: 6 June 1997/Accepted: 11 August 1997 相似文献
12.
Late rejection of the mesh after laparoscopic hernia repair 总被引:4,自引:0,他引:4
We report the first case of late rejection of a mesh after laparoscopic hernia repair. It occurred in a 48-year-old man who
had had a laparoscopic hernia repair by transabdominal preperitoneal approach 3 years earlier. The most characteristic finding
was the slow development of a firm mass in the right groin, without pain or fistula. At admission 3 months later, US and CT
scans demonstrated a necrotic mass extending into both iliac fossa. The mass was approached through a midline incision. Pus
was taken for microscopic examination (negative), and the mesh was removed, along with several staples. Ultramicroscopic examination
of the mesh showed breakdown of the fibers, collagen reduction, and no chronic inflammatory cells. No infectious cause of
inflammation was identified.
Received: 5 May 1997/Accepted: 11 July 1997 相似文献
13.
A new approach in the management of incarcerated hernia 总被引:1,自引:0,他引:1
The authors describe the case of a 74-year-old male presenting with an incarcerated epigastric hernia. An algorithm for successful
management of such a case is proposed.
Received: 18 November 1996/Accepted: 26 December 1996 相似文献
14.
Background: We compared the incidence of early hernia recurrence in nonrandomized but consecutive patients undergoing laparoscopic repair
of paraesophageal hernia (LRPH) without and with excision of the hernia sac.
Methods: LRPH was completed in 55 of 58 patients. In the first 25 patients, the sac was not excised. Total sac excision was performed
in the subsequent 30 patients. All patients had crural repair with or without fundoplication, or gastropexy.
Results: Mean age of patients was 68 years (range, 34–95). There were three conversions; one patient died postoperatively. Mean operative
time was 225 min in the first group and 190 min in the sac excision group. Median length of stay was 2 days (range, 1–15)
for both groups.
Conclusions: A precise method of total sac excision simplified dissection. It also ensured complete reduction of the hernia and availability
of adequate esophageal length. Operative time was not increased, and no subsequent early recurrences were observed (p < 0.05).
Received: 3 April 1997/Accepted: 18 July 1997 相似文献
15.
Background: In addition to its well-known benefits of decreased postoperative pain and shorter recovery time, laparoscopic hernia repair
has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The
purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally extraperitoneal
(TEP) laparoscopic inguinal herniorrhaphy and to analyze the risks and benefits of identifying these hernias at the time of
the initial surgery.
Methods: We did a retrospective review of the charts of all of the 724 male patients who underwent laparoscopic TEP repair of 958
groin hernias between September 1991 and September 1999. The initial clinical impression of the existence of unilateral or
bilateral hernias was noted and compared to our operative findings. The same surgeon performed all the repairs. Exploration
of the contralateral side was performed in a systematic fashion. A second mesh prosthesis was placed if a contralateral hernia
was found.
Results: Bilateral hernia repair was performed on 234 patients (32.3%). In 62 of them (11.2%), the contralateral hernia was diagnosed
only at the time of the procedure. Operative time ranged from 14 to 185 min (median, 38.6). The operative time for the contralateral
exploration ranged from 2 to 5 min (median, 2.8). The rate of complications was 4.1%, but no complications were directly related
to the exploration of the asymptomatic side.
Conclusion: Our study shows that a large number of inguinal hernias are undiagnosed by physical examination (11.2%). Systematic contralateral
exploration using the TEP approach is safe and does not greatly increase the operative time. Early identification and repair
of a contralateral hernia obviates the need for reoperation, reduces overall costs to the health care system, and eliminates
any further work loss for the patient.
Received: 24 November 1999/Accepted: 3 February 2000/Online publication: 8 May 2000 相似文献
16.
The role of endoscopic extraperitoneal herniorrhaphy (EEPH) in the management of giant scrotal hernias has not been well
defined, and the technical details relating to operations on such hernias have not been described. We present our experience
with 17 patients undergoing repair of giant scrotal hernias. Foley catheter bladder decompression was routinely employed.
The Retzius space was developed early in the procedure and hernia sac contents were reduced in all cases. The inferior epigastric
vessels were likewise divided in all patients. The average operative time was 76 min and all patients were discharged home
the same day. There have been no recurrences on follow-up. There was no mortality, and morbidity was limited to seroma formation
in two patients. We conclude that with certain technical modifications, EEPH can be safely employed for the treatment of giant
scrotal hernias.
Received: 7 May 1996/Accepted: 12 July 1996 相似文献
17.
Background: This report describes the technique and early results of a simple outpatient laparoscopic ventral hernia repair.
Methods: Data were gathered prospectively for all laparoscopic ventral hernia repairs from January 1996 to December 1997 at a 228-bed
hospital. Prolene mesh was stapled to the peritoneal surface of the abdominal wall, leaving sac in situ and mesh uncovered. Patients were seen by the operating surgeon within 2 months, and by an impartial surgeon (J.S.) after
3 to 14 months (average, 7 months; median, 6 months).
Results: Repairs involved 44 hernias with orifice sizes 2 to 20 cm in diameter, and an average area of 20 cm2. Of these 44 hernias, 36 were postoperative and 8 primary. Furthermore, 20% were recurrent hernias. There were four conversions.
The outpatient rate was 98%, with one readmission for ileus. The early recurrence rate was 5%.
Conclusions: Laparoscopic mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence
rate that can be performed safely on an outpatient basis.
Received: 15 October 1998/Accepted: 18 October 1999/Online publication: 10 April 2000 相似文献
18.
Background: Laparoscopic total extraperitoneal (TEP) hernia repair utilizes slit mesh that is placed around the spermatic cord to secure
the prosthesis and prevent recurrence. Because of concern that encircling of the cord might increase pain and morbidity, we
compared patients with mesh repairs using encircled and nonencircled techniques.
Methods: The 191 male patients who underwent bilateral TEP repairs were divided into three groups. In 100 consecutive patients (group
A), the slit mesh was closed around both spermatic cords; in 56 patients (group B), the slit mesh was tucked under the spermatic
cords but not closed; in 35 consecutive patients (group C), the slit was closed around one cord and tucked under the other,
in a randomized fashion.
Results: The groups had similar operative times (A: 83 ± 25 min; B: 79 ± 21; C; 77 ± 24), use of pain medication (A: 2.7 ± 2.5 days;
B: 2.4 ± 1.9; C: 3.1 ± 2.4), and recovery before return to work (A: 7.9 ± 7.0 days; B: 8.2 ± 6.1; C: 6.7 ± 4.8). The incidence
of indirect hernias was similar in all groups. Complication rate was 20% in A, 20% in B, and 14% in C (p= NS). Chronic pain was more frequent in A (A: 6, B: 0, p= 0.06). In group C, fluid collections were more common on the closed side (closed: 3, tucked: 0; p= 0.08). There were no recurrences in any group.
Conclusions: Closing the slit around the spermatic cord in laparoscopic inguinal hernia repair is not essential for prevention of early
recurrence. Fluid collections tended to be more frequent when the mesh was closed around the cord, and chronic pain was more
frequent in the group with closed mesh bilaterally.
Received: 3 April 1997/Accepted: 3 July 1997 相似文献
19.
H. Spivak I. Nudelman V. Fuco M. Rubin P. Raz A. Peri S. Lelcuk L. A. Eidelman 《Surgical endoscopy》1999,13(10):1026-1029
Background: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse
effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia
repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with
nitrous oxide insufflation was investigated.
Methods: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures
(24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported
operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications
were collected prospectively.
Results: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time
was 39 ± 7 min for unilateral hernia and 65 ± 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients
(63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable
throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after
the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence.
Conclusions: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal
nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.
Received: 17 February 1999/Accepted: 1 July 1999 相似文献
20.
Emergency laparoscopic repair of a paraesophageal hernia 总被引:1,自引:0,他引:1
A 63-year-old male with a previously documented paraesophageal hernia presented with acute severe epigastric pain and bloating.
He was taken urgently to the operating room for laparoscopic exploration. The hernia sac was reduced with difficulty owing
to extensive adhesions and the incarcerated portion of the stomach was mottled and blue. After 10 min of observation the stomach
began to resume a normal appearance. The anterior crura were approximated and an anterior gastropexy was performed. The patient
was discharged on the 3rd postoperative day and has been asymptomatic since. Paraesophageal hernias with evidence of impending
gastric necrosis can be approached laparoscopically as long as basic principles are observed. 相似文献