Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients’ outcome and cost-effectiveness

Background Numerous studies have demonstrated the feasibility of laparoscopy in the management of acute adhesive small-bowel obstruction (AASBO). However, comparative data with laparotomy are lacking. The aim of this study was to compare laparoscopy and laparotomy for the treatment of AASBO in terms of patient outcome and cost-effectiveness. Methods A retrospective chart review of all patients who underwent surgery for AASBO from 1999 to 2005 was conducted. Data recorded included operative and postoperative course, among others. Operative and total hospital charges were estimated from the Patient Accounting System. Results Thirty-one patients who underwent laparoscopy were matched to a similar group of patients who underwent laparotomy. In the laparoscopy group, four patients (13%) had a laparoscopy-assisted procedure and ten patients (32%) were converted. The laparoscopy group was subdivided into laparoscopy, laparoscopy-assisted, converted, and assisted-converted subgroups. In the majority of the patients, AASBO was secondary to a single band. Overall morbidity was significantly higher in the laparotomy group (p = 0.007). Morbidity rates were statistically significant between the laparoscopy and assisted-converted subgroups (p = 0.0001) but not between the laparotomy group and assisted-converted subgroup (p = 0.19). Median hospital stay and median time to first bowel movement were significantly shorter in the laparoscopy group. Charge data were available for only the last three years of the study. Operative charges and total hospital charges were similar between the laparoscopy and the laparotomy groups (p = 0.14 and p = 0.10, respectively). There was a significant difference in total hospital charges between the laparoscopy subgroup and laparotomy group (p = 0.03). Conclusions Laparoscopy for AASBO is associated with reduced hospital stay, early recovery, and decreased morbidity. Laparoscopy-assisted and converted surgeries do not differ significantly from laparotomy in regard to patient outcome. Operative and total hospital charges are similar for both laparoscopy and laparotomy. Presented at the Northeastern Society of Colon and Rectal Surgeons Annual Meeting, Palm Beach, FL 6–9 November 2005, and at the 17th Annual Meeting of the South Florida Chapter of the American College of Surgeons, Miami, FL, 20 April 2006 This study was supported in part by an educational grant from Ethicon Endo-Surgery Inc. and in part by the 21st Century Oncology Chair in Colorectal Surgery     

Impact of previous abdominal surgery on the outcome of laparoscopic colectomy: a case-matched control study

Background Adhesions are a major risk for visceral injury and can increase the difficulty of both laparoscopic and open colectomy. The aim of the present study was to evaluate the impact of previous abdominal surgery on laparoscopic colectomy in terms of early outcome. Methods We performed a case-control study of patients who underwent laparoscopic colectomy for colorectal disease. The case group comprised 91 patients with a history of prior abdominal surgery, while the 91 controls had no such history. Case and controls were matched for age, gender, site of primary disease, comorbidity on admission and body mass index. Results The two groups were homogeneous for demographic and clinical characteristics. Conversion rate was 16.5% in the case group and 8.8% in the control group (p=0.18). Of the 7 patients who underwent conversion because of adhesions, six had prior surgery (cases) and one did not (p=0.001). Operative time was 26 minutes longer in the case group than in the control group (p=0.001). Morbidity rate was 25.3% among cases and 23.1% for controls. Patients in the two groups experienced a similar time to recovery of bowel function, length of postoperative stay, and 30-day readmission rate. Conclusions Laparoscopic colectomy in previously operated patients is a time-consuming operation, but it does not appear to affect the short-term postoperative outcome.     

宫腔镜下Nd:YAG激光手术治疗宫腔粘连

目的 探讨宫腔镜下Ｎｄ：ＹＡＧ激光手术治疗宫腕粘连的安全性和有效性。方法 对１９９４年５月至１９９９年６月期间施宫腔镜下Ｎｄ：ＹＡＧ激光手术治疗宫腕肌性或纤维性粘边的５３例患者的临床资料进行总结分析。结果 术后５３例患者宫腔均恢复正常形态,其中轻中度粘连患者共４２例均行１次手术,重度粘中边患者１１例中３例行１次手术,７例行２次手术,１例行３次手术。术后月经恢复正常率为７６．５％（２６／３４）,月经     

甘油合剂和透明质酸钠预防鸡鞘管区屈肌腱粘连的实验研究

目的 研究甘油合剂预测鞘管区屈肌腱粘连的作用和对肌腱愈合的影响,并与透明质酸钠的作用相比较。方法 双Ａ鸡７８只,随机分为基油合剂（ＧＭ）组,秀明质酸钠（ＳＨ）组及生理盐水（ＮＳ）组,每组各２６只。将鸡右足第三趾趾深屈肌腱切断,做改良Ｋｅａｓｌｅｒ 法缝合,并修复腱鞘,然后在修复的腱鞘内及肌腱周围注入相应药物。术后第１、２、４、６、８周取材,分别进行大体观察、组织学检查、生物力学测试。结果 ＧＭ组术     

Ⅰ型牛胶原蛋白生物膜对鸡趾屈肌腱损伤术后生物力学的影响

目的:从生物力学角度探讨Ⅰ型牛胶原蛋白生物膜预防肌腱粘连作用。方法:三黄鸡,3月龄,60只,雌雄各半,体重1.5～2.0 kg,以右足第3趾屈趾深肌腱断裂1/2吻合模型,随机分为假手术组、对照组和Ⅰ型牛胶原蛋白生物膜组,再根据取材时间分为2周组、4周组、6周组、8周组4个亚组,术后2、4、6、8周对吻合端周围粘连程度观察和对包括患侧及健侧第3趾关节屈曲角度、肌腱滑动距离、肌腱最大抗断裂负荷的生物力学检测。结果:Ⅰ型牛胶原蛋白生物膜在术后2、4、6、8周,与假手术组及对照组比较,粘连程度评分明显优于假手术组及对照组(P0.05);生物力学指标测定显示,关节屈曲角度、肌腱滑动距离、肌腱最大抗断裂负荷各项指标,实验组均优于对照组(P0.05)。结论:Ⅰ型牛胶原蛋白生物膜可以减少粘连,提高肌腱生物力学指标,具有一定的预防粘连的作用,是一种有效的预防肌腱粘连的新型生物性材料。