Emphysematous Cholecystitis

Emphysematous cholecystitis is a relatively rare variant of acute cholecystitis with infection by gas-producing organisms. Diagnosis involves the demonstration of gas within the lumen or wall of the gallbladder by ultrasound or CT scan. In contrast to acute cholecystitis, emphysematous cholecystitis occurs more commonly in elderly and diabetic patients, and is frequently associated with perforation and death. We report here a case of a 75-year old man who developed emphysematous cholecystitis.     

Surgical management of pelvic organ prolapse

Pelvic organ prolapse is a common condition which can have a profound effect on health-related quality of life. The lifetime risk of surgery for pelvic organ prolapse for all women is around 10–12%, making prolapse surgery one of the most commonly performed operations of all. Surgery is generally offered only to women to do not respond to conservative measures such as physiotherapy and/or vaginal pessaries. It is very important to ensure excellent clinical governance around the decision-making process for this elective surgical problem, and this may include the use of written information, face to face and telephone consultations, patient reported outcome measures and patient decision aids. This chapter will cover all the different techniques for prolapse surgery including conventional approaches using native tissue, uterus conserving prolapse surgery and surgery for post-hysterectomy vault prolapse. This will also include laparoscopic prolapse surgery. The role of mesh in prolapse surgery will also be discussed and this chapter will cover important topics including patient selection and preparation for prolapse surgery, shared decision making and how best to facilitate this, patient preparation before prolapse surgery and follow-up post operation.     

Immediate Continence Rates in RALRP: A Comparison of Three Techniques

Methods:We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009–February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12.Results:Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484).Conclusion:Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.     

改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性和安全性*

目的探讨改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性及安全性。方法回顾性分析该院40例腹腔镜手术治疗肾盂癌及中上段上尿路肿瘤患者病例,其中21例患者选择改良后腹腔镜联合经尿道电切镜下肾、输尿管切除术(A组),另外19例患者采用后腹腔镜联合下腹部小切口、经尿道电切镜肾、输尿管切除术(B组)。比较两种手术方式的手术时间、术中出血量、术后留置引流管时间、术后首次肛门排气时间及术后住院时间的差异。结果两组共40名患者,手术均顺利完成,无中转手术。A组与B组患者平均年龄、性别比、肿瘤位置比较,差异无统计学意义(P0.05)。A组手术时间较B组明显缩短(P0.01);A组患者术后住院时间明显少于B组(P0.05)。两组均无术中、术后并发症。A、B组间术中失血量、术后留置引流管时间、术后首次肛门排气时间均差异无统计学意义(P0.05)。结论和后腹腔镜联合下腹部小切口手术方式相比,改良后腹腔镜手术方式安全有效,可缩短手术时间,减少患者术后住院时间,可在上尿路肿瘤,特别是肾盂及中上段输尿管肿瘤的治疗中选择应用。     

Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

ObjectiveThis study aims to compare between operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy (SPA-LAVH) and single-port-access total laparoscopic hysterectomy (SPA-TLH), further subdivided by vaginal cuff closure via laparoscopic suture (VCC-L) or via the vaginal route (VCC-V).Materials and methodsA custom-made port was used for single-port laparoscopy in 111 patients who underwent SPA-LAVH (n = 33), SPA-TLH with VCC-L (n = 35), and SPA-TLH with VCC-V (n = 43) during October 2009–October 2010. Records were reviewed retrospectively.ResultsA significant difference in the operating time was observed among the groups (p = 0.009). SPA-TLH with VCC-L took a significantly longer time to be performed (118.6 ± 41.8 minutes) than SPA-TLH with VCC-V (98.6 ± 21.3 minutes) or SPA-LAVH (102.0 ± 20.3 minutes). The decrease in hemoglobin level on the 1^st day postsurgery was significantly smaller in case of SPA-LAVH (1.56 ± 0.97 g/dL, p = 0.005) compared with that in case of SPA-TLH with VCC-L (2.19 ± 0.95 g/dL) and SPA-TLH with VCC-V (2.24 ± 0.95 g/dL). No significant differences in other surgical outcomes were found.ConclusionSPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.     

AAGL Practice Report: Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH)

The first subtotal abdominal hysterectomy was described by Charles Clay in 1843, and the first laparoscopic subtotal hysterectomy (LSH) was described by Semm [1] in 1991. Whether to retain or remove the cervix remains controversial, with surgeons citing sexual satisfaction and prevention of pelvic organ prolapse as indicators for retention [2]. Because the only absolute indication for cervical removal is malignancy or its precursors, debate has continued as to the optimum surgical approach to hysterectomy for other indications. The evidence obtained from evaluating the effects of retaining the cervix, via any surgical approach, on sexual, urinary, and bowel function remains controversial 3, 4, 5, 6, 7, 8, 9, 10, 11. The literature evaluating LSH is limited, and only 3 randomized controlled trials (RCTs), including 342 women, have reported psychologic outcomes, complications, and additional cervical procedures 4, 12, 13. For the abdominal equivalent, there are 9 RCTs, including 1553 women, and a Cochrane review reported few important differences between the 2 approaches [8]. No such comparative data are available for LSH. This practice guideline will evaluate the evidence for LSH. This report was developed under the direction of the Practice Committee of the AAGL as a service to their members and other practicing clinicians.     

局麻单孔腹腔镜双极电凝与经腹近端抽芯包埋两种输卵管绝育术对生殖激素近期影响的对比观察

目的:比较观察局麻单孔腹腔镜双极电凝输卵管绝育术与经腹近端抽芯包埋输卵管绝育术对卵巢功能的影响。方法:在贵州省内14个县随机抽取2014年10月~2015年10月行上述两种输卵管绝育术妇女各100例,测定卵巢基础激素(FSH、LH和E2)。结果:共133例研究对象进入观察,其中腹腔镜输卵管绝育术组82名,年龄28.84±4.02岁;开腹输卵管绝育术组51名,年龄27.61±4.20岁。两组术后1个月的卵巢基础性激素平均水平无统计学改变;术后1个月基础FSH≥10U/L、基础FSH/LH升高2的比例开腹组明显高于腹腔镜组。结论:腹腔镜输卵管绝育术近期对卵巢功能的影响小于开腹输卵管绝育术。