共查询到20条相似文献,搜索用时 31 毫秒
1.
Katkhouda N Mavor E Gugenheim J Mouiel J 《Journal of Hepato-Biliary-Pancreatic Surgery》2000,7(2):212-217
We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical
feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31
patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located
in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts
in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were
excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size
of the solitary liver cysts was 14 cm (range, 7–22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control
bleeding. The median operative time was 141 min (range, 94–165 min) for patients with PLD and 179 min (range, 88–211 min)
for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications
occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts.
Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1–3 days), 3 days (range, 2–7 days),
and 5 days (range, 2–17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range,
3–78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic
recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely
in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should
be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through
an open approach.
Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999 相似文献
2.
Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts 总被引:3,自引:0,他引:3
Background: Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible
and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer
long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented.
Methods: Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker
measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented.
Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6–6.4 years) by clinical investigation
and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively.
Results: All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six
cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient
with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the
cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic
recurrence and successfully underwent reoperation endoscopically.
Conclusions: The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that
laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of
cases when diagnosis is correct.
Received: 16 July 1998/Accepted: 17 December 1998 相似文献
3.
Background: Despite the reduced rate of occurrence, the hydatidosis of the liver is still taking an important place in surgical practice
in Asia Minor and the Middle East. Traditional techniques for performing liver cyst surgery seem to be comparatively traumatic.
In this clinical study, we present our experience with laparoscopic treatment of hydatid cyst of the liver and discuss the
validity of the gasless technique as a solution to carbon dioxide (CO2) ensufflation problems.
Methods: All patients were prepared by administrating albendazole for 21 days preoperatively. Surgery was performed on 87 patients
under general anesthesia. Working space was obtained in 51 operations by using an abdominal wall lifting device, Laparolift™
(Origin Med Systems, Menlo Park, California, USA) (group 1). In 36 patients, the abdominal cavity was insufflated with CO2 gas (group 2). In all cases, hydatid cysts were identified, and gauses soaked in germicide solution were placed around them.
The cysts were punctured and aspirated. Then germisid solution was injected into the cysts. The cysts walls were opened, and
germinative membranes were evacuated.
Results: The median operation time was 50.49 ± 10.9 min (range, 30–75 min) in group 1 and 70.8 ± 16 min (ranges 40–120 min) in group
2. The difference in the operative times of the two groups was significant (p < 0.01). There was no significant difference between the minor complications of the two groups. There were no deaths and
no major complications or conversions to open surgery in any of the groups. There were no recurrences during follow-up time.
Conclusions: The use of gasless technique for the laparoscopic treatment of liver cyst is a safe, time-saving, and promising procedure
that can be applied in selected cases.
Received: 1 March 1999/Accepted: 1 July 1999 相似文献
4.
Laparoscopic management of ovarian cysts in newborns 总被引:3,自引:0,他引:3
Background: Cysts are the most common ovarian masses found in newborn girls. Spontaneous regression, which occurs in ∼25–50% of cases,
is more frequent with smaller cysts. Pre- or postnatal complications are common; these complications may consist of intracystic
bleeding, torsion of the cyst or corresponding annex, or self-amputation of the cyst. When the cyst is <4 cm it is possible
to perform a simple echographic monitoring to check for the possibility of spontaneous involution; all other cases require
surgery.
Methods: Between February 1985 and June 1997, we treated 22 neonatal ovarian cysts laparoscopically. In 14 cases, the right side was
involved; in eight cases, it was the left. The patients' ages ranged between 7 days and 5 months (median, 45 days). In all
cases, we used three trocars. An intraperitoneal cystectomy was done in eight cases, a transparietal cystectomy in four cases,
an ovariectomy in seven cases, and the simple removal of the cyst in one case where self-amputation had occurred. In two cases
of bilateral pathology, the cysts, which were <1 cm, were left untreated.
Results: Average operating time was 40 min (range, 25–60 min). Intraabdominal pressure never exceeded 6–8 mmHg during the intervention.
The postoperative course was always under 3 days. No intra- or postsurgical complications were recorded, and long-term ultrasonographic
follow-ups were all normal.
Conclusion: Our experience indicates that the laparoscopic approach is a reliable and safe technique in the treatment of neonatal ovarian
cysts.
Received: 30 July 1997/Accepted: 24 October 1997 相似文献
5.
A. Emmermann C. Zornig D. M. Lloyd M. Peiper C. Bloechle C. E. Broelsch 《Surgical endoscopy》1997,11(7):734-736
Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing;
the last 13 of them also received an omental transposition flap in addition.
Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An
omental transposition flap was fashioned and stapled into the cyst cavity itself.
Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection
which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was
performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases
without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0).
Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver
cysts and can be performed using minimal-access surgical techniques.
Received: 19 January 1996/Accepted: 26 August 1996 相似文献
6.
Laparoscopic liver surgery 总被引:7,自引:0,他引:7
Background: An effort was made to evaluate the indications, safety, and therapeutic efficacy of laparoscopic liver surgery.
Methods: Between 1989 and 1996, 28 patients, 23 to 88 years old were operated upon laparoscopically. Pathology consisted of simple
cyst (ten), polycystic liver disease (seven), hydatid cyst (three, two of them calcified), abscess (one), focal nodular hyperplasia
(six), and metastatic breast cancer (one).
Results: Operations included 17 fenestrations, three pericystectomies, and eight resections (two lateral lobes). Operative time was
45 to 525 min with only four cases longer than 4 h. There was a 21% morbidity rate. There were no mortalities. Follow-up was
1–67 months with one asymptomatic recurrence.
Conclusions: Laparoscopic hepatic surgery can be performed safely with good results by surgeons with hepatic and laparoscopic experience
when careful selection criteria are followed. We advocate the ``four-hands technique' for simultaneous dissection and control
of bleeding and bile ducts during resections.
Received: 10 May 1996/Accepted: 26 July 1996 相似文献
7.
Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas 总被引:11,自引:1,他引:10
Background: A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction.
In some cases, they present initially with both complications. These conditions contribute markedly to their discomfort and
certainly justify palliative intervention. The purpose of this study was to examine the feasibility and safety of simultaneous
laparoscopic biliary and gastric bypass in patients with unresectable carcinoma of the pancreas.
Methods: Between August 1995 and July 1998, simultaneous laparoscopic biliary and retrocolic gastric bypass was performed successfully
in 12 consecutive patients with unresectable carcinoma of the pancreas. There were eight men and four women. Their median
age was 72 years (range, 50–82). In all patients, the indications for gastrointestinal bypass were gastric outlet obstruction
and obstructive jaundice. The following parameters were evaluated for each patient: procedure-related morbidity and mortality,
operative time, length of hospital stay, overall survival, and ability to sustain oral nutrition during the survival period.
Results: All procedures were completed laparoscopically. The mean operative time was 89 ± 29.56 min. There were no intraoperative
complications. Postoperative morbidity consisted of wound infection in two patients and pneumonia in one patient. One patient
died of multiorgan failure on postoperative day 2. The mean hospital stay was 6.4 ± 1.5 days (range, 5–17). The mean survival
time until death from underlying disease was 85 ± 32.46 days (range, 31–260). None of the patients had recurrent jaundice,
and all of them were able to maintain oral nutrition.
Conclusion: Simultaneous laparoscopic biliary and retrocolic gastric bypass is a safe and effective technique for the treatment of biliary
and gastroduodenal obstruction in patients with unresectable pancreatic cancer.
Received: 17 December 1998/Accepted: 13 May 1999 相似文献
8.
Background: Experience with 94 resections in 88 patients with Crohn's disease using advanced laparoscopic techniques is reported. Records
of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed.
Indications, operative findings, clinicopathologic, and postoperative data were recorded.
Methods: In this study, the mean age was 37 years (range, 16–70 years), and 55% of the participants were women. Indications for surgery
included obstruction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 case). Seventy patients underwent ileocolic
resection, 28 of whom had a previous history of one or two ileocolic resections. Eight of these patients had additional procedures
including tubal ligation (1), sigmoidectomy (1), cholecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection
(13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anterior rectal resection (2 cases), and sigmoid
resection (3 cases) were performed in the remaining patients. All but one procedure were completed laparoscopically with extracorporeal
anastomosis. The average length of intestine resected was 33 cm (range, 10–92 cm). Forty-one patients had 58 fistulae between
ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. Mean blood loss was 168 ml (range, 30–800 ml) and mean
operative time was 183 min (range, 96–400 min).
Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay
was 4.2 days (range, 3–11 days). Complications included anastomotic leak necessitating reoperation, stricture requiring endoscopic
dilation, hemorrhage treated expectantly, urinary tract infection, pulmonary embolus, line sepsis, and early postoperative
intestinal obstruction (7 cases) requiring reoperation in three cases.
Conclusions: Experience with both advanced laparoscopic techniques and conventional surgery for inflammatory bowel disease allowed successful
laparoscopic management of patients with complicated Crohn's disease.
Received: 29 August 1998/Accepted: 22 January 1999 相似文献
9.
T. W. Bax D. R. Marcus G. Q. Galloway L. L. Swanstrom B. C. Sheppard 《Surgical endoscopy》1996,10(12):1150-1153
Background: Laparoscopic adrenalectomy has recently been shown to be a safe and effective means of treating adrenal pathology with much
lower morbidity than the traditional approach. The majority of reports in the literature involve removal of adrenal tumors.
Although open bilateral adrenalectomy has been utilized for persistent Cushing's syndrome following attempted hypophysectomy,
there is little data available describing the application of laparoscopic adrenal surgery to this problem.
Methods: Four patients with persistent Cushing's syndrome after attempted treatment with hypophysectomy underwent laparoscopic bilateral
adrenalectomy at our institution. One procedure was done transabdominally in the supine position. Three procedures were done
transabdominally using sequential lateral decubitus positions.
Results: All procedures were completed laparoscopically. The mean operative time was 4.6 h (range 3.9–5.25). Repositioning and reprepping
the patients resulted in a slight increase in operative time, but visualization was improved using the lateral decubitus position.
Average blood loss: 156 cc (range 50–300). One patient required early reoperation for bleeding from the left adrenal bed,
which was controlled laparoscopically. Three patients were eating the following day and were discharged on postoperative days
1, 2, and 5. The fourth patient remained hospitalized for 18 days due to problems unrelated to surgery. After a mean follow-up
of 10 months, all patients have done well and have no clinical or biochemical evidence of recurrent disease.
Conclusion: Our clinical experience indicates that laparoscopic bilateral adrenalectomy is a viable treatment option for Cushing's syndrome
following failed hypophysectomy.
Received: 29 March 1996/Accepted: 12 June 1996 相似文献
10.
J. L. Bouillot K. Aouad A. Badawy B. Alamowitch J. H. Alexandre 《Surgical endoscopy》1998,12(12):1393-1396
Background: Although several recent reports described the different methods utilized for laparoscopic colon resection, only a few of
them questioned whether the procedure is appropriate for the surgical treatment of diverticular disease. To assess this question,
we performed a retrospective study of 50 consecutive patients operated using laparoscopic assistance to remove the sigmoid
colon for diverticular disease.
Method: The surgical technique was a laparoscopically assisted procedure that included mobilization of the left colon and vascular
ligation laparoscopically and then, via a small abdominal incision, division of the colon, removal of the specimen, and hand-sewn
anastomosis.
Results: The surgical goal was achieved in 46 cases, with a conversion rate of 8%. The mean operative time was 195 min (range 150–280
min). There was no mortality, and the morbidity rate was 14%. There were no complications directly related to the laparoscopic
technique. The mean return of regular bowel habits was 3.2 days, and the median postoperative stay was 10 days.
Conclusions: These preliminary results suggest that laparoscopic-assisted sigmoidectomy can be used safely for the surgical treatment
of diverticular disease.
Received: 30 July 1997/Accepted: 21 January 1998 相似文献
11.
R. Rosati U. Fumagalli S. Bona L. Bonavina M. Pagani A. Peracchia 《Surgical endoscopy》1998,12(3):270-273
Background: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure
of choice to treat stage I–III esophageal achalasia.
Methods: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients
underwent laparoscopic Heller-Dor for stage I–III achalasia. Conversion to laparotomy was done in three cases. All procedures
were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were
sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative
treatment).
Results: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year.
After a mean follow-up (F.U.) of 21 months (1–62), clinical results range from excellent to good in 98.2%. One patient (1.7%)
complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure
reduced from 30.3 ± 12.4 to 10.7 ± 3.5 mmHg (basal) and from 14.8 ± 9.3 to 2.9 ± 2.1 mmHg (residual).
Conclusions: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous
endoscopic dilations.
Received: 3 April 1997/Accepted: 28 July 1997 相似文献
12.
R. Cadrobbi G. Zaninotto P. Rigotti N. Baldan G. Sarzo E. Ancona 《Surgical endoscopy》1999,13(10):985-990
Background: Laparoscopic treatment of pelvic lymphocele secondary to kidney transplant has gained popularity in the last few years, although
lesions of the urinary tract (ureter, renal pelvis, and bladder) have been reported frequently. To evaluate the result of
this treatment and the associated risk of urinary tract lesions, we reviewed our experience and reports in the medical literature
on open and laparoscopic surgery.
Methods: From 1991 to 1999, we laparoscopically treated 12 patients (7 men and 5 women; median age, 43 years; range, 17–59 years)
with symptomatic pelvic lymphocele causing a deterioration of renal function because of compression on the ureter in 10 of
the 12 patients and lymphocele compression of the iliac vein in the other 2 patients. In nine patients, the lymphocele wall
was opened and sutured to the peritoneum to keep the window open. In two patients, an omentoplasty was performed, and in the
remaining patient, both techniques were used. All patients were followed up clinically with ultrasound and biochemistry for
a median period of 33 months (range, 1–96 months). Using Medline, we reviewed the medical literature from 1980 to 1998 and
collected 252 cases in which operations had been performed to drain an internal lymphocele secondary to kidney transplantation.
Results: Laparoscopic treatment was successful in 11 of the 12 patients. One patient was converted to open surgery because of a lesion
in the transplanted ureter. One patient needed repeat laparoscopy 24 hours after the operation because of bleeding from the
peritoneal window. The median duration of the operation was 120 min (range, 70–200 min), and the median postoperative hospital
stay was 5 days (range, 2–12 days). None of the patients needed to discontinue oral cyclosporine assumption. The serum creatinine
level dropped significantly after surgery (p < 0.05). No symptomatic recurrences were observed. Of the 252 patients found in the medical literature, in 129 the procedure
was performed with open surgery and in 123 laparoscopically (our 12 patients included). The prevalence of iatrogenic lesions
to the urinary tract increased threefold with the use of laparoscopic surgery (from 1.6% in open surgery to 7% in laparoscopy).
The recurrence rate of symptomatic lymphocele, however, decreased from 15% to 4%.
Conclusions: Laparoscopic drainage of posttransplantation lymphocele is a relatively simple method for treating this complication, although
it bears the burden of an increased incidence of urinary tract lesions, as confirmed by a review of the literature. The major
advantage of the laparoscopic approach is the absence of postoperative ileus with the opportunity to continue the enteral
immunosuppressive regimen and a lower recurrence rate. These data suggest that laparoscopic lymphocele treatment might be
considered the therapy of choice, provided the iatrogenic lesions of the urinary tract diminish as more experience with this
technique is gained.
Received: 1 March 1999/Accepted: 1 July 1999 相似文献
13.
Background: A disparity exists between the incidence of accessory spleens reported in the open (15–30%) versus the laparoscopic (0–12%)
literature. This disparity implies that a percentage of laparoscopic patients will require a reoperation for accessory splenectomy.
We present our experience with the laparoscopic management of accessory spleens discovered after primary splenectomy for idiopathic
thrombocytopenic purpura (ITP).
Methods: Seventeen patients who underwent primary splenectomy for ITP were reviewed (1 open, 16 laparoscopic). In the laparoscopic
group, the incidence of accessory spleens was 3 in 16 (19%). In 1 of these 3 patients, the accessory spleen was found and
removed at the initial operation, whereas in 2 of the 16 patients (13%), the accessory spleens were missed. A third patient,
whose initial operation was open, presented with recurrent thrombocytopenia after primary splenectomy. After recurrent thrombocytopenia
developed, radio nuclide spleen scans were performed showing accessory spleens in all three patients. These three patients
underwent accessory splenectomy using a four-port laparoscopic approach.
Results: Laparoscopic accessory splenectomy was successfully performed in all three patients. Location of accessory spleens correlated
with the spleen scan in each case. Mean operation time was 180 min. There were no conversions to open surgery and no complications.
All patients were discharged from the hospital on postoperation day 1. The three patients had a good clinical response and
were weaned effectively from their steroid medications.
Conclusions: Patients undergoing a laparoscopic splenectomy for chronic ITP have a higher probability of requiring a reoperation for a
missed accessory spleen. To minimize missing an accessory spleen, a systematic search should be made at the beginning of the
laparoscopic operation. We have found that preoperation imaging with heat-treated erythrocyte scans is valuable for locating
accessory spleens before reoperation. When reoperation for accessory splenectomy is necessary, a laparoscopic approach is
safe and effective.
Received: 22 July 1998/Accepted: 13 October 1998 相似文献
14.
The laparoscopic management of post-transplant lymphocele 总被引:2,自引:0,他引:2
W. S. Melvin G. L. Bumgardner E. A. Davies E. A. Elkhammas M. L. Henry R. M. Ferguson 《Surgical endoscopy》1997,11(3):245-248
Background: The management of lymphocele in patients following kidney (KT) and kidney pancreas (KPT) transplants is evolving. Open surgery
has been the traditional treatment, but some authors have advocated laparoscopic drainage in selected patients.
Methods: We retrospectively reviewed our results in lymphocele treatment since developing a laparoscopic program at our institution.
Results: Between May 1994 and June 1995, 186 KTs and 48 KPTs were performed, and 1,354 patients are currently being followed. Eight
patients developed symptomatic lymphoceles an average of 26 months (range 4–59) following 6 KTs and 2 KPTs. All patients diagnosed
were successfully drained laparoscopically, with no conversions to open surgery. Laparoscopic ultrasound was used to help
with localization of the fluid collection. Operative time averaged 59 min, median hospital stay was 1 day (range 1–4), and
there were no perioperative complications. Follow-up imaging was obtained on six patients, 3–16 months following their procedures,
and no recurrences were noted. A review of the literature demonstrates a 5.3% rate of major complications and a 7% incidence
of lymphocele recurrence.
Conclusions: Intraoperative laparoscopic ultrasound can help localize fluid collections and prevent organ injuries. Laparoscopic drainage
of lymphocele following transplantation results in minimal disability and an acceptable complication rate, although it is
higher than with open drainage. Therefore, laparoscopic drainage should be considered as primary treatment for all patients
with symptomatic post-transplant lymphocele.
Received: 15 March 1996/Accepted: 3 July 1996 相似文献
15.
Laparoscopic ventral hernia repair 总被引:1,自引:0,他引:1
Introduction: Effective surgical therapy for ventral and incisional hernias is problematic. Recurrence rates following primary repair range
as high as 25–49%, and breakdown following conventional treatment of recurrent hernias can exceed 50%. As an alternative,
laparoscopic techniques offer the potential benefits of decreased pain and a shorter hospital stay. This study evaluates the
efficacy of the laparoscopic approach for ventral herniorrhaphy.
Methods: A retrospective review was performed for 100 consecutive patients with ventral hernias who underwent laparoscopic repair
at our institutions between November 1995 and May 1998. All patients who presented during this period and were candidates
for a mesh hernia repair were treated via an endoscopic approach.
Results: One hundred patients underwent a laparoscopic ventral hernia repair. There were 48 men and 52 women. The patients were typically
obese, with a mean body mass index (BMI) of 31 kg/m2. Each had undergone an average of 2.5 (range; 0–8) previous laparotomies. Forty-nine repairs were performed for recurrent
hernias. An average of two patients (range; 1–7) had previously failed open herniorhaphies; in 20 cases, intraabdominal polypropylene
mesh was present. There were no conversions to open operation. The mean size of the defects was large at 87 cm2 (range; 1–480). In all cases, the mesh (average, 287 cm2) was secured with transabdominal sutures and metal tacks or staples. Operative time and estimated blood loss averaged 88
min (range; 18–270) and 30 cc (range; 10–150). Length of stay averaged 1.6 days (range; 0–4). There were 12 minor and (two)
major complications: cellulitis of the trocar site (two), seroma lasting >4 weeks (three), postoperative ileus (two), suture
site pain > 2 weeks (two), urinary retention (one), respiratory distress (one), serosal bowel injury (one), and skin breakdown
(one) and bowel injury (one). Both of the latter complications required mesh removal. With an average follow-up of 22.5 months
(range; 7–37), there have been (three) recurrences.
Conclusion: The laparoscopic approach to the repair of both primary and recurrent ventral henias offers a low conversion rate, a short
hospital stay, and few complications. At 23 months of follow-up, the recurrence rate has been 3%. Laparoscopic repair should
be considered a viable option for any ventral hernia.
Received: 11 February 1999/Accepted: 15 March 2000/Online publication: 28 April 2000 相似文献
16.
Background: Colic ischemia is a serious complication that can occur after abdominal aortic surgery. It has been described in two patients
after laparoscopic aortic surgery. The goal of the current experiment was to determine the feasibility of inferior mesenteric
artery (IMA) reimplantation during laparoscopic aortobifemoral bypass (LAFB).
Methods: Six piglets were submitted to the laparoscopic approach according to the ``apron' technique previously described. The infrarenal
aorta was clamped and an LAFB was performed using a dacron graft. The IMA was reimplanted in the body of the graft with a
running 5-0 polypropylene suture.
Results: Mean operation and dissection times were 282.5 min (range, 270–310 min) and 123 min (range, 110–140 min), respectively, with
a mean blood loss of 108 ml (range, 80–150 ml). Aortic clamping and anastomotic times were 123 min (range, 110–135 min) and
33 min (range, 24–45 min), respectively. The IMA reimplantation took 55 min (range, 45–70 min). At autopsy, all anastomoses
were patent with no stenosis nor leak.
Conclusion: Laparoscopic IMA reimplantation during laparoscopic aortobifemoral bypass is feasible.
Received: 10 July 1998/Accepted: 15 November 1998 相似文献
17.
Background: Percutaneous balloon-tipped laparoscopic cannulas designed for preperitoneal hernia repair can be readily used to treat gastric
bleeding laparoscopically.
Methods: Between 1995 and 1997, we successfully used balloon-tipped cannulas to visualize, biopsy, and suture acutely bleeding gastric
lesions in five patients. These case histories are reviewed for this study.
Results: Patients received an average of six units of blood preoperatively (range, 0–15). Operative time averaged 207 min (range,
149–270). At surgery, gastrotomies were made for cannula placement under laparoscopic visualization. Operative findings included:
lesser curve gastric ulcer, Mallory-Weiss tear, prepyloric ulcer, duodenal ulcer, and angiosarcoma. Three patients had successful
percutaneous suture of bleeding gastric lesions. One patient was converted to open surgery. One patient had local resection
of an angiosarcoma.
Conclusion: The laparoscopic use of balloon-tipped cannulas allows the expeditious diagnosis and treatment of acute gastric hemorrhage.
Received: 31 March 1998/Accepted: 26 February 1999 相似文献
18.
Laparoscopic closure of perforated duodenal ulcer 总被引:4,自引:2,他引:2
Background: Medical treatment of peptic ulcer is highly successful, and the eradication of Helicobacter pylori (H. pylori) reduces ulcer recurrence. However, the incidence of perforated duodenal ulcer and its associated mortality have not been
reduced by modern methods of therapy. Laparoscopic simple closure and omental plug by suturing, fibrin glue, and stapler have
been successful.
Methods: Over a 1-year period (1996–97), 21 patients with perforated duodenal ulcer were operated on in our hospital by laparoscopic
simple closure and omental patch. The mean age was 36.4 ± 11.8 years (range, 18–61). Twenty patients were male (93.7%). The
mean duration of pain was 9.1 ± 11.7 hs (range, 2–48). Three patients had a previous history of duodenal ulcer (14.3%), and
another three (14.3%) patients had a history of nonsteroidal antiinflammatory drug (NSAID) intake. Erect chest radiograph
showed that 19 patients had air under the diaphragm (90.5%). Sixteen patients (76.2%) had frank pus in the abdomen, and five
patients had a minimal peritoneal reaction (23.8%).
Results: The mean operative time was 71.6 ± 24.6 mins (range, 40–120), and the mean hospital stay was 5.2 ± 1.6 days (range, 3–9).
The mean time to resume oral fluids was 3.1 ± 0.8 days (range, 2–4). Only one patient was reoperated due to leakage identified
by gastrographin swallow.
Conclusions: This procedure is safe and efficient; however, further study of its long-term effectiveness and comparability to existing
therapy is still needed.
Received: 28 May 1998/Accepted: 17 November 1998 相似文献
19.
Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.
Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of
Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized
laparoscopically. A standard posterior colo-anal anastomosis was fashioned and a stapler was used for the anterior anastomosis.
The top of the rectum was then closed by endo stapler under laparoscopic vision.
Results: Thirty patients underwent laparoscopic surgery for this procedure. Three laparoscopic procedures were converted because of
technical difficulties. The operative time was 100–330 mn. Oral feeding was started at a mean postoperative time of 2.5 days.
Mean postoperative hospitalization was 9 days. Early postoperative complications included 1 anastomotic leak, 1 retrorectal
abscess, 2 urinary infections, and 1 evisceration (after conversion). No enterocolitis or enterocolitis-like symptoms were
noted. All patients now have daily spontaneous bowel movements.
Conclusion: The laparoscopic Duhamel procedure can be performed safely, giving good results.
Received: 6 November 1998/Accepted: 12 February 1999 相似文献
20.
Laparoscopic repair of rectal prolapse 总被引:4,自引:0,他引:4
Background: There have been few large series that have focused on the feasibility of the laparoscopic approach for rectal prolapse. This
single-institution study prospectively examines the surgical outcome and changes in symptoms and bowel function following
the laparoscopic repair of rectal prolapse.
Methods: In a selected group of 34 patients (total prolapse, 28; intussusception, six), 17 patients underwent laparoscopic-assisted
resection rectopexy and 17 patients received a laparoscopic sutured rectopexy. Preoperative and postoperative evaluation at
3, 6, and 12 months included assessment of the severity of anal incontinence, constipation, changes in constipation-related
symptoms, and colonic transit time.
Results: Median operation time was 255 min (range, 180–360) in the resection rectopexy group and 150 min (range, 90–295) in the rectopexy
alone group. Median postoperative hospital stay was 5 days (range, 3–15) and median time off work was 14 days (range, 12–21)
in both groups. There were no deaths. Postoperative morbidity was 24%. Incontinence improved significantly regardless of which
method was used. The main determinant of constipation was excessive straining at defecation. Constipation was cured in 70%
of the patients in the rectopexy group and 64% in the resection rectopexy group. Symptoms of difficult evacuation improved,
but the changes were significant only after resection rectopexy. Two patients (7%) developed recurrent total prolapse during
a median follow-up of 2 years (range 12–60 months).
Conclusions: Laparoscopic-sutured rectopexy and laparoscopic-assisted resection rectopexy are feasible and carry an acceptable morbidity
rate. They eliminate prolapse and cure incontinence in the great majority of patients. Constipation and symptoms of difficult
evacuation are alleviated.
Received: 30 April 1999/Accepted: 8 July 1999/Online publication: 22 May 2000 相似文献