Laparoscopic surgery for diverticulitis

Background: Resection of diverticular disease may be quite challenging; the acute inflammatory process, thick sigmoid mesentery, and any associated fistula or abscess can make this procedure technically demanding. The aim of this study was to compare the results between laparoscopic and laparotomy-type resections stratified by disease severity and thereby predict outcome and possibly a subset of patients who may benefit from a laparoscopic approach. Methods: From August 1991 to December 1995, all patients with diverticular disease were classified according to a modified Hinchey classification system. The laparoscopic group included 18 patients who underwent a laparoscopic assisted colectomy, one with a loop ileostomy. The identical procedures were performed in 18 patients by laparotomy. The mean age of the two groups were 62.8 and 67.1 years, respectively (p= NS). Results: Seven of 18 patients in whom laparoscopy was attempted (38.9%) had conversion to laparotomy. Six of seven (85.7%) conversions were directly related to the intense inflammatory process. Laparoscopic treated patients with Hinchey IIa or IIb disease had a morbidity rate of 33.3% and a conversion rate of 50% while all patients with Hinchey I disease were successfully completed without morbidity or conversions to laparotomy. However, after the first four cases, the intraoperative morbidity and postoperative morbidity rates were zero and 14.3% and after ten cases they were zero and zero, respectively. Furthermore, the median length of hospitalization for Hinchey I patients after laparoscopy was 5.0 days vs 7 days after laparotomy (p < 0.05). In Hinchey IIa and IIb patients, the median length of hospitalization was almost 50% shorter with a laparoscopic approach (6 days vs 10 days, p < 0.05). Conclusion: In conclusion, laparoscopic resection of diverticulitis can be performed without additional morbidity particularly in Hinchey I patients and with a reduced length of hospitalization in patients with class I or II disease. Patients with class I disease, and after initial experience even those with class II disease, can benefit from the reduced morbidity and length of hospitalization associated with laparoscopic treatment. Received: 25 March 1996/Accepted: 17 July 1996     

Laparoscopy for cryptorchidism

Laparoscopy is suggested as an accurate way to localize the non-palpable testicle or to diagnose anorchia without an abdominal exploration. From our early experience laparoscopy will aid greatly in the management of the intra-abdominal testicle.     

Laparoscopy for adhesions

Intestinal and abdominal adhesions may be responsible for a variety of clinical conditions, including chronic recurrent small-bowel obstruction, acute small-bowel obstruction, closed-loop bowel obstruction and, debatably, abdominal or pelvic pain. Experience in laparoscopic surgery has increased at a rapid pace, thus adhesions are no longer considered a contraindication to treatment of these conditions. In recent years, numerous publications have reported the feasibility, safety, and favorable outcome of laparoscopic intervention in various adhesion-related conditions. As adhesions are the most common cause of recurrent or acute bowel obstruction, this review will focus on the laparoscopic management of these conditions and outline the technical considerations, indications, contraindications, and results.     

Laparoscopic surgery for colon diverticulitis

BACKGROUND: Laparoscopic surgery is used with increasing frequency to treat colorectal pathologies and some groups have also attempted to treat the complicated forms of diverticulitis (abscesses and/or fistulas). The results reported in the international literature are still controversial, especially in terms of the duration of surgery, the frequency of laparotomic conversions and postoperative morbidity. The aim of this study was to analyse the results of laparoscopic or laparotomic treatment of diverticular disease of the colon in patients admitted to the Department of Colorectal Surgery at the Cleveland Clinic in Florida over a three-year period. METHODS: A retrospective analysis was made of 57 patients with diverticular disease of the colon who were admitted to CCF (Cleveland Clinic Florida) between January 1996 and December 1998 and underwent elective laparoscopic or laparotomic surgery. A comparative analysis was made of the results in the two groups. RESULTS: Of the 57 patients treated only 15 underwent laparoscopic surgery; the majority were treated for uncomplicated diverticulitis. 22 out of 42 patients (53%) undergoing laparotomic surgery presented complicated diverticulitis (abscesses, fistulas or stenosis), whereas 12 out of 15 patients undergoing laparoscopic surgery (80%) were treated for uncomplicated diverticulitis. Statistically significant differences were found in relation to the duration of surgery: 152 min in the laparotomic group vs 209 in the laparoscopic group. No differences were found in the frequency of intraoperative complications, transfusions and the number of drainages inserted (p=0.66). The postoperative period showed significant differences in terms of the reappearance of intestinal peristalsis, use of PCA and postoperative stay. CONCLUSIONS: This retrospective study confirms that the laparoscopic treatment of colon diverticulitis offers a number of advantages: reduced postoperative pain, more rapid recovery of intestinal peristalsis and shorter postoperative stay. Laparoscopic sigma colectomy represents the treatment of choice for diverticulitis in uncomplicated cases.     

腹腔镜在妇科急症中的应用

目的:探讨腹腔镜在妇科急症中的应用价值。方法:2002年以来,应用腹腔镜行妇科急症手术85例,其中异位妊娠62例中行患侧输卵管切除术36例,输卵管切开取胚术及病灶清除术23例,1例卵巢妊娠行卵巢部分切除术,输卵管病灶注药术2例;卵巢破裂10例,9例行电凝止血术,1例行患侧附件切除术;卵巢肿瘤蒂扭转6例,2例不全扭转行囊肿剥除术,4例完全扭转附件坏死行一侧附件切除术;急性盆腔炎7例,行脓肿清除、输卵管切除及盆腔粘连松解术。结果:85例急诊腹腔镜手术全部顺利完成,无一例并发症。结论:腹腔镜治疗妇科急症安全有效,较开腹手术有很多优越性。     

妇科腹腔镜手术体位的探讨

目的 探讨改良妇科腹腔镜手术体位的效果.方法 选择行妇科腹腔镜手术患者58例,随机分成传统组和改良组各29例.传统组采用传统截石位;改良组患者取平卧位,两侧髋关节屈曲90°、外展45°,双下肢水平分开90°～100°.结果 两组不同时间血压、心率比较,差异有统计学意义(均P<0.05).两组术后下肢疼痛发生率比较,差异无统计学意义;术后24 h改良组麻木发生率显著低于传统组(P<0.05).结论 妇科腹腔镜手术采用平卧"人"字形体位术中手术野暴露满意,患者循环系统功能稳定.     

Laparoscopy for colorectal cancer

The advantages of laparoscopy in the treatment of benign disease have been well demonstrated. Compared to open surgery, laparoscopy is associated with a shorter hospital stay, less ileus, decreased postoperative pain, earlier return to work, and better cosmesis. The role of laparoscopy for the cure of malignant disease, however, remains controversial. In order to elucidate the safety and efficacy of laparoscopy for malignancy, worldwide large controlled randomized trials were developed. While awaiting the results of large randomized trials, a review of the many published studies to date was undertaken demonstrating a high level of evidence of the superiority of laparoscopy over laparotomy in regard to short-term benefits, when performed by appropriately skilled surgeons in properly selected patients. The data also suggest similar or superior local recurrence and long-term survival rates. However, further follow-up and review of large, multicenter, randomized trials will be needed before widespread acceptance of the technique can be recommended.     

Laparoscopy for Crohn disease

The laparoscopic approach to Crohn disease offers the multiple potential benefits of faster recovery, better cosmesis, and a lower incidence of adhesion-related complications and incisional hernias. Most of these advantages are unproven, but a review of the current literature reveals that advantages have been suggested in almost all series that have compared laparoscopy to laparotomy. Some features of Crohn disease, such as fistula, abscess, and phlegmon, may pose a surgical challenge; however, laparoscopic resection is often feasible, with morbidity rates comparable to or lower than those associated with laparotomy. Experience both in advanced laparoscopic techniques and surgery for Crohn disease, coupled with sound surgical judgment and a reasonably low threshold to convert to laparotomy before intraoperative complications occur, are essential for the successful and safe employment of these procedures.     

Laparoscopy for abdominal emergencies

Background Emergency laparoscopic exploration can be used to identify the causative pathology of acute abdominal pain. Laparoscopic surgery also allows treatment of many intraabdominal disorders. This report was prepared to describe the effectiveness of laparoscopic surgery compared to laparotomy or nonoperative treatment. Methods A panel of European experts in abdominal and gynecological surgery was assembled and participated in a consensus conference using Delphi methods. The aim was to develop evidence-based recommendations for the most common diseases that may cause acute abdominal pain. Recommendations Laparoscopic surgery was found to be clearly superior for patients with a presumable diagnosis of perforated peptic ulcer, acute cholecystitis, appendicitis, or pelvic inflammatory disease. In the emergency setting, laparoscopy is of unclear or limited value if adhesive bowel obstruction, acute diverticulitis, nonbiliary pancreatitis, hernia incarceration, or mesenteric ischemia are suspected. In stable patients with acute abdominal pain, noninvasive diagnostics should be fully exhausted before considering explorative surgery. However, diagnostic laparoscopy may be useful if no diagnosis can be found by conventional diagnostics. More clinical data are needed on the use of laparoscopy after blunt or penetrating trauma of the abdomen. Conclusions Due to diagnostic and therapeutic advantages, laparoscopic surgery is useful for the majority of conditions underlying acute abdominal pain, but noninvasive diagnostic aids should be exhausted first. Depending on symptom severity, laparoscopy should be advocated if routine diagnostic procedures have failed to yield results. Paper presented at the 13th International Congress of the European Association for Endoscopic Surgery (EAES), Venice, Italy, June 2005 S. Sauerland and E. A. M. Neugebauer are the Conference organizers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (EAES), c/o EAES Office, P.O. Box 335, 5500 AH Veldhoven, The Netherlands     

Laparoscopy for nonpalpable testes

Purpose

Laparoscopy is now considered integral to the management of nonpalpable testes, although its benefits are not clearly documented. The authors prospectively determined the value of laparoscopy in patients with nonpalpable testes.

Methods

Between December 1997 and October 2001, 37 patients with 40 nonpalpable testes were scheduled for laparoscopy followed by definitive treatment. Laparoscopy was cancelled in 4 patients (5 testes) because their testes became palpable under anesthesia. In the remaining 33 patients (35 testes), it was determined at the time of surgery whether, as a consequence of laparoscopy: (1) retroperitoneal exploration was avoided (2) definitive treatment was facilitated.

Results

Laparoscopy did not alter the management of 27 testes (77%) that were treated through an inguinal incision with orchiopexy for 17 testes (6 intraabdominal and 9 at the deep ring) and removal of 10 atrophic nubbins. It was only useful in avoiding retroperitoneal dissection for 5 (14%) vanishing testes, and it may have been of benefit for 3 testes treated with a 2-stage Fowler-Stephens orchiopexy.

Conclusions

The majority of our patients with nonpalpable testes could have been treated through an inguinal incision with laparoscopy being reserved for situations in which the testis was not identified on inguinal exploration.