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1.
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
2.
Lymphoceles are a well-known complication of renal transplantation, with incidence rates up to 18%. The management of symptomatic lymphocele remains controversial. We report the case of a lymphocele which was successfully drained into the peritoneal cavity using laparoscopic surgery. 相似文献
3.
The recent development of endoscopic surgery and its use in treating several abdominal and thoracic surgical pathologies lead us to suggest its application in the treatment of posttransplant lymphoceles. The authors report two cases treated by the laparoscopic approach. Recurrence occurred in one of them. The technique is described and its place among other therapeutic modalities is discussed. 相似文献
4.
Laparoscopic treatment of ventral hernia 总被引:3,自引:0,他引:3
Farrakha M 《Surgical endoscopy》2000,14(12):1156-1158
Laparoscopic repair of abdominal wall hernias has been introduced recently to treat both spontaneous and incisional hernias
with reported good results. In the Mafraq and Al Jaziera Hospitals in the United Arab Emirates, 18 patients have been treated
using the laparoscopic technique. These cases included 11 incisional hernias, 5 spontaneous paraumbilical hernias, and 2 combined
incisional and paraumbilical hernias. A bilayer repair was performed in all cases using a layer of polyester mesh to bridge
the defect and a sheet of Gore-Tex (W. L. Gore & Associates, Flagstaff, AZ, USA) to prevent adhesions between first layer
and the bowel. Seroma at the hernia site was the most frequent postoperative complication. Hospital stay ranged from 2 to
7 days (mean, 3.2 days). Recurrent hernia developed in one patient after a mean follow up of 22.3 months. This technique is
in its evolution. Long follow-up evaluation is required before the effect on recurrence is known, and further development
regarding the composition of prosthetic biomaterials and the methods of its fixation is expected.
Received: 4 February 2000/Accepted: 11 May 2000/Online publication: 28 September 2000 相似文献
5.
Laparoscopic treatment of large paraesophageal hernias 总被引:6,自引:4,他引:2
van der Peet DL Klinkenberg-Knol EC Alonso Poza A Sietses C Eijsbouts QA Cuesta MA 《Surgical endoscopy》2000,14(11):1015-1018
Background: We set out to evaluate the results of the laparoscopic treatment of large paraesophageal hernias in 22 patients.
Methods: Between 1993 and 1998, we operated on 22 consecutive patients. Preoperative assessment consisted of endoscopy, barium esophagogram,
24-h pH testing, manometry, and gastric emptying times.
Results: In the first three patients, the sac was not excised and gastropexy was not performed. Because of recurrences, we decided
to change the technique in an attempt to avoid further complications. During middle- to long-term follow-up, only three recurrences
were seen in the subsequent 19 patients. There were no deaths in this series.
Conclusions: Laparoscopic treatment of large paraesophageal hernias is feasible. Because recurrences may occur after successful laparoscopic
treatment, both resection of the sac and some form of gastropexy are imperative.
Received: 22 March 2000/Accepted: 30 April 2000/Online publication: 20 September 2000 相似文献
6.
Laparoscopic treatment of gastric stromal tumors 总被引:9,自引:4,他引:5
Basso N Rosato P De Leo A Picconi T Trentino P Fantini A Silecchia G 《Surgical endoscopy》2000,14(6):524-526
Background: The laparoscopic resection of gastric stromal tumors (GST) is being performed with increased frequency.
Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent
laparoscopic resection using intraoperative endoscopy. For lesions located on the anterior wall (three cases), a direct approach
was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small
opening on the omentum or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means
of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic stapler
device was used in one case only.
Results: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged
from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively.
The average postoperative hospital stay was 4 days (range, 2–6).
Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection
of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The
treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions
located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric
approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn
sutures are always feasible, and they are cheaper than stapled ones.
Received: 30 April 1999/Accepted: 7 October 1999/Online publication: 10 April 2000 相似文献
7.
Background: This study investigates the feasibility of performing a subsequent laparoscopic antireflux procedure after former placement
of a percutaneous endoscopic gastrostomy (PEG).
Methods: Between 1997 and 1998, five patients with a gastrostomy in place presented with an indication for laparoscopic antireflux
procedure due to persisting vomiting.
Results: All patients were managed laparoscopically with a four-trocar technique.
Conclusions: Primary PEG placement has no adverse effects on a later secondary antireflux procedure. In some cases, four rather than five
trocars can be used.
Received: 7 December 1999/Accepted: 7 March 2000/Online publication: 29 August 2000 相似文献
8.
R. J. Rosenthal S. C. Chen W. Hewitt C. C. Wang S. Eguchi S. Geller E. H. Phillips A. A. Demetriou J. Rozga 《Surgical endoscopy》1996,10(11):1075-1079
Background: The preferred therapy for acute and chronic liver insufficiency and severe heritable disorders of liver metabolism is whole-organ
transplantation. However, due to the shortage of organ doproposed, including transplantation of normal allogeneic hepatocytes.
Recently, it has been reported that many hepatocytes transplanted into the spleen migrated to the liver. We therefore carried
out a series of large-animal experiments to reexamine the intrasplenic route and to develop a method for large-scale hepatocellular
transplantation in pigs.
Methods: Allogeneic porcine hepatocytes were transplanted using the following routes: (1) retrograde injection of cells via the splenic vein, (2) intraarterial injection of cells, (3) direct intrasplenic injection of cells after laparotomy, (4)
percutaneous intrasplenic injection of cells under laparoscopic control, (5) laparoscopic intrasplenic injection of cells.
The number of cells injected varied from 2 × 109 to 10 × 109 cells.
Results: Of all the methods tested, only direct intrasplenic injection of 2 bln of cells was found to be compatible with survival.
However, even with this ``small' number of cells (2% original liver mass), there was a significant risk of spleen infarction,
perisplenic adhesion formation, and portal vein thrombosis. The laparoscopic approach was found to be reliable, simple, and
safe.
Conclusion: Even though the spleen is considered by many authors the optimal site for hepatocellular transplantation, transplantation
of cells in a number needed to support the failing liver may be associated with significant complications, morbidity, and
mortality.
Received: 2 March 1996/Accepted 17 May 1996 相似文献
9.
Laparoscopic cholecystectomy and time-course changes in renal function 总被引:10,自引:3,他引:10
Y. Miki K. Iwase W. Kamiike E. Taniguchi K. Sakaguchi J. Sumimura H. Matsuda I. Nagai 《Surgical endoscopy》1997,11(8):838-841
Background: Recently, the retraction method has been used to reduce intraabdominal pressure (IAP) during laparoscopic surgery. The purpose
of this study was to determine the serial changes in renal function during laparoscopic cholecystectomy (LC) using the retraction
method.
Methods: Urine output, effective renal plasma flow (ERPF), and glomerular filtration rate (GFR) were measured serially in seven patients
who underwent LC with 12 mmHg pneumoperitoneum (High-IAP group) and five who underwent LC using the retraction method with
4 mmHg pneumoperitoneum (Low-IAP group).
Results: Urine output, ERPF, and GFR were decreased during pneumoperitoneum in the High-IAP group, whereas no significant changes
in any of these parameters were observed in the Low-IAP group.
Conclusions: Our findings demonstrate that reduction of IAP to 4 mmHg using the retraction method prevents the transient renal dysfunction
caused by prolonged 12 mmHg pneumoperitoneum during LC, suggesting that the retraction method reduces the risk of perioperative
renal dysfunction during laparoscopic surgery.
Received: 26 March 1996/Accepted: 27 July 1996 相似文献
10.
Background: The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the University
of California, San Francisco.
Methods: The medical records of the initial 52 unselected patients undergoing LS were reviewed and compared to 28 concurrently treated
open splenectomy patients (OS).
Results: Patients did not differ with regard to age, gender, body, or splenic weights. The operative time was longer in the LS patients
(mean 196 vs 156 min), but the length of stay and duration of ileus were shorter in the LS group. For adult patients admitted
exclusively for splenectomy, operative times did not differ between LS and OS and total hospital cost was less in the LS group
(mean $8,939 vs $14,022). Six patients required conversion to OS, four occurring in the first 11 patients treated (overall
conversion rate of 11%). Three patients died from complications related to their underlying disease. Two other major complications
occurred. Complication rates and transfusion requirements did not differ between OS and LS patients.
Conclusions: Laparoscopic splenectomy is a safe and effective alternative to open splenectomy for treatment of hematologic diseases in
patients of all ages.
Received: 16 April 1996/Accepted: 5 July 1996 相似文献
11.
W. W. Roberts T. A. Dinkel P. G. Schulam L. Bonnell L. R. Kavoussi 《Surgical endoscopy》1997,11(12):1221-1223
A system was developed to determine the potential role of infrared imaging as a tool for localizing anatomic structures and
assessing tissue viability during laparoscopic surgical procedures. A camera system sensitive to emitted energy in the midinfrared
range (3–5 μm) was incorporated into a two-channel visible laparoscope. Laparoscopic cholecystectomy, dissection of the ureter,
and assessment of bowel perfusion were performed in a porcine model with the aid of this infrared imaging system. Inexperienced
laparoscopists were asked to localize and differentiate structures before dissection using the visible system and then using
the infrared system. Assessment of bowel perfusion was also conducted using each system. Infrared imaging proved to be useful
in differentiating between blood vessels and other anatomic structures. Differentiation of the cystic duct and arteries and
transperitoneal localization of the ureter were successful in all instances using the infrared system when use of the visible
system had failed. This system also permitted assessment of bowel perfusion during laparoscopic occlusion of mesenteric vessels.
These initial studies demonstrate that infrared imaging may improve the differentiation and localization of anatomic structures
and allow assessment of physiologic parameters such as perfusion not previously attainable with visible laparoscopic techniques.
It may thus potentially be a powerful adjunct to laparoscopic surgery.
Received: 23 August 1996/Accepted: 14 October 1996 相似文献
12.
13.
We report a case of laparoscopic repair of a diagnostic colonoscopic perforation. No other such reports were noted in the
literature. The management of colonoscopic perforations has become controversial. Operative vs nonoperative treatment is continually
debated. The morbidity of operative management is significant. Colostomy is often performed. Laparoscopy should allow early
evaluation of operative patients and primary repair of those with minimal contamination and no residual pathology. The benefits
of minimally invasive surgery, such as shortened hospitalization and rapid return to full activities, including work, were
realized in our patient. Laparoscopy should be considered in the selective management of colonoscopic perforations.
Received: 15 September 1995/Accepted: 16 January 1996 相似文献
14.
Background: The treatment of the morbidly obese patient is difficult because compliance with dietary regimens is poor. As a result, most
weight reduction programs fail very quickly. Surgical treatment, on the other hand, provides a reliable method for sustained
weight reduction. The most frequently performed procedure has been the vertical banded gastroplasty. Adaptation of the standard
open procedure to laparoscopic techniques has been technically difficult and imprecise. We have developed, in the laboratory,
an anterior wall banded gastroplasty that can be performed precisely and reproducibly using laparoscopic techniques.
Methods: Five Yorkshire pigs were used in attempt to laparoscopically perform the standard vertical banded gastroplasty. The procedure
was difficult and was associated with a risk of staple line leak and with bleeding along the lesser curvature of the stomach.
Furthermore, a reproducible pouch of proper dimension could not be created reliably. Fifteen animals were then used to develop
a new technique using a small gastric pouch based on the anterior gastric wall.
Results: A reproducible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube. A standard polyproylene band of 5.2 cm
in length was utilized at the gastric pouch outlet.
Conclusions: This operation can be reproduced accurately and has not demonstrated any leaks on postmortem examination.
Received: 14 July 1997/Accepted: 4 February 1998 相似文献
15.
Background
The laparoscopic management of tubo-ovarian abscesses (TOA) was evaluated. The study sought to answer the following question: Does operative laparoscopy with only incision of the abscess cavity and lavage (organpreserving treatment) improve intraoperative and postoperative safety and long-term prospects of fertility as compared with laparoscopic salpingectomy or salpingo-oophorectomy (ablative treatment)?Methods
A retrospective chart review of 60 patients with TOA undergoing laparoscopic treatment in combination with broad-spectrum antibiotics from 1994 to 1998 was performed. Patients not wishing to have children underwent salpingectomy or salpingo-oophorectomy, whereas patients wishing to remain fertile were treated by means of an organpreserving procedure. To investigate the operative and reproductive outcome, patients were interviewed by telephone.Results
Of 60 women with TOA, 25 were treated laparoscopically, preserving the internal genital organs, and 35 underwent ablative treatment. Apart from one postoperative readmission because of lower pelvic pain in the organpreserving group, there were no operative complications or serious systemic sequelae. In contrast, there was a significantly higher incidence of intraoperative and postoperative complications when ablative treatment was performed: one intestinal perforation requiring subsequent laparotomy, four serosal lesions, two lesions of the greater omentum, two lacerated collaterals of the internal iliac artery, one postoperative fever higher than 38°C for 2 days, two bowel obstructions, one thrombosis of the upper leg, and one thrombosis of the lower leg. There were no significant differences between the two patient groups in body mass index, duration of pelvic pain, laboratory findings at admission, ultrasonic assessment of abscess size, and the extent of the abscess at laparoscopy.Conclusions
When laparoscopic treatment of TOA is performed, organ-preserving treatment should be chosen irrespective of the patient’s age or desire to have children because of the risk of complications. 相似文献16.
Laparoscopic colectomy 总被引:4,自引:1,他引:3
G. A. Fielding J. Lumley L. Nathanson P. Hewitt M. Rhodes R. Stitz 《Surgical endoscopy》1997,11(7):745-749
Background: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation
of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible.
Methods: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases,
operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence
of disease.
Results: There were 359 cases (206 females, 153 male) average age 58.8 years (18–94), and 149 patients had malignancy. All types of
resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22
rectopexies. Operating times fell with experience—the last 20 cases of anterior resection took 150 min (110–240) and of RHC
took 130 min (65–210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted
5–7 days (2–33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures
(1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days—sepsis, myocardial infarction,
aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one
pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence
was 33 months (15–46 months).
Conclusions: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are
possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills
are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible
role in treating cancer.
Received: 26 March 1996/Accepted: 15 October 1996 相似文献
17.
Laparoscopic management of acute small-bowel obstruction 总被引:2,自引:0,他引:2
I. M. Ibrahim F. Wolodiger B. Sussman M. Kahn F. Silvestri A. Sabar 《Surgical endoscopy》1996,10(10):1012-1015
Background: A retrospective review is given of the authors' experience with a consecutive series of acute small-bowel obstruction unresponsive
to medical management.
Methods: There were 33 exploratory laparoscopies. The etiology was accurately diagnosed in 100% of the cases. Twenty-five (76%) were
secondary to postoperative adhesions, of which 18 (72%) were successfully treated by laparoscopic lysis of adhesions. Minilaparotomy
was needed to treat iatrogenic perforation (two), gangrenous bowel (one), and Meckel's diverticulectomy (one). Formal laparotomy
was utilized for small-bowel resection (two), malignant adhesions (two), and intolerance of pneumoperitoneum (one). Four cases
of incarcerated hernias were treated by conventional herniorrhaphy.
Results: Overall, 67% of our cases were spared formal laparotomy.
Conclusion: We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which
can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure,
or when the pathology dictates.
Received: 4 March 1996/Accepted: 13 May 1996 相似文献
18.
Background: High error rates are reported in the clinical diagnosis of acute appendicitis. This study was undertaken to discover what
additional value laparoscopy has in the diagnosis of suspected acute appendicitis.
Methods: From April 1995 to November 1996, a diagnostic laparoscopy, before open appendicectomy, was performed in 100 consecutive
patients with suspected acute appendicitis. Appendicectomy was performed only if the appendix showed signs of inflammation
at laparoscopy or if the appendix could not be visualized.
Results: Twenty-four patients were spared an appendicectomy, and in half of them a new diagnosis was established during laparoscopy.
The rate of misdiagnosis was 41% in female patients of reproductive age and 8% in male patients. There were no cases of missed
appendicitis in this trial, and all removed appendices showed signs of inflammation at histology.
Conclusions: It is safe to rely on the diagnosis made at laparoscopy. Its use for establishing diagnosis before appendicectomy in women
of reproductive age is recommended.
Received: 13 June 1997/Accepted: 24 October 1997 相似文献
19.
Laparoscopic resection of posterior gastric leiomyoma 总被引:4,自引:0,他引:4
Laparoscopic gastric surgery is gaining momentum, especially in the treatment of benign disease. Simultaneous endoscopy and
laparoscopy allow precise localization of lesions. Because of the stomach's size, mobility, and distensibility, relatively
large lesions can be safely excised. Wedge resection for anterior lesions and a transgastric or intragastric approach for
posterior lesions are feasible laparoscopically. Two cases of posterior gastric leiomyomas successfully resected laparoscopically
are presented. The use of stapling devices greatly facilitates this procedure.
Received: 17 February 1995/Accepted: 7 September 1995 相似文献
20.
Background: Inappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller's cardiomyotomy,
is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The
goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic
Heller's cardiomyotomy.
Methods: In a group of 19 patients with intraoperative endoscopy with laparoscopic Heller's cardiomyotomy, surgical and endoscopic
criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared
with those of another group of 16 patients previously operated on without intraoperative endoscopy.
Results: Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19,
58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal
technique were more frequent in the group without intraoperative endoscopy (7/16 patients) than in the other group (2/19 patients).
Conclusions: Endoscopy during laparoscopic Heller's cardiomyotomy is of great assistance in identifying the cardia, and thereby could
improve surgical outcomes.
Received: 20 October 1998/Accepted: 20 January 1999 相似文献