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1.
Background Few studies are available comparing open with laparoscopic treatment of Hirschsprung’s disease. This study compares a laparoscopic
series of 30 patients with a historical open series of 25 patients.
Methods The charts of all patients having had a Duhamel procedure in the period from June 1987 through July 2003 were retrospectively
reviewed. Open procedures were performed until March 1994. Patients with extended aganglionosis, pre-Duhamel ostomy, or syndrome
were excluded from the study. End points were intraoperative complications, postoperative complications, time to first feeding,
hospital stay, and outcome at follow-up such as stenosis, enterocolitis, constipation, fecal incontinence, and enuresis.
Results Twenty-five patients had an open Duhamel (OD) and 30 had a laparoscopic one (LD). There were no differences in patient characteristics
and there were no intraoperative complications in either group. Time to first oral feeds was significantly longer in the OD
group as was the duration of hospital stay. No significant differences at follow-up were observed but there was a tendency
for a higher enterocolitis rate in the LD group. In contrast, the adhesive obstruction and enuresis rates were higher in the
OD group. Cosmetic results were superior in the LD group.
Conclusions Except for a significantly shorter hospital stay and shorter time to first oral feeds in favor of LD, no significant differences
could be observed. The cosmetic result was not an end point but there was no doubt that it was better in the LD group. Although
not statistically significant different, there were no adhesive bowel obstructions in the LD group compared with 3 of 25 in
the OD group. Fecal incontinence was not encountered in either group. 相似文献
2.
Chiengkriwate P Patrapinyokul S Sangkhathat S Chowchuvech V 《Journal of pediatric surgery》2007,42(6):1075-1080
Background/Purpose
Primary pull-through for Hirschsprung disease has been reported to give comparable surgical outcomes to staged operations with less morbidity. The aim of this study was to review the early experiences in our institution with the primary pull-through option.Methods
Medical records of 50 consecutive patients with Hirschsprung disease who underwent a modified Duhamel pull-through operation from 2001 to 2004 were retrospectively reviewed. For analysis, cases were divided into 2 groups: primary pull-through (group I, 30 patients), and patients with a previously established colostomy who underwent a staged operation (group II, 20 patients). Comparisons were made regarding operating time, operative morbidity, and medium-term functional outcomes.Results
There was no difference between the groups with respect to median age and weight at time of surgery, sex ratio, presenting symptoms, and extent of aganglionosis. Seventy-four percent of the procedures were performed on infants (group I, 21 [70%] of 30 patients; group II, 16 [80%] of 20 patients). Acute postoperative complications were experienced by 4 (13.3%) of 30 patients in group I and 4 (20%) of 20 patients in group II (P <.05). Postoperative enterocolitis occurred in 11 (36.7%) of 30 patients in group I and in 7 (41.2%) of 17 patients in group II.Conclusions
Our experience indicates that the primary pull-through using a modified Duhamel technique gave neither difference in functional outcomes nor medium-term complications compared to a staged procedure. Considering a sparing of colostomy and a potential economic benefit, the procedure should be considered in selected patients. 相似文献3.
Laparoscopic splenectomy using a wall-lifting procedure 总被引:1,自引:1,他引:0
T. Nishizaki I. Takahashi T. Onohara K. Wakasugi T. Matsusaka K. Kume 《Surgical endoscopy》1999,13(10):1055-1056
A laparoscopic splenectomy using a hanger wall-lifting procedure is herein described. The patient is placed in the right
lateral position. The left lower chest and left abdominal wall are then lifted by three wires in two directions, left laterally
and vertical to the abdominal wall. The view of the operative field thus obtained is excellent. The lifting wires and bars
do not hinder the movement of the forceps, since the angles of the instruments to approach the spleen are different from those
of the wires. A laparoscopic splenectomy using this wall-lifting procedure avoids the usual complications associated with
pneumoperitoneum while still being technically comparable to a procedure with pneumoperitoneum.
Received: 7 October 1998/Accepted: 22 February 1999 相似文献
4.
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
5.
Conway SJ Craigie RJ Cooper LH Turner K Turnock RR Lamont GL Newton S Baillie CT Kenny SE 《Journal of pediatric surgery》2007,42(8):1429-1432
Purpose
To assess both early adult functional outcome and change in long-term functional outcome over time after the Duhamel procedure (DP) for left-sided Hirschsprung disease (HSCR).Methods
The study population consisted of 78 children (aged 19.9 ± 3.6 years) who previously underwent objective outcome assessment after DP was performed for HSCR during the period of 1980 to 1991. Inclusion criteria were previous evaluation of functional outcome and either rectosigmoid or left-sided HSCR. Outcome measures were assessed twice within the cohort, in 1997 and in 2005. The primary outcome measure was the Rintala (J Ped Surg. 1995;30:491-494) functional outcome score (FOS; maximum, 20). Controls consisted of 20 age-matched healthy children. Satisfactory functional score was defined as an FOS at or above the 10th percentile of controls (FOS, ≥17). Secondary outcome measures were the operation failure rate (defined by requirement for a stoma or major reoperative surgery), and enterocolitis rates (defined by intention to treat). Consecutive outcome scores were compared by paired t test. Data were expressed as mean ± SD, and P < .05 was considered significant.Results
Operation failure occurred in 9 (11.5%) of 78. Consecutive FOSs were obtained in 40 (57%) of 69. A satisfactory functional score was observed in 23 (58%) of 40 adults as opposed to 33 (47%) of 70 children 8 years previously (P = .02). Satisfactory outcome (defined by satisfactory functional score and lack of enterostomy or major revision pull-through procedure) was observed in 23 (47%) of 49. Previously, this figure was 34 (44%) of 78. Individual paired FOSs showed a significant improvement with time (1997: 14.9 ± 4.1; 2005: 16.4 ± 2.8; P = .02).Conclusions
At early adult follow-up, the operation failure rate has not changed from that of the same cohort 8 years earlier. However, a significant improvement in individual FOSs was demonstrated. 相似文献6.
7.
Laparoscopic surgery for diverticulitis 总被引:11,自引:3,他引:8
M. E. Sher F. Agachan M. Bortul J. J. Nogueras E. G. Weiss S. D. Wexner 《Surgical endoscopy》1997,11(3):264-267
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 相似文献
8.
Objective
To compare treatment outcomes in children with Hirschsprung's disease who underwent treatment using the Duhamel or TERPT surgical procedures.Methods
Medline, Cochrane, EMBASE, and Google Scholar databases were searched through December 26, 2016. Search strings included Hirschsprung's disease, fecal incontinence, transanal endorectal pull-through, and Duhamel operation. Randomized controlled studies (RCTs) and retrospective studies that compared the treatment of Hirschsprung's disease in with TERPT or Duhamel surgical procedures in neonates, infants, or children were included.Results
The study included six studies with a total of 280 patients. The meta-analysis indicated that the Duhamel and TERPT interventions were similar with respect to rate of postoperative fecal incontinence (OR = 0.85, 95% CI = 0.37 to 1.92, P = 0.692) and operation time (difference in means = 46.68 min, 95% CI = ? 26.96 to 114.31, P = 0.226). The Duhamel procedure was associated with longer postoperative hospital stay (Difference in means = 3.14 days, 95% CI = 1.46 to 4.82, P < .001) and a lower rate of enterocolitis (OR = 0.21, 95% = 0.07 to 0.68, P = 0.009) compared with the TERPT procedure.Conclusions
The study found that Duhamel and TERPT procedures showed similar benefit in treating Hirschsprung's disease, although differences exist with respect to length of postoperative hospital stay and the incidence of enterocolitis.The type of study
Meta-analysis.Level of evidence
Level II. 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.
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.
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
13.
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
14.
Laparoscopic vs conventional Nissen fundoplication 总被引:18,自引:6,他引:12
Background: Laparoscopic Nissen fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure
have not been compared to the results of an open fundoplication in a randomized study.
Methods: Some 110 consecutive patients with prolonged symptoms of grade II–IV esophagitis were randomized, 55 to laparoscopic (LAP)
and 55 to an open (OPEN) Nissen fundoplication. Postoperative recovery, complications, and outcome at 3- and 12-month follow-up
were compared in the two groups.
Results: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical difficulties (two),
and bleeding (one). In the OPEN group (two) patients underwent splenectomy. There was no mortality. The mean hospital stay
was 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months
after the operation in both groups. These symptoms had disappeared at the 12-month follow-up examination. All patients in
the LAP group and 86% in the OPEN group were satisfied with the result.
Conclusions: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good
if not better than those of conventional open surgery.
Received: 15 May 1996/Accepted: 10 September 1996 相似文献
15.
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
16.
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
17.
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
18.
Ana Cristina Aoun Tannuri Rodrigo Luiz Pinto Romão 《Journal of pediatric surgery》2009,44(4):767-4944
Purpose
Transanal endorectal pull-through (TEPT) has drastically changed the treatment of Hirschsprung's disease (HD). A short follow-up of children submitted to TEPT reveals results that are similar to the classic transabdominal pull-through procedures. However, few reports compare the late results of TEPT with transabdominal pull-through procedures with respect to complication rates and the fecal continence. The aims of the present work are to describe some technical refinements that we introduced in the procedure and to compare the short and long-term outcome of TEPT with the outcomes of a group of patients with HD who previously underwent the Duhamel procedure.Methods
Thirty-five patients who underwent TEPT were prospectively studied and compared to a group of 29 patients who were treated with colostomy followed by a classical Duhamel pull-through. The main modifications introduced in the TEPT group were no preoperative colon preparation, operation conducted under general anesthesia in addition to regional sacral anesthesia, use of only one purse-string suture in the rectal mucosa before transanal submucosal dissection, and no use of retractors and electrocautery during the submucosal dissection.Results
The most frequent early complications of TEPT group were perineal dermatitis (22.8%) and anastomotic strictures (8.6%). The comparison with patients who underwent Duhamel procedure revealed no difference in the incidence of preoperative enterocolitis, the patients of the TEPT group were younger at the time of diagnosis and of surgery, they had shorter operating times, and they began oral feeding more quickly after the operation. The incidence of wound infection was lower in the TEPT group. Moreover, the TEPT and Duhamel groups showed no difference in the incidences of mortality, postoperative partial continence, and total incontinence. Although the incidences of complete continence and postoperative enterocolitis were not different, a tendency to the increased incidence in the TEPT group was observed.Conclusions
This study further supports the technical advantages, the simplicity, and the decreased incidence of complications of a primary TEPT procedure when compared to a classical form of pull-through. Some technical refinements are described, and no preoperative colon preparation was necessary for the patients studied here. The results show that the long-term outcomes of the modified TEPT procedure are generally better than those obtained with classical approaches. 相似文献19.
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20.
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