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1.
Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic
approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with
LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis.
Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled
by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting
of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction
with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal
of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All
patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit.
Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two
were hospitalized for observation after experiencing intraoperative technical problems.
Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All
were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related
to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of
urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction
with early discharge on follow-up interview.
Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize
nausea and provide adequate pain control.
Received: 1 April 1996/Accepted: 29 May 1997 相似文献
2.
Laparoscopic fundoplication in infants and children 总被引:2,自引:0,他引:2
Background: Laparoscopic fundoplication is a new method for treating gastroesophageal reflux in children. We present 160 children with
gastroesophageal reflux treated by laparoscopic fundoplication.
Methods: Patients underwent either a laparoscopic Nissen or Toupet fundoplication. Many patients also required gastrostomies and gastric
outlet procedures.
Results: Twelve patients (7.5%) were converted to open fundoplication. Laparoscopic gastrostomies were placed in 112 patients (75.7%)
and laparoscopic gastric outlet procedures in 62 patients (41.9%). Feedings were initiated by postoperative day 2 in 126 children
(85.7%). Sixty-four percent were discharged by postoperative day 3. Complications occurred in 11 of 148 fundoplications (7.4%),
in nine of 112 gastrostomies (8.0%), and in three of 62 gastric outlet procedures (4.8%). One patient died as a result of
a surgical error in placing a gastrostomy (0.7%).
Conclusion: Laparoscopic fundoplication appears to foster a more rapid recovery and decreased hospital stay while maintaining complication
rates similar to or better than open fundoplication.
Received: 22 March 1996/Accepted: 12 June 1996 相似文献
3.
Early international results of laparoscopic gastrectomies 总被引:9,自引:4,他引:5
Background: The first totally laparoscopic Billroth II gastrectomy was performed in 1992. To date, laparoscopic gastrectomy has been
performed by a small number of surgeons around the world and the laparoscopic approach has been extended to Billroth I and
total gastrectomy. The aim of this study is to review the state of laparoscopically performed gastrectomies in the international
scene.
Methods: Questionnaires were prepared and sent to every surgeon in the world known by the authors or their contacts to have performed
a laparoscopic gastrectomy. A questionnaire survey was started in July 1994 and completed by November 1994. Data collected
included age, sex, type of gastric resection, technique of reconstruction after resection, average duration of surgery, time
to liquid and solid intake, postoperative hospital stay, complications, and opinions of the surgeons.
Results: Sixteen surgeons contributed to this study. A total number of 118 cases of laparoscopic gastrectomies, comprising Billroth
I (11), Billroth II (87), vagotomy and antrectomy (10), and total gastrectomy (10) had been performed. The indications were
gastric and/or duodenal ulcers and benign and malignant gastric tumors.
Conclusions: Laparoscopic gastrectomy was found to be superior to the open technique by 10 of 16 surgeons because of faster recovery,
less pain, and better cosmesis. The procedure was an expensive and long operation according to four. Two surgeons were uncertain
of any benefit because of limited experience.
Received: 7 August 1996/Accepted: 28 October 1996 相似文献
4.
Laparoscopy for chronic abdominal pain 总被引:3,自引:1,他引:2
Background: This purpose of this investigation was to evaluate the utility of laparoscopy in patients with chronic abdominal pain.
Methods: A retrospective review was performed of 34 patients who underwent laparoscopy for chronic abdominal pain. Average patient
age was 39 years. The majority were women. Most had undergone abdominal surgery in the past.
Results: All procedures were performed laparoscopically. A positive finding was made in 65% of patients. Fifty-six percent of patients
underwent adhesiolysis, but 26% required no operative intervention other than laparoscopic exploration. Notably, 73% of patients
reported improvement in pain postoperatively, whether or not a positive finding had been made on laparoscopy.
Conclusions: This retrospective study suggests laparoscopy can identify abnormal findings and improve outcome in a majority of selected
cases. Recommendations are provided for patient selection. Prior abdominal surgery is not an absolute contraindication to
laparoscopic exploration for chronic abdominal pain.
Received: 16 April 1996/Accepted: 30 May 1996 相似文献
5.
Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy 总被引:6,自引:1,他引:5
A. L. DePaula K. Hashiba M. Bafutto C. Machado A. Ferrari M. M. Machado 《Surgical endoscopy》1998,12(7):933-935
Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration.
Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy
included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach
proved impossible or unsuccessful.
Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy
in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary
drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited
biliary leak.
Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital
stay.
Received: 29 March 1996/Accepted: 12 June 1996 相似文献
6.
J. K. Edoga K. Asgarian D. Singh K. V. James J. Romanelli S. Merchant D. Romano B. Joostema J. Street 《Surgical endoscopy》1998,12(8):1064-1072
Background: Laparoscopic surgery for infrarenal aortic aneurysms is based on the principle of retroperitoneal exclusion of the aneurysm
sac with aortofemoral or aortoiliac bypass.
Methods: Of 22 patients who met the selection criteria, 20 successfully underwent laparoscopic aortic surgery at Morristown Memorial
Hospital between February and October 1997. Technical elements and steps of this operation are described and illustrated.
Results: Within 30 days of surgery, 2 patients died and 9 had various major and minor perioperative complications. As a group, the
laparoscopic patients had less postoperative pain, needed fewer hours of ventilator support, had shorter intensive care unit
(ICU) and hospital lengths of stay, and resumed diet and normal activity earlier than the historical norms for patients undergoing
transabdominal or retroperitoneal aortic resections at the same institution.
Conclusions: These early observations suggest that the laparoscopic treatment of infrarenal abdominal aneurysms may have several significant
potential benefits. Long-term results and randomized prospective studies with patients matched by risk stratification will
be needed to confirm these impressions.
Received: 23 June 1997/Accepted: 11 December 1997 相似文献
7.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
8.
Background: In spite of the emergence of laparoscopic cholecystectomy as the gold standard for treatment of symptomatic gallstones, questions
still remain regarding its overall cost effectiveness, especially at low-volume centers where operating room (OR) time and
operative complications are higher. We hypothesize that the presence of a well-organized, dedicated laparoscopic OR team will
improve surgical outcomes for this procedure. This study compares the operative results of an advanced and a basic laparoscopic
surgeon using either a designated laparoscopic operating team or a nondesignated team.
Methods: The hospital records for 71 elective laparoscopic cholecystectomies with cholangiograms were retrospectively reviewed and
anesthesia times and conversion rates were analyzed. Procedures were performed either at a hospital with a dedicated laparoscopy
team or a hospital with nondedicated OR personnel. All procedures were done by an advanced laparoscopic surgeon or a basic
laparoscopic surgeon.
Results: Case characteristics were evenly matched between sites and surgeons. The mean total anesthesia time at the dedicated site
was 120.8 min, compared to 152.3 min at the nondedicated site with a mean difference of 31.5 min (p= 0.001). A 12% conversion rate was documented at the nondedicated site. There were no conversions at the site with a dedicated
laparoscopy team. No major complications were encountered in this series.
Conclusion: This study demonstrates that having a designated laparoscopic trained team provides a time savings to both advanced and basic
laparoscopic surgeons. Although no major complications were encountered, there was a significant conversion rate for the less
experienced surgeon operating without the support of a trained team. The end result from having a dedicated team in endoscopic
surgery is decreased operative time, an improvement in patient care, and decreased costs to the patient and institution.
Received: 5 July 1996/Accepted: 9 January 1997 相似文献
9.
A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit 总被引:8,自引:5,他引:3
Background: Laparoscopic hernia repair has often been criticized for its high costs.
Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic
or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit.
Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable
for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open
group. The hospital costs were 2051 FIM ($1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed
patients (including expenses due to lost work days) were lower.
Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the
laparoscopic technique, when the cost of lost work days is factored into overall expense.
Received: 5 May 1997/Accepted: 28 October 1997 相似文献
10.
Background: Clinical diagnosis of acute appendicitis is most difficult in fertile-age women. In this patient group up to 50% of open
appendectomies are negative for appendicitis. We conducted a randomized study to compare laparoscopic and open appendectomy
in young female patients with suspected acute appendicitis.
Methods: Fifty female patients between the ages of 16 and 40 years presenting with acute right lower abdominal pain were randomized,
25 to laparoscopy and 25 to an open appendectomy. Diagnostic accuracy, rate of negative appendectomies, safety, and final
outcome were compared in the two groups.
Results: Diagnosis was established in 96% of patients in the laparoscopic group and in 72% in the open group. There were 11 (44%)
unnecessary appendectomies in the open group, but only one (4%) in the laparoscopic group (p < 0.0005).
Conclusions: In young women with right lower abdominal pain, laparoscopy can give precise diagnosis and reduce the rate of negative appendectomies.
Received: 18 March 1996/Accepted: 12 June 1996 相似文献
11.
A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones 总被引:3,自引:0,他引:3
J. F. Gigot B. Navez J. Etienne E. Cambier P. Jadoul P. Guiot P. J. Kestens 《Surgical endoscopy》1997,11(7):722-728
Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The
recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim
of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration
(CBDE) for CBDS.
Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial
transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or
by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance
was assessed by choledochoscopy and control cholangiography.
Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion
to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative
complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated
(small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct)
the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative
hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher
success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is
related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications
rate was 15%.
Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between
a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy
is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which
is due to external biliary drainage.
Received: 7 May 1996/Accepted: 19 November 1996 相似文献
12.
Background: Whether or not laparoscopic cholecystectomy may be performed safely as an outpatient procedure is controversial. In 1993,
a protocol for outpatient laparoscopic cholecystectomy was instituted to determine the benefits and safety of discharging
patients within several hours of surgery.
Methods: The initial 60 outpatient laparoscopic cholecystectomies performed by one surgeon in a hospital-based outpatient teaching
facility between February 1993 to June 1996 were prospectively studied.
Results: Fifty-eight (97%) patients were discharged successfully after an average stay in the recovery room of 3 h. There were no
deaths. Two patients required overnight observation and three patients required readmission. Two patients (3%) had cystic
duct leak. The average hospital stay for all patients undergoing laparoscopic cholecystectomy at the institution (inpatient
and outpatient) decreased from 3.2 to 1.5 days and the average hospital cost decreased from $7,800 to $4,600 during this period.
Conclusion: Laparoscopic cholecystectomy in an outpatient setting is safe and cost-effective in healthy patients.
Received: 3 April 1997/Accepted: 10 June 1997 相似文献
13.
Duration of postlaparoscopic pneumoperitoneum 总被引:4,自引:0,他引:4
Background: Patients who present with abdominal pain after recent laparoscopic surgery present a diagnostic dilemma when pneumoperitoneum
is present. Previous studies do not define the duration of postlaparoscopic pneumoperitoneum. In this study, we attempted
to define the duration of laparoscopic pneumoperitoneum and to identify factors which affect resolution time.
Methods: We followed 57 patients who underwent laparoscopic cholecystectomy (34), inguinal herniorraphy (20), or appendectomy (three).
Serial abdominal films were taken until all residual gas was resolved.
Results: Thirty patients resolved their pneumoperitoneum within 24 h; 16 patients resolved between 24 h and 3 days; nine patients
resolved between 3 and 7 days; two patients resolved between 7 and 9 days. Mean resolution time for all patients was 2.6 ±
2.1 days. There was no apparent difference in resolution time between the three types of procedures; however, the sample size
may be insufficient. Duration of the pneumoperitoneum did not correlate with gender, age, weight, initial volume of CO2 used, length of time for the procedure, or postoperative complications. Sixteen patients had bile spillage during cholecystectomy
which significantly reduced the duration of postoperative pneumoperitoneum (p < 0.008), resulting in a mean resolution time of 1.3 ± 0.9 days. While 14 patients reported postoperative shoulder pain,
no correlation was found between the presence or duration of shoulder pain and the extent or duration of pneumoperitoneum.
Conclusions: We conclude that the residual pneumoperitoneum following laparoscopic surgery resolves within 3 days in 81% of patients and
within 7 days in 96% of patients. The resolution time was significantly less in patients sustaining intraoperative bile spillage
during cholecystectomy. There was no correlation found between postoperative shoulder pain and the presence or duration of
the pneumoperitoneum.
Received: 22 March 1996/Accepted: 12 July 1996 相似文献
14.
Postoperative complications of laparoscopic-assisted colectomy 总被引:4,自引:2,他引:2
A. M. Lacy J. C. García-Valdecasas S. Delgado L. Grande J. Fuster J. Tabet C. Ramos J. M. Piqué A. Cifuentes J. Visa 《Surgical endoscopy》1997,11(2):119-122
Background: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic
assisted colorectal resections.
Methods: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative
ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique.
Results: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients
for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and
one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%).
The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was
36 ± 16 h. Mean postoperative stay was 5.4 (range 3–13) days. Eight patients (6.8%) sustained complications: four unrelated
to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach:
one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma.
Conclusions: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic
colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic
approach to colorectal surgery.
Received: 25 March 1996/Accepted: 8 July 1996 相似文献
15.
Postoperative pain and fatigue after laparoscopic or conventional colorectal resections 总被引:16,自引:0,他引:16
Background: Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic
approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after
colorectal resections.
Methods: Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n= 30) or conventional (n= 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine
sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue
scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR).
Results: Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately
after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5–95 percentile 0.71–2.46
mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24–2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative
day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh
day (p < 0.05).
Conclusions: This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional
colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences,
the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.
Received: 4 July 1997/Accepted: 16 November 1997 相似文献
16.
Background: The laparoscopic approach must be shown to be cost-effective as well as safe and technically effective before being widely
adopted. A review of 54 consecutive patients who underwent open and laparoscopic colposuspension is presented and a cost-analysis
is performed comparing the two approaches.
Methods: This study was a retrospective controlled review of patient records and accounts of in-hospital costs incurred at a private
hospital.
Results: Theater costs were significantly greater in the laparoscopic group but this was balanced by a shorter length of stay and
subsequent reduced accommodation cost. There was no difference in the overall in-hospital costs between the two groups.
Conclusion: The laparoscopic surgical approach is safe and effective and by no means more expensive than the open approach. In the future,
the laparoscopic approach can only become more cost efficient; techniques will improve and there will be earlier returns to
work and, subsequently, greater productivity.
Received: 19 August 1996/Accepted: 20 December 1996 相似文献
17.
Background: The aim of this study was to compare the significance of routine examinations prior to laparoscopic cholecystectomy (LC)
with intraoperative abdominal investigation. Preoperative evaluation becomes increasingly important when laparoscopic procedures
are performed for the removal of gallstones because other intraabdominal diseases may coexist in these patients, mimicking
biliary tract disease.
Methods: Over the last 6 years, we treated 816 patients with symptomatic cholecystolithiasis using LC. Prior to surgery, routine tests
such as upper abdominal ultrasonography, chest radiography, and standard laboratory blood tests were carried out.
Results: Despite these routine tests, coexisting colonic cancers escaped detection in four out of 816 cases. This indicates a risk
of more ``missed pathologies' during the course of laparoscopic operations compared to standard laparotomy.
Conclusion: The risk of missing coexisting diseases during laparoscopic operations has to be minimized by placing additional emphasis
on careful evaluation of anamnesis. Physical examination and additional laboratory tests—such as analysis of tumor markers
and blood in the stool—combined with complete abdominal ultrasonography, gastroscopy, and/or complete colonoscopy should be
performed prior to LC.
Received: 6 October 1996/Accepted: 19 February 1997 相似文献
18.
Donini A Baccarani U Terrosu G Corno V Ermacora A Pasqualucci A Bresadola F 《Surgical endoscopy》1999,13(12):1220-1225
Background: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative
stay and more rapid return to full activity are the primary advantages of LS.
Methods: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive
open splenectomies (OS) (group 2) were performed for hematologic diseases.
Results: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started
to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and
age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach.
Conclusions: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach.
The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Received: 16 July 1998/Accepted: 20 January 1999 相似文献
19.
Laparoscopic repair of perforated duodenal ulcer 总被引:5,自引:2,他引:3
M. L. Druart R. Van Hee J. Etienne G. B. Cadière J. F. Gigot M. Legrand J. M. Limbosch B. Navez M. Tugilimana E. Van Vyve L. Vereecken E. Wibin J. P. Yvergneaux 《Surgical endoscopy》1997,11(10):1017-1020
Background: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The
feasibility of the laparoscopic repair was evaluated.
Methods: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary
in eight patients. The morbidity rate was 9% and mortality rate 5%.
Results: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the
mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively
increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study.
Conclusions: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and
mortality rate, compared with conventional surgery.
Received: 16 August 1996/Accepted: 1 April 1997 相似文献
20.
Laparoscopic vs open colectomy for sigmoid diverticulitis 总被引:3,自引:0,他引:3
Tuech JJ Pessaux P Rouge C Regenet N Bergamaschi R Arnaud JP 《Surgical endoscopy》2000,14(11):1031-1033
Background: The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis
in patients aged ≥75 years.
Methods: From January 1993 to December 1998, all patients 75 years of age and older undergoing an elective colectomy for sigmoid diverticulitis
were included in the study. The patients were divided into the following two groups: group 1 (n= 22) consisted of patients who underwent a laparoscopic procedure; group 2 (n= 24) consisted of patients who underwent an open procedure.
Results: In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75–82); in group 2, there were 14 women
and 10 men with a mean age of 78 years (range, 76–84) (p= 0.37). There was no difference between the groups in ASA classification. The operative time was shorter in group 2 (136
vs 234 mins). The postoperative period during which parenteral analgesics were required (5.4 vs 8.2 days, p= 0.001), postoperative morbidity (18% vs 50%, p= 0.02), postoperative length of hospital stay (13.1 vs 20.2 days, p= 0.003), and the inpatient rehabilitation (6 vs 15 patients, p= 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was
9% in group 1.
Conclusion: The data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older
patients with fewer complication, less pain, shorter hospital stay, and a more rapid return to preoperative activity levels
than that seen with open colorectal resection.
Received: 22 November 2000/Accepted: 22 February 2000/Online publication: 7 September 2000 相似文献