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1.
Factors associated with complications of open versus laparoscopic sigmoid resection for diverticulitis. 总被引:3,自引:0,他引:3
T Simon G R Orangio W L Ambroze D N Armstrong M E Schertzer D Choat E E Pennington 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2005,9(1):63-67
BACKGROUND: This study critically reviews sigmoid colon resection for diverticulitis comparing open and laparoscopic techniques. METHODS: We conducted a retrospective review of all open and laparoscopic cases of diverticulitis between 1992 and 2001. Data analyzed included the following: indications for operation, postoperative complications, and incidence of laparoscopic conversion to laparotomy. Major and minor complications were analyzed in relation to patients' preoperative diagnosis, age, presence or absence of splenic flexure mobilization, length of stay, and laparoscopic sigmoid resection versus open sigmoid resection. RESULTS: Over a 10-year period, 166 resections for diverticulitis were performed including 126 open cases and 40 laparoscopic cases. No significant differences existed in patient characteristics between the groups. Major complications occurred in 14% of patients, and the laparoscopic conversion rate was 20%. The presence of abscess, fistula, or stricture preoperatively was associated with a higher complication rate only in patients > or =50 years old undergoing open sigmoid resection. The length of stay between patients undergoing laparoscopic resection was significantly less than in patients having open resection. CONCLUSION: Advanced laparoscopic sigmoid resection is an alternative to open sigmoid resection in patients with diverticulitis and its complications. Open sigmoid resection in patients >50 years may have a higher complication rate in complicated diverticulitis when compared with laparoscopic sigmoid resection (all patient ages) and open sigmoid resection (patients <50 years old). Regarding complications, no difference existed between the length of stay in patients with open vs. laparoscopic resection. 相似文献
2.
Wieland Raue V. Paolucci W. Asperger R. Albrecht M. W. Büchler W. Schwenk for the LAPDIV-CAMIC Trial Group 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2011,396(7):973-980
Purpose
Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period. 相似文献3.
Bastiaan R. Klarenbeek Veerle M. H. Coup�� Donald L. van der Peet Miguel A. Cuesta 《Surgical endoscopy》2011,25(3):776-783
Background
Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented. 相似文献4.
Background Incisional hernia after open surgery is a well-known complication with an incidence of up to 20% after a 10-year period. Data
regarding the long-term hernia risk after laparoscopic colonic surgery are lacking in the literature. In the present study
we compared the long-term hernia incidence after laparoscopic versus open sigmoid resection.
Methods The study included patients undergoing laparoscopic sigmoid resection in the period January 1995 to December 2004 in the eastern
part of Denmark. This group was matched with a consecutive group of patients undergoing open surgery in our department in
the same period. Patients were contacted by telephone, and a questionnaire was completed for each patient. If the patient
was believed to have a hernia or if there was any suspicion of a hernia, a consultant surgeon examined the patient and completed
the questionnaire. Factors related to the primary operation, the hernia and general risk factors were registered for all patients.
Results A total of 201 patients answered the questionnaire (95.3%). The laparoscopy group was comprised of 58 patients and 143 patients
were included in the laparotomy group. The patients had a median follow-up of 4.6 years (range 2.4–11.7 years) and 4.9 years
(range 2.4–8.5 years) after laparoscopic and open surgery, respectively (P = 0.326). Incisional hernia was found in two of 58 patients (3.4%, 95% CI -1.4–7.4) in the laparoscopic surgery group compared
with 21 of 143 patients (14.7%, 95% CI 8.9–20.5) in the open surgery group (P = 0.026). There were no significant differences in demographic data or the occurrence of risk factors between the two groups.
Conclusion Laparoscopic sigmoid resection leads to a significantly lower incidence of incisional hernia compared with the open surgical
technique. 相似文献
5.
Background
Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra- and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease. 相似文献6.
Marty Zdichavsky Thomas Kratt Dietmar Stüker Tobias Meile Maximilian v. Feilitzsch Dörte Wichmann Alfred Königsrainer 《Journal of gastrointestinal surgery》2013,17(11):1966-1971
Background
Surgical treatment of acute complicated sigmoid diverticulitis is still under debate while elective treatment of recurrent diverticulitis has proven benefits. The aim of this study was to evaluate the clinical and histological outcome of acute and elective laparoscopic sigmoid colectomy in patients with diverticulitis.Methods
A retrospective review was conducted where 197 patients were analyzed undergoing laparoscopic sigmoid resection for acute complicated diverticulitis and recurrent diverticulitis. Single-stage laparoscopic resection and primary anastomosis were routinely performed using a 3-trocar technique. Recorded data included age, sex, American Society of Anesthesiologists (ASA)-score, operative time, duration of hospital stay, complications, and histological results.Results
Ninety-one patients received laparoscopy for acute diverticular disease (group I) and 93 patients underwent elective laparoscopic sigmoid resection for diverticulitis (group II). M/F ratio was 49:42 for group I and 37:56 for group II. Mean operative time and hospital stay was similar in both groups. Majority of patients were ASA II in both groups. Rate of minor complications was 14.3 % in group I and 7.5 % in group II. Major complications were 2.2 % for acute treatment and 4.3 % for elective resections. No anastomotic leakage and no mortality occurred. In 32.3 % of the patients of elective group II, destruction of the colonic wall with pericolic abscess, fistulization, or fibrinoid purulent peritonitis were identified.Conclusions
Laparoscopic surgery for acute diverticular disease is safe and effective. Continuing bowl inflammations in histological specimens justify sigmoid resection in elective patients, but more effective pre-operative parameters need to be found to identify patients that would benefit from surgery during the initial episode. 相似文献7.
Purpose
The safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I–II. 相似文献8.
Bastiaan R. Klarenbeek Roberto Bergamaschi Alexander A. F. A. Veenhof Donald L. van der Peet Wim T. van den Broek Elly S. M. de Lange Willem A. Bemelman Pieter Heres Antonio M. Lacy Miguel A. Cuesta 《Surgical endoscopy》2011,25(4):1121-1126
Background
The short-term results of the Sigma trial show that laparoscopic sigmoid resection (LSR) used electively for diverticular disease offers advantages over open sigmoid resection (OSR). This study aimed to compare the overall mortality and morbidity rates after evaluation of the clinical outcomes at the 6-month follow-up evaluation. 相似文献9.
Laparoscopic Hartmann’s procedure: a viable option for treatment of acutely perforated diverticultis
Emmanuel A. Agaba Raza M. Zaidi Peter Ramzy Muhammad Aftab Eugene Rubach Gary Gecelter Thanjur S. Ravikumar George DeNoto 《Surgical endoscopy》2009,23(7):1483-1486
Background A laparoscopic technique for acutely perforated diverticulitis (i.e., laparoscopic Hartmann’s procedure) has not been described.
The authors present their technique for laparoscopic sigmoid resection, end colostomy, and subsequent laparoscopic takedown
of colostomy.
Methods A retrospective review of patients with Hinchey III/IV diverticulitis who underwent a laparoscopic Hartmann’s procedure was
performed in this study. Laparoscopic takedown of sigmoid colostomy was performed 2 to 3 months later. Data from these procedures
including estimated blood loss (EBL), length of the operative procedure, patient outcomes, and demographics were evaluated.
Results Seven patients with a mean age of 49.7 years underwent laparoscopic sigmoid colectomy with end colostomy. None of these patients
had a history of diverticulitis. Their mean EBL was 138 ml, and their mean operative time was 154 min. None of the procedures
required conversion to use of a hand port or conversion to open procedure. The average time to return of bowel function was
3.7 days, with one patient experiencing a postoperative ileus. The mean postoperative hospital stay was 6.6 days. There were
no complications. Laparoscopic Hartmann’s takedown was performed for all the patients approximately 2 to 3 months later. The
mean EBL was 107 ml, and the average operative time was 189 min. One patient had intraoperative anastomotic leak, which was
successfully repaired and retested. Again, none of the procedures required the use of a hand port or a laparotomy. The average
time to return of bowel function was 3.4 days. The average length of hospital stay was 5.3 days, with one patient experiencing
a fat necrosis.
Conclusions Laparoscopic Hartmann’s procedure and laparoscopic takedown are technically feasible procedures with reasonable outcomes. 相似文献
10.
Marty Zdichavsky Frank A. Granderath Gunnar Blumenstock Michael Kramer Markus A. Küper Alfred Königsrainer 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2010,395(1):41-48
Introduction
Early laparoscopic rectosigmoid resection for acute complicated diverticulitis may avoid secondary hospital stay and stoma-related complications. Benefits of elective surgical therapies could advance the early laparoscopic approach for acute sigmoid diverticulitis. 相似文献11.
T. Junghans B. Böhm W. Schwenk K. Gründel J. M. Müller 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1997,382(5):266-270
The full significance of laparoscopic technique in elective surgery of sigmoid diverticulitis has yet to be determinated. However, it seems worthwhile to evaluate how minimally invasive surgery could be integrated into the surgical treatment of diverticulitis disease. Between January 1995 and August 1996, 26 patients with sigmoid diverticulitis underwent elective surgery. Following diagnostic laparoscopy, seven patients were treated with primary conventional resection, 15 patients with laparoscopic resection and four patients with laparoscopic-assisted surgery. One laparoscopic resection had to be converted to a median laparotomy. Postoperative complications (n=2) only appeared in the group of conventional resections. Conventional resections required less time than laparoscopic or laparoscopic-assisted resections, but postoperatively, patients with laparoscopic resection were able to defecate sooner and required a shorter hospital stay. For 60% of the patients with diverticulitis disease of the colon, elective laparoscopic resection may prove to be the best alternative of surgical treatment. In selected patients it is a sound technique with a low complication rate. We recommend that all patients with diverticulitis disease requiring elective surgery undergo diagnostic laparoscopy to determine whether or not laparoscopic resection is a viable option. 相似文献
12.
Background This study aimed to determine whether the number of diverticulitis or complicated diverticulitis episodes affects the conversion
rate or postoperative complication rate in elective laparoscopic sigmoid colectomy.
Methods In this study, 216 charts were reviewed for baseline characteristics, diverticulitis history, and intra- and postoperative
complications. Analysis was performed with the Student’s t-test, the chi-square test, and Fisher’s exact tests.
Results Of 216 sigmoid colectomies, 151 were laparoscopic, 19 were converted, and 46 were open. Baseline characteristics were similar
for patients with zero to two and those with three or more inpatient diverticulitis attacks. Patients with uncomplicated diverticulitis
had a higher rate of conversion after three or more inpatient episodes (2.6% vs 25%; p = 0.04). There was no difference in operative times or postoperative complication rates. Patients with a history of abscess
had a 23% chance of conversion. Those with no abscess history had an 8% chance of conversion (p = 0.02). In general, converted procedures required more time than open procedures but were associated with decreased hospital
length of stay (LOS) and a decreased rate of postoperative ileus.
Conclusion Multiple inpatient diverticulitis attacks and a history of abscess were associated with laparoscopic conversion. Converted
procedures required more time than open procedures, but had reduced LOS and postoperative ileus. Laparoscopic sigmoid colectomy
can be attempted safely for patients with three or more inpatient attacks or a history of complicated diverticulitis. 相似文献
13.
Background The best type of laparoscopic approach in solid liver tumours (SLTs), whether total laparoscopic surgery or hand-assisted
laparoscopic surgery (HALS), has not yet been established. Our objective is to present our experience with laparoscopic liver
resections in SLTs performed by HALS using a new approach.
Methods We performed 35 laparoscopic resections in SLTs, of which 26 were carried out using HALS (in 25 patients) and 21 patients
had liver metastases of a colorectal origin (LMCRC) (1 patient had 2 resections), 1 metastasis from a neuroendocrine tumour
of the pancreas, 1 hepatocarcinoma on a healthy liver, 1 primary hepatic leiomyosarcoma and 1 giant haemangioma. Mean follow-up
was 22 months.
Operation One right hemihepatectomy, one left hemihepatectomy, five bisegmentectomies II–III, three bisegmentectomies VI–VII and 16
segmentectomies (five of S. VI, three of S. VIII; three of S. V; two of S. IVb; one of S. II; one of S. IV; and in the remaining
case resection of S. III and VI plus resection of a metastasis in S. VIII).
Main outcome measures Morbidity and mortality, conversion to open procedure, intraoperative blood loss, intra- and postoperative transfusion, length
of stay and survival.
Results There were no intra- or postoperative deaths, nor were there any conversions. One patient presented with morbidity (3.8%)
(liver abscess). Mean blood loss was 200 ml (range 0–600 ml). One patient required transfusion (3.8%). Mean operative time
was 180 min (range 120–360 min). Mean length of hospital stay was 4 days (range 2–5 days). The actuarial survival rate of
the patients at 36 months with liver metastases from colorectal carcinoma (LMCRC) was 80%.
Conclusions Liver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery
in SLTs when indicated selectively. 相似文献
14.
Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins
Sarela AI 《Surgical endoscopy》2009,23(1):153-160
Background Laparoscopic assisted distal gastrectomy for adenocarcinoma has been widely reported from Japan and Korea but there are sparse
data for Western patients. This study aimed to describe and compare the perioperative outcomes and pathological staging for
consecutive patients who underwent laparoscopic or open gastrectomy by a single surgeon in the UK.
Methods During the period from April 2005 to May, 2007, patients with gastric adenocarcinoma were selected for open or laparoscopic
resection at the discretion of the surgeon. Gastric resections for gastrointestinal stromal tumour (GIST) or benign disease
were excluded. Laparoscopic gastrectomy was performed entirely laparoscopically with intracorporeal anastomosis, followed
by specimen retrieval via a suprapubic incision.
Results There were 21 men and 8 women, median age 75 years (range 45–88 years), with American Anaesthesiology Association scores of
3 or 4 in 19 patients. Gastrectomy was performed laparoscopically in 18 patients (62%; total gastrectomy, 6 patients) or open
in 11 patients (total gastrectomy, 7). Five laparoscopic gastrectomies were converted to open procedures, three patients had
re-laparoscopy and one patient had subsequent laparotomy. As compared with open gastrectomy, laparoscopic resection had longer
operation time and similar length of hospital stay. There was one postoperative mortality in each group. There was similar
lymph node retrieval for laparoscopic or open resection [23 (range 10–44) versus 26 (8–95), respectively; p = 0.40], with inadequate lymphadenectomy (<15 nodes) in two laparoscopic cases and one open case. R1 resection was limited
to patients with pT3 disease (laparoscopic, 4; open, 2).
Conclusions Perioperative outcomes were similar for laparoscopic or open gastrectomy. Lymphadenectomy was adequate in 89% of laparoscopic
gastrectomies. pT3 tumours were at risk of noncurative resection, as described in large Western series of open gastrectomy. 相似文献
15.
Background The safety and benefits of laparoscopic colon resection are well documented. However, few reports have addressed the safety
and comparative outcome of laparoscopic colon operations that necessitated conversion.
Methods All consecutive laparoscopic colon resections performed by a single surgeon from July 1996 to October 2003 were assessed.
Data obtained from a prospective computerized database included demographics, diagnosis, reason and time to conversion, length
of stay, morbidity, and mortality. Additionally, all laparoscopic-converted colectomies were then matched with open colectomies
by diagnosis and severity of disease and analyzed with respect to morbidity, mortality, and clinical outcome.
Results A total of 143 laparoscopic colon resections were analyzed, 78 of which were left colon resections and 65 were right colon
resections. The overall conversion rate was 19.6% (28 patients). The disease entities of the 28 converted patients were diverticulitis
(16), polyps (four), Crohn’s disease (three), metastatic cancer (three), and others (two). Conversion was higher in the left-sided
(24 patients, 30.8%) versus right-sided (four patients, 6.1%) procedures. There were no differences regarding age, gender,
and comorbidities among the laparoscopic, open, and converted groups; the median follow-up was 39 months. The median length
of stay was 6, 8, and 12 days for the laparoscopic, open, and converted groups, respectively. Right-sided conversions were
due to the size of the inflammatory mass in three patients and intraoperative bleeding in one patient. Left-sided conversions
were due to the inflammatory process extending beyond the sigmoid colon in 12 patients, adhesions in five, obesity in four,
pericolonic abscess in two, and fixed mass in one patient. Postoperative morbidity was significantly higher for laparoscopic
procedures that were converted to open procedures more than 30 min into the operation. Preoperative predictors of conversion
were extent of inflammatory process beyond the sigmoid colon and obesity, whereas intraoperative predictors were adhesions
and bleeding.
Conclusions Laparoscopic-converted colon resection is associated with significantly greater morbidity, particularly wound complications
and greater length of hospital stay, compared to open or laparoscopic colectomies. Prompt conversion (<30 min) may reduce
the overall morbidity associated with converted procedures. Furthermore, thoughtful patient selection may decrease the conversion
rate and thereby prevent the inherent morbidity associated with converted procedures. 相似文献
16.
Weber WP Guller U Jain NB Pietrobon R Oertli D 《Archives of surgery (Chicago, Ill. : 1960)》2007,142(3):253-9; discussion 259
HYPOTHESIS: High-volume surgeons and hospitals are more likely to perform laparoscopic procedures than open procedures for diverticular disease as compared with low-volume surgeons and hospitals. DESIGN: Real-world analysis. SETTING: United States community hospitals. PATIENTS: Patients with primary International Classification of Diseases, Ninth Revision diagnosis codes for diverticulosis or diverticulitis and International Classification of Diseases, Ninth Revision procedure codes for laparoscopic or open sigmoidectomy were selected from the 1992 to 2001 Nationwide Inpatient Samples commercially available US databases. MAIN OUTCOME MEASURES: The outcome variable was the likelihood of performing laparoscopic vs open sigmoid resection. The primary predictor variable was the annual caseload of sigmoid resections per surgeon and hospital. RESULTS: The study population included 55,949 patients who were predominantly white (70.5%) with a mean (SD) age of 60.7 (14.7) years. Unadjusted and risk-adjusted odds ratios of performing laparoscopic sigmoidectomy were significantly higher for high-volume surgeons and high-volume hospitals. In fact, high-volume surgeons were 8.80 times more likely to perform a laparoscopic sigmoid resection compared with low-volume surgeons. Similarly, in high-volume hospitals, patients were 3.02 times more likely to undergo a laparoscopic sigmoid resection compared with patients who underwent surgery in low-volume hospitals. These clinically relevant differences remained statistically significant in subset analyses stratified by age (<65 vs > or =65 years) and time of surgery (elective vs nonelective). CONCLUSIONS: The findings of the present investigation based on data from large US nationwide databases provide compelling evidence that high-volume surgeons and hospitals are significantly more likely to perform laparoscopic surgery for diverticular disease compared with low-volume surgeons and hospitals. Based on recent studies showing clear advantages of the laparoscopic technique over the open counterpart, our results should be considered by both patients and physicians. 相似文献
17.
Background
Prospective randomized studies and meta-analyses have shown that laparoscopic resection for colonic cancer is equivalent to open resection with respect to the oncological results and has short-term advantages in the early postoperative outcome. The aim of this study was to investigate whether laparoscopic colonic resection has become established as the standard in routine treatment.Methods
Data from the multicenter observational study ?Quality assurance colonic cancer (primary tumor)“ from the time period from 1 January 2009 to 21 December 2011 were evaluated with respect to the total proportion of laparoscopic colonic cancer resections and tumor localization and specifically for laparoscopic sigmoid colon cancer resections. A comparison between low and high volume clinics (<?30 versus ≥?30 colonic cancer resections/year) was carried out.Results
Laparoscopic colonic cancer resections were carried out in 12 % versus 21.4 % of low and high volume clinics, respectively (p?<?0.001) with a significant increase for low volume clinics (from 8.0 % to 15.6 %, p?<?0.001) and a constant proportion in high volume clinics (from 21.7 % to 21.1 %, p?=?0.905). For sigmoid colon cancer laparoscopic resection was carried out in 49.7 % versus 47.6 % (p?=?0.584). Differences were found between low volume and high volume clinics in the conversion rates (17.3 % versus 6.6 %, p?<?0.001), the length of the resected portion (Ø 23.6 cm versus 36.0 cm, p?<?0.001) and the lymph node yield (Ø n?=?15.7 versus 18.2, p?=?0.008). There were no differences between the two groups of clinics regarding postoperative morbidity and mortality. The postoperative morbidity and length of stay were significantly lower for laparoscopic sigmoid resection than for conventional sigmoid resection.Conclusion
The laparoscopic access route for colonic cancer resection is not the standard approach in the participating clinics. The laparoscopic access route has the highest proportion for sigmoid colon resection. The differences in the conversion rates, length of the resected portion and the number of lymph nodes investigated between the low volume and high volume clinics must be viewed critically and must be interpreted in connection with the long-term oncological results. 相似文献18.
Khaled El Zarrok Elgazwi Ivo Baca Leszek Grzybowski Armin Jaacks 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(4):469-475
Background:
Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of this prospective study was to evaluate the outcome of laparoscopic sigmoid colectomy in patients with diverticulitis. Patients offered laparoscopic surgery presented with acute complicated diverticulitis (Hinchey type I, II, III), chronically recurrent diverticulitis, bleeding, or sigmoid stenosis caused by chronic diverticulitis.Method:
All patients who underwent laparoscopic colectomy within a 12-year period were prospectively entered into a database registry. One-stage laparoscopic resection and primary anastomosis constituted the planned procedure. A 4-trocar approach with suprapubic minilaparotomy was performed. Main data recorded were age, sex, postoperative pain, return of bowel function, operation time, duration of hospital stay, and early and late complications.Results:
During the study period, 260 sigmoid colectomies were performed for diverticulitis. The cohort included 104 male and 156 female patients; M to F ratio was 4:6. Postoperative pain was controlled by NSAIDs or weak opioid analgesia. Fifteen patients (5.7%) required conversion from laparoscopic to open colectomy. The most common reasons for conversion were directly related to the inflammatory process, abscess, and peritonitis. Mean operative time was 130±54. Average postoperative hospital stay was 10±3 days. A longer hospital stay was recorded for Hinchey type IIb patients. Complications were recorded in 30 patients (11.5%). The most common complications that required reoperation were hemorrhage in 2 patients (0.76) and anastomotic leak in 5 patients (only 3 of them required reoperation). The mortality among them was 2 patients (0.76%).Conclusions:
Laparoscopic surgery for diverticular disease is safe, feasible, and effective. Therefore, laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis at our institution. 相似文献19.
R. Santambrogio L. Aldrighetti M. Barabino C. Pulitanò M. Costa M. Montorsi G. Ferla E. Opocher 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):255-264
Background Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver, above all
for patients with hepatocellular carcinoma (HCC) and cirrhosis. This approach mainly includes diagnostic procedures and interstitial
therapies. However, we believe there is room for laparoscopic liver resections in well-selected cases. The aim of this study
is to assess: (a) the risk of intraoperative bleeding and postoperative complications, (b) the safety and the respect of oncological
criteria, and (c) the potential benefit of laparoscopic ultrasound in guiding liver resection.
Methods A prospective study of laparoscopic liver resections for hepatocellular carcinoma was undertaken in patients with compensated
cirrhosis. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2–6), and
the tumor had to be 5 cm or smaller. Tumor location and its transection margins were defined by laparoscopic ultrasound.
Results From January 1997, 22 out of 250 patients with HCC (9%) underwent laparoscopic liver resections. The mean patient age was
61.4 years (range, 50–79 years). In three patients, conversion to laparotomy was necessary. The laparoscopic resections included
five bisegmentectoies (2 and 3), nine segmentectomies, two subsegmentectomies and three nonanatomical resections for extrahepatic
growing lesions. The mean operative time, including laparoscopic ultrasonography, was 199 ± 69 min (median, 220; range, 80–300).
Perioperative blood loss was 183 ± 72 ml (median, 160; range, 80–400 ml). There was no mortality. Postoperative complications
occurred in two out of 19 patients: an abdominal wall hematoma occurred in one patient and a bleeding from a trocar access
in the other patient requiring a laparoscopic re-exploration. Mean hospital stay of the whole series was 6.5 ± 4.3 days (median,
5; range, 4–25), while the mean hospital stay of the 19 laparoscopic patients was 5.4 ± 1 (median, 5; range, 4–8).
Conclusion Laparoscopic treatment should be considered in selected patients with HCC and liver cirrhosis in the left lobe or segments
5 and 6 of the liver. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by adequately
skilled surgeons with appropriate instruments. 相似文献
20.
BackgroundThe use and outcomes of laparoscopic sigmoid resection during emergency admissions for diverticulitis are unknown.MethodsThe Nationwide Inpatient Sample was queried for colorectal resections performed for diverticulitis during emergent hospital admissions (2003–2007). Univariate and multivariate analyses including patient, hospital, and outcome variables were performed.ResultsA national estimate of 67,645 resections (4% laparoscopic) was evaluated. The rate of conversion to open operation was 55%. Ostomies were created in 66% of patients, 67% open and 41% laparoscopic. Laparoscopy was not a predictor of mortality (odds ratio [OR] =.70; confidence interval [CI], .32–1.53). Laparoscopy predicted routine discharge (OR = 1.31; CI, 1.06–1.63) and a decreased length of stay (absolute days = ?.78; CI, ?1.19 to ?.37). There was no difference in the cost of hospitalization between the 2 groups (P = .45).ConclusionsIn acute diverticulitis, urgent laparoscopic resection decreases the length of stay. However, it is associated with a high conversion rate, no cost savings, and no difference in mortality. 相似文献