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1.
Short-term outcome of laparoscopic paraesophageal hernia repair 总被引:5,自引:0,他引:5
T. R. Huntington 《Surgical endoscopy》1997,11(9):894-898
Background: The purpose of this study is to determine the morbidity, mortality, and short-term outcomes associated with laparoscopic
paraesophageal hernia repair (LPHR).
Methods: A series of 58 consecutive LPHRs performed by the author were reviewed with an average 1-year follow-up. Morbidity and mortality
rates were compared with historical series of open repairs. Anatomy and technical considerations pertinent to LPHR were reviewed.
Results: There were no procedure-related or perioperative deaths in this series of patients undergoing LPHR. Four major complications
occurred (7%), two of which required reoperation, all in urgently repaired patients. One patient required conversion to laparotomy
(1.7%). Based on symptoms, there were no reherniations. No patients had long-term dysphagia worse than preoperatively. Preoperative
symptoms of chest pain, esophageal obstruction, hemorrhage, and reflux were resolved in all patients.
Conclusions: LPHR is safe, effective, and compares favorably to historical series of open paraesophageal hernia repair.
Received: 24 July 1996/Accepted: 20 November 1996 相似文献
2.
This paper addresses gastric herniation following laparoscopic fundoplication for reflux esophagitis. Case history: A 46-year-old
woman underwent Nissen fundoplication. Two days postoperatively she developed gastric herniation and perforation with subsequent
pleural effusion and necrotizing fasciitis of the chest wall. A patent crural repair might reduce the occurrence of paraoesophageal
herniation.
Received: 12 April 1996/Accepted: 26 November 1996 相似文献
3.
Laparoscopic management of lumbar hernia 总被引:1,自引:1,他引:0
We describe (for the first time) a laparoscopic approach to repair an acquired superior triangle lumbar hernia in a morbidly
obese woman by using prosthetic mesh. Such a technique provides an excellent anatomic view, thus avoiding injury to structures
in proximity to the hernia during repair; eventually the well-known advantages of such approach result.
Received: 10 November 1996/Accepted: 20 December 1996 相似文献
4.
Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy 总被引:1,自引:2,他引:1
Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt
to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty
during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux
and a large (≥8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty
was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (≤11 months) the patients are
doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement
of the repair with PTFE mesh.
Received: 5 March 1996/Accepted: 3 June 1996 相似文献
5.
Background: The short esophagus increases the difficulty and limits the effectiveness of laparoscopic Nissen fundoplication. In our experience,
∼20–25% of esophagi judged by preoperative criteria to be foreshortened will, after dissection, be insufficiently long to
allow 2 cm of esophagus to reside below the diaphragm without inferior distraction (i.e., tension free). Collis gastroplasty
combined with Nissen fundoplication has become the standard approach for the creation of an intraabdominal neoesophagus and
fundic wrap.
Methods: After developing methods of performing totally laparoscopic stapled gastroplasty in the cadaver lab in 1994, we started applying
the technique clinically in 1996. We performed 220 laparoscopic antireflux procedures between January 1996 and July 1997.
Of these 220 patients, 26% were suspected to have esophageal foreshortening based on preoperative barium studies and/or endoscopy.
Results: After hiatal dissection, nine patients, or 16% of those suspected to have esophageal foreshortening and 4% of the entire
population, required the laparoscopic Collis-Nissen procedure. There was symptomatic improvement in all patients as assessed
by patient-initiated symptom scores.
Conclusions: The management of patients with esophageal foreshortening is a complex problem. We believe that our technique of laparoscopic
Collis-Nissen provides an effective means of achieving intraabdominal placement of the fundic wrap while maintaining the benefits
of a minimally invasive approach.
Received: 8 September 1997/Accepted: 17 December 1997 相似文献
6.
A new approach in the management of incarcerated hernia 总被引:1,自引:0,他引:1
The authors describe the case of a 74-year-old male presenting with an incarcerated epigastric hernia. An algorithm for successful
management of such a case is proposed.
Received: 18 November 1996/Accepted: 26 December 1996 相似文献
7.
A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive
diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically
under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with
no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni
hernia.
Received: 3 April 1996/Accepted: 3 May 1996 相似文献
8.
Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair 总被引:6,自引:1,他引:5
A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent
inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and
small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy
has remained intact. This complication needs to be added to the differential diagnosis in patients who present inflammation,
abscess formation, or cutaneous fistula following laparoscopic hernia repair.
Received: 7 October 1996/Accepted: 14 October 1996 相似文献
9.
The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients
who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations
were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could
be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels
from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other
three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal
during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one
patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found
to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic
reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided.
Received: 9 February 1996/Accepted: 20 May 1996 相似文献
10.
The role of endoscopic extraperitoneal herniorrhaphy (EEPH) in the management of giant scrotal hernias has not been well
defined, and the technical details relating to operations on such hernias have not been described. We present our experience
with 17 patients undergoing repair of giant scrotal hernias. Foley catheter bladder decompression was routinely employed.
The Retzius space was developed early in the procedure and hernia sac contents were reduced in all cases. The inferior epigastric
vessels were likewise divided in all patients. The average operative time was 76 min and all patients were discharged home
the same day. There have been no recurrences on follow-up. There was no mortality, and morbidity was limited to seroma formation
in two patients. We conclude that with certain technical modifications, EEPH can be safely employed for the treatment of giant
scrotal hernias.
Received: 7 May 1996/Accepted: 12 July 1996 相似文献
11.
Background: The laparoscopic repair of inguinal hernia is still controversial. Transabdominal preperitoneal repair violates the peritoneal
cavity and may result in visceral injuries or intestinal obstruction. The laparoscopic extraperitoneal approach has the disadvantage
of being technically demanding and requires extensive extraperitoneal mobilization. The Lichtenstein repair gives good long-term
results, is easy to learn, can be performed under local anesthesia, but requires a larger incision.
Methods: We describe a novel percutaneous tension-free prosthetic mesh repair performed through a 2-cm groin incision. The inguinal
canal is traversed with the aid of a 5-mm video-endoscope and the canal is widened using specially designed balloons. Spermatic
cord mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic
guidance.
Results: Between October 1993 and July 1995, 85 primary inguinal hernia repairs (48 indirect and 33 direct) were performed on 81 patients
(80 men, one woman) by the author (A.D.). The mean age was 41 years (range 17–83 years). Six repairs were performed under
local anesthetic. Mean operative time was 42 min (range 25–74). Mean hospital stay was 1.2 days (0–3 days). The mean return
to normal activity was 8 days (2–10 days). Eight complications have occurred: a serous wound discharge, two scrotal hematomas,
a scrotal swelling that resolved spontaneously, wound pain lasting 2 weeks, an episode of urinary retention, and two recurrences
early in the series (follow-up 1–22 months).
Conclusion: The endoscopically guided percutaneous hernia repair avoids the disadvantages of laparoscopy (i.e., lack of stereoscopic
vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation
allows operation through a 2-cm incision. The minihernia repair thus combines the virtues of an open tension-free repair with
minimal access trauma.
Received: 21 May 1996/Accepted: 8 August 1996 相似文献
12.
Laparoscopic repair of a paraduodenal hernia 总被引:1,自引:1,他引:0
T. Uematsu H. Kitamura M. Iwase K. Yamashita H. Ogura T. Nakamuka H. Oguri 《Surgical endoscopy》1998,12(1):50-52
Paraduodenal hernias have traditionally been treated by conventional laparotomy. We report the first case of a left paraduodenal
hernia treated laparoscopically. A 44-year-old man was admitted with abdominal pain and nausea. Computed tomography and an
upper gastrointestinal series with small-bowel followthrough showed accumulation of the small bowel on the left side of the
abdomen. A laparoscopic repair was performed. The small bowel was observed beneath a thin hernia capsule. Approximately 1.5
m of jejunum was easily reduced into the abdominal cavity. The hernia orifice (5-cm diameter) was closed intracorporeally
with five interrupted sutures. Good exposure of the operative field is critical to this procedure; poor exposure may limit
the applicability of the laparoscopic approach. This minimally invasive operation is currently indicated in nonobstructive
paraduodenal hernias, especially on the left.
Received: 7 October 1996/Accepted: 11 April 1997 相似文献
13.
First trimester of pregnancy laparoscopic procedures 总被引:3,自引:3,他引:0
Laparoscopic procedures are being performed during pregnancy with increasing frequency; however, few first-trimester operations
have been published. Two first-trimester procedures are here reported, both performed with uneventful recoveries.
Received: 25 March 1996/Accepted: 24 January 1997 相似文献
14.
Hand-assisted laparoscopic splenectomy for hydatid cyst 总被引:1,自引:1,他引:0
K. E. W. Ballaux J. M. Himpens G. Leman M. R. P. Van den Bossche 《Surgical endoscopy》1997,11(9):942-943
Splenic hydatidosis is a rare condition. We performed a hand-assisted laparoscopic splenectomy for a large hydatid cyst localized
in the center of the spleen. We discuss the advantages of the ``helping hand.'
Received: 27 September 1996/Accepted: 19 November 1996 相似文献
15.
P. R. Schauer W. H. Schwesinger C. P. Page R. M. Stewart B. A. Levine K. R. Sirinek 《Surgical endoscopy》1997,11(1):8-11
Background: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe.
Methods: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications
and deaths occurring up to 30 days following the procedures.
Results: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality
rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication.
Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each
resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period.
Conclusions: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity
and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of
common complications and application of appropriate precautions and instruction are critical for minimizing complications.
Received 25 March 1996/Accepted: 24 April 1996 相似文献
16.
Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases 总被引:9,自引:3,他引:6
E. Chelala G. B. Cadiére F. Favretti J. Himpens M. Vertruyen J. Bruyns L. Maroquin M. Lise 《Surgical endoscopy》1997,11(3):268-271
Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study
was to analyze the complications of this approach.
Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique.
A minimally invasive procedure using five trocars was performed.
Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in
eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations
and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications:
There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis.
One fatality on the 45th day in a patient with a Prader-Willi syndrome.
Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence
may be reduced by improving the technique and by considering pitfalls of the procedure.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献
17.
Laparoscopic treatment of large paraesophageal hernias 总被引:6,自引:4,他引:2
van der Peet DL Klinkenberg-Knol EC Alonso Poza A Sietses C Eijsbouts QA Cuesta MA 《Surgical endoscopy》2000,14(11):1015-1018
Background: We set out to evaluate the results of the laparoscopic treatment of large paraesophageal hernias in 22 patients.
Methods: Between 1993 and 1998, we operated on 22 consecutive patients. Preoperative assessment consisted of endoscopy, barium esophagogram,
24-h pH testing, manometry, and gastric emptying times.
Results: In the first three patients, the sac was not excised and gastropexy was not performed. Because of recurrences, we decided
to change the technique in an attempt to avoid further complications. During middle- to long-term follow-up, only three recurrences
were seen in the subsequent 19 patients. There were no deaths in this series.
Conclusions: Laparoscopic treatment of large paraesophageal hernias is feasible. Because recurrences may occur after successful laparoscopic
treatment, both resection of the sac and some form of gastropexy are imperative.
Received: 22 March 2000/Accepted: 30 April 2000/Online publication: 20 September 2000 相似文献
18.
As the immunocompromised patient population grows, the gastrointestinal surgeon is increasingly called upon to make complex
diagnostic and therapeutic decisions. The surgeon should first identify the patient as immunocompromised and then categorize
the probable degree of immunocompromise as mild, moderate, or severe. Mildly immunocompromised patients tend to present late
and with minimal symptoms, but the disease entities are the same ones seen in the general population. Moderately and severely
immunocompromised patients may also develop the usual surgical problems, but the differential diagnosis is expanded to include
complications of the immunocompromised state or complications of the underlying problem which caused the immune compromise.
The expanded differential diagnosis includes infections with atypical organisms, opportunistic neoplasms, neutropenic enterocolitis,
complications of medications, and forms of biliary tract disease not seen in the general population. Advances in oncology,
transplantation, and the treatment of AIDS, have extended the life expectancy of these patients and increased the immunocompromised
population. Prompt appropriate operative therapy may be lifesaving when surgical complications develop.
Received: 11 April 1996/Accepted: 1 May 1996 相似文献
19.
Familial hypocalciuric hypercalcemia (FHH) is often considered in the differential diagnosis of hyperparathyroidism, but
is rarely diagnosed. So far, FHH has not been documented in Israel. This report presents preliminary evidence for the occurrence
of FHH in Israel.
Received: 11 June 1996 / Accepted: 31 December 1996 相似文献
20.
We have developed a new device which enables rapid sealing of a minilaparotomy during laparoscopic assisted surgery to recreate
an airtight condition. This device consists of a center rod and two discs (7 cm in diameter) which form an airtight condition
by compressing the inner and outer surfaces of the abdominal wall. Advanced laparoscopic procedures requiring both pneumoperitoneum
and minilaparotomy are facilitated with the use of this device. This new device is called the Sandwich-disc: Takasago Medical
Industry Co., Ltd.
Received: 11 January 1996/Accepted: 22 March 1996 相似文献