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1.
Laparoscopic gastric banding for morbid obesity 总被引:2,自引:1,他引:2
Background: Morbid obesity occurs in 2–5% of the population of Europe, Australia, and the United States and is becoming more common.
Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to
long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients.
Materials and methods: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance
and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and
a full understanding of all possible complications.
Results: All patients have needed band adjustments of 1–4 ml over the course of their follow-up. No patient had increased his or her
weight during the follow-up, and only three patients have not enjoyed sustained weight loss.
Conclusions: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness
of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is
maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery
is laparoscopic experience.
Received: 12 May 1998/Accepted: 12 February 1999 相似文献
2.
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
3.
Endoscopy in patients undergoing gastroplasty for morbid obesity 总被引:1,自引:0,他引:1
H. S. Himal 《Surgical endoscopy》1987,1(4):207-209
Summary Fifty patients underwent gastroplasty for morbid obesity. The follow-up regimen included both nutritional and weight assessment and gastroscopy. Weight loss was satisfactory in patients with gastric stomas less than 9 mm in diameter. Stomal obstruction was endoscopically diagnosed in 5 patients. Endoscopic dilatation was successful in 4 patients. Gastroscopy should thus be a routine postoperative procedure in patients undergoing gastric partitioning for morbid obesity. 相似文献
4.
Awad ZT Filipi CJ Mittal SK Roth TA Marsh RE Shiino Y Tomonaga T 《Surgical endoscopy》2000,14(5):508-512
Laparoscopic antireflux surgery is the procedure of choice for gastroesophageal reflux disease (GERD). However, many clinicians
have reservations about its application in patients with complicated GERD, notably those with esophageal shortening. In this
report, we present our experience with the laparoscopic management of the shortened esophagus. A total of 235 patients with
primary GERD underwent laparoscopic antireflux procedures, 38 of whom were suspected preoperatively to have a shortened esophagus.
Of the 235 patients, 8 (3.4%) needed a left thoracoscopically assisted gastroplasty in addition to laparoscopic Toupet repair
(n= 4) or Nissen fundoplication (n= 4). Complications included pleural effusion (n= 1), pneumothorax (n= 2), and minor atelectasis (n= 1). The average hospital stay was 3 days. Results were satisfactory in 7 of 8 patients, with a mean follow-up of 20.2 months
(range, 9–34 months). The surgical management of the shortened esophagus is difficult. However, the role of minimally invasive
techniques is justified. Early results are appealing, with less morbidity, satisfactory control of GERD related symptoms,
and a shortened hospital stay.
Received: 3 August 1999/Accepted: 10 November 1999/Online publication: 17 April 2000 相似文献
5.
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
6.
Background: The introduction of laparoscopic techniques—especially that of gastric banding—and the fact that conservative management
does not provide satisfactory long-term results in patients with morbid obesity has resulted in a marked increase in the demand
for bariatric surgery in our department since 1995. In this paper, we present our experience during the first 3 years with
this approach.
Methods: Data for all patients who had bariatric surgery at our institution were collected prospectively. They were analyzed for the
purpose of this study.
Results: A total of 150 patients were operated on between December 1995 and December 1998 (37 months). There were 130 women and 20
men, with a mean age of 37.5 years (range, 19–62). The mean initial excess body weight was 102.9% (range, 58–191%), and the
mean initial body mass index (BMI) was 44.6 kg/m2 (range, 35.1–64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In two patients in whom conversion was necessary,
we performed a vertical banded gastroplasty. Duration of surgery decreased over time from 210 min (first 20 cases) to 73 min
(last 20 cases). Six patients (4%) developed major complications, one of whom died. The median duration of postoperative hospital
stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%) developed late complications, and 22 (14.6%)
required reoperation, mainly for band slippage and/or pouch dilatation (14 cases). An incorrect surgical technique used for
the first 30 patients (Lapband within the lesser sac) was responsible for more than half of these complications. The mean
excess weight loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to vertical banded gastroplasty (197 cases
between 1981 and 1995), postoperative morbidity was greatly decreased, late morbidity was similar, and weight loss was equivalent.
Conclusions: Laparoscopic gastric banding is followed by a weight reduction that is similar to that observed after vertical banded gastroplasty,
with a much lower postoperative morbidity, a shorter hospital stay, and an earlier resumption of normal activities. If these
results can be confirmed by long-term follow-up, laparoscopic gastric banding will be confirmed as the restrictive procedure
of choice for morbid obesity.
Received: 20 July 1999/Accepted: 16 December 1999/Online publication: 8 May 2000 相似文献
7.
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
8.
Pouch dilatation with stoma obstruction is a well-known late complication after adjustable gastric banding operations for
morbid obesity. Surgical treatment of this problem usually results in removal of the band, with or without replacement by
another, or in repositioning of the band via laparotomy. We present the case of a patient with late pouch dilatation and stoma
obstruction after placement of a Laparoscopic Adjustable Gastric Banding system (LAGB—Bioenterics) and in whom the adjustable
band was laparoscopically opened, disconnected from the access port, and repositioned more proximally on the stomach. The
postoperative course was uneventful. A postoperative radiographic contrast examination showed a correct repositioning of the
band. The case demonstrates that the LAGB can be successfully opened and repositioned by a minimal invasive procedure. This
is the first time to our knowledge that such a procedure has been reported.
Received: 25 May 1996/Accepted: 26 November 1996 相似文献
9.
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
10.
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
11.
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
12.
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
13.
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目的 评估腹腔镜垂直捆绑胃成形术(LVBG)的减肥效果并探讨肥胖手术治疗的适应证。方法 利用该手术治疗25例病态肥胖病人,平均年龄27.56岁(12-47岁),体重指数(BMI)为41(26-56)。结果 平均手术时间120min(50-240min),未出现手术死亡和并发症。术后随访23例病人,第1个月减重均在12kg以上,6个月后平均减重24.3kg,平均BMI降至35。一年平均减重约42kg,平均BMI降至31。无营养不良。结论 LVBG是一种治疗病态肥胖症的安全、有效手术方法。 相似文献
14.
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15.
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
16.
The number of people in the population who have undergone an operative procedure for morbid obesity is likely to rise steadily as the awareness and popularity of bariatric surgery continues to develop. As this number increases, the number of patients with long-term failures and complications from these procedures will also rise. Although previous operations, particularly open procedures, normally deter surgeons from choosing a laparoscopic approach, the evolving technical skill of laparoscopic surgeons should allow for the reconsideration of these inhibitions. In this case, we present of laparoscopic Roux-en-Y gastric bypass on a 48-year-old woman who had undergone horizontal gastric stapling 20 years prior to presentation. 相似文献
17.
D. Collet 《Surgical endoscopy》1997,11(1):56-63
Background: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation
as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of
laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the
beginning years in which the technique was being used.
Methods: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy
started laparoscopically during 1994 have been included.
Results: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 ± 19.8 years old) and 1,314 males
(56.3 ± 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while
4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N= 230)—4.7% in group I (N= 203) and 8.4% in group II (N= 27). Mortality was 0.2% (N= 9)—namely four intraabdominal complications (three cases of peritonitis and one biliary reoperation), two cardiac failures,
and one brain infarction. The causes of death were not specified in two patients.
Conclusions: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas
the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These
results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient
and the biliary symptoms.
Received: 25 January 1996/Accepted: 10 April 1996 相似文献
18.
Laparoscopic resection of posterior gastric leiomyoma 总被引:4,自引:0,他引:4
Laparoscopic gastric surgery is gaining momentum, especially in the treatment of benign disease. Simultaneous endoscopy and
laparoscopy allow precise localization of lesions. Because of the stomach's size, mobility, and distensibility, relatively
large lesions can be safely excised. Wedge resection for anterior lesions and a transgastric or intragastric approach for
posterior lesions are feasible laparoscopically. Two cases of posterior gastric leiomyomas successfully resected laparoscopically
are presented. The use of stapling devices greatly facilitates this procedure.
Received: 17 February 1995/Accepted: 7 September 1995 相似文献
19.
Communicating hydrocephalus can be handled either by the ventriculoperitoneal or, occasionally, the ventriculoatrial shunt.
The lumboperitoneal shunt is another option. It does not require a transcranial approach; therefore, it is safer for the patient.
We describe a technique that can be performed easily by a skilled laparoscopic surgeon through an anterior approach transabdominally.
The lumboperitoneal (LP) shunt is placed laparoscopically under direct videoscopic vision, with the catheter inserted transabdominally
through the L3 disc space into the thecal sac. In our patient, the lumboperitoneal shunt was placed at the L3 disc space for
communicating hydrocephalus. There were no intraoperative or postoperative complications. The LP shunt can be easily placed
by a skilled laparoscopic surgeon. The incidence of infection and complications is lower, and the patency rate is higher.
This should be the initial choice for communicating hydrocephalus. 相似文献
20.
Background: High error rates are reported in the clinical diagnosis of acute appendicitis. This study was undertaken to discover what
additional value laparoscopy has in the diagnosis of suspected acute appendicitis.
Methods: From April 1995 to November 1996, a diagnostic laparoscopy, before open appendicectomy, was performed in 100 consecutive
patients with suspected acute appendicitis. Appendicectomy was performed only if the appendix showed signs of inflammation
at laparoscopy or if the appendix could not be visualized.
Results: Twenty-four patients were spared an appendicectomy, and in half of them a new diagnosis was established during laparoscopy.
The rate of misdiagnosis was 41% in female patients of reproductive age and 8% in male patients. There were no cases of missed
appendicitis in this trial, and all removed appendices showed signs of inflammation at histology.
Conclusions: It is safe to rely on the diagnosis made at laparoscopy. Its use for establishing diagnosis before appendicectomy in women
of reproductive age is recommended.
Received: 13 June 1997/Accepted: 24 October 1997 相似文献