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1.
Laparoscopic colotomy repair following colonoscopic polypectomy. 总被引:1,自引:0,他引:1
Ahmet Kilic Stephen M Kavic 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2008,12(1):93-96
BACKGROUND AND OBJECTIVES: The unfortunate complication of a colotomy resulting from a colonoscopic polypectomy can be disastrous. Using the versatility of laparoscopic surgery, we aim to provide a treatment algorithm for these colonoscopic perforations. METHODS: We report a case of cecal perforation, in a 70 year old female, following colonoscopic polypectomy that was treated successfully with laparoscopic application of an Endo-GIA linear stapler. RESULTS: Four months following staple resection of her cecal perforation, the patient is asymptomatic and has undergone a repeat colonoscopy without any sequelae. CONCLUSIONS: Laparoscopic techniques can be safely applied in the treatment of colonic perforations following therapeutic polypectomies. A suggested management algorithm is provided highlighting the role laparoscopy may provide in selected patients. 相似文献
2.
Laparoscopic bowel mobilization combined with intraoperative colonoscopic polypectomy in patients with an inaccessible polyp of the colon 总被引:2,自引:0,他引:2
Background: The purpose of this report was to describe a simple technique suitable for polyps where circumstances of the bowel anatomy
prevent complete access and control of the colonoscopic procedure.
Methods: By combining laparoscopic mobilization of the bowel with colonoscopic polypectomy, previously inaccessible polyps could be
snared in two patients.
Results: Both patients had 3-cm large sessile adenomas in the sigmoid colon safely removed, and they returned home within a day.
Conclusions: The described procedure increases the safety of the otherwise difficult polypectomy and also avoids laparotomy with enterotomy
or bowel resection as the alternative.
Received: 5 May 1996/Accepted: 19 September 1996 相似文献
3.
Perforation of the colon is an uncommon complication of colonoscopy in children. In the past, such injuries were treated by laparotomy with primary repair or colostomy. We performed laparoscopic primary repair of the colon in 2 young boys who showed signs of bowel perforation after colonoscopic polypectomy. Both recovered uneventfully and were discharged within several days of admission. In the first patient, the colon had been well prepared, and the perforation was identified almost immediately, resulting in minimal peritoneal contamination. The second patient presented 48 hours after colonoscopy, but there was no gross fecal contamination. In each case, primary repair was felt to be a safe option. Laparoscopic primary repair of colon perforation after colonoscopic polypectomy in children appears to be safe and effective in selected cases. Advantages of the minimally invasive approach include the ability to evaluate the entire colon for injuries, more rapid postoperative recovery, and improved cosmesis. 相似文献
4.
A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that
had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of
the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect
was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene
mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative
course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding
the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair.
Received: 6 June 1997/Accepted: 11 August 1997 相似文献
5.
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
6.
Laparoscopic repair of rectal prolapse 总被引:4,自引:0,他引:4
Background: There have been few large series that have focused on the feasibility of the laparoscopic approach for rectal prolapse. This
single-institution study prospectively examines the surgical outcome and changes in symptoms and bowel function following
the laparoscopic repair of rectal prolapse.
Methods: In a selected group of 34 patients (total prolapse, 28; intussusception, six), 17 patients underwent laparoscopic-assisted
resection rectopexy and 17 patients received a laparoscopic sutured rectopexy. Preoperative and postoperative evaluation at
3, 6, and 12 months included assessment of the severity of anal incontinence, constipation, changes in constipation-related
symptoms, and colonic transit time.
Results: Median operation time was 255 min (range, 180–360) in the resection rectopexy group and 150 min (range, 90–295) in the rectopexy
alone group. Median postoperative hospital stay was 5 days (range, 3–15) and median time off work was 14 days (range, 12–21)
in both groups. There were no deaths. Postoperative morbidity was 24%. Incontinence improved significantly regardless of which
method was used. The main determinant of constipation was excessive straining at defecation. Constipation was cured in 70%
of the patients in the rectopexy group and 64% in the resection rectopexy group. Symptoms of difficult evacuation improved,
but the changes were significant only after resection rectopexy. Two patients (7%) developed recurrent total prolapse during
a median follow-up of 2 years (range 12–60 months).
Conclusions: Laparoscopic-sutured rectopexy and laparoscopic-assisted resection rectopexy are feasible and carry an acceptable morbidity
rate. They eliminate prolapse and cure incontinence in the great majority of patients. Constipation and symptoms of difficult
evacuation are alleviated.
Received: 30 April 1999/Accepted: 8 July 1999/Online publication: 22 May 2000 相似文献
7.
Laparoscopic ventral hernia repair 总被引:1,自引:0,他引:1
Introduction: Effective surgical therapy for ventral and incisional hernias is problematic. Recurrence rates following primary repair range
as high as 25–49%, and breakdown following conventional treatment of recurrent hernias can exceed 50%. As an alternative,
laparoscopic techniques offer the potential benefits of decreased pain and a shorter hospital stay. This study evaluates the
efficacy of the laparoscopic approach for ventral herniorrhaphy.
Methods: A retrospective review was performed for 100 consecutive patients with ventral hernias who underwent laparoscopic repair
at our institutions between November 1995 and May 1998. All patients who presented during this period and were candidates
for a mesh hernia repair were treated via an endoscopic approach.
Results: One hundred patients underwent a laparoscopic ventral hernia repair. There were 48 men and 52 women. The patients were typically
obese, with a mean body mass index (BMI) of 31 kg/m2. Each had undergone an average of 2.5 (range; 0–8) previous laparotomies. Forty-nine repairs were performed for recurrent
hernias. An average of two patients (range; 1–7) had previously failed open herniorhaphies; in 20 cases, intraabdominal polypropylene
mesh was present. There were no conversions to open operation. The mean size of the defects was large at 87 cm2 (range; 1–480). In all cases, the mesh (average, 287 cm2) was secured with transabdominal sutures and metal tacks or staples. Operative time and estimated blood loss averaged 88
min (range; 18–270) and 30 cc (range; 10–150). Length of stay averaged 1.6 days (range; 0–4). There were 12 minor and (two)
major complications: cellulitis of the trocar site (two), seroma lasting >4 weeks (three), postoperative ileus (two), suture
site pain > 2 weeks (two), urinary retention (one), respiratory distress (one), serosal bowel injury (one), and skin breakdown
(one) and bowel injury (one). Both of the latter complications required mesh removal. With an average follow-up of 22.5 months
(range; 7–37), there have been (three) recurrences.
Conclusion: The laparoscopic approach to the repair of both primary and recurrent ventral henias offers a low conversion rate, a short
hospital stay, and few complications. At 23 months of follow-up, the recurrence rate has been 3%. Laparoscopic repair should
be considered a viable option for any ventral hernia.
Received: 11 February 1999/Accepted: 15 March 2000/Online publication: 28 April 2000 相似文献
8.
9.
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
10.
Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence,
the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated
laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter.
Methods: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair
with (n= 17) or without (n= 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both
repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis,
PTFE mesh with a 3-cm ``keyhole' was positioned around the gastroesophageal junction with the esophagus through the keyhole.
The PTFE was stapled to the diaphragm and crura with a hernia stapler.
Results: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every 6 months thereafter.
Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the
repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention)
in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE
was notable for three (16.7%) recurrences within the first 6 months of surgery.
Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence
in patients with large hiatal hernia defects.
Received: 1 May 1998/Accepted: 22 December 1998 相似文献
11.
Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs 总被引:3,自引:2,他引:1
C. Bloechle A. Emmermann T. Strate U. J. Scheurlen C. Schneider E. Achilles M. Wolf D. Mack C. Zornig C. E. Broelsch 《Surgical endoscopy》1998,12(3):212-218
Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical
concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure
and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional
open repair of gastric perforation and abdominal lavage for associated peritonitis.
Methods: To simulate gastric perforation, female Duroc pigs were subjects to standardized gastrotomy. Either 6 or 12 h after gastric
perforation, the animals underwent either traditional open or laparoscopic repair of the gastric defect and peritoneal lavage.
The subjects were divided into the following four groups: peritonitis for 6 h and open surgery (group I) or laparoscopic surgery
(group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group IV). After an observation period
of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics
suggestive for septic shock, bacteremia, and endotoxemia.
Results: There were no significant differences between group I and II. Mortality was 22% in group III, as compared to 78% in group
IV (p= 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly higher
than in group III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac
output suggested a higher incidence of septic shock in group IV.
Conclusion: Critical appraisal of laparoscopic surgery is warranted in conditions associated with severe, longstanding peritonitis.
Received: 28 February 1997/Accepted: 1 July 1997 相似文献
12.
结肠镜已成为目前诊治结直肠疾病最常用的方法.尽管肠穿孔与医源性因素及患者某些高危因素有关,发生率较低,但被认为是结肠镜术严重的并发症之一,病死率高.根据结肠镜术中或术后患者的临床表现,早期发现肠穿孔是成功治疗的前提,也是降低病死率的关键.在治疗上有保守治疗、开腹手术、腹腔镜手术及内镜夹等多种方法.临床上应具体分析和准确判断病情,不能一概而论,根据患者的临床表现、穿孔大小、肠道准备情况、确诊时间、结肠原发病变等具体临床条件选择合理有效的治疗方案. 相似文献
13.
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
14.
M. Miyahara S. Kitano K. Shimoda T. Bandoh K. Chikuba S. Maeo M. Kobayashi 《Surgical endoscopy》1996,10(3):352-353
A patient who sustained a colonic perforation during therapeutic colonoscopy was treated successfully by laparoscopic repair. Laparoscopy was performed 5 h after polypectomy. Fecal matter was not identified in the peritoneal cavity. Local peritonitis was mild. The laceration was oversewn with five sutures using the extracorporeal endoscopic knot technique. The appendix epiploica was then anchored over the lesion. The postoperative recovery was rapid and uneventful. Laparoscopic surgery may become a useful tool for the safe, effective, and minimally invasive management of iatrogenic colonic perforation. 相似文献
15.
腹腔镜胃十二指肠溃疡穿孔修补术28例报告 总被引:9,自引:0,他引:9
目的:探讨腹腔镜手术在胃十二指肠溃疡穿孔修补术中的应用价值。方法:2003年1月~2006年8月我院为28例胃十二指肠溃疡穿孔患者行腹腔镜穿孔修补术。结果:27例成功完成腹腔镜手术,1例中转开腹。手术时间30~100m in,平均45m in,术后住院时间5~10d,平均7.8d,术后并发症少,无一例死亡。结论:腹腔镜胃十二指肠溃疡穿孔修补术具有痛苦小,恢复快,并发症少,住院时间短等优点,疗效确切,操作简单易行,值得在临床工作中推广应用。 相似文献
16.
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
17.
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
18.
Laparoscopic splenectomy using a wall-lifting procedure 总被引:1,自引:1,他引:0
T. Nishizaki I. Takahashi T. Onohara K. Wakasugi T. Matsusaka K. Kume 《Surgical endoscopy》1999,13(10):1055-1056
A laparoscopic splenectomy using a hanger wall-lifting procedure is herein described. The patient is placed in the right
lateral position. The left lower chest and left abdominal wall are then lifted by three wires in two directions, left laterally
and vertical to the abdominal wall. The view of the operative field thus obtained is excellent. The lifting wires and bars
do not hinder the movement of the forceps, since the angles of the instruments to approach the spleen are different from those
of the wires. A laparoscopic splenectomy using this wall-lifting procedure avoids the usual complications associated with
pneumoperitoneum while still being technically comparable to a procedure with pneumoperitoneum.
Received: 7 October 1998/Accepted: 22 February 1999 相似文献
19.
Laparoscopic-assisted colonoscopic polypectomy 总被引:2,自引:0,他引:2
Background: The majority of colonic polyps found at endoscopy are suitable for diathermy snare excision via colonoscope. Due to location
or size, some are deemed unsafe to treat in this manner and therefore require colectomy. This study describes the technique
and early results of a laparoscopic-assisted colonoscopic polypectomy technique that can be used to manage such polyps and
thereby avoid laparotomy and colectomy.
Methods: Colonoscopy with simultaneous laparoscopy was utilized to locate the site of the polyp. The colon was mobilized, if required,
and the polyp resected by electrosurgical snare via the colonoscope while the serosal aspect of the colon was monitored laparoscopically.
Results: The technique has been tried successfully in six patients. Three polyps were in the cecum and three were within the left
colon. The size of the polyps ranged from 3 to 7 cm. All polyps were benign on histological examination. The patients were
discharged on the day following the procedure. There were no complications.
Conclusions: The combination of laparoscopy with colonoscopic resection of a select group of large polyps represents a safe alternative
to colonic resection.
Received: 18 March 1998/Accepted: 7 May 1998 相似文献
20.
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