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1.
Laparoscopic vs open colectomy for sigmoid diverticulitis 总被引:3,自引:0,他引:3
Tuech JJ Pessaux P Rouge C Regenet N Bergamaschi R Arnaud JP 《Surgical endoscopy》2000,14(11):1031-1033
Background: The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis
in patients aged ≥75 years.
Methods: From January 1993 to December 1998, all patients 75 years of age and older undergoing an elective colectomy for sigmoid diverticulitis
were included in the study. The patients were divided into the following two groups: group 1 (n= 22) consisted of patients who underwent a laparoscopic procedure; group 2 (n= 24) consisted of patients who underwent an open procedure.
Results: In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75–82); in group 2, there were 14 women
and 10 men with a mean age of 78 years (range, 76–84) (p= 0.37). There was no difference between the groups in ASA classification. The operative time was shorter in group 2 (136
vs 234 mins). The postoperative period during which parenteral analgesics were required (5.4 vs 8.2 days, p= 0.001), postoperative morbidity (18% vs 50%, p= 0.02), postoperative length of hospital stay (13.1 vs 20.2 days, p= 0.003), and the inpatient rehabilitation (6 vs 15 patients, p= 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was
9% in group 1.
Conclusion: The data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older
patients with fewer complication, less pain, shorter hospital stay, and a more rapid return to preoperative activity levels
than that seen with open colorectal resection.
Received: 22 November 2000/Accepted: 22 February 2000/Online publication: 7 September 2000 相似文献
2.
F. K. Toy R. W. Bailey S. Carey C. W. Chappuis M. Gagner L. G. Josephs E. C. Mangiante A. E. Park A. Pomp R. T. Smoot Jr. J. F. Uddo Jr. G. R. Voeller 《Surgical endoscopy》1998,12(7):955-959
Background: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE]
patch for hernias ≥4 cm2) is being used in a prospective, multicenter, long-term study.
Methods: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted
7–10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients.
Results: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120
min. The mean follow-up was 222 days (range 5–731). Postoperative complications were five infections, three cases of prolonged
ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge
occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively.
Conclusions: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications
and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty,
the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.
Received: 3 April 1997/Accepted: 10 August 1997 相似文献
3.
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
4.
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
5.
Background: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin
hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine
low recurrence rates with minimal postoperation morbidity.
Methods: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients)
and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded.
Results: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0.001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced
less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p= 0.03) for work, and 29 versus 21 days, respectively (p= 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7
in 56 (12.5%) for TAPP (p= 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179.
Conclusions: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult
operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic
mesh repair remains the best repair.
Received: 14 April 1998/Accepted: 28 May 1998 相似文献
6.
A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair 总被引:5,自引:2,他引:3
A. M. Paganini E. Lezoche F. Carle F. Carlei F. Favretti F. Feliciotti R. Gesuita M. Guerrieri D. Lomanto M. Nardovino M. Panti P. Ribichini L. Sarli M. Sottili A. Tamburini A. Taschieri 《Surgical endoscopy》1998,12(7):979-986
Background: The aim of this prospective, randomized, controlled clinical study was to compare laparoscopic transabdominal preperitoneal
(TAPP) hernia repair with a standard tension-free open mesh repair (open).
Methods: A total of 108 low-risk patients with unilateral (primary or recurrent) or bilateral hernias were randomized to TAPP (group
1 = 52 cases) or open (group 2 = 56 cases). The outcome measures included operating time, complications, postoperative pain,
return to normal activity, operating theater costs, and recurrences.
Results: The mean operative time was longer for the TAPP than for the open group only in unilateral primary hernias. At rest, the
median Visual Analog Scale (VAS) score was higher for group 1 than group 2 at 48 h postoperatively. Mild to discomforting
pain in the inguinal region after 7 days, night pain after 30 days, and inguinal hardening after 3 months were more frequent
in group 2 than group 1. No significant differences were observed in return to normal activities between the groups. One hernia
recurrence was observed after 1 month in group 1. TAPP was significantly more expensive than open.
Conclusions: TAPP was associated with less postoperative pain than open. The increase in operating theater costs, however, was dramatic
and was not compensated by shorter time away from work. TAPP should not be adopted routinely unless its costs can be drastically
reduced.
Received: 10 June 1997/Accepted: 6 October 1997 相似文献
7.
Postoperative pain and fatigue after laparoscopic or conventional colorectal resections 总被引:16,自引:0,他引:16
Background: Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic
approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after
colorectal resections.
Methods: Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n= 30) or conventional (n= 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine
sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue
scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR).
Results: Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately
after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5–95 percentile 0.71–2.46
mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24–2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative
day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh
day (p < 0.05).
Conclusions: This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional
colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences,
the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.
Received: 4 July 1997/Accepted: 16 November 1997 相似文献
8.
Background: Laparoscopic nephrectomy in the adult population is reported with increased frequency. We present our initial experience
with laparoscopic nephrectomy in children.
Methods: Over a 2-year period, 11 nephrectomies were performed in nine children aged 16 months to 16 years (mean, 6.5 years). All
patients were referred due to complications of a nonfunctioning kidney. Seven patients had recurrent urinary tract infections,
and two had refractory hypertension. Two patients underwent bilateral laparoscopic nephrectomy. The operation was performed
using four access ports measuring 3.5 to 10 mm.
Results: All kidneys were removed successfully using a laparoscopic technique. The average length of the operation was 163 min per
kidney (range, 90–420). The estimated blood loss was <10–150 ml (mean, 45). No patient required transfusion. Seven patients
were discharged home by postoperative day 2. The two patients with the longest operating times were discharged home on postoperative
days 4 and 5 due to delay in return of bowel function. Narcotic use was minimal, and all patients enjoyed a rapid return to
full activity.
Conclusion: Laparoscopic nephrectomy is a viable alternative to open nephrectomy in children. Further experience with this technique
is required to establish its efficacy and reduce the operating time
Received: 29 April 1999/Accepted: 29 August 1999/Online publication: 17 April 2000 相似文献
9.
Background: We compared the incidence of early hernia recurrence in nonrandomized but consecutive patients undergoing laparoscopic repair
of paraesophageal hernia (LRPH) without and with excision of the hernia sac.
Methods: LRPH was completed in 55 of 58 patients. In the first 25 patients, the sac was not excised. Total sac excision was performed
in the subsequent 30 patients. All patients had crural repair with or without fundoplication, or gastropexy.
Results: Mean age of patients was 68 years (range, 34–95). There were three conversions; one patient died postoperatively. Mean operative
time was 225 min in the first group and 190 min in the sac excision group. Median length of stay was 2 days (range, 1–15)
for both groups.
Conclusions: A precise method of total sac excision simplified dissection. It also ensured complete reduction of the hernia and availability
of adequate esophageal length. Operative time was not increased, and no subsequent early recurrences were observed (p < 0.05).
Received: 3 April 1997/Accepted: 18 July 1997 相似文献
10.
Donini A Baccarani U Terrosu G Corno V Ermacora A Pasqualucci A Bresadola F 《Surgical endoscopy》1999,13(12):1220-1225
Background: Laparoscopic splenectomy (LS) is becoming the gold standard in the treatment of several splenic diseases. Shorter postoperative
stay and more rapid return to full activity are the primary advantages of LS.
Methods: Prospective data collection of 44 consecutive LS (group 1) and comparison with a historical control group of 56 consecutive
open splenectomies (OS) (group 2) were performed for hematologic diseases.
Results: The LS patients started earlier on an oral diet (p < 0.0001) and left the hospital sooner (p < 0.0002) than OS patients. Less blood transfusion (p < 0.004) and pain medication (p < 0.0001) was required by LS patients. They also had fewer postoperative complications (p < 0.03). Compared by diagnosis, patients with laparoscopic idiopathic thrombocytopenic purpura or Hodgkin's disease started
to eat earlier (p < 0.0001) and left the hospital sooner (p < 0.01). Multivariate analysis showed that time to oral diet and postoperative stay was related to operative technique and
age. Morbidity and pain medications were related, respectively, to transfusion requirements and type of surgical approach.
Conclusions: Used to manage hematologic diseases, LS is feasible, effective, and safe. It offers several advantages over the open approach.
The type of surgical approach seems to be the crucial factor in determining the length of the postoperative course.
Received: 16 July 1998/Accepted: 20 January 1999 相似文献
11.
Comparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer 总被引:10,自引:7,他引:3
Background: The aim of the study is to evaluate the safety and efficacy of laparoscopic omental patch repair.
Method: This is a retrospective review of 53 consecutive patients with omental patch repair for perforated duodenal ulcer; 38 underwent
conventional open approach and 15 underwent laparoscopic patch repair. The only selection criterion was availability of expertise
for laparoscopic repair on the day of admission. By chance, the open group had poorer ASA scores. There were four deaths and
five postoperative complications in the open group.
Results: Laparoscopic repair was successful in 14 cases with one postoperative complication. Operative time was longer in the laparoscopic
group (80 vs 65 min in open group, p= 0.02). Patients required less postoperative analgesics in the laparoscopic group (median amount of pethidine was 75 mg vs
175 mg in the open group, p= 0.03). There was no statistically significant difference in terms of hospital stay and return to normal activities between
the two procedures. Follow-up Visick scores were comparable in both groups.
Conclusions: Laparoscopic omental patch repair offers a safe alternative to the conventional method and causes less postoperative pain.
Received: 29 December 1995/Accepted: 3 May 1996 相似文献
12.
A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit 总被引:8,自引:5,他引:3
Background: Laparoscopic hernia repair has often been criticized for its high costs.
Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic
or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit.
Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable
for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open
group. The hospital costs were 2051 FIM ($1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed
patients (including expenses due to lost work days) were lower.
Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the
laparoscopic technique, when the cost of lost work days is factored into overall expense.
Received: 5 May 1997/Accepted: 28 October 1997 相似文献
13.
Tension-free Laparoscopic and Open Hernia Repair: Randomized Controlled Trial of Early Results 总被引:3,自引:0,他引:3
Marcello Picchio Assunta Lombardi Aleksejs Zolovkins Maris Mihelsons Giuseppe La Torre 《World journal of surgery》1999,23(10):1004-1009
The aim of the study was prospectively to compare the early results and outcome in 105 patients randomly allocated to undergo
tension-free laparoscopic hernia repair (LHR) with transabdominal preperitoneal technique (53 patients) or open hernia repair
(OHR) with mesh apposition (52 patients). The mean (SD) operation time was longer in the LHR group than in the OHR group:
49.6 (5.4) versus 33.9 (6.2) minutes; p < 0.001. One laparoscopic case was converted to open repair to deal with a hemorrhage from an aberrant obturatory artery
at the level of Cooper's ligament. Groin discomfort or pain was the most common complication after both procedures. The patients
requiring none, one, two, or more than two doses of intramuscular diclofenac were, respectively, 40.4%, 40.4%, 15.4%, and
3.8% after LHR and 50.0%, 30.8%, 17.3%, and 1.9% after OHR (p= 0.69; NS). The mean ± SEM (range) postoperative visual analog scale score, ranging from 0 (no pain) to 10 (worst pain imaginable),
was 3.1 ± 0.2 (1–7) in the LHR subset and 2.7 ± 0.2 (1–5) in the OHR group (p= 0.14; NS); on the second postoperative day the score was 2.3 ± 0.2 (1–6) and 1.8 ± 0.1 (1–4), respectively (p < 0.03). The time ± SEM (range) of resumption of pain-free normal activities and work was faster in OHR group: 6.1 ± 0.2
(4–8) weeks versus 6.5 ± 0.1 (4–8) weeks; p < 0.03. Our results showed that tension-free open hernia repair is superior to LHR in terms of postoperative pain with no
important differences in recovery. 相似文献
14.
Background: Unlike sliding hiatal hernias, paraesophageal hiatal hernias (PEH) present a risk of catastrophic complications and should
be repaired. To assess laparoscopic repair of PEH, we prospectively evaluated the outcome of 38 consecutive patients with
type II (20 patients) or III (18 patients) PEH treated laparoscopically.
Methods: With the use of 5 or 6 ports, laparoscopic PEH reduction and repair was attempted. One patient (3%) was converted to an open
procedure. In the first 12 patients, the hiatus was closed using varying techniques including the placement of prothestic
mesh in 6 patients, and the hernia sac was not routinely excised. In the next 25 patients, the hernia sac always was excised
and the hiatus routinely sutured posteriorly to the esophagus. Twenty-nine patients also underwent either a Nissen (n= 27) or Toupet (n= 2) fundoplication, which is now performed routinely. Sutured anterior gastropexy was performed selectively in 10 of the
first 20 patients, then routinely, using T-fasteners in the last 17 patients. Barium swallow studies were performed on all
patients at 3 to 5 months postoperatively.
Results: Mean ± standard error of the mean (SEM) age was 67 ± 2 year (range, 39–92 years; 11 men, 27 women), and the American Society
of Anesthesia (ASA) score was 2.5 ± 0.1. The operating time was 195 ± 10 min: 244 ± 15 min in the first 12 patients and 170
± 11 min in the last 25 patients (p < 0.001). There were three (8%) intraoperation complications, which were treated without sequelae, and four (11%) grade II
postoperation morbidities. Median discharge was 3 days, and return to full activity was 14 days. Two patients (5%) died of
cardiovascular disease after discharge. Barium swallow revealed 2/35 (6%) PEH recurrences (1 reoperated), 3 (9%) intrathoracic
wraps, and 3 (9%) small sliding hiatal hernias. At follow-up of 1 year or more, 6/28 (21%) patients noted mild symptoms of
reflux or bloating, but only 1 patient (4%) required medication for these symptoms.
Conclusions: Laparoscopic PEH repair offers a reasonable alternative to traditional surgery, especially for high-risk patients. Rapid
recovery is achieved with acceptable morbidity and early outcome. Barium x-rays revealed hiatal abnormalities in a significant
fraction of patients, many of whom were asymptomatic. Longer follow-up will be required to determine the ideal strategy for
management of these patients.
Received: 4 April 1998/Accepted: 9 December 1998 相似文献
15.
Laparoscopic creation of stomas 总被引:5,自引:0,他引:5
Background: Some indications for laparoscopic bowel surgery are still controversial. However, the use of laparoscopic techniques for
the treatment of benign disorders is less often challenged. Moreover, the morbidity of nonresectional procedures is less than
that encountered with resectional cases. Therefore, stoma creation seems ideally suited to laparoscopy. The aim of our study
was to assess the outcome of laparoscopic stoma creation.
Methods: All patients who underwent laparoscopic intestinal diversion were evaluated; parameters included age, gender, indication
for the procedure, history of previous surgery, operative time, length of hospitalization, recovery of bowel function, and
postoperative complications.
Results: Between March 1993 and January 1996, 32 patients of a mean age of 42.2 (range 19–72) years (14 males, 18 females) underwent
elective laparoscopic fecal diversion (25 loop ileostomy, four loop colostomy, three end colostomy). Indications for fecal
diversion were fecal incontinence (n= 11), Crohn's disease (n= 6), unresectable rectal cancer (n= 4), pouch vaginal fistula (n= 3), rectovaginal fistula (n= 2), colonic inertia (n= 2), radiation proctitis (n= 1), anal stenosis (n= 1), Kaposi's sarcoma of the rectum (n= 1), and tuberculous fistula (n= 1). Conversion was required in five patients (15.6%) due to the presence of adhesions (three), enterotomy (one), or colotomy
(one). All of these five patients had undergone previous abdominal surgery and were operated on early in our experience. Major
postoperative complications occurred in two patients (6%) and in both cases consisted of stoma outlet obstruction after construction
of a loop ileostomy. One of the two patients had undergone prior surgery. This patient required reoperation, at which time
a rotation of the terminal ileum at the stoma site was found. The other patient had a narrow fascial opening which was successfully
managed with 2 weeks of self-intubation of the stoma. The mean operative time was 76 (range 30–210) min; mean length of hospitalization
was 6.2 (range 2–13) days; stoma function started after a mean of 3.1 (range 1–6) days. Patients with previous abdominal surgery
had a longer mean operative time (14/32; 117 min) compared to patients who had no previous surgery (18/32; 55 min) (p < 0.0002). These longer operative times and hospital stay were attributable to extensive enterolysis, which was required
in some cases.
Conclusion: In conclusion, laparoscopic creation of intestinal stomas is safe, feasible, and effective. Although the length of the procedure
is longer in patients who have had prior surgery, previous surgery is not a contraindication, and even in these cases, a laparotomy
can be avoided in the majority of patients. Lastly, care must be taken to ensure adequate fascial opening and correct limb
orientation.
Received: 25 March 1996/Accepted: 21 May 1996 相似文献
16.
Laparoscopic versus open ventral hernia mesh repair: a prospective study 总被引:15,自引:4,他引:11
Background An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding
unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased
the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality
as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was
applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and
decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open
and laparoscopic ventral hernia repair.
Methods The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive
unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique
using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair
technique in all cases.
Results The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30–83 years). The patients
in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients
in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640–23.0227 months). The mean surgery
durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open
hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic
group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair
than among those who had open repair (30% and 10%, respectively).
Conclusions The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative
time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of
choice for ventral hernia repair. 相似文献
17.
A. D. K. Hill P. E. Banwell A. Darzi N. Menzies-Gow J. R. T. Monson P. J. Guillou 《Surgical endoscopy》1995,9(6):695-698
Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma. We hypothesized that the inflammatory response is less with minimally invasive procedures. The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair. Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospectively assigned to either laparoscopic mesh hernia repair (n=14), open mesh hernia repair (n=11), or a Bassini repair (n=9). Serum samples withdrawn prior to surgery, 6 h after surgery, and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content. Interleukin-6 levels at 24 h in the laparoscopic (13.1±3.1 pg/ml), open mesh (15.5±2.5 pg/ml), or Bassini group (15.4±2.0 pg/ml) did not differ significantly. Neither did C-reactive protein levels at 24 h in the laparoscopic (12.4±2.7 pg/ml), open mesh (23.0±7.8 pg/ml), or Bassini group (18.6±6.6 pg/ml) differ significantly. The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically. 相似文献
18.
Intermittent pneumatic sequential compression (ISC) of the lower extremities prevents venous stasis during laparoscopic cholecystectomy 总被引:2,自引:1,他引:1
Background: Fifty patients were included in a prospective randomized trial to evaluate the efficacy of intermittent sequential compression
(ISC) of the lower extremities in preventing venous stasis during laparoscopic cholecystectomy.
Methods: We treated 25 patients with (+ISC) and 25 without (–ISC) intermittent sequential compression. Peak flow velocity (PFV) and
cross-sectional area (CSA) of the right femoral vein were measured by Doppler ultrasound before, during, and after capnopneumoperitoneum
with 14 mm Hg.
Results: PFV was 26.4 (8.4) cm/s and CSA was 1.03 (0.23) cm2 before pneumoperitoneum was induced. During abdominal insufflation, PFV decreased to 61% of the baseline value in the (–ISC)
group but remained unchanged in the (+ISC) group (t = 5.17, df = 42.8, p < 0.01). CSA was 1.06 (0.22) cm2 before insufflation. It increased to 118% of the baseline in the (–ISC) group and to 108% in the (+ISC) group (t =–1.55,
df = 47.1, p= 0.13). PFV and CSA returned to baseline values within 5 min after abdominal desufflation.
Conclusions: ISC effectively neutralizes venous stasis during laparoscopic surgery and may decrease the risk of postoperative thromboembolic
complication. Therefore, it is recommended for all prolonged laparoscopic procedures.
Received: 10 April 1996/Accepted: 24 April 1997 相似文献
19.
Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease 总被引:3,自引:0,他引:3
Background: A prospective assessment of the impact of laparoscopic colon resection (LCR) was carried out in order to quantify immediately
recognizable benefits and limitations of this approach.
Methods: Elective LCR was attempted in 95 selected patients (mean age 64 years, range 39–81 years) presenting with benign disease
of the colon. A completely intracorporeal approach was adopted. Results were compared with a control group of 90 patients
who had previously undergone open colectomy (OC) by the same surgeons at the same institution.
Results: There were no perioperative deaths. Intraoperative complications included difficult extraction of accidentally detached anvil
(n= 1), air leak at colonoscopy (n= 2), and conversion to OC (n= 1). Operating time was significantly longer after LCR compared with OC (180 ± 10.3 vs 116 ± 97, p < 0.001). Passage of flatus (3.5 ± 1.2 days vs 4.4 ± 1.4, p < 0.5) and morbidity (4 vs 3, p= 0.48) were not significantly different in the two groups. Hospital stay was significantly shorter after LCR (5.2 ± 1.3 days
vs 12.2 ± 1.9 days, p < 0.001). Theater and ward costs were, respectively, significantly increased ($ 2,829.6 ± 340 vs $ 1,422 ± 318, p < 0.001) and decreased ($ 2,600 ± 366 vs $ 6,022 ± 916, p < 0.001) in LCR patients compared with the OC group. There was no significant difference in total hospital costs ($ 10,929
± 369 vs $ 9,944 ± 1,014).
Conclusions: LCR does not appear to offer any immediately recognizable advantages.
Received: 15 October 1996/Accepted: 13 December 1996 相似文献
20.
Microlaparoscopic cholecystectomy 总被引:11,自引:4,他引:7
Background: We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope
and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC).
Methods: Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics,
history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia
were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was
78 kg (range, 48–119) and average height was 163 cm.
Results: Operative time for MLC was 72 ± 25 min (range, 35–140), somewhat less than the referenced standard of 79 ± 27 min (p= 0.1). The skin-to-trocar time (6 ± 2 vs 13 ± 77 min) and intraoperative cholangiogram time (9 ± 8 vs 11 ± 6 min) were significantly
shorter (p < 0.01 and p < 0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74 ± 21 min
(range, 44–118) compared to 75 ± 27 min (range, 35–140) for PGY3 and 53 ± 5 (range, 43–59) for PGY5. Patient weight influenced
time. Patients <65 kg averaged 56 ± 12 min; 66–80 kg, 72 ± 24 min; 81–95 kg, 78 ± 26 min; and >95 kg, 85 ± 22 min. Previous
abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of
adhesions, wall thickening, or need for better retraction. Time in these patients was 95 ± 26 min vs 68 ± 21 min in other
patients (p < 0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile
duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm
port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21 ± 0.19 mg/kg (range, 0–0.8). Hospital
stay was 1.31 days (range, 0.5–4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity
was seen with MLC.
Conclusion: MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and
possibly an earlier return to normal activity.
Received: 16 February 1999/Accepted: 8 October 1999 相似文献