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1.
Postoperative complications of laparoscopic-assisted colectomy 总被引:4,自引:2,他引:2
A. M. Lacy J. C. García-Valdecasas S. Delgado L. Grande J. Fuster J. Tabet C. Ramos J. M. Piqué A. Cifuentes J. Visa 《Surgical endoscopy》1997,11(2):119-122
Background: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic
assisted colorectal resections.
Methods: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative
ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique.
Results: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients
for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and
one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%).
The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was
36 ± 16 h. Mean postoperative stay was 5.4 (range 3–13) days. Eight patients (6.8%) sustained complications: four unrelated
to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach:
one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma.
Conclusions: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic
colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic
approach to colorectal surgery.
Received: 25 March 1996/Accepted: 8 July 1996 相似文献
2.
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
3.
Background: In order to better investigate the effects of laparoscopic surgery, it is necessary to establish reliable, reproducible,
and economical animal models of laparoscopic intervention. Here we describe a mouse model of laparoscopic-assisted colon resection.
Methods: After successful induction of anesthesia the mouse is placed in Trendelenburg position and the peritoneal cavity is insufflated
with carbon dioxide gas through an angiocatheter placed in the right upper quadrant. A 4-mm rigid scope with camera attachment
is then inserted through a midline port created just caudal to the xiphoid. A second port is then created in the right lower
quadrant to allow introduction of laparoscopic forceps into the peritoneal cavity. The cecum, which extends 1.5 cm beyond
the ileocecal valve, is grasped with forceps and exteriorized through the operative port. Extracorporeally, the cecum is ligated
and resected before the cecal stump is returned to the peritoneal cavity. The abdominal wall defects are then stapled closed.
Results: This simple model can be mastered by individuals with very limited surgical experience. This laparoscopic model has been
used successfully in our laboratory in a number of experiments with an intraoperative complication rate of 3.2% (3/94), which
was similar to the open surgery group rate of 2.1% (2/95, p= 0.99 by chi square). We observed no postoperative leaks in either group. The only postoperative death occurred in the open
resection group due to dehiscence of the laparotomy wound.
Conclusions: We propose that this model may be useful for comparing the effects of open to laparoscopic surgery.
Received: 19 June 1996/Accepted: 2 November 1996 相似文献
4.
Background: Intra-abdominal complications from transabdominal properitoneal (TAP) laparoscopic herniorrhaphy that would not be expected
to occur in an open herniorrhaphy are possible. In a previous study, we reported the incidence of significant intra-abdominal
adhesions from TAP herniorrhaphies using polypropylene in pigs.
Methods: To compare this with an open herniorrhaphy technique, we performed open herniorrhaphies on 31 pigs. Additional animals underwent
TAP herniorrhaphy with PTFE. Data were collected on operative and trocar-site adhesions. Graft incorporation was recorded.
Results: No intra-abdominal adhesions were found in the 31 animals undergoing open herniorrhaphy. Fifteen adhesions were found in
the 31 pigs that underwent TAP herniorrhaphy. These adhesions were graded and there were a total of nine significant adhesions
with the TAP procedure. A total of 124 trocar sites resulted in two adhesions. Laparoscopically placed polypropylene was better
incorporated than PTFE. The laparoscopically placed PTFE grafts commonly were poorly incorporated.
Conclusions: We conclude that there is a risk of intra-abdominal adhesions to either the operative site or the trocar sites in TAP herniorrhaphy
that is not present in open techniques. One should, therefore, be circumspect in the choice of TAP herniorrhaphy as a primary
repair.
Received: 8 April 1996/Accepted: 21 May 1996 相似文献
5.
Background: Tumor dissemination to trocar sites following the removal of a gallbladder malignancy by laparoscopic cholecystectomy is
well documented. The mode of transfer of malignant cells to those sites remains unclear.
Methods: The appearance and movement of gallbladder mucosal cells within the peritoneal cavity during laparoscopic cholecystectomy
was prospectively studied in 15 patients. The appearance of cells on laparoscopic instruments, laparoscopic working ports,
and also within a 5-μm polycarbonate filter, filtering exhaust carbon dioxide and attached to one of the main working ports,
was noted.
Results: Four out of 15 gallbladders were perforated during cholecystectomy. Operative choledochography was performed in 11 of the
15 cases. Glandular cells were found on instruments at the end of the procedure in six cases. Cells were also found in two
of the 15 polycarbonate filters and on the laparoscopic ports in two of the 15 cases.
Conclusion: These findings suggest that cellular contamination of the peritoneal cavity is frequent during laparoscopic cholecystectomy.
This may occur when the gallbladder wall is macroscopically breached or when operative choledochography is performed, or by
microperforation due to the application of crushing laparoscopic graspers to the gallbladder wall. Glandular cells adhere
to instruments in 40% of the operative procedures and may be the main source of dissemination of malignant cells through the
peritoneal cavity.
Received: 29 January 1996/Accepted: 8 April 1996 相似文献
6.
S. H. Kim J. W. Milsom J. M. Church K. A. Ludwig A. Garcia-Ruiz J. Okuda V. W. Fazio 《Surgical endoscopy》1997,11(10):1013-1016
Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before
resection is undertaken.
Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for
laparoscopic colorectal operations and to review their effectiveness.
Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization
was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon,
even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy
reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize
the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative
colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension
(nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy
alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and
in no patient was the wrong segment resected.
Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking.
Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates
intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative
tattooing. Further studies regarding the technique of tattooing are warranted.
Received: 18 July 1996/Accepted: 10 March 1997 相似文献
7.
Determination of the learning curve of the AESOP robot 总被引:11,自引:1,他引:10
Background: As the variety of procedures performed with laparoscopic technology increases, the skill levels and equipment demands also
increase. Laparoscopic appendectomy, hernia repair, colon resection, and Nissen fundoplication all require someone whose only
responsibility is to control the laparoscope and therefore the operative field. This is usually the most inexperienced person
on the operating team. The Automated Endoscope System for Optimal Positioning (AESOP) robot provides a means to eliminate
the need for the camera person, returns control of the camera and operative field to the operating surgeon, and enhances human
performance. The purpose of this study was to evaluate the acquisition of skills to control the laparoscope in a satisfactory
fashion.
Methods: We selected medical students as our study group because they have no prior experience in laparoscopic procedures. They performed
a readily reproducible task in a pelvic trainer with hand control and with the AESOP robot. Their initial times are compared,
as is the improvement in their times after 10 min of practice with the AESOP robot.
Results: These data show that in this study group use of the AESOP robot was not as fast as hand control but the skill to use it was
learned as quickly. Additional features of the robut such as a steady view and the ability to acquire images and return to
them reliably are other advantages.
Conclusion: The AESOP robotic arm provides a stable support for the laparoscope during laparoscopic procedures which can be manipulated
by the surgeon. We found that the time required to learn control of the laparoscope manually and with the AESOP robot is equal.
Received: 22 April 1996/Accepted: 17 June 1996 相似文献
8.
Background: In spite of the emergence of laparoscopic cholecystectomy as the gold standard for treatment of symptomatic gallstones, questions
still remain regarding its overall cost effectiveness, especially at low-volume centers where operating room (OR) time and
operative complications are higher. We hypothesize that the presence of a well-organized, dedicated laparoscopic OR team will
improve surgical outcomes for this procedure. This study compares the operative results of an advanced and a basic laparoscopic
surgeon using either a designated laparoscopic operating team or a nondesignated team.
Methods: The hospital records for 71 elective laparoscopic cholecystectomies with cholangiograms were retrospectively reviewed and
anesthesia times and conversion rates were analyzed. Procedures were performed either at a hospital with a dedicated laparoscopy
team or a hospital with nondedicated OR personnel. All procedures were done by an advanced laparoscopic surgeon or a basic
laparoscopic surgeon.
Results: Case characteristics were evenly matched between sites and surgeons. The mean total anesthesia time at the dedicated site
was 120.8 min, compared to 152.3 min at the nondedicated site with a mean difference of 31.5 min (p= 0.001). A 12% conversion rate was documented at the nondedicated site. There were no conversions at the site with a dedicated
laparoscopy team. No major complications were encountered in this series.
Conclusion: This study demonstrates that having a designated laparoscopic trained team provides a time savings to both advanced and basic
laparoscopic surgeons. Although no major complications were encountered, there was a significant conversion rate for the less
experienced surgeon operating without the support of a trained team. The end result from having a dedicated team in endoscopic
surgery is decreased operative time, an improvement in patient care, and decreased costs to the patient and institution.
Received: 5 July 1996/Accepted: 9 January 1997 相似文献
9.
Background: The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy.
Methods: A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract
injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire.
Results: Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant
correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative
bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions,
more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries
and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography
and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury
or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to
multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and
advanced age.
Conclusions: The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.
Received: 1 March 1996/Accepted: 26 November 1996 相似文献
10.
Bile duct injury after laparoscopic cholecystectomy 总被引:27,自引:3,他引:27
Background: Forty series reporting experience with laparoscopic cholecystectomy in the United States from 1989 to 1995 were reviewed.
A total of 114,005 cases were analyzed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or
liver bed (0.38%) were recorded. Intraoperative cholangiography (IOC) was attempted in 41.5% of the laparoscopic cholecystectomies
and was successful in 82.7%. In major bile duct injuries, the common bile duct/common hepatic duct were the most frequently
injured (61.1%) and only 1.4% of the patients had complete transection.
Methods: When reported, most of the bile duct injuries were managed surgically with a biliary-enteric anastomosis (41.8%) or via laparotomy
and t-tube or stent placement (27.5%). The long-term success rate could not be determined because of the small number of series
reporting this information. The management for bile leaks usually consisted of a drainage procedure (55.3%) performed endoscopically,
percutaneously, or operatively.
Results: The morbidity for laparoscopic cholecystectomy, excluding bile duct injuries or leaks, was 5.4% and the overall mortality
was 0.06%. It was also noted that the conversion rate to an open procedure was 2.16%.
Conclusions: It is concluded based on this review of laparoscopic cholecystectomies that the morbidity and mortality rates are similar
to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore,
bile duct injuries can be minimized by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle,
the cystic duct–gallbladder junction, and the cystic duct–common bile duct junction.
Received: 24 September 1996/Accepted: 28 July 1997 相似文献
11.
Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma 总被引:11,自引:3,他引:8
Background: A combination of digital palpation and ultrasonography plays an important role in locating insulinomas intraoperatively.
Laparoscopic resection of insulinomas has been described recently, but experience in locating insulinomas during laparoscopy
is lacking.
Methods: From January 1998 to January 1999, three patients with pancreatic insulinomas underwent laparoscopy and laparoscopic ultrasonography
aimed at intraoperative localization and potential resection. The role of laparoscopy and laparoscopic ultrasonography in
locating insulinomas is evaluated.
Results: Preoperative localization studies were routinely performed, and two patients had an occult tumor before laparoscopy. None
of the tumors was detected by laparoscopic examination, but laparoscopic ultrasonography identified solitary tumors located
at the body and tail of the pancreas. Conversion to laparotomy was performed in one patient as a planned procedure. One patient
underwent laparoscopic enucleation, whereas the other had a laparoscopic distal pancreatectomy.
Conclusions: Laparoscopic ultrasonography seems to be sensitive in locating insulinomas at the body and tail of the pancreas. It optimizes
and facilitates resection of insulinomas through a minimally invasive approach.
Received: 8 March 1999/Accepted: 10 August 1999/Online publication: 7 September 2000 相似文献
12.
Background: Experience with 94 resections in 88 patients with Crohn's disease using advanced laparoscopic techniques is reported. Records
of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed.
Indications, operative findings, clinicopathologic, and postoperative data were recorded.
Methods: In this study, the mean age was 37 years (range, 16–70 years), and 55% of the participants were women. Indications for surgery
included obstruction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 case). Seventy patients underwent ileocolic
resection, 28 of whom had a previous history of one or two ileocolic resections. Eight of these patients had additional procedures
including tubal ligation (1), sigmoidectomy (1), cholecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection
(13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anterior rectal resection (2 cases), and sigmoid
resection (3 cases) were performed in the remaining patients. All but one procedure were completed laparoscopically with extracorporeal
anastomosis. The average length of intestine resected was 33 cm (range, 10–92 cm). Forty-one patients had 58 fistulae between
ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. Mean blood loss was 168 ml (range, 30–800 ml) and mean
operative time was 183 min (range, 96–400 min).
Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay
was 4.2 days (range, 3–11 days). Complications included anastomotic leak necessitating reoperation, stricture requiring endoscopic
dilation, hemorrhage treated expectantly, urinary tract infection, pulmonary embolus, line sepsis, and early postoperative
intestinal obstruction (7 cases) requiring reoperation in three cases.
Conclusions: Experience with both advanced laparoscopic techniques and conventional surgery for inflammatory bowel disease allowed successful
laparoscopic management of patients with complicated Crohn's disease.
Received: 29 August 1998/Accepted: 22 January 1999 相似文献
13.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
14.
Background: Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive
than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality
than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced
laparoscopic techniques to deal with iatrogenic colonic perforations.
Methods: Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent
of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection,
or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded.
Results: Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients
(one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures.
There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically
treated patients were satisfied with their clinical outcome and cosmetic results.
Conclusions: Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive
than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to
colonoscopy.
Received: 25 February 1998/Accepted: 22 June 1998 相似文献
15.
Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic
gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared
to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal
cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery.
Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy
was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach,
and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated
medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric
bypass was performed.
Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of
the stomach and surrounding upper abdominal organs.
Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to
decrease operation time.
Received: 18 September 1996/Accepted: 26 December 1996 相似文献
16.
Laparoscopy for chronic abdominal pain 总被引:3,自引:1,他引:2
Background: This purpose of this investigation was to evaluate the utility of laparoscopy in patients with chronic abdominal pain.
Methods: A retrospective review was performed of 34 patients who underwent laparoscopy for chronic abdominal pain. Average patient
age was 39 years. The majority were women. Most had undergone abdominal surgery in the past.
Results: All procedures were performed laparoscopically. A positive finding was made in 65% of patients. Fifty-six percent of patients
underwent adhesiolysis, but 26% required no operative intervention other than laparoscopic exploration. Notably, 73% of patients
reported improvement in pain postoperatively, whether or not a positive finding had been made on laparoscopy.
Conclusions: This retrospective study suggests laparoscopy can identify abnormal findings and improve outcome in a majority of selected
cases. Recommendations are provided for patient selection. Prior abdominal surgery is not an absolute contraindication to
laparoscopic exploration for chronic abdominal pain.
Received: 16 April 1996/Accepted: 30 May 1996 相似文献
17.
Laparoscopic liver surgery 总被引:7,自引:0,他引:7
Background: An effort was made to evaluate the indications, safety, and therapeutic efficacy of laparoscopic liver surgery.
Methods: Between 1989 and 1996, 28 patients, 23 to 88 years old were operated upon laparoscopically. Pathology consisted of simple
cyst (ten), polycystic liver disease (seven), hydatid cyst (three, two of them calcified), abscess (one), focal nodular hyperplasia
(six), and metastatic breast cancer (one).
Results: Operations included 17 fenestrations, three pericystectomies, and eight resections (two lateral lobes). Operative time was
45 to 525 min with only four cases longer than 4 h. There was a 21% morbidity rate. There were no mortalities. Follow-up was
1–67 months with one asymptomatic recurrence.
Conclusions: Laparoscopic hepatic surgery can be performed safely with good results by surgeons with hepatic and laparoscopic experience
when careful selection criteria are followed. We advocate the ``four-hands technique' for simultaneous dissection and control
of bleeding and bile ducts during resections.
Received: 10 May 1996/Accepted: 26 July 1996 相似文献
18.
Background: Laparoscopic appendectomy was first described in the early 1980s and is currently widely used for the treatment of acute
appendicitis. The application of laparoscopic techniques to interval appendectomy and the value of this procedure as compared
to open elective interval appendectomy remains uncertain. Therefore, we set out to assess the usefulness of interval laparoscopic
appendectomy following periappendicular abscess.
Methods: This study analyzes the data for 10 patients who underwent interval laparoscopic appendectomy 8–10 weeks following documented
periappendicular abscess in the period between January 1996 and June 1998.
Results: Laparoscopic appendectomy was completed successfully in all 10 patients. Nine patients were discharged 1 day after the operation;
one patient was discharged on the evening of the operative day. There were no complications and no wound infections.
Conclusion: We conclude that the laparoscopic approach is the preferable treatment for interval appendectomy. It is associated with minimal
or no morbidity and a very short hospital stay.
Received: 13 May 1999/Accepted: 9 December 1999/Online publication: 12 July 2000 相似文献
19.
Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.
Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of
Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized
laparoscopically. A standard posterior colo-anal anastomosis was fashioned and a stapler was used for the anterior anastomosis.
The top of the rectum was then closed by endo stapler under laparoscopic vision.
Results: Thirty patients underwent laparoscopic surgery for this procedure. Three laparoscopic procedures were converted because of
technical difficulties. The operative time was 100–330 mn. Oral feeding was started at a mean postoperative time of 2.5 days.
Mean postoperative hospitalization was 9 days. Early postoperative complications included 1 anastomotic leak, 1 retrorectal
abscess, 2 urinary infections, and 1 evisceration (after conversion). No enterocolitis or enterocolitis-like symptoms were
noted. All patients now have daily spontaneous bowel movements.
Conclusion: The laparoscopic Duhamel procedure can be performed safely, giving good results.
Received: 6 November 1998/Accepted: 12 February 1999 相似文献
20.
Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined
with endoscopic biliary stent placement seems to offer a minimally invasive palliation.
Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy
was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved
preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively.
Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became
necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention;
there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%)
patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain
oral intake during the remaining survival time.
Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional
result while impairing the quality of life only to a minimal extent.
Received: 7 May 1996/Accepted: 12 December 1996 相似文献