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21.
Z. Malazgirt K. Topgul S. Sokmen S. Ersin A. G. Turkcapar H. Gok N. Gonullu M. Paksoy M. Ertem 《Hernia》2006,10(4):326-330
Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective
multicenter study, we aimed to outline the specific features of spigelian hernias and patients’ characteristics more clearly.
Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline
and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34
patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred
technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare
condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications
and is very well tolerated by the patient. 相似文献
22.
23.
A Alzahrani M Anvari B Dallemagne D Mutter J Marescaux 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):97-100
OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively. 相似文献
24.
Marcelo W. Hinojosa Zuri A. Murrell Viken R. Konyalian Steven Mills Ninh T. Nguyen Michael J. Stamos 《Journal of gastrointestinal surgery》2007,11(11):1423-1430
Few studies have examined outcomes of laparoscopic and open sigmoid colectomy performed at US academic centers. Using ICD-9
diagnosis and procedural codes, data was obtained from the University HealthSystem Consortium (UHC) Clinical Database of 10,603
patients who underwent laparoscopic or open sigmoid colectomy for benign and malignant disease between 2003–2006. A total
of 1,092 patients (10.3%) underwent laparoscopic sigmoid colectomy. Laparoscopic sigmoid colectomy was associated with a significantly
shorter length of stay (5.4 vs 7.4 days), lower overall complication rate (19.7 vs 26.0%), lower 30-day readmission rate (3.4
vs 4.6), and a lower hospital cost ($13,814 vs $15,626). When a subset analysis of malignant and benign groups was performed,
a significantly shorter length of stay in both the malignant laparoscopic group (6.4 ± 6.4 vs 7.8 ± 6.6 days) and in the benign
laparoscopic groups (5.1 ± 3.5 vs 7.2 ± 7.6) exists. A lower wound complication rate (2.1 vs 5.5%, malignant and 4.0 vs 6.1,
benign) is also evident. Laparoscopic sigmoid colectomy was associated with a shorter length of stay, less complications,
and a lower 30-day readmission rate. The shorter length of stay and wound infection rate maintain significance when comparing
laparoscopic vs open sigmoid resections for malignant and benign disease.
Presented at the 48th annual meeting of the Society for Surgery of the Alimentary Tract at Digestive Disease Weak, Washington,
DC, May 21st 2007.
The information contained in this article was based on the Clinical Data Base provided by the University HealthSystem Consortium. 相似文献
25.
Laureano Fernández-Cruz Rebeca Cosa Laia Blanco Sammy Levi Miguel-Angel López-Boado Salvador Navarro 《Journal of gastrointestinal surgery》2007,11(12):1607-1622
Laparoscopic pancreatic surgery (LPS) has seen significant development but much of the knowledge refers to small and benign
pancreatic tumors. This study aims to evaluate the feasibility, safety, and long-term outcome of the laparoscopic approach
in patients with benign, premalignant, and overt malignant lesions of the pancreas. This study, currently, is the largest
single center experience worldwide. One hundred twenty-three consecutive patients underwent laparoscopic pancreatic surgery
from April 1998 to April 2007, 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic
drainage was performed, and were excluded from the analysis. The 103 patients were divided based on preoperative diagnosis:
group I, inflammatory tumors for chronic pancreatitis (eight patients); group II, cystic pancreatic neoplasms (29 patients);
group III, intraductal papillary mucinous neoplasms (10 patients); group IV, neuroendocrine pancreatic tumors (NETs) (43 patients);
and group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R
0 or R
1 resection (transection margins on the specimen were inked). Perioperative data, postoperative complications, and resection
modalities were compared using statistical analysis. Long-term outcomes were analysed by tumor recurrence and patient survival.
The overall conversion rate was 7%. Laparoscopic distal pancreatic resection was performed in 82 patients (79.6%). Laparoscopic
spleen-preserving distal pancreatectomy (Lap SPDP) was performed in 52 patients (63.7%), but with splenic vessels preservation
in 22% and without splenic vessels preservation in 41.5%. Laparoscopic en-bloc splenopancreatectomy (Lap SxDP) was performed
in 30 patients (36.6%) and laparoscopic enucleation (Lap En) in 20 patients (19.4%). There was no mortality. The overall complication
rate was 25.2, 16.7, and 40% after Lap SPDP, Lap SxDP, and Lap En, respectively. The overall morbidity rate was significantly
higher (p > 0.05) in the group of Lap SPDP without splenic vessels preservation comparing with Lap SPDP with splenic vessels preservation
because of the occurrence of splenic complications (20.6%). The overall pancreatic fistulas was 7.7, 10, and 35% after Lap
SPDP, Lap SxDP, and Lap En, respectively; the severity of fistula was significantly higher in the Lap En group (p > 0.05). The mean hospital stay was within 1 week in all groups, except in the group of ductal adenocarcinoma, which is 8 days.
In this series, 27 patients (26.2%) had malignant disease. R
0 resection was achieved in 90% of ductal adenocarcinoma and 100% for other malignant tumors. The median survival for ductal
adenocarcinoma patients was 14 months. This series demonstrates that LPS is feasible and safe in benign-appearing and malignant
lesions of the pancreas. 相似文献
26.
Background The incidence rate of incisional hernias after open surgery has been reported to be higher than that of port site hernias
after laparoscopic surgery. No studies have compared the costs for the health care system in treating those two types of hernia.
Methods A systematic review was conducted to obtain the baseline data, and a decision analysis model was created to simulate the occurrence
and recurrence of incisional and port site hernias.
Results The overall risk of having incisional hernias was eight-times higher than that of having port site hernias (7.4% vs 0.9%).
A cost savings of £93 per patient can be generated for the health care system in the UK. Similar results were obtained for
Germany, Italy and France.
Conclusions The additional treatment costs for incisional hernia should be taken into account when the costs of a surgery performed by
open approach are compared with by laparoscopy. 相似文献
27.
Vincenzo Neri Antonio Ambrosi Giuseppe Di Lauro Tiziano Pio Valentino 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(1):66-69
OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of laparoscopic-assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages. METHODS: From 1999 to 2001, 5 patients were selectively operated on with a laparoscopic-assisted procedure for uncomplicated sigmoid diverticulitis. In the preceding period (September 1997 through December 1998), 4 patients underwent open procedures for the same pathology. The surgical indication with the same criteria was restrictive: at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period (2 months) of medical therapy. RESULTS: No conversions of laparoscopy to an open procedure were necessary. Age, sex, weight, morbidity, and mortality were similar between the 2 groups. Operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy. Postoperative resumption of peristalsis was 24 hours versus 4 days, resumption of alimentation was on the second postoperative day versus the fifth postoperative day, and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy, respectively. CONCLUSION: This study shows the feasibility and the advantages of elective laparoscopic-assisted colonic resection for uncomplicated sigmoid diverticulitis. The advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation, canalization, resumption of alimentation, and the shorter hospital stay. 相似文献
28.
腹腔镜辅助子宫肌瘤剔除术30例手术体会 总被引:1,自引:0,他引:1
目的:观察腹腔镜辅助子宫肌瘤剔除术的疗效,探讨腹腔镜辅助子宫肌瘤剔除术的可行性。方法:回顾性分析我院2008年全年30例子宫肌瘤患者的手术方法及手术结果。结果:30例患者全部治愈,平均手术时间78min,术后患者指征数据佳。结论:腹腔镜辅助子宫肌瘤剔除术综合了经典开腹及微创手术的优点,可以提倡。 相似文献
29.
Alessio Pigazzi Minia Hellan Douglas R. Ewing Benjamin I. Paz Garth H. Ballantyne 《Journal of gastrointestinal surgery》2007,11(6):778-782
Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right-
and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first,
followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line
of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders
the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that
surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges
of laparoscopic colectomy. 相似文献
30.
Gastroesophageal reflux disease (GERD) is a common disease and can be successfully treated by laparoscopic fundoplication.
This article describes the technique of laparoscopic surgery for GERD with a focus on operative pitfalls. 相似文献