[A comparative study of the hospital costs for laparoscopic cholecystectomy and classical cholecystectomy].
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Anesthesia↗
Biomedical subjects
C Copăescu
Publications and source records attributed to C Copăescu.
[Laparoscopic reoperations].
The progress of laparoscopic techniques have made possible video-assisted miniinvasive surgery in patients with indication of reoperation. Knowing that there are many controversies against this type of surgery, the authors tried to formulate their own point of view in this matter by analyzing their experience in such particular cases. In this study there are included both laparoscopic re-operations (or re-laparoscopies), consecutive to video-assisted surgery, and the mini-invasive procedures performed for complications after open surgery. Of the total 3901 laparoscopic operations (in 3714 patients) we performed 34 laparoscopic re-operations for postoperative complications occurred in patients previously operated on in our clinic or in other departments (29 re-laparoscopies and 5 after open surgery) The objective of the study was to verify if the laparoscopic techniques are useful in diagnostic and treatment of the postoperative complications which need surgical re-exploration, and the conclusions have shown that laparoscopy may be appropriate in re-exploration of the surgical patients, if the rules of the operative management is respected and the well defined standards are fulfilled.
Appendicitis↗
[Transperitoneal laparoscopic right sympathectomy].
Laparoscopic lumbar transperitoneal sympathectomy represents the miniinvasive approach of laterocolic procedure Adson-Diez. It is suitable to laparoscopic surgery, has a good reproducibility and it is more advantageous than total retroperitoneal approach because of a larger working space.
Humans↗
[Laparoscopic approach in large hiatal hernia--particular considerations].
UNLABELLED: Large hiatal hernia are associated with permanent or intermittent protrusion of more than 1/3 of the stomach into the chest, single or in associated with other organs, a hiatal defect greater than 5 cm and various complications related to the morphological and physiological modifications. While the laparoscopic approach in small hiatal hernia and gastro-esophageal reflux disease is a standard procedure in large hiatal hernia persists a number of questions and controversies. Between 1995 and 2002 a number of 23 patients with large hiatal hernia (9 men, 14 women), mean age 65.8 years (range 49 to 77) underwent laparoscopic surgery. The majority of the patients had complications of the disease (dysphagia, severe esophagitis, anemia, respiratory and cardiac failure). In 16 cases was a sliding hernia (one recurrent after open procedure), in 2 paraesophageal and in 5 a mixed hernia (two "upside-down" type). In 7 cases we perform, in the same operation, cholecystectomy for gallbladder stones and in one cases Heller myotomy for achalasia. In all cases the repairs was performed by using interrupted stitches to approximate the crurae, but in three of them (recurrent and upside down hernia) we consider necessary to repair with a polypropylene mesh (10 x 5 cm) with a "keyhole" for the esophagus. In these particular cases we do not perform a antireflux procedure, in others 20 cases a short floppy Nissen was done. During the operation one patient developed a left pneumothorax and required pleural drainage. Postoperatively one patient had dysphagia treated by pneumatic dilatation and another die 3 weeks after the surgery because severe respiratory and cardiac failure. CONCLUSIONS: Laparoscopic approach is a feasible and effective procedure with good postoperatively results, but required good skills in mininvasive technique.
Aged↗
[Cavitary viscera injuries during laparoscopy].
Intraoperative incidents of laparoscopic surgery resulting in cavitary viscera injuries are analyzed, based on a series of 6308 patients (6800 operations) operated during a period of 9 years. This retrospective study includes 11 cases: 6 intraoperative cavitary viscera perforations (esophagus, gastric fornix, ileum, sigmoid) have been recognized and solved in the same laparoscopic operation or after conversion. In 5 cases the diagnosis was established in the postoperative period as fistulas (urinary bladder) or diffuse peritonitis caused by various types of injuries (esophagus, small and large bowel) and required reoperations. We present a global view of these cases and also analyze the determinant causes of the complications, emphasize the importance of intraoperative identification of such injuries and specify the place of minimally invasive surgery in the treatment of such accidents with an optimum healing and low rate of postoperative morbidity and mortality.
Abdominal Injuries↗
[Laparoscopic mini gastric bypass for the treatment of morbid obesity. Initial experience].
The mini-invasive treatment of morbid obesity represents a priority of our surgical team. The majority of the patients have been operated on restrictive bariatric procedures. The technique we are presenting is indicated for the extreme and super obese patients (BMI >50 kg/m2) for whom the restrictive procedures are less efficient. In these situations we have performed a mixed procedure, combining two principles restriction and malabsorption by creating a low capacity gastric tube connected to the jejunum through a linear stapled anastomosis. The name of these procedure is mini gastric bypass and our experience is consisting of 7 patients, with BMI between 52.7 and 71.69 kg/m2, with very important comorbidities. In this paper we are describing the specifics of the laparoscopic approach and the postoperative results at 3-18 months. We have recorded one conversion to the open surgery, two hemorrhagic postoperative complications and one marginal ulcer (3 month post-operatively); all complications were treated conservatively. All the patients lost weight, the EWL at 12 months was between 45.26% and 77.65%, while the co-morbidities had a significant good evolution. The procedure was efficient, well accepted and tolerated by the patients.
Adult↗
[The 10th World Congress of Obesity Surgery].
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Bariatric Surgery↗
[Laparoscopic appendectomy--considerations in about 1000 cases].
Laparoscopic appendectomy (LA) is a well spread method today, but not as largely accepted as cholecystectomy, the cure of gastro-esophageal reflux and some other procedures (relatively small in number) for which the laparoscopic approach is the golden standard. Otherwise it is improbable that LA will gain such a status, at least in the near future. On the other hand it is obvious that LA offers important advantages for some special situations: the right iliac area syndrome, obesity, professional sportsmen, abnormal localization of the appendix, as well for the cases when localized and especially diffuse peritonitis is associated. Our paper analyses the experience of General Surgery Department at the "St.John" Emergency Hospital Bucharest on laparoscopic appendectomy. The retrospective study includes 996 cases that were treated laparoscopic between 1996-2004. Of these 745 cases were catarrhal, 166 cases were phlegmonous and 76 gangrenous appendicitis. In 93 cases localized or diffuse peritonitis was associated. There were recorded also 3 cases of each of the following: chronic appendicitis, appendicular mass and mucocele. The number of conversions was 28 (2.81%). There were also 10 reinterventions (1.004%), 7 because of intraperitoneal abscess and we also recorded one death.
Appendectomy↗
[Laparoscopic treatment of transhiatal gastric hernia].
The paper is referring to the laparoscopic cure of the gastric transhiatal hernia. The first part is a short comment on the way to establish the need for surgery and to choose the adequate procedure. Then the main tactical aspects of the laparoscopic Nissen fundoplication are discussed. Finally the technique of the operation is detailed. Six patients were operated on with good results.
Cholecystectomy↗
[The laparoscopic treatment of varicocele--a technical note].
After a short exposure of the main clinical and anatomical aspects of the varicocele, as arguments for a wider surgical indication, the authors present the technique of laparoscopic varicocelectomy. The operation implies general anesthesia and may be performed by transperitoneal or properitoneal approach--similar to laparoscopic hernia repair. The main step is the dissection, clipping or bipolar coagulation and section of the varicose spermatic veins.
Anesthesia, Epidural↗
[Right laparoscopic lumbar sympathectomy].
Laparoscopic lumbar sympathectomy was performed on a young man with thromboangiitis obliterans (Buerger's disease). The surgeons disposition, trocars placement and dissection technique are described in detail. The retroperitoneal approach was done in a manner similar to laparoscopic properitoneal hernia repair. The operation can be carried out with common laparoscopic equipment (for cholecystectomy) and offers the benefits of minimally invasive surgery.
Adult↗
[Thoracic sympathectomy via the thoracoscopic approach. The operative technic].
The authors describe the technique of thoracic sympathectomy by thoracoscopic approach in the variant in which the sympathetic chain is divided between T4 and T5 sympathetic ganglion associated with the division of the gray and white rami communicantes of the T2-T3-T4 sympathetic ganglions. The article emphasizes the importance of the 2nd sympathetic ganglion in the regulation of the blood circulation of the arm and the advantages of the thoracoscopic approach for this type of intervention.
Adult↗
[Conversions and reinterventions in laparoscopic cholecystectomy].
From the introduction of the laparoscopy in our clinic, more and more of the cholecystectomies, reaching over 50% are done by this technique. Based upon the accumulation of an already important experience, the paper tries to analyze the situations in which, during or after laparoscopic cholecystectomy, intraoperative conversions (deliberate or of necessity) or reinterventions were necessary. We present a global view of the number of these cases and also (an in detail) analysis of the causes the imposed such decisions and of the solutions adopted. The percentages of 5.55 conversions and 1.49 reinterventions seem reasonable and acceptable in comparison with the initial results published by some experience surgeons in the field of laparoscopic surgery.
Adult↗