Biomedical subjects
Publications and source records attributed to C Dragomirescu.
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.
We studied laparoscopic urological procedures in 14 cases between July 1995 and October 1996. We applied retroperitoneal lomboscopic technique for 2 cases with symptomatic renal cyst (over 500 ml) and laparoscopic retroperitoneal lymphadenectomy in 12 cases (adenocarcinoma of the prostate-5 cases, pT2-3bMo, Gleason score between 3-9, PSA between 11-46 ng/ml and invasive bladder tumors-7 cases, pT2-3bMoG2-3). For the renal cyst we used extraperitoneal approach and for the pelvic lymph nodes we used in 8 cases intraperitoneal approach and in 4 cases extraperitoneal approach (patients with multiple prior abdominal surgeries). Lymph node tissue was present in 11 cases. For the bladder tumors we did first iliac lymph nodes dissection and for the prostate adenocarcinoma we did first obturator lymph nodes dissection. We didn't describe complications. For our patients it was 3 days long hospitalization. So, we consider that laparoscopic lymphadenectomy is essential for evaluation of the patients with prostate adenocarcinoma having markedly elevated prostate specific antigen, high Gleason grade, large clinical burden of tumor. For the invasive bladder tumors, radical cystectomy and especially bladder replacement surgery need absolutely evaluation of regional lymph nodes. For the symptomatic renal cysts (over 500 ml) laparoscopic surgery is with very good results, minimally invasive.
Explore the source record for details and available documents.
There is presented the case of a patient with liver cirrhosis hepatomegalic form, echinococcosis and gallbladder stones. After the presentation of the clinical findings, there are discussed the problems of the surgical treatment. The remaining cavity was treated by pericysto-jejunostomy. The postoperative recovery was uneventful.
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.
The authors present 7 cases of acute non-lithiasic cholecystitis, representing 1.5% of the total number of acute cholecystitis cases in their personal statistics. The determining factor of the acute inflammatory process of the gallbladder was represented in 6 of the cases by non-lithiasic obstruction of the cystic duct. In the last case there was acute segmental cholecystitis secondary to a gallbladder septum, probably of congenital origin. Clinical and anatomo-pathological aspects are discussed, of acute non-lithiasic cholecystites, the origin of which is located in the diverticular apparatus of the biliary pathways. From the therapeutical viewpoint cholecystectomy is the most indicated attitude in such cases.