Biomedical subjects
Publications and source records attributed to J D Corbitt.
Intraoperative cholangiography was successfully performed in 99% of 525 consecutive laparoscopic cholecystectomies. There were 386 chronic, 54 acute, 44 fibrotic, 19 gangrenous, and 22 hydrops cases. Unsuspected common duct stones were identified in 5% of patients. Routine cholangiography to clarify the biliary anatomy, however, was of greater significance than the discovery of unsuspected common duct stones.
There have been multiple different approaches to laparoscopic herniorrhaphy with a tendency toward exposure of the preperitoneal space with placement of a prosthesis into this area. The transabdominal preperitoneal (TAPP) approach is a reasonably simple, safe repair, resulting in a less than 1% recurrence rate with minimal complications. This relatively pain-free herniorrhaphy allows rapid return to normal activity.
Laparoscopic-assisted colonic resection was attempted in 18 patients: 12 patients had surgery for ascending colon lesions, three underwent attempted left-sided colectomies, and three patients had low anterior resection. Three early patients required conversion to open laparotomy when the pathologic lesion could not be identified under laparoscopic guidance. In patients undergoing laparoscopic surgery, postoperative pain was markedly reduced. Oral intake was begun between the first and third postoperative days, and average hospital stay was 4 days. No operative morbidity or mortality occurred in this small group of patients.
Laparoscopic herniorrhaphy is compared with conventional herniorrhaphy in 20 patients, who underwent laparoscopic herniorrhaphy utilizing a Mersilene plug and patch graft, and high ligation of the neck of the sac with an Endo-GIA. Patients were pain-free and returned to normal activity the first postoperative day. There was one recurrent direct inguinal hernia in an indirect repair. Laparoscopic herniorrhaphy appears to be a safe, effective way to repair indirect inguinal hernias and certain direct inguinal hernias. There is a marked reduction of pain and rapid return to normal activity. The disadvantage of this procedure is the lack of long-term follow-up.
Laparoscopic cholecystectomy has been reported to be a safe and effective way to remove a diseased gallbladder with essentially no morbidity or mortality (1,2). This procedure was first introduced in Europe using electrosurgery, and later introduced in the United States using the laser (1). No clinical trial compares the laser to the standard electrosurgery method. In a review, as well as an ongoing study, morbidity, mortality, intraoperative procedures, indications, and cost effectiveness are considered in these two groups. Three hundred cases were reviewed with 150 patients in each group. There were no deaths or significant complications in either group. In the laser group, bleeding seemed slightly more excessive during removal of the gallbladder from the liver bed and required more time to control. The electrosurgery group required slightly less operative time and was less costly. The postoperative recovery time was the same in each group.
Intraoperative cholangiography was successfully performed in 98% of 300 consecutive laparoscopic cholecystectomies, including 290 chronic, 44 acute, 33 fibrotic, 16 gangrenous, and 17 hydropsed cases. Unsuspected common duct stones were identified in 16 patients (4%). The presence of two surgeons and the ability of routine cholangiography to clarify the biliary anatomy produced excellent results with no injuries to the common duct in this series.
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At the present time laparoscopic herniorrhaphy appears to be successfully performed by utilizing a preperitoneal approach. The major indications are bilaterals hernia and the recurrent hernia. Other routine hernias may be done at the decision of the surgeon and patient depending upon the necessity of rapid return to work and desire to minimize pain. Utilizing this approach, the recurrence rate at the present time is less than 1%, which compares favorably with all other types of repair.
Anterior inguinal hernia repair is the second-most-commonly performed abdominal operation and has been associated with low morbidity and mortality rates. The principle of laparoscopy has been applied to this surgical problem in a series of 762 patients with 841 inguinal hernias. Four types of laparoscopic repairs were conducted: (1) high ligation of the indirect inguinal hernia sac and closure of the internal ring (87 patients with 89 hernias); (2) plug and patch of the internal ring (74 patients with 87 hernias); (3) transperitoneal suture repair of the transversalis fascia to the iliopubic tract or Cooper's ligament (28 patients with 30 hernias); and (4) placement of a large prosthesis over the myopectoneal orifice (563 patients with 635 hernias). These early results indicate that the overall complication rates were low, especially when a large prosthesis was used to reinforce the myopectoneal orifice. It is concluded that laparoscopic inguinal herniorrhaphy is a safe and effective procedure with which to manage this surgical problem.
Intraoperative cholangiography was successfully performed in 1,000 out of 1,006 attempts in 1019 consecutive cholecystectomies. There were 783 chronic, 95 acute, 61 fibrotic, 27 gangrenous and 40 cases of hydrops of the gallbladder in those laparoscopic cholecystectomies performed. unsuspected common duct stones were identified in 5% of the patients. There were no injuries resulting from intraoperative cholangiography performed via the cystic duct. In this large series, routine cholangiography was thought to be helpful in the prevention of common bile duct injuries and the establishment of abnormal anatomy. In non-acute cholecystitis, intraoperative cholangiography is necessary due to the importance of abnormal anatomy verification. The technique of laparoscopic cholecystectomy differs greatly from that of open technique, and, therefore, routine intraoperative cholangiography is strongly advised.