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At least 559 records · Page 31Linked to original sources
PubMed2000

[Contribution of lumboscopy in the treatment of pyeloureteral junction syndromes. Report of 25 cases].

OBJECTIVE: Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. MATERIAL AND METHOD: Retrospective study of 25 consecutive lumboscopic retroperitoneal pyeloplasties performed over 3 years in 14 women and 11 men with symptomatic ureteropelvic junction syndrome. RESULTS: The mean operating time was 200 minutes (range: 120-360 minutes) and mean blood loss was 60 ml. Surgical conversion was necessary in three cases due to the difficulty of dissection and in one case because of rupture of the ureter. Analgesic prescription was generally only necessary for the first 2 postoperative days. The mean hospital stay was six days (range: 2-16 days). Patients were able to return to work an average of 10 days after the operation. With a mean follow-up of 9 months (range: 6 to 18 months), all patients were asymptomatic except for one patient who reported pain at a trocar site. Follow-up urography at 3 months showed marked improvement in 18 patients (85.7%), moderate pyelocaliceal dilatation in 2 cases and one failure. CONCLUSION: Lumboscopic pyeloplasty is an alternative to endopyelotomy. It provides a comparable success rate to that of conventional surgery, while reducing the morbidity, length of hospital stay and convalescence. However, it requires mastery of intracorporeal suture techniques.

Adult↗
PubMed2000

[Atrial septal defect--catheter-based closure now feasible!].

Atrial septal defects (ASD) of hemodynamic significance are usually treated surgically in early childhood. However, many cases will not be detected until the patient has become an adult. As there is a risk of development of pulmonary hypertension and tachyarrythmia in hemodynamically significant defects, closure is necessary. Although surgery is considered a safe procedure with very low perioperative mortality, there is a risk of complications and prolonged hospitalization, and postoperative convalescence is two months. Today we are able to offer patients with ASD of the secundum type an alternative treatment using catheter technique. The devices used are self expanding and easy to deploy, with a high success rate and low complication rate. Post-procedural convalescence is two days.

Cardiac Catheterization↗
PubMed2001

Laparoscopy versus laparotomy management of tubal pregnancy.

OBJECTIVE: To compare laparoscopy versus laparotomy management of tubal pregnancy and the reproductive outcome. METHODS: A retrospective chart review of 81 patients admitted for management of tubal pregnancy was carried out at Riyadh Armed Forces Hospital from January 1998 until January 2000. The patients were divided according to surgical procedure performed into: Group I (33 patients) laparoscopy and group II (48 patients) laparotomy. We evaluated pre and postoperative serum b-human chorionic gonadotrophin levels, total operating time, total blood loss or blood transfusion or both, duration of hospital stay, recurrence rates of ectopic pregnancy and future fertility outcome for all patients. RESULTS: No differences were found between both groups in patient age, parity, size of adnexal mass, condition at the time of presentation, site of tubal pregnancy, previous history of ectopic, pre and postoperative serum b-human chorionic gonadotrophin and the total operating time. There were significant reductions of total blood loss, number of blood transfusion units, and duration of hospital stay, in the laparoscopic group compared to the laparotomy group. A total of 54 patients desired pregnancy, 23 patients in the laparoscopy and 31 patients in the laparotomy group. No significant differences were found in the fertility outcome between both groups. The rates of subsequent intrauterine pregnancy were 74% (17/23) in the laparoscopy group and 61%, (19/31) in the laparotomy group and the rates of subsequent ectopic pregnancy were 4% (1/23) in the laparoscopy group and 10% (3/31) in the laparotomy group. CONCLUSION: Laparoscopic treatment of ectopic pregnancy in hemodynamically stable patients offers major economic benefits superior to laparotomy in terms of less need for blood transfusion, shorter duration of hospital stay and convalescence.

Adolescent↗
PubMed2002

[Uterine fibroids embolization: a review].

Uterine artery embolization for symptomatic leiomyomas is a new attractive treatment in patients who do not desire pregnancy and for whom conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or/and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pain, and in bulk-related symptoms. This technique allows reduction of the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.

Angiography↗
PubMed2002

[Embolization of uterine fibroids].

Uterine artery embolization (UAE) for symptomatic leiomyomas is a new attractive treatment in patients who don't desire pregnancy and for which conventional therapy has failed. Uterine fibroid embolization can also be considered for patients who desire pregnancy when myomectomy is technically difficult or impossible and in case of recurrence after myomectomy. 90% improvements are commonly reported in abnormal bleeding, pelvic pains, and in bulk-related symptoms. Although numerous pregnancies have been reported after UAE, the fertility rate after UAE remains to be compared to myomectomy. Absolute contra-indications are pregnancy, endometrial carcinoma, gynaecologic infections, adnexal masses, and rapid growth of uterine leiomyomas (considered as a significant sign of sarcoma). Besides procedure related risks of angiography some specific complications are reported: deep pelvic vein thrombosis with exceptional pulmonary embolus, vaginal discharges with sometime transcervical expulsion of fibroid (5%), transient or permanent amenorrhea (4-5%) and extensive necrosis (1-2%) with possible perforation and infection. A hysterectomy is needed to manage this complication in 0.9 to 0.3% of case. The mortality rate of embolisation is evaluated to 1/3.000 against 6/10.000 for the hysterectomy. UAE is proposed as a less invasive alternative to hysterectomy and myomectomy for the treatment of symptomatic leiomyomas. This technique allows reducing the hospital stay, the convalescence period, the morbidity and the mortality rate compared to conventional surgical treatment.

Contraindications↗
PubMed2003

[Manually-assisted laparoscopic nephrectomy in a living donor].

Manually assisted laparoscopic nephrectomy from a live donor combines the advantage of a mini-invasive approach with the advantage of the assisting hand in the abdominal cavity to which the surgeon is used from classical operations. The authors performed the first nephrectomy from a live donor by this method on May 13, 2002. Our initial experience with five nephrectomies by this method indicate that every subsequent operation was shorter and the period of warm ischemia was also shorter. There was no postoperative complication. In the second operation suppuration of the minilaparotomy occurred which protracted hospitalization and the convalescent period. The prerequisite of these operations is a certain amount of experience with laparoscopic operations. This type of nephrectomy has the general advantages of a miniinvasive approach, i.e. greater postoperative comfort and a shorter convalescence as compared with an open operation. The period of warm ischaemia does not differ markedly from nephrectmies by the classical procedure.

Adult↗
PubMed1992

Endolaparoscopic palliation of pancreatic cancer.

Two patients with advanced pancreatic cancer were palliated for both duodenal and biliary obstruction without laparotomy. The techniques of endoscopic biliary stent and laparoscopic gastrojejunostomy are described. This combination achieved rapid palliation with minimum morbidity. Patients with advanced pancreatic cancer and a limited life expectancy benefit greatly from the shortened hospital stay and convalescence this manner of treatment offers.

Adult↗
PubMed1992

[Initial experience with laparoscopic cholecystectomy].

The authors discuss the technique and indications for laparoscopic cholecystectomy. n the course of four and a half months they operated, using this technique, 74 patients, in two patients they had to switch over to open cholecystectomy. They did not perform peroperative biligraphy. Complications occurred twice, once an injured ductus choledochus, once a biliary fistula. The mean period of hospitalization was 4.7 days. Advantages of the procedure are minimal surgical trauma, less intense postoperative pain, a shorter hospitalization period, rapid convalescence.

Cholecystectomy↗
PubMedDate not supplied

[Laparoscopic adrenalectomy. Results of 10 cases].

AIM OF THE STUDY: To report our experience in laparoscopic adrenalectomy and to evaluate the effectiveness of this technique for a variety of endocrine disorders. METHODS: Ten patients were operated for laparoscopic adrenalectomy between January 1998 and January 2001. RESULTS: Eight females and two men, of 45 years mean age (range, 16-71 years), were operated for laparoscopic adrenalectomy. There were 8 tumours in right adrenal gland and two in the left adrenal gland. Indications were: pheochromocytomas (n = 5), aldosterone-producing adenoma (n = 2), cortisol-producing adenoma (n = 2) and cyst (n = 1). All patients had a CT Scan or RMI preoperatively. The patients with pheochromocytoma were prepared preoperatively. Mean operative time was 133 minutes (range, 110-190 minutes). There was no mortality and morbidity was encountered in one patient (bleeding in a trocart site peroperatively). During pheochromocytoma operation, hypertension occurred in two patients. There was one conversion secondary to bleeding. The average length of stay was 3.6 days (range, 2-7 days). During follow-up (range, 6-36 months), the patients were satisfied and none had recurrence of hormonal excess. CONCLUSION: Laparoscopic adrenalectomy is safe, effective and decreases hospital stay and convalescence. The laparoscopic approach is the procedure of choice for adrenalectomy except in the case of carcinoma.

Adolescent↗
PubMedDate not supplied

Fifty-five consecutive laparoscopic appendectomy procedures without conversion.

BACKGROUND: In patients with suspected appendicitis, laparoscopic appendectomy is gaining increasing acceptance primarily because it is associated with less postoperative pain and a shorter hospital stay. Experience with 55 consecutive laparoscopic appendectomies, performed without conversion by the same surgeon, is herein examined and analyzed. METHODS: The medical records of 55 consecutive patients with suspected appendicitis who underwent laparoscopic exploration (from 2000 to 2002) were analyzed for demographic information, clinical findings, laboratory/computed tomography scan results, intraoperative diagnosis, clinicopathologic correlation, complications, incidental findings, and operative time. RESULTS: Twenty-six males (47%) and 24 females (53%) underwent surgery. Mean age was 25.2 years (range, 6 years to 67 years). Computerized tomography scans obtained in 37 cases (74%) had a sensitivity of 86.7% and a specificity of 62.5%. Average length of stay was 2.3 days (median, 1 day). Average operating room time was 69 minutes (range, 40 to 173 minutes). Five patients experienced postoperative complications: 2 had intraperitoneal abscesses, 1 had urinary retention, and 2 had postoperative ileus. No operative conversions or postoperative wound infections occurred. CONCLUSION: Laparoscopy confirmed the clinical diagnosis of acute appendicitis and allowed the safe, effective treatment of both complicated and uncomplicated appendicitis with minimal hospitalization, recovery and convalescent times, and zero open conversion and wound infections. Laparoscopic appendectomy is advocated as the procedure of choice for patients with clinically suspected appendicitis.

Adolescent↗
PubMed2004

Minimally invasive total hip replacement.

Total hip replacement (arthroplasty) is a widely used procedure that alleviates pain and disability in people with hip disorders, such as osteoarthritis. Minimally invasive (MI) total hip replacement uses a smaller surgical incision than the conventional method. Possible advantages include less damage to tissue and muscle, smaller scars, less blood loss during surgery, less postoperative pain and shorter hospital stays and convalescence. Well designed, long-term studies are needed to compare patient outcomes and costs of the different types of MI hip replacement procedures.

Arthroplasty, Replacement, Hip↗
PubMed1992

Minimally invasive gynaecological surgery.

Most gynaecological operations can now be performed laparoscopically. The results for patients are a reduction in pain, less time spent in hospital and in convalescence and cost savings. For some procedures the risk of infection and adhesion formation is also reduced. This pelviscopic surgery requires extra training in special surgical skills to overcome the risks that include incomplete surgery resulting from poor access to a pelvic lesion or trauma to organs as a result of poor technique. Most patients with ectopic pregnancy, pelvic adhesions, endometriosis, ovarian cysts and fibromyomata can be treated by this advanced laparoscopic surgery. Hysteroscopic endometrial resection can replace hysterectomy for most patients with menorrhagia who have a normal size uterus.

Female↗
PubMed2006

Laparoscopic Heller-Dor operation for patients with achalasia.

BACKGROUND: Laparoscopic Heller cardiomyotomy and Dor fundoplication is the surgical procedure of choice for esophageal achalasia. The aim of this study was to investigate the clinical outcome of laparoscopic Heller-Dor procedure in our initial series of 25 patients with achalasia. METHODS: Between October 2003 and January 2006, a total of 25 patients with achalasia underwent laparoscopic Heller-Dor operation. Among them, 9 were male and 16 were female with an average age of (41.5 +/- 5.1) years (21-66). All the patients received upper gastrointestinal series (barium swallow), esophagogastroscopy, esophageal manometry to exclude esophageal carcinoma and to confirm the diagnosis, and 21 patients also had 24-hour ambulatory pH studies. All the patients were operated by laparoscopic modified Heller's myotomy with Dor fundoplication. In addition, 2 of them had combined laparoscopic cholecystectomy + excision of hepatic hemangioma and laparoscopic cholecystectomy, respectively. RESULTS: The average operating time was (110.6 +/- 12.9) minutes (range, 60-180), operative blood loss averaged (18.6 +/- 7.1) ml (5-50), the median time to oral feeding was (1.6 +/- 0.4) days (1-4) and the median hospital stay was (12.6 +/- 1.2) days (10-20). There was no conversion to open surgery. Intraoperative mucosal perforation was encountered in six patients and was repaired in all of them by laparoscopic suture. All the patients had an uneventful recovery without postoperative complication. After a median follow-up of (10.6 +/- 7.2) months (1-27), 24 patients were asymptomatic and 1 had mild postoperative dysphagia. CONCLUSIONS: Laparoscopic Heller-Dor operation had the advantages of reduced compromise of the cardiopulmonary function, with less disruption of the supporting structures (phrenoesophageal membrane) of the antireflux mechanism, requiring simpler general anesthesia and providing excellent exposure permitting an easy fundoplication, less pain and reduced morbidity, shorter hospitalization and faster convalescence.

Adult↗
PubMedDate not supplied

[Cholecystectomy by video laparoscopy in acute cholecystitis: report of 25 cases].

The cholecystectomy by video laparoscopy has made a big revolution in biliary surgery during de last three or four years. We present the first 25 cases with acute cholecystitis operated on by this technique with very low morbidity a convalescence period and hospitalization time inferior to the one expected for open cholecystectomy and a conversion to open laparotomy in a relatively low percentage of the cases. In order to perform this procedures a basic training in surgery and laparoscopy is necessary groups of surgeons that work coordinated with adequate instrumentation as well as experience in laparoscopic cholecystectomy in non acute cases is always necessary.

Acute Disease↗
PubMed1990

Non-narcotic modalities for the management of acute pain.

The possible options for the management of acute pain are quite numerous and continue to expand as our understanding of the mechanisms of pain becomes increasing sophisticated. Many of the options discussed have been available for years, and their present underutilization may be a reflection of the lack of emphasis on the importance of management of acute pain. An illustration of this would be our present ritual of prescribing narcotics postoperatively, a longstanding, but unfortunately inadequate practice. Because of poor selection and scheduling of doses, postoperative analgesia is typically a less than satisfactory experience for many patients convalescing in a hospital following surgery. The clinician should of course be guided by the clinical situation itself in order to determine what modality or combination of modalities may be appropriate for pain management. Certain techniques, such as continuous local anesthetic infusions, may warrant an escalated level of monitoring and ancillary care. Other techniques, such as the infiltration of a wound with local anesthetic or the addition of a nonsteroidal anti-inflammatory agent to a regimen of mild oral narcotics are so simple that excluding them from patient care is almost callous and inconsiderate. Attention to the mechanisms of pain that may be present in a given situation, whether it be muscle spasm, ischemia, inflammation, edema, or nerve injury, may guide the clinician toward a more rational approach in managing that pain.

Acute Disease↗
PubMed1987

[Transcervical intrauterine resection. A surgical technique that is safely controlled and non-traumatic].

The author describes a safe narrow intra-uterine resectoscope which allows complete treatment of benign lesions inside the uterus. A continuous flow of liquid washes away all haemorrhage from the cavity of the uterus and allows a continuous good view. The author reports his three years experience which includes biopsies from eighteen zones of haemorrhage and the successful treatment of 92 submucous fibroids, 81 fibroid polyps, 57 endometrial polyps, 33 cases of synechiae, 8 cases of retained placental products and 7 of septa in the uterus. He says that it is extremely important to have complete histological analyses of all "chips" that are removed by this technique, which is similar to the technique employed for trans-urethral resection of the prostate gland. Histological examination helped to make the diagnosis of 9 cancers which would have been missed had laser been used. Other advantages of this new technique, which requires special training for gynaecologists already mastering open surgery, are the shortness of the time needed to stay in hospital and for convalescence. Furthermore, the uterus is conserved, as is the strength of the uterine wall and this allows normal deliveries to take place.

Endoscopy↗
PubMed1984

Endoscopic and fluoroscopic transpapillary placement of a large caliber biliary endoprosthesis.

Nonoperative decompression procedures for the relief of obstructive jaundice have been used in both malignant and benign processes. These techniques have proven to be as effective as surgical procedures in the palliative management of malignant biliary stenosis. However, nonoperative decompression procedures have certain advantages, in that they reduce morbidity and mortality associated with palliative surgical procedures, resulting in a decrease in the length of hospital stay and convalescence. Endoscopic transduodenal and percutaneous methods continue to evolve with improved techniques. Herein, we describe a new technique of transduodenal endoscopic decompression of a malignant obstruction of the common bile duct using a large caliber (15 French) endoprosthesis. This is the first report of successful endoscopic placement of such a large caliber endoprosthesis reported in the United States. Subsequently, three other prostheses have been placed in a similar manner. The procedure uses a combined endoscopic-fluoroscopic method and is performed in the same setting as endoscopic retrograde cholangiopancreatography in patients with cancer of the pancreas, cholangiocarcinomas, metastatic disease, and benign strictures.

Adenoma, Bile Duct↗
PubMed1983

Comparison of cefuroxime and gentamicin in combination with metronidazole in the treatment of peritonitis due to perforation of the appendix.

A study on 42 surgical patients was carried out to find out whether cefuroxime may be substituted for gentamicin in combination with metronidazole in the treatment of peritonitis secondary to perforation of appendix. All patients recovered and there were four wound infections in each group. Both aerobic and anaerobic bacteria were cultured in the peritoneal fluid in 69% of cases and anaerobes only in 19% of the patients. Postoperatively the patients were followed up for one month. The mean length of the hospital stay and convalescence did not differ significantly. There was also no difference in the time to the removal of gastric suction, laboratory measurements and the incidence of pyrexia between the study groups. Although the number of patients was limited the present study indicates that gentamicin may be replaced by less toxic cefuroxime. This is especially the case if there are several risk factors in the use of gentamicin and if there is not a possibility for monitoring the serum levels of gentamicin.

Adult↗