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PubMed1997

Abdominal fat tissue necrosis as a cause of acute abdominal pain. Laparoscopic diagnosis and therapy.

BACKGROUND: Infarctions of the greater omentum and of the epiploic appendages are rare etiologies of acute abdominal pain. The aims of the study were to determine the incidence of abdominal fat tissue necroses and to discuss the clinical features and the role of laparoscopy in the treatment of these conditions. METHODS: A retrospective study in 563 consecutive patients with acute abdominal pain was performed. In all patients diagnostic laparoscopy was indicated. RESULTS: The incidence of abdominal fat tissue necroses in 563 patients with acute abdominal pain was 1.1%. Six patients had either infarctions of the omentum or of the epiploic appendages. Pain was the predominant clinical symptom and the preoperative diagnosis depended upon the location of the omental or epiploic necroses. Diagnosis and treatment were performed laparoscopically without morbidity. CONCLUSION: The incidence of abdominal fat tissue necroses in our patients was increased compared to the prelaparoscopic period. Omental and epiploic necroses are significant in the differential diagnosis of appendicitis, acute cholecystitis, and diverticulitis.

Abdominal Pain↗
PubMed1998

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. A 1-year follow-up study.

BACKGROUND: Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. METHODS: Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n = 14) to determine the short- and long-term results of the procedure. RESULTS: Mean operation time was 123.4 +/- 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 +/- 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 +/- 47.3 g. Mean postoperative hospital stay was 4.6 +/- 0. 4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). CONCLUSIONS: Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.

Adolescent↗
PubMed1999

Bursting strength evaluation after different types of mesh fixation in laparoscopic herniorrhaphy.

BACKGROUND: In laparoscopic inguinal herniorrhaphy, meshes commonly have been fixed with a stapler. Recently, a new mode of fixation using a helical fastener has been introduced. The purpose of this experimental study was to compare the stability achieved by various types of mesh fixation. METHODS: In 20 human cadavers, polypropylene meshes 10 x 15 cm in size were fixed in both groins by using either a helical fastener or a hernia stapler (4.8 mm). The mesh was fixed with 2, 4, and 8 elements and stressed with a dynamometer until the prosthesis ruptured. A paired and two-sided Student's t-test was used for statistical evaluation. RESULTS: With the helical fastener, the mesh could be fixed always at the desired site. However, with the stapler, it was not possible to fix the mesh in the pubic bone or, at times, in the Cooper's ligament. When two fixation elements were used, the mesh fixed by the helical fastener was able to withstand a median load of 34 N (range 23-53 N), and that fixed by the stapler 7.5 N (range 3-12 N; p < 0.001). When four fixation elements were used, the mesh fixed by the helical fastener was able to withstand 70.5 N (range 53-80 N) and that fixed by the stapler 17. 5 N (range 4-25 N; p < 0.001). With the use of eight elements, the mesh fixed by the helical fastener withstood 127 N (range 84-156 N) and that fixed by the stapler 32.5 N (range 15-59 N; p < 0.001). Thus, in all cases the helical fastener was significantly more stress resistant. The main reason for detachment of the mesh was tissue disruption or deformation of the fixation elements. Only when a stress of more than 130 N was applied did the mesh tear in two cases. CONCLUSIONS: The stress-bearing capacity (shear force resistance) of a mesh fixed by a helical fastener is up to four times that of a mesh fixed by a stapler. Therefore, the helical fastener provides significantly more stable fixation and will be able to protect the patient better from recurrent hernias caused by mesh migration.

Aged↗
PubMed1999

Laparoscopic Duhamel procedure. Management of 30 cases.

BACKGROUND: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department. METHODS: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized laparoscopically. A standard posterior colo-anal anastomosis was fashioned and a stapler was used for the anterior anastomosis. The top of the rectum was then closed by endo stapler under laparoscopic vision. RESULTS: Thirty patients underwent laparoscopic surgery for this procedure. Three laparoscopic procedures were converted because of technical difficulties. The operative time was 100-330 mn. Oral feeding was started at a mean postoperative time of 2.5 days. Mean postoperative hospitalization was 9 days. Early postoperative complications included 1 anastomotic leak, 1 retrorectal abscess, 2 urinary infections, and 1 evisceration (after conversion). No enterocolitis or enterocolitis-like symptoms were noted. All patients now have daily spontaneous bowel movements. CONCLUSION: The laparoscopic Duhamel procedure can be performed safely, giving good results.

Anastomosis, Surgical↗
PubMed2004

Laparoscopic distal pancreatectomy as the total biopsy of the pancreas: tool of minimally invasive surgery.

Because of recent progress in imaging modalities, the opportunities to detect pancreatic cystic neoplasms are increasing. However, serous cystadenoma is still uncommon. We report a case of serous cystadenoma treated by laparoscopic distal pancreatectomy. A 52-year-old woman presented with mild upper abdominal pain. Dynamic computed tomography (CT) revealed a solitary cystic lesion 3 cm in diameter in the pancreatic tail. Endoscopic ultrasound showed a honeycomb pattern, indicative of serous cystadenoma. To obtain the final diagnosis of the tumor, we performed laparoscopic distal pancreatectomy. A histopathological study showed microcystadenoma with no evidence of malignancy.

Cystadenoma, Serous↗
PubMed2002

Failure of endoscopic removal of common bile duct stones due to endo-clip migration following laparoscopic cholecystectomy.

We report herein an extremely rare complication; namely, endo-clip migration into the common bile duct, following laparoscopic cholecystectomy, that occurred in a 57-year-old man. He underwent laparoscopic cholecystectomy, but postoperative bile leakage occurred from the cystic duct stump and he was treated by conservative drainage for 1 month. Five years later, he complained of vomiting and pain in the right hypochondrium, and he was admitted for investigations of jaundice and liver dysfunction. Computerized tomography scanning of the abdomen and endoscopic retrograde cholangiography revealed that several calculi, with six endo-clips as nuclei, had migrated into the biliary tract. Endoscopic removal of the calculi following endoscopic sphincterotomy, using a basket catheter, was unsuccessful, and it was therefore necessary to remove the basket catheter surgically. The mechanism of endo-clip migration and the method for removing the endo-clips are briefly discussed.

Biliary Tract Surgical Procedures↗
PubMed2002

Laparoscopic hepatobiliary and pancreatic surgery: an overview.

Although they are not widely employed, advanced laparoscopic hepatobiliary pancreatic (HBP) procedures can be performed. Laparoscopic common bile duct (CBD) exploration has gained wide acceptance, and endoscopic retro-grade cholangiopancreatography/endoscopic sphincterotomy (ERCP/ES) may become less important in the treatment of CBD stones. Choledochal cyst is another example that is suitable for laparoscopic treatment. It can be removed, and bilioenteric flow is reestablished laparoscopically. Simple cyst of the liver is an excellent indication for laparoscopic surgery. Cysts are unroofed, and recurrence is rare. Hydatid disease can also be treated laparoscopically. In liver resection, the use of laparoscopy is limited to wedge resection and left lateral segmentectomy at most. Laparoscopic staging for pancreatic cancer can demonstrate respectability in 90% of cases. This staging may obviate unnecessary laparotomy. Although laparoscopic Whipple is feasible, laparoscoic distal pancreatectomy is a realistic indication for pancreatic resection. Laparoscopic distal pancreatectomy may be indicated for cystic neoplasms of low-grade malignancy, and for islet cell tumors. When internal drainage is indicated, pseudocysts can be treated laparoscopically. If the cyst is located close to the posterior gastric wall, cystgastrostomy can also be achieved with an endoluminal surgical technique.

Biliary Tract Surgical Procedures↗
PubMed2004

Laparoscopic spleen-preserving pancreatic tail resection for an intrapancreatic accessory spleen mimicking a nonfunctioning endocrine tumor: report of a case.

Laparoscopic surgery is now performed for several pancreatic disorders, such as benign tumors of the pancreatic body or tail, which are a good indication for laparoscopic resection. However, the risk of pancreatic fistula after distal pancreatectomy, performed laparoscopically or by open surgery, is a topic of debate. We report the case of a 61-year-old man in whom a routine follow-up computed tomography (CT) scan showed a solid, well-defined mass, 1.5 cm in diameter, in the pancreatic tail. The mass was homogeneously enhanced from the early phase to the super-delayed phase on enhanced CT. We suspected a nonfunctioning endocrine tumor of the pancreas, and surgery was performed laparoscopically. After dissecting the pancreatic tail away from the splenic hilum and the splenic vessels, it was resected using only a linear stapler. The histological diagnosis was an intrapancreatic accessory spleen. The patient was discharged on postoperative day 14, but was readmitted 6 days later because of a pancreatic fistula, which was treated by CT-guided percutaneous drainage.

Choristoma↗
PubMed1998

A new technique of laparoscopic obturator hernia repair: report of a case.

An 84-year-old woman presented with ileus. Ultrasonography, a computed tomography scan, and small bowel contrast examination showed a Richter-type hernia in her left obturator orifice. Under general anesthesia, laparoscopic surgery with low-pressure (4mmHg) pneumoperitoneum was carried out using a peritoneal needle retractor, and a reduction of the strangulated intestinal loop was thus achieved. Because the hernial opening measured 5mm in diameter, it could be closed with four pieces of End-Universal stapler without polypropylene mesh. The ischemic ileum was resected, and the bowel was anastomosed extracorporeally with a minimal skin incision. She was ambulant on the first postoperative day, and her postoperative course was good. Obturator hernias are rare, but when a definitive diagnosis is made in such elderly patients, laparoscopic repair using the peritoneal needle retractor is recommended for minimally invasive surgery. We recommend doing the repair with an End-Universal stapler, since this procedure is more simple and useful for preventing infection than using polypropylene mesh in such a strangulated case.

Aged↗
PubMed2004

Local correction of a transverse loop colostomy prolapse by means of a stapler device.

Prolapse is a common complication in patients with a transverse loop colostomy. In most cases, the prolapse can be managed conservatively awaiting time for closure eventually. However, loop stoma may also be intentionally permanent or the patient may be too fragile to have the colostomy closed and in these cases a laparotomy is required for correction of the prolapse. A simple method allowing local correction of the prolapsed loop stoma is described.

Colectomy↗
PubMed2006

Evaluation of anastomotic microcirculation after low anterior rectal resection: an experimental study with different reconstruction forms in dogs.

BACKGROUND: Data on anastomotic microcirculation of coloanal anastomoses are contradictory. Therefore, it was the aim of the present study to investigate perianastomotic blood perfusion in a standardized experimental setting comparing three forms of reconstruction using laser fluorescence videography, a new method for the evaluation of microcirculation. METHODS: After a standardised rectal resection in dogs, reconstruction was performed as straight end-to-end (n = 6), side-to-end (n = 6), or J-pouch (n = 6) coloanal anastomosis. Bowel perfusion was evaluated using IC-View laser fluorescence videography. RESULTS: The perfusion index was significantly reduced in all three groups compared to the reference regions: endto-end anastomosis, median, 93% (range, 63%-136%); side-to-end-anastomosis, 65% (35%-138%); colonic-J-pouch anal anastomosis, 52% (32%-72%); p < 0.001). CONCLUSIONS: Straight coloanal anastomoses provide better anastomotic microcirculation after rectal resections than colonic-J-pouch anal anastomoses or side-to-end anastomoses. However this effect does not seem to be decisive for the prevention of anastomotic leaks.

Anastomosis, Surgical↗
PubMed2004

Long-term results of transanal repair of rectocele using linear stapler.

PURPOSE: This study was designed to determine the long-term outcomes of transanal rectocele repair using a linear stapler. METHODS: Between 1989 and 1999, 21 patients with symptomatic rectocele were enrolled for this study. Median age at time of presentation was 52 (range, 21-75) years. All patients underwent a transanal repair using a linear stapler. End evaluation to assess long-term results was performed after a median duration of follow-up of 58 (range, 12-118) months. Patients were asked about current problems with constipation, use of laxatives, incontinence, vaginal digitalization, presence of vaginal bulge, pain, bleeding, and sexual dysfunction. RESULTS: The postoperative course was uneventful in all cases. Sixteen (76 percent) patients had symptomatic relief. The operation reduced symptoms of obstructed defecation (21 vs. 5, preoperative vs. postoperative; P < 0.001) and the need of vaginal digitalization (21 vs. 6; P < 0.001). Only three patients (14 percent) showed no sign of improvement. Two patients (9 percent) had temporary improvement for three years before recurrence. CONCLUSIONS: Transanal repair of rectocele using a linear stapler is an easy, safe, and useful procedure for the correction of symptomatic rectocele. Successful long-term outcome can be achieved with this procedure.

Adult↗
PubMed2002

Use of endoscopic titanium stapler in rectal anastomotic stricture.

A quick and effective technique is described here for the treatment of rectal anastomotic stricture. It consisted of cutting the stricture using the Ethicon 35-mm Endoscopic Titanium Stapler. A patient was treated here as a day-surgery case. Good functional and anatomic results were achieved on follow-up.

Aged↗
PubMed2005

Transabdominal anastomosis after low anterior resection: A prospective, randomized, controlled trial comparing long-term results between side-to-end anastomosis and colonic J-pouch.

PURPOSE: Colonic J-pouch has been constructed to overcome reservoir dysfunction after restorative rectal surgery, whereas no effort has been made for sphincter dysfunction. We conducted a prospective, randomized study comparing surgical and functional outcomes between side-to-end anastomosis and colonic J-pouch after low anterior resection in which the anastomosis was constructed from the abdomen. METHODS: Fifty-six consecutive patients with middle-to-low rectal cancer undergoing low anterior resection were randomly assigned to side-to-end or colonic J-pouch group preoperatively. Surgical outcomes of all the patients were recorded. Patients underwent functional evaluation, including anorectal manometry and functional assessment, preoperatively and then 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS: Twenty-four patients in each group completed the study. The demographic data and preoperative functional assessment did not differ between the two groups. There was no significant difference in surgical outcomes with regard to anastomotic height (5 cm), blood loss, protective colostomy, operative time, complications, and adjuvant therapy. Anal pressures showed no significant change postoperatively and during the follow-up period; there were no differences between the two groups. Temporal minor fecal incontinence was noted in the early postoperative period in both groups. With regard to bowel function, a significant reduction of volume of urgency and maximal tolerable volume was found postoperatively in both groups; however, a faster recovery was noted in the colonic J-pouch group. Stool frequency increased significantly after surgery in both groups; however, in contrast to rectal volume, a faster recovery was noted in the side-to-end group. CONCLUSIONS: Anastomosis after low anterior resection for middle to low rectal cancer could be performed safely from the abdomen. It minimized sphincter injury and showed good continence preservation. On the other hand, the surgical outcomes and long-term functional results of side-to-end anastomosis were comparable with colonic J-pouch. Side-to-end anastomosis provides an easier, alternative way for reconstruction after restorative rectal surgery.

Abdomen↗
PubMed1994

Videothoracoscopic operation for secondary spontaneous pneumothorax.

Thoracotomy for the management of a secondary spontaneous pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. Videothoracoscopy offers the potential therapeutic benefits of a minimally invasive approach. We report on a series of 22 patients (19 men and 3 women) with a mean age of 70 years (range, 46 to 92 years) who underwent videothoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. All patients had emphysema; their mean preoperative forced expiratory volume in 1 second was 48% of predicted and their mean forced vital capacity was 64% of predicted. Eighteen patients presented with a persistent air leak and their mean preoperative hospital stay was 18 days (range, 6 to 40 days). Pleurectomy was performed in all 22 patients, together with bullectomy in 20 patients, with a mean overall operating time of 57 minutes (range, 24 to 90 minutes). General anesthesia was used in each patient. Single-lung ventilation, used in the majority, was found to be superior to high-frequency jet ventilation. The postoperative analgesic requirement was minimal (average, 15 mg of morphine in the first 12 hours), and no patient required reventilation. A revisional thoracotomy for the management of a persistent postoperative air leak was required in 4 patients, one of whom subsequently died in respiratory failure. The mean postoperative stay was 9 days (range, 3 to 26 days). At a mean follow-up of 8.6 months (range, 2 to 15 months), no pneumothorax had recurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗