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At least 1,279 records · Page 71Linked to original sources
PubMed1995

[Randomized trial on the value of diagnostic laparoscopy before appendectomy].

Two groups of 30 women with clinical signs of appendicitis were randomized to immediate appendicectomy or diagnostic laparoscopy. In the latter group, appendicectomy was performed if a diagnosis of acute appendicitis was established or if the appendix could not be visualized. Eleven patients who underwent immediate operation had unnecessary appendicectomy, compared with two who underwent laparoscopy. This difference of 30% (95% confidence interval 11-49%) was significant (p = 0.01). There was no significant difference in postoperative morbidity rate in the two groups. Diagnostic laparoscopy is a useful preliminary investigation in women with clinical signs of acute appendicitis.

Adolescent↗
PubMedDate not supplied

[Emergency laparoscopy in hematology practice].

Outcomes of urgent laparoscopy performed in 31 patients with various hematological diseases were favourable in spite of serious condition of the patients and apparent hemorrhagic syndrome. No laparoscopy-related complications were registered. Due to endoscopic investigation surgical intervention was rejected as unjustified in half of the examinees, 11 operations were performed just in time. Diagnostic difficulties in acute abdominal conditions requiring surgery and indications to laparoscopy in suspected perforations, peritonitis, acute appendicitis, hemorrhages are detailed.

Adolescent↗
PubMed1995

[The value of laparoscopy in diagnosis and therapy in patients with chronic pelvic pain].

The anamnesis, the preoperative diagnostics, the laparoscopic findings, and the therapeutic management are reported of 303 patients who underwent laparoscopy because of chronic pelvic pain during the years of 1989 and 1993. The most common laparoscopic diagnosis were adhesions of the bowel and omentum (34.7%), adhesions of the genital organs (24.1%) and endometriosis (19.8%). In 31.4% there were normal pelvic findings. In patients with a history of surgical or other gynecological procedures we found significantly more adhesions as compared to nontreated controls; the adhesions were predominantly confined to the bowel and rather than the gynecologic pelvis. PID-Patients had significantly more genital adhesions. The high frequency of surgical laparoscopies and therapeutic recommendations following a diagnostic laparoscopy emphasize the importance of a laparoscopic investigation in patients with chronic pelvic pain.

Adult↗
PubMed1995

Use of hysteroscopy in addition to laparoscopy for evaluating chronic pelvic pain.

This study assessed whether hysteroscopy can provide information concerning the cause of chronic pelvic pain. We prospectively evaluated the findings in 547 consecutive patients who had laparoscopy to evaluate chronic pelvic pain at a large, referral-based clinic and outpatient suite of a suburban hospital. Forty-eight had previous hysterectomies. The remaining 499 had hysteroscopy during the same surgery and met the following qualifications: chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, back pain, pelvic pressure or dyschezia for a duration greater than six months and previous failed medical therapy. When endometriosis was the primary diagnosis at laparoscopy, hysteroscopy revealed abnormalities in 62 (32.5%) of 191 patients. At hysteroscopy, 46 of 105 patients (43.8%) with single or multiple leiomyomas of significant sizes diagnosed laparoscopically were noted to have pathology within the uterine cavity. Ten of 11 patients (90.9%) found to have ovarian cysts underwent hysteroscopy. Four (40%) had uterine abnormalities; the most common was cervical stenosis. Pelvic adhesions were found in 118 patients (21.6%). Eighty-nine underwent hysteroscopy, and 24 (27%) had intrauterine abnormalities. Ninety-six patients (17.5%) who underwent laparoscopic evaluation had endometriosis and pelvic adhesions. Ninety-three of these underwent hysteroscopy, and abnormalities were noted in 26 (28.0%). In eight women (1.5%) no abnormality was found at laparoscopy. Two underwent hysteroscopy, and no abnormality was noted in either woman. Hysteroscopy provides useful, adjunctive information and may improve the diagnosis and treatment of chronic pelvic pain.

Chronic Disease↗
PubMed1994

[Post-traumatic hemoperitoneum: role of laparoscopy].

The use of laparoscopic as a diagnostic instrument in blunt penetrating abdominal traumas was first proposed by some authors in the 70s. The introduction of sophisticated instrumental tests, such as CAT and echotomography (ETG), confined this method to narrow diagnostic field which was gradually less frequently used. The lively interest expressed by the surgical world and the enormous spread of laparoscopy after the end of the 80s, following the introduction of laparoscopic cholecystectomy, has prompted the renewed use of the laparoscopic technique also in those subjects with blunt abdominal trauma. Over the past 12 months the authors have used laparoscopy in 8 subjects with hemoperitoneum secondary to contusive abdominal trauma in hemodynamically stable conditions, in which instrumental test (CAT and ETG) and peritoneal lavage were positive for the presence of hematic effusion. The use of laparoscopy in 7 patients allowed a wait-and-see approach to be adopted, thus eliminating the need for explorative laparotomy. It was only necessary to proceed with laparotomy in one patient to control bleeding from a major splenic lesion.

Abdominal Injuries↗
PubMed1994

Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy.

Recently, a high incidence of sonographically detected hepatic hematomas following percutaneous liver biopsy and laparoscopy-guided liver biopsy has been reported. For this reason a prospective study in 178 patients was performed. The patients were examined by ultrasound before and 24 hours after percutaneous liver biopsy using the 1.4 mm-Menghini needle (n = 107) and by laparoscopically-guided biopsy with the 2.5 mm-Silverman needle (n = 71). Four of the 107 patients (4%) who underwent percutaneous Menghini biopsy displayed hepatic hematoma on ultrasonography, and in 2 of these cases the hematoma was > 6 cm in diameter and persisted for more than seven months. In the group of patients who underwent laparoscopy-guided Silverman biopsy (n = 71) a liver hematoma occurred twice (3%). Both hematomas were small and disappeared within several days. There was no need for special therapeutic interventions due to complications. In contrast to recent data about Tru-cut and JAM-Shidi biopsy, the results of this study indicate that percutaneous Menghini biopsy and laparoscopy-guided Silverman biopsy are relatively safe diagnostic procedures.

Adult↗
PubMed1995

Complications and results of 361 hysterectomies performed at laparoscopy.

BACKGROUND: Before the appropriate use of laparoscopy in hysterectomy can be determined, it is necessary to evaluate the results, including complications. There must also be an accepted classification system to facilitate accurate comparison to total abdominal hysterectomy. STUDY DESIGN: We retrospectively evaluated the charts of 361 women who underwent hysterectomy for various benign pathologic conditions. Intraoperative and postoperative complication rates for hysterectomy performed at operative laparoscopy were examined. The hysterectomies were classified as one of four types according to the number of steps performed laparoscopically. All women were candidates for total abdominal hysterectomy, but not vaginal hysterectomy. RESULTS: The overall complication rate for hysterectomy performed at operative laparoscopy was 11.1 percent. Most complications were minor, including cystitis (1.66 percent), transient high fever (1.39 percent), abdominal wall ecchymosis (1.12 percent), and pneumonia and bronchitis (1.12 percent). There was no correlation between the type of laparoscopic hysterectomy performed and the complication rate. CONCLUSIONS: Our rate of intraoperative and postoperative complications associated with laparoscopic hysterectomy compares favorably with published complication rates for vaginal and abdominal hysterectomy.

Abdominal Muscles↗
PubMed1994

Laparoscopy for the nonpalpable testis.

Between 1988 and 1992, 287 infants and children have been evaluated for an undescended testis. In 35, the testis was not palpable. These 35 patients ranged in age between 10 months and 14 years, with a mean of 44 months and a median of 15 months. Thirteen patients had a nonpalpable right testis, 18 had a nonpalpable left testis, and four had bilateral nonpalpable testes. Diagnostic laparoscopy was performed in these 35 boys with a nonpalpable testis to allow a planned approach to management of this condition. In 11 children, a testis was visualized. The testis was in an inguinal hernia sac in seven, and single stage conventional orchiopexy was performed. In four children an intra-abdominal testis was seen, and three infants underwent laparoscopic clip ligation of the testicular vessels. One teenager underwent orchiectomy. In 21 of the remaining 24 boys, small, attenuated testicular vessels were noted to pass into the inguinal canal and inguinal exploration was required. A small testicular remnant was excised in 15 patients, but orchiopexy was possible in six boys. Diagnostic laparoscopy takes 7 to 10 minutes and enables the surgeon to develop a planned approach to this condition. With the information gathered at laparoscopy, the surgeon is best able to decide if an inguinal exploration is necessary or if a single-stage orchiopexy is possible. If a two-stage orchiopexy is required for an intra-abdominal testis, then clip ligation of the testicular vessels can be performed laparoscopically as the first stage, followed by Fowler-Stephens orchiopexy 6 to 9 months later.

Adolescent↗
PubMed1994

[The value of laparoscopy in the diagnosis and treatment of non-palpable testicular cryptorchism].

Laparoscopy is useful in both the diagnosis and the management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchidopexy. A second-stage vasal-based orchidopexy can then be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of 6 years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies and one microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchiectomies for atrophic testes and 8 testicular vessel clippings followed by 6 second stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.

Adolescent↗
PubMed1993

[Laparoscopy in the differential diagnosis of acute disorders of the mesenteric blood circulation and acute pancreatitis].

Difficulties in differential diagnosis of acute impairement in mesenterial circulation (AIMC) and acute pancreatitis (AP) were noted in 39 patients. At laparoscopy, AP was diagnosed in 21 patient, AIMC--in 11, acute appendicitis--in 3, perforative gastric ulcer--in 2. In 2 patients, no pathologic changes were revealed. The diagnosis established by means of laparoscopy, in 9 patients was confirmed at operation, in 10--at autopsy, in the remaining patients--at dynamic follow-up and use of other methods of investigation. Use of therapeutic laparoscopy contributed to improved of the results of treatment of the patients.

Abdomen↗
PubMed1994

Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists.

OBJECTIVE: To estimate the risk factors for and incidence of post-laparoscopy incisional hernia. METHODS: A questionnaire was sent to all individuals on a mailing list from the American Association of Gynecologic Laparoscopists. Adequately completed responses were entered into a computer-based data bank for analysis. Of the 11,500 surveys mailed, 3293 were returned; of these, 3217 were evaluable. RESULTS: A total of 933 hernias was reported from an estimated 4,385,000 laparoscopic procedures (an incidence of 21 per 100,000); 167 (17.9%) were reported to have occurred despite fascial closure. Six hundred sixty-five patients (71:3%) had subsequent surgical repair. Seven hundred twenty-five (86.3%) of the 840 hernias in which the size of the original fascial defect was noted, occurred in sites where ports 10 mm in diameter or larger had been placed. The occurrence of hernias is a function of the number of laparoscopies performed (P < .0001) and is not related to the length of the surgeon's career (P = .41). In at least 157 instances (16.8%), the presenting symptom or morbidity of the hernia was directly related to the involvement of the large or small intestine. CONCLUSION: Post-laparoscopy incisional hernias occur at an approximate incidence of 21 per 100,000 and are associated with significant morbidity. These hernias are most likely to occur when large ports are used. As currently practiced, closure is not completely protective. Further methods or devices should be developed to minimize the risk of hernia formation.

Female↗
PubMed1994

Pharmacologic intervention can reestablish baseline hemodynamic parameters during laparoscopy.

BACKGROUND: Several studies in both animal models and human beings have shown that CO2 abdominal insufflation for laparoscopy can cause a variety of alterations in hemodynamic and pulmonary physiology. These physiologic changes could potentially have deleterious effects in patients with underlying cardiopulmonary disease. METHODS: We prospectively evaluated 15 patients with preexisting heart and/or lung disease to determine whether the use of invasive monitoring would allow early identification and treatment of these physiologic alterations and thus enable laparoscopy to be performed safely in this group of patients. RESULTS: CO2 abdominal insufflation caused statistically significant increases in systemic vascular resistance, mean arterial pressure, left ventricular stroke work index, and pulmonary capillary wedge pressure along with a concomitant decrease in cardiac index and oxygen delivery in these patients. The use of intravenous nitroglycerin resulted in a rapid return of the systemic vascular resistance, mean arterial pressure, pulmonary capillary wedge pressure, and cardiac index to baseline levels. No significant intraoperative or postoperative cardiac or pulmonary complications were noted. CONCLUSIONS: These results suggest that laparoscopy with CO2 pneumoperitoneum can be safely performed in high-risk patients if appropriate monitoring and pharmacologic interventions are used.

Aged↗
PubMed1994

Implication of laparoscopy and peritoneal cytology in the staging of early pancreatic cancer.

Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure. Actually this policy has not to be followed because the possibility to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and celiac alcoholization. In this viewpoint, preoperative staging has acquired an important role for a correct treatment, be it surgical or medical. Laparoscopy allows it to overcome the understaging produced by the more common diagnostic means, with the possibility to view directly the celomatic space and the surface of the abdominal viscera; moreover, during this procedure it is possible to perform a peritoneal washing to obtain other information about the cancer stage. In our experience, 56 patients were judged as resectable by radiologic methods; 31 were excluded from surgery by laparoscopy; 10 of the remaining 25 cases were submitted to radical resection. The operative resectability rate resulted in 40%, against 18% in cases where we submitted to surgery all the patients. Seven patients underwent peritoneal washing, always with a negative result; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal washing represent useful tools in the staging of patients affected by pancreatic cancer.

Ascitic Fluid↗
PubMed1994

[The role of laparoscopy and peritoneal cytology in the preoperative staging of pancreatic carcinoma].

The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical. Laparoscopy allows us to overcome the understaging of the more common diagnostic methods and view directly the coelomatic space and the surface of the abdominal viscera; moreover during this procedure it is possible to perform a peritoneal wash to obtain other information on the cancer stage. We judged 56 patients by radiological diagnosis; 31 were excluded from surgery by laparoscopy; 10 of the other 25 cases were submitted to radical resection. The resectability operative rate was 40%, compared with 18% if we had submitted patients to surgery. Several patients underwent peritoneal wash, always with negative results; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal wash represent useful tools in the staging of patients affected with pancreatic cancer.

Biopsy↗
PubMed1993

[Place and role of laparoscopy in the obstetric-gynecologic division of a municipal hospital].

An analysis was done of 125 diagnostic laparoscopies performed in the Obstetric-Gynaecological Division, Municipal Hospital in Pruszków in the years 1988-1992. Indications to operations were in the first place adnexal pathological processes (including diagnosis of extrauterine pregnancy), infertility diagnosis, lower abdominal pain of unclear origin, primary and secondary amenorrhoea, postmenopausal bleeding. In 92% of cases pathological processes were found in the small pelvis, and in almost 34% this method made the initial diagnosis more precise, and in 38% pathological changes were detected owing to laparoscopy. On the basis of the above material the significant role of laparoscopy was demonstrated in the diagnosis of pathological processes in the small pelvis, especially in adnexa, in the work of municipal hospital division.

Abdominal Pain↗
PubMed1994

The application of laparoscopy in colorectal surgery: a preliminary report of twelve cases.

BACKGROUND: With the development of video camera imaging system and the improvement of laparoscopic manipulation instruments, laparoscopic surgery has become applicable to many abdominal surgeries. Having completed the feasibility studies of animal model over 10 dogs, we began to apply this new technique in the field of colorectal surgery. METHODS: From March to July 1993, 12 cases of large bowel resection were performed with laparoscopy. Operations performed included seven cases of laparoscopy-assisted right colectomy (LARC), three cases of laparoscopic abdominal-perineal resection (LAPR), one case of laparoscopic low anterior resection (LLAR) and one case of laparoscopy-assisted subtotal colectomy. Five cases received operation due to diverticular disease, three due to rectal carcinoma, three due to broad villous adenoma and one due to lipoma over ileocecal region. RESULTS: The average operation time for LARC was 4 hours and 50 minutes, and for LAPR was 6 hours and 35 minutes. Operation time required decreased substantially as the number of laparoscopic surgery performed increased. The average post-operative length of stay was 5.5 days for LARC and 11.5 days for LAPR. Most of the patient started diet intake on the third day after surgery. There was no major complication. Only two cases developed minor complications of subcutaneous hematoma over trocar insertion site and minor wound infection. CONCLUSIONS: Laparoscopic technique can feasibly be employed in certain cases of colorectal surgery, although it is rather complicated and requires longer learning curve than other laparoscopic procedures. Therefore, surgeons should take it most caution while carrying out this procedure. Experimental trials over animal model is also highly recommended before clinical practice.

Adult↗
PubMed1994

Outcome of pregnancy after laparoscopy and chromotubation during cycles of conception: a report of three cases.

BACKGROUND: Diagnostic tubal patency procedures may displace an early pregnancy. Hysterosalpingography performed in the presence of an unrecognized pregnancy has been reported to result in an ectopic pregnancy. No such information on laparoscopy performed during a cycle of conception has been reported. CASES: Three cases of laparoscopy were performed during the luteal phase of an unrecognized pregnancy cycle. The three patients were counseled to avoid conception before surgery. All had an undetectable serum hCG level within 3 days of surgery and an undetectable urine hCG level on the day of surgery. The three pregnancies had an uneventful prenatal course, with delivery at term. CONCLUSION: Although follicular phase scheduling of tubal patency tests would avoid potential pregnancy complications, the risk from luteal phase laparoscopy and chromotubation to an unrecognized pregnancy may be less than expected.

Adult↗
PubMed1993

Pain relief following day-case diagnostic hysteroscopy-laparoscopy for infertility: a double-blind randomized trial with preoperative naproxen versus placebo.

OBJECTIVE: To study the effects of preoperative naproxen on postoperative and post-discharge outcome and consumption of analgesics in patients undergoing diagnostic hysteroscopy and laparoscopy for infertility. METHODS: A double-blind, placebo-controlled study was conducted in 60 healthy women scheduled for day-case hysteroscopy and laparoscopy. Subjects were randomized to receive either 500-mg naproxen suppositories (n = 30) or placebo (n = 30) preoperatively. Following discharge, each patient was given two naproxen suppositories for treatment of pain at home. Pain was scored on the Visual Analogue Scale, and the postoperative and post-discharge use of analgesics was determined, recorded, and analyzed. RESULTS: Patients premedicated with naproxen had significantly less postoperative pain, showed more rapid ambulation, could be discharged earlier, and had less post-discharge pain. On the day after surgery, only six of 28 naproxen-treated patients needed analgesics, compared to 18 of 30 placebo patients. CONCLUSION: Day-case diagnostic hysteroscopy and laparoscopy for evaluation of infertility is potentially painful and stressful. Preoperative naproxen contributed to postoperative pain prevention, reduced hospital stay and consumption of analgesics, and shortened the period of post-discharge abdominal discomfort.

Ambulatory Surgical Procedures↗