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Ileal perforation by a solidified root pulp - Minimally invasive surgery management. 凝固根髓造成的回肠穿孔--微创手术治疗。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-10-09 DOI: 10.4103/jmas.jmas_312_23
Anmol Galhotra, Deepa Kizhakke Veetil, Randeep Wadhawan, Arun Bhardwaj, Naveen Verma

Abstract: Foreign body (FB) ingestion results in perforation in 1% of cases and is associated with significant morbidity and rarely mortality. This case reports the delayed presentation of distal ileal perforation following accidental ingestion of solidified root pulp. A 46-year-old male presented to the emergency department with complaints of right iliac fossa pain, clinical diagnosis of appendicitis was made. Computed tomography of the abdomen revealed an FB in the distal ileum with contained perforation. Revised history was suggestive of FB aspiration during root canal therapy 3 weeks back. The patient underwent diagnostic laparoscopy, removal of FB and primary closure of the perforation. FB was revealed to be solidified root pulp macroscopically and hyalinised material microscopically. Localised perforation following ingestion of FB results in significant morbidity due to delayed diagnosis. With the increasing number of dental procedures, this becomes relevant globally as well. Varied clinical presentations pose diagnostic challenges to the clinician.

摘要:异物(FB)摄入导致穿孔的病例占 1%,与严重的发病率和罕见的死亡率有关。本病例报告了因误食凝固的牙根果肉而延迟出现的远端回肠穿孔。一名 46 岁的男性因右髂窝疼痛到急诊科就诊,临床诊断为阑尾炎。腹部计算机断层扫描显示回肠远端有一个 FB,并伴有穿孔。复查病史提示,3 周前根管治疗时吸入了 FB。患者接受了诊断性腹腔镜检查,切除了 FB 并对穿孔进行了初步闭合。从宏观上看,FB为凝固的根髓,从微观上看为透明质。摄入 FB 后造成的局部穿孔会因诊断延误而导致严重的发病率。随着牙科手术的日益增多,这一问题在全球范围内也变得越来越重要。不同的临床表现给临床医生的诊断带来了挑战。
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引用次数: 0
Transvaginal natural orifice specimen extraction surgery for left-sided colorectal resection: A single-centre cohort study. 经阴道自然开口标本提取手术治疗左侧结直肠切除术:一项单中心队列研究。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-12-24 DOI: 10.4103/jmas.jmas_108_24
Ruben Gregory Xavier, Tao-Wei Ke, William Tzu-Liang Chen

Introduction: Transvaginal natural orifice specimen extraction surgery (NOSES) is an innovative and feasible approach for left-sided colorectal resections in females. This study aimed to report our experience with transvaginal NOSES for left-sided laparoscopic colorectal resections.

Patients and methods: We analysed data for all patients with transvaginal extraction performed for left-sided laparoscopic colorectal resections between 2011 and 2021 at a tertiary teaching hospital in Taiwan.

Results: The 18 post-menopausal patients were of a mean age of 69.2 ± 10.14 years. The lesions were located at the descending ( n = 5), sigmoid colon ( n = 12) and rectum ( n = 1). The operative time was 262.5 ± 83.91 min, and the blood loss was 34 ± 35.98 mL. All patients had an end-to-end anastomosis, and the anastomotic height was 15.06 ± 8.57 cm. Two patients received diversion stoma. The mean length of hospital stay was 5.1 days (standard deviation ± 2.42; range: 3-12 days). There were no cases of clinical infection. The pathology was malignancy ( n = 14, 77.8%), diverticulitis ( n = 2, 11.2%) and benign ( n = 2, 11.2%). In cancers, they were Stage I ( n = 1, 7.1%), IIa ( n = 1, 7.1%), IIIb ( n = 15, 78.7%) and IV ( n = 1, 7.1%). Malignant specimens ( n = 14) were mostly moderately differentiated ( n = 11, 78.6%), with two poorly differentiated (14.3%) and one well-differentiated (7.1%). The lymph nodes harvested were 16.1 ± 8.11. The widest dimension of the lesion was 3.43 cm ± 1.28 (range: 1.5-6) and the length of the specimen was 14.69 cm ± 5.01 (range: 8-27).

Conclusion: Transvaginal NOSES is safe and feasible for left-sided colorectal resection. Factors to consider are the characteristics of the specimen, anal canal and vagina.

简介:经阴道自然口标本提取手术(鼻)是一种创新和可行的方法,左侧结肠直肠切除术的女性。本研究旨在报告经阴道鼻治左侧腹腔镜结肠直肠切除术的经验。患者和方法:我们分析了2011年至2021年在台湾一家三级教学医院进行的左侧腹腔镜结肠直肠切除术中经阴道取出的所有患者的数据。结果:18例绝经后患者平均年龄69.2±10.14岁。病变位于降结肠(n = 5)、乙状结肠(n = 12)和直肠(n = 1),手术时间262.5±83.91 min,出血量34±35.98 mL。所有患者均行端对端吻合,吻合高度15.06±8.57 cm。2例患者行分流造口术。平均住院时间5.1天(标准差±2.42;范围:3-12天)。无临床感染病例。其中恶性14例(77.8%),憩室炎2例(11.2%),良性2例(11.2%)。在癌症中,它们是I期(n = 1, 7.1%)、IIa期(n = 1, 7.1%)、IIIb期(n = 15, 78.7%)和IV期(n = 1, 7.1%)。恶性标本(n = 14)以中分化为主(n = 11, 78.6%),低分化2例(14.3%),高分化1例(7.1%)。淋巴结清扫数为16.1±8.11。病变最宽尺寸为3.43 cm±1.28(范围:1.5-6),标本长度为14.69 cm±5.01(范围:8-27)。结论:经阴道鼻治左侧结直肠是安全可行的。考虑的因素是标本、肛管和阴道的特点。
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引用次数: 0
Is the double-ligation method safe and effective in laparoscopic paediatric inguinal hernia repair? A retrospective cohort study. 腹腔镜小儿腹股沟疝修补术中的双结扎法是否安全有效?一项回顾性队列研究。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-01-19 DOI: 10.4103/jmas.jmas_232_23
Jong Hyuk Yun, Myoung Won Son, Geum Jong Song, Moon-Soo Lee

Introduction: Laparoscopic paediatric hernia repair has since been performed more frequently. Recently, a double-ligation method was introduced to prevent recurrence in laparoscopic surgery. The objective of our study was to compare the postoperative outcomes of patients who underwent double and single ligations.

Patients and methods: We performed a retrospective review of patients with inguinal hernia who underwent laparoscopic paediatric inguinal hernia repair from 2014 to 2018 at our institution. Patients were divided into two groups and underwent single ligation and double ligation.

Results: Three hundred and six patients (single-ligation group: 142 and double-ligation group: 164) were included. Four patients experienced recurrence, and the recurrence rate was 1.29%. The recurrence rate was significantly higher in the single-ligation group. There were no statistically significant differences in the postoperative complications between the two groups.

Conclusion: Double-ligation method in laparoscopic paediatric hernia repair was relatively safe and helpful.

导言:腹腔镜小儿疝气修补术的应用越来越广泛。最近,为了防止腹腔镜手术中的复发,引入了双结扎法。我们的研究旨在比较接受双结扎和单结扎手术患者的术后效果:我们对 2014 年至 2018 年在本院接受腹腔镜小儿腹股沟疝修补术的腹股沟疝患者进行了回顾性回顾。患者分为两组,分别接受单结扎和双结扎手术:共纳入 360 例患者(单结扎组:142 例,双结扎组:164 例)。四名患者复发,复发率为 1.29%。单结扎组的复发率明显更高。两组患者的术后并发症差异无统计学意义:结论:腹腔镜小儿疝气修补术中的双结扎法相对安全且有帮助。
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引用次数: 0
Stitch-induced caecal fecolith: An unusual long-term complication following laparoscopic appendicectomy. 缝线引起的盲肠粪结:腹腔镜阑尾切除术后一种不寻常的长期并发症。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2023-07-05 DOI: 10.4103/jmas.jmas_14_23
S Sree Subramaniyan, Sri Vengadesh Gopal

Abstract: A fecolith is a mass of accumulated hardened faecal matter usually seen in patients with Chagas disease, Hirschsprung's disease and inflammatory bowel disease. We report a 21-year-old female with chronic right lower abdominal pain post-appendicectomy. An abdominal computed tomography revealed a fecolith near the caecum and a right simple ovarian cyst. On diagnostic laparoscopy, a Prolene stitch in the previous appendicectomy site acting as a nidus and forming a fecolith was noted. It was excised by a small enterotomy and primary closure of the same. She had an uneventful post-operative course. This case highlights the danger of using a non-absorbable suture for appendicectomy and the rare phenomenon of fecolith formation post-appendicectomy after 4 years presenting with features of chronic recurrent abdominal pain.

摘要粪石是一种堆积硬化的粪便物质,常见于恰加斯病、先天性巨结肠病和炎症性肠病患者。我们报告一位21岁女性阑尾切除术后慢性右下腹痛。腹部计算机断层扫描显示盲肠附近有粪石和右侧单纯性卵巢囊肿。在诊断性腹腔镜检查中,在先前阑尾切除术的部位发现一个Prolene针作为病灶并形成粪石。通过小肠切开术和初级小肠闭合切除。她的术后过程平淡无奇。本病例强调了在阑尾切除术中使用不可吸收缝合线的危险,以及4年后阑尾切除术后出现粪石形成的罕见现象,其特征是慢性复发性腹痛。
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引用次数: 0
Robotic versus laparoscopic intersphincteric resection for patients with low rectal cancer: Short-term outcomes. 机器人与腹腔镜下低位直肠癌患者的括约肌间切除术:短期结果。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-12-24 DOI: 10.4103/jmas.jmas_320_23
Wei Ge, Li-Hua Shao, Yu-Dong Qiu, Gang Chen

Introduction: This study aimed to evaluate the short-term outcomes between laparoscopic intersphincteric resection (L-ISR) and robotic intersphincteric resection (R-ISR) for low rectal cancer.

Patients and methods: We performed a retrospective clinical analysis between August 2018 and August 2021 at the Department Of General Surgery, the Affiliated Hospital of Nanjing University Medical School.

Results: A total of 28 patients were recruited in this research. Among these patients, there were 12 patients who underwent L-ISR and assigned to L-ISR group, and the remaining 16 patients underwent R-ISR and assigned to R-ISR group. The time to start oral fluids, time to start soft diet and time to first motion in R-ISR group were earlier than those in L-ISR group ( P < 0.05). The hospital stay in R-ISR group was shorter than that in L-ISR group ( P < 0.05). However, the operation time of R-ISR was longer compared to L-ISR group ( P < 0.05). Most important of all, the Kelly score in R-ISR group was 5.1 ± 0.9, which was higher than that in L-ISR group ( P = 0.004).

Conclusion: R-ISR is safe and feasible for patients with low rectal cancer. R-ISR is superior to L-ISR despite the operation time of R-ISR is longer. A randomised controlled trial will be performed to confirm the conclusion further.

简介本研究旨在评估腹腔镜括约肌间切除术(L-ISR)和机器人括约肌间切除术(R-ISR)治疗低位直肠癌的短期疗效:我们在南京大学医学院附属医院普外科进行了2018年8月至2021年8月的回顾性临床分析:本研究共招募了28例患者。其中,12 名患者接受了 L-ISR 并被分配到 L-ISR 组,其余 16 名患者接受了 R-ISR 并被分配到 R-ISR 组。R-ISR 组患者开始口服液的时间、开始软食的时间和首次活动的时间均早于 L-ISR 组(P < 0.05)。R-ISR 组的住院时间比 L-ISR 组短(P < 0.05)。然而,与 L-ISR 组相比,R-ISR 组的手术时间更长(P < 0.05)。最重要的是,R-ISR 组的 Kelly 评分为 5.1 ± 0.9,高于 L-ISR 组(P = 0.004):结论:R-ISR对低位直肠癌患者安全可行。结论:R-ISR 对低位直肠癌患者来说安全可行,尽管 R-ISR 的手术时间更长,但 R-ISR 优于 L-ISR。将进行随机对照试验以进一步证实该结论。
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引用次数: 0
Conversion of 2-dimensional to 3-dimensional mesh for resource-limited centres in developing countries. 将发展中国家资源有限的中心的二维网格转换为三维网格。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-12-24 DOI: 10.4103/jmas.jmas_52_24
Shaikh Nazrah, Shrivastava Rajesh

Background: In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost.

Patients and methods: We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation.

Results and conclusions: All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.

背景:近年来,腹腔镜疝修补术,即经腹腹膜前修补术和全腹膜外修补术被认为是首选的方法,特别是对于开放性修补术后复发疝或双侧腹股沟疝。然而,它们带来了许多挑战,例如由于补片的锁定或固定而增加的术后疼痛,由于神经卡压和补片迁移或内陷而引起的慢性疼痛综合征。为了克服二维网格不符合腹股沟解剖结构的缺点,引入了三维网格。然而,在印度这样一个资源有限的国家,由于成本高昂,3D网格的广泛使用可能是不可能的。患者和方法:我们的研究共纳入55例患者,从2021年12月至2022年11月,他们接受了腹腔镜扩展完全腹膜外修补疝修补术,为期1年,随访至少1年至2023年11月。在我们的研究组(n = 27)中,我们使用了一种将2D网格转换为3D网格的新技术,随后将其放置而不固定。在我们的对照组(n = 28)中,我们使用标准聚丙烯网片和一点缝合固定。结果与结论:本组患者术后均恢复良好。两组术后疼痛无显著差异(视觉模拟评分:1.24±0.44比1.87±0.56;P < 0.01)和平均住院天数(1.12±0.33∶1.16±0.38;P < 0.01),分别为研究组和对照组。在随访期间,所有患者均未出现慢性疼痛或复发的体征或症状。我们将2D网格转换为3D网格的技术是一种安全可行的方法,在资源有限的情况下可能是传统3D网格的潜在替代方案。
{"title":"Conversion of 2-dimensional to 3-dimensional mesh for resource-limited centres in developing countries.","authors":"Shaikh Nazrah, Shrivastava Rajesh","doi":"10.4103/jmas.jmas_52_24","DOIUrl":"10.4103/jmas.jmas_52_24","url":null,"abstract":"<p><strong>Background: </strong>In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost.</p><p><strong>Patients and methods: </strong>We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation.</p><p><strong>Results and conclusions: </strong>All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"93-96"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhanced view totally extraperitoneal approach: A better alternative to transabdominal preperitoneal approach for irreducible inguinoscrotal and giant inguinal hernias! 增强型全腹膜外入路:经腹腹膜前入路治疗不可复性腹股沟斜疝和巨大腹股沟疝的更好选择!
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2023-09-20 DOI: 10.4103/jmas.jmas_243_23
K Ganesh Shenoy

Abstract: The advantages of enhanced view totally extraperitoneal (eTEP) over TEP approach are well established in large inguinoscrotal, recurrent inguinal, patients with short pubis to umbilicus distance and in obese patients. Irreducible inguinoscrotal hernias (IISHs) and giant inguinal hernias (GIHs) pose a great challenge. GIHs are hernias which extend below the midpoint of the inner thigh with the patient in the standing position. Majority of these hernias are managed by open, hybrid or by transabdominal pre-peritoneal (TAPP) approach. TAPP was considered the optimal minimally invasive approach for these hernias as it provides a large working space and reduction of contents under vision. My practice of eTEP has been limited to IISH and GIH. I would like to share some technical tips to manage these cases by eTEP approach.

与TEP方法相比,增强型全腹膜外视野(eTEP)的优势在大型腹股沟斜肌、复发性腹股沟、耻骨至脐距离短的患者和肥胖患者中得到了很好的证实。不可治愈的腹股沟腹股沟疝(IISHs)和巨大腹股沟疝(GIHs)是一个巨大的挑战。GIH是指在患者处于站立姿势时延伸至大腿内侧中点以下的疝。这些疝大多通过开放式、混合式或经腹腹膜前(TAPP)入路治疗。TAPP被认为是治疗这些疝的最佳微创方法,因为它提供了大的工作空间并减少了视觉下的内容物。我的eTEP实践仅限于IISH和GIH。我想分享一些通过eTEP方法管理这些案例的技术技巧。
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引用次数: 0
Incidental detection of rare vascular variation during pyeloplasty and its clinical implication - A case report. 肾盂成形术中偶然发现的罕见血管变异及其临床意义--病例报告。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-02-09 DOI: 10.4103/jmas.jmas_154_23
Deepak Prakash Bhirud, Shashank Shekhar Tripathi, Amit Aggarwal, Mahendra Singh

Abstract: Crossing vessels is one of the important causes of pelviureteric junction obstruction (PUJO). Accessory lower polar vessels are commonly seen with congenital PUJO, but they are not always the cause of obstruction. We incidentally encountered a variation in the lower polar crossing vessel while doing laparoscopic pyeloplasty in a patient with congenital PUJO. We encountered a right accessory lower polar artery and vein along with a right gonadal artery arising from the accessory right renal artery and right gonadal vein draining into the right lower polar crossing accessory renal vein. Knowledge of variations in genitourinary vasculature is important in the current era to prevent inadvertent complications.

摘要:血管交叉是导致肾盂输尿管连接处梗阻(PUJO)的重要原因之一。先天性肾盂输尿管连接部梗阻(PUJO)常伴有附属下极血管,但它们并不总是梗阻的原因。我们在为一名先天性 PUJO 患者进行腹腔镜肾盂成形术时,偶然发现了下极交叉血管的变异。我们发现了一条右侧附属下极动脉和静脉,以及一条由附属右肾动脉产生的右侧性腺动脉和右侧性腺静脉引流至右侧下极交叉附属肾静脉。在当今时代,了解泌尿生殖系统血管的变异对于预防意外并发症非常重要。
{"title":"Incidental detection of rare vascular variation during pyeloplasty and its clinical implication - A case report.","authors":"Deepak Prakash Bhirud, Shashank Shekhar Tripathi, Amit Aggarwal, Mahendra Singh","doi":"10.4103/jmas.jmas_154_23","DOIUrl":"10.4103/jmas.jmas_154_23","url":null,"abstract":"<p><strong>Abstract: </strong>Crossing vessels is one of the important causes of pelviureteric junction obstruction (PUJO). Accessory lower polar vessels are commonly seen with congenital PUJO, but they are not always the cause of obstruction. We incidentally encountered a variation in the lower polar crossing vessel while doing laparoscopic pyeloplasty in a patient with congenital PUJO. We encountered a right accessory lower polar artery and vein along with a right gonadal artery arising from the accessory right renal artery and right gonadal vein draining into the right lower polar crossing accessory renal vein. Knowledge of variations in genitourinary vasculature is important in the current era to prevent inadvertent complications.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"80-82"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes following laparoscopic adrenalectomy: Experience of more than two decades at a tertiary care centre. 结果后腹腔镜肾上腺切除术:经验超过二十年,在三级保健中心。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-12-24 DOI: 10.4103/jmas.jmas_8_24
Virinder Kumar Bansal, Krishna Asuri, Deepti Singh, Keshav Agarwal, Raghunandan Dixit, Om Prakash, Subodh Kumar, Rajeshwari Subramaniam, Rashmi Ramachandran, Nikhil Tandon, M C Misra

Introduction: Laparoscopic transperitoneal adrenalectomy was first described by Gagner M et al . Here, we present our experience of more than two decades of laparoscopic adrenalectomy performed in a single surgical unit at a tertiary care centre.

Patients and methods: A prospectively collected database of patients undergoing laparoscopic adrenalectomy from December 1994 to May 2020 was analysed retrospectively. The demographic profile, details of clinical workup and laboratory parameters were recorded in a pre-structured pro forma. Functional workup and anatomical imaging were performed for all the patients. Patients were taken up for surgery after adequate pre-operative optimisation using a multidisciplinary approach. All the patients were operated by a single surgical team of experienced laparoscopic surgeons.

Results: A total of 158 patients underwent laparoscopic transperitoneal adrenalectomy. The majority patients were females (64.5%). The median tumour size was 5 cm (range, 1-18 cm). The diagnosis in the majority of the patients was pheochromocytoma (56.3%). The mean operative time was 80 min (range: 45-210 min). The most common complication was bleeding in 6 (3.7%) patients, which required laparotomy. The median duration of post-operative hospital stay was 3 days (range: 1-13). There was no 30-day mortality. The mean follow-up period was 15 months (range: 6-72 months), during which two patients developed local recurrence.

Conclusion: The advantages of laparoscopic surgery are well established and have been extensively explored for the management of adrenal lesions. A multidisciplinary approach to management, consisting of endocrinologists, surgeons and anaesthesiologists is preferred. Pre-operative evaluation, optimisation and accurate selection of patients are crucial for successful laparoscopic adrenalectomy.

引言:腹腔镜经腹膜肾上腺切除术是由Gagner等人首次提出的。在这里,我们提出我们的经验超过二十年腹腔镜肾上腺切除术在一个单一的外科单位在三级护理中心。患者和方法:回顾性分析前瞻性收集的1994年12月至2020年5月行腹腔镜肾上腺切除术的患者数据库。人口统计资料,详细的临床检查和实验室参数记录在一个预先结构化的形式。所有患者均行功能检查和解剖影像学检查。采用多学科方法进行充分的术前优化后,患者接受手术。所有患者均由经验丰富的腹腔镜外科医生组成的单一手术小组进行手术。结果:158例患者行腹腔镜经腹膜肾上腺切除术。女性占多数(64.5%)。中位肿瘤大小为5cm(范围1- 18cm)。以嗜铬细胞瘤居多(56.3%)。平均手术时间80 min(范围45 ~ 210 min)。最常见的并发症是出血,6例(3.7%)患者需要开腹手术。术后住院时间中位数为3天(范围:1-13天)。没有30天死亡率。平均随访15个月(6 ~ 72个月),随访期间2例局部复发。结论:腹腔镜手术在肾上腺病变治疗中的优势已被广泛探讨。由内分泌学家、外科医生和麻醉师组成的多学科管理方法是首选。术前评估、优化和准确选择患者是腹腔镜肾上腺切除术成功的关键。
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引用次数: 0
Totally laparoscopic partial splenectomy and gastropexy for a splenic cyst in a wandering spleen. 全腹腔镜脾部分切除术和胃切除术治疗游走性脾囊肿。
IF 1 4区 医学 Q3 SURGERY Pub Date : 2025-01-01 Epub Date: 2024-01-19 DOI: 10.4103/jmas.jmas_212_23
Taher Saifuddin Merchant, Hussain Kotawala

Abstract: With only seven reported cases until 2019 as noted by Lim et al ., cases of a wandering spleen (WS) accompanied by splenic cyst (SC) are exceptionally rare. Furthermore, both entities are notoriously 'silent' until they present as an emergency with complications, often warranting total splenectomy. Management of SC in a WS eventually depends on its clinical presentation, disease type and functional reservoir of the spleen. However, it is desirable to operate electively and perform a spleen salvage with splenic reposition surgery. Our case describes the first totally laparoscopic partial splenectomy and intraperitoneal fixation of the spleen by means of gastropexy for a large non-parasitic SC in a WS. Partial splenectomy instead of just a cystectomy tackles the risk of cyst recurrence, and a gastropexy over other splenic repositioning techniques would allow the spleen to remain as an intraperitoneal organ.

摘要:Lim 等人指出,游走性脾脏(WS)伴有脾囊肿(SC)的病例到 2019 年为止仅有 7 例报道,异常罕见。此外,这两种病症都是出了名的 "沉默",直到出现并发症的紧急情况,往往需要进行全脾切除术。对 WS 脾囊肿的处理最终取决于其临床表现、疾病类型和脾脏的功能储备。然而,最好是选择性手术,通过脾脏复位手术进行脾脏挽救。我们的病例描述了首例全腹腔镜脾脏部分切除术,并通过胃镜在腹腔内固定脾脏,以治疗 WS 中的大块非寄生性 SC。部分脾脏切除术而不是单纯的囊肿切除术可解决囊肿复发的风险,胃镜手术而不是其他脾脏复位技术可使脾脏作为腹腔内器官保留下来。
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引用次数: 0
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Journal of Minimal Access Surgery
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