Journal of laparoendoscopic surgery最新文献

Laparoscopic treatments of nonparasitic splenic and liver cysts in the period between March 1993 and April 1995 have been reported: partial decapsulation-fenestration and evacuation of a splenic pseudocyst in one patient, fenestration of large congenital liver cysts with total excision of a few smaller liver cysts in two patients and two unsuccessful treatments of splenic cysts. After successful laparoscopic procedures the patients experienced immediate and complete relief of the symptoms. Two years after the splenic cyst procedure and 6 months after the liver cyst operation, the patients remained free of the symptoms, and complete absence of the cysts was confirmed by computerized tomography scans. Laparoscopic fenestration of nonparasitic splenic and liver cysts with total excision of smaller liver cysts is a simple and safe surgical method with lower morbidity and a quick return to normal activity.

A 2.8-year prospective multicenter trial was conducted to evaluate the ePTFE peritoneal onlay laparoscopic inguinal hernioplasty. A total of 441 inguinal hernias were repaired in 351 patients (326 male; 25 female). Two hundred twenty-six of the hernias were direct, 185 indirect, 4 femoral, 26 pantaloon, 90 bilateral, and 92 recurrent. Standardized data collection forms were used and submitted for centralized data analysis. For the hernioplasty, Cooper's ligament was exposed and an 8 cm x 12 cm x 1 mm GORE-TEX Soft Tissue Patch was stapled circumferentially to Cooper's ligament and the endoabdominal fascia. Patients were followed at 1 week, 6 months, 1 year, and then annually. Three-month intervals were used as needed. There was a mean follow-up of 447 days, with 21% of the total repairs followed for more than 2 years and 56% for more than a year. The overall follow-up rate was 95.5%. The operative and postoperative complication rates were 0.45% and 8%, respectively. There were 17 recurrent hernias (3.8%). The range of experience among the investigators was 13 to 168 hernioplasties. With the completion of 25 cases per investigator, the recurrence rate fell to 0.39%. Postoperative analgesia averaged a 24-hr supply of medication; 12.2% of patients required no analgesia. Convalescence averaged 5.4 days, and return to work averaged 7.7 days. This multicenter trial demonstrates that the ePTFE laparoscopic peritoneal onlay inguinal hernioplasty is a safe and dependable repair, especially after the initial learning curve is surmounted.

This report demonstrates the use of the laparoscope as a means of selecting and facilitating cases of incidental appendectomy by the vaginal route in 12 patients undergoing laparoscopic-assisted vaginal hysterectomy. The procedure was performed successfully in all cases, required an average of 12 min additional of operating time, and was not accompanied by intraoperative or postoperative complications. Our preliminary experience suggests that in selected cases, laparoscopic-assisted transvaginal appendectomy is a simple, cost-effective alternative to laparoscopic appendectomy.

Although the use of laparoscopic techniques in gastric surgery had become a focus in upper gastrointestinal surgery, standardized procedures have not yet been developed. The purpose of the study was to develop a standardized technique for laparoscopic Billroth-II resection in a cadaver model. End points were intraoperative complications and patency of the gastro jejunostomy. Laparoscopic partial stomach resection was performed in seven cadavers. The specimen was removed through an enlarged trocar incision. The first part of the jejunum was temporarily taken out through the same incision and a side-to-side jejuno-jejunostomy created. The gastrojejunostomy was stapled intracorporally. After surgery, all cadavers underwent autopsy. No lesions of intraabdominal organs were found, and the gastrojejunostomy was patent with correct stapling. No major intraoperative complications were recorded. Using the described technique, a laparoscopic Billroth-II operation can safely be accomplished. The technique has been successfully performed in three patients in the last month.

Routine identification and resection of accessory splenic tissue, an integral part of splenectomy for immune thrombocytopenic purpura (ITP), is not necessarily a "blind spot" of the laparoscopic technique. This case report of laparoscopic resection of accessory spleen for recurrent ITP 19 yr after splenectomy supports this view.

The development of biliary tract calculi after orthotopic liver transplantation presents a unique clinical problem. Previously described techniques for removing biliary stones by shock wave lithotripsy, litholytic therapy with oral bile acids, and endoscopic mechanical extraction may be ineffective or contraindicated in liver transplant patients. For this reason, percutaneous transhepatic electrohydraulic lithotripsy (EHL) was performed using an 11 French flexible ureteroscope in two pediatric patients who developed biliary tract calculi following orthotopic liver transplant. There were no complications and postoperative follow-up over 4 years has been uneventful. To our knowledge, these represent the first reported cases of percutaneous transhepatic endoscopic EHL to fragment biliary tract stones in a transplanted liver, which for us has been a safe and effective therapeutic option.

Dieulafoy's lesion is a vascular malformation, usually of the stomach but occasionally of the small or large bowel. It is an uncommon but clinically significant source of massive upper gastrointestinal (GI) hemorrhage. The lesion is generally located high on the lesser curvature in the proximal stomach. Although most bleeding can be controlled endoscopically, surgery is occasionally required. The traditional approach was open laparotomy, gastrotomy to localize the lesion, followed by partial gastrectomy or wedge resection. The following case report describes and illustrates a method of intraluminal endoscopic localization of the lesion followed by laparoscopic gastric wedge resection using a 3-port technique.

The laparoscopic repair of an inguinal hernia usually involves the use of mesh reinforcement. We present a case of migration of mesh from the posterior inguinal wall into the adjacent bladder.