Surgical endoscopy
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Review Meta Analysis Comparative Study
A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for carefully selected patients. ⋯ Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level of patient satisfaction.
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Randomized Controlled Trial Comparative Study
Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial.
A clinical trial was designed to assess the use of preincisional and intraperitoneal ropivacaine, combined or not with normal saline, to reduce pain after laparoscopic cholecystectomy (LC). ⋯ Preincisional local infiltration plus intraperitoneal infusion of ropivacaine at the beginning of LC combined with normal saline infusion at the end of the procedure is a safe and valid method for reducing pain after LC.
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Laparoscopic Roux-en-Y gastric bypass surgery reportedly has a higher rate of postoperative internal hernias than open bypass surgery. Even with closure of mesenteric defects, hernias occur in up to 9% of cases. To minimize this complication, an antecolic antegastric approach to anastomosis of the Roux limb and gastric pouch has been used. Whereas the retrocolic retrogastric technique creates three mesenteric defects, the antecolic approach produces only two: Petersen's defect and the jejunojejunostomy. The rate of internal hernias was compared among patients undergoing laparoscopic Roux-en-Y gastric bypass surgery using the retrocolic and antecolic approaches. ⋯ The antecolic antegastric approach to laparoscopic Roux-en-Y gastric bypass is associated with fewer postoperative hernias than the retrocolic retrogastric approach. The frequency of hernias using either technique is low if meticulous attention is paid to closure of all mesenteric defects.
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We aimed to test the efficacy and safety of closure of the appendeceal stump with only laparoscopic bipolar electrocautery in rats. ⋯ At late course, coagulated stumps did not allow the leakage or burst, unlike ligated stumps. However, coagulation of the stump seemed to contribute more to epithelial healing. This experimental model suggests that the closure of the stump with only bipolar coagulation was a safe and feasible method.