Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Apr 2009
Interobserver variation in the assessment of appendiceal perforation.
Following an appendectomy, surgeons define appendicitis, for treatment and billing purposes, into one of four categories: normal appendix, acute appendicitis, gangrenous appendicitis, and perforated appendicitis. Treatment of appendicitis is predicated upon classification at the time of visual inspection. Further, this classification often plays a role in the assessment of hospital outcomes. The currently accepted classification system is based solely upon intraoperative surgeon opinion and not objective data. Inconsistent surgeon grading of the severity of appendicitis may have implications in both management and outcomes. ⋯ There is poor agreement among surgeons in describing the severity of appendicitis. Treatment protocols based on more accurate assessment and categorization could potentially lead to more favorable, cost-effective outcomes. Further, studies determining efficacy in the diagnosis and treatment of appendicitis should consider observer variability. Future work must attempt to define critical objective assessment points, such as visible discontinuity of the appendix or fecal soilage, to assure a better correlation of findings with prognosis.
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J Laparoendosc Adv Surg Tech A · Apr 2009
Case ReportsRetroperitoneal cystic lymphangioma: a rare presentation in childhood, treated laparoscopically.
Retroperitoneal cystic lymphangioma is a rare benign lesion of childhood. A 15-year-old girl underwent laparoscopic excision of such a cyst. ⋯ We report this in view of the rarity of this condition and also the unusual presentation of this case. Complete surgical excision via laparoscopy is a feasible option.
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J Laparoendosc Adv Surg Tech A · Apr 2009
Therapeutic indications of fetoscopy: a 5-year institutional experience.
Prenatal ultrasound study allows the detection of fetal malformations. Intrauterine interventions are now contemplated to correct, or interfere with, the natural history of these anomalies. Minimally invasive techniques, such as the so-called "Fetendo" (fetal endoscopy), are now therapeutic possibilities. ⋯ Fetoscopy can lower the incidence of preterm labor that occurs in response to the aggression of open surgery. At present, fetoscopy is effective for treating several fetal anomalies. Preterm rupture of membranes remains the weak link of fetoscopy. Refinement of the technique and technologic advances will help this problem and allow the use of fetoscopy for other pathologies in the future.
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J Laparoendosc Adv Surg Tech A · Apr 2009
Should intraoperative hypercapnea or hypercarbia raise concern in neonates undergoing thoracoscopic repair of diaphragmatic hernia of Bochdalek?
Better understanding of cardiopulmonary physiology in children with congenital diaphragmatic hernia of Bochdalek (CDH) has facilitated improved survival. In addition, it has allowed surgeons to employ minimally invasive techniques to their repair under conditions that might result in hypercarbia and/or recurrent pulmonary hypertension. ⋯ Hypercapnea and hypercarbia are common phenomena during T-CDH but do not appear to correlate with one another nor result in clinically evident recurrent pulmonary hypertension, hypoxemia, hypotension, need for support with vasoactive medications, inhaled nitric oxide, or buffering agents.
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J Laparoendosc Adv Surg Tech A · Apr 2009
Laparoscopic strategy for inguinal ovarian hernias in children: when to operate for irreducible ovary.
Sliding indirect inguinal hernias containing the ovary and fallopian tube are not uncommon in younger girls. Although an irreducible ovary is not at great risk of incarceration, this condition may become a significant risk factor for torsion or strangulation. This paper describes the indications for surgery in children with irreducible ovaries. ⋯ Many irreducible ovarian hernias can be corrected laparoscopically, and their hernial orifices are easily repaired by LPEC. We strongly emphasize that irreducible ovarian hernias should be treated by LPEC,as soon as possible after they are detected.