Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Jun 2009
The use of bedside diagnostic laparoscopy in the intensive care unit.
The clinical evaluation of the abdomen in intensive care (ICU) patients who are intubated can be very complex. Many bedside diagnostic tests are available to assist the clinician, including ultrasound, peritoneal lavage, and plain X-rays. However, in the ICU setting, these tests can be unreliable. An abdominal computed tomography (CT) scan is more reliable, but it requires transportation to the Radiology Department, which can be risky. In this paper, we present our experience with bedside laparoscopy in the general ICU population. ⋯ The evaluation of the critically ill patient for intra-abdominal pathology with DL is a practical solution and needs to be used more frequently in this setting. In this paper, we present our experience with diagnostic laparoscopy in the ICU and found it to be safe and, in certain cases, may have a potential role as a bedside therapeutic tool. Although a number of reports with small series of patients have addressed the benefits and feasibility of DL, it is still being underutilized in the ICU. A more aggressive attempt should be made to incorporate DL as a routine procedure in the ICU.
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J Laparoendosc Adv Surg Tech A · Jun 2009
Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients.
Spinal anesthesia (SA) for laparoscopic cholecystectomy (LC) is only contemplated in patients where general anesthesia (GA) is contraindicated. In this paper, we present our experience of over 12 years of performing laparoscopic cholecystectomy, primarily under spinal anesthesia. ⋯ LC done under spinal anesthesia does not require any change in technique and, at the same time, has a number of advantages, as compared to general anesthesia, and should be the anesthesia of choice.
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J Laparoendosc Adv Surg Tech A · Jun 2009
Case ReportsTotal laparoscopic repair of sigmoid foreign body perforation.
We describe the case of a 43-year-old male who presented with lower abdominal pain following rectal foreign body introduction and self-removal. Clinical examination revealed generalized peritonitis with pneumoperitoneum on Erect Chest X-ray. ⋯ The patient was discharged home four days later: He subsequently underwent successful reversal of his colostomy at four months. Herein we present to the best of our knowledge the first case in the literature of a successful total laparoscopic repair of sigmoid perforation resulting from transanal foreign body abuse.