Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Aug 2009
Risk of ventriculoperitoneal shunt infections after laparoscopic placement of Chait Trapdoor cecostomy catheters in children.
Laparoscopic placement of Chait Trapdoor (Cook, Bloomington, IN) cecosotomy catheters has been practiced in our institution since 1999. Chait cecostomy catheters allow antegrade irrigation of the colon without the complications associated with appendicostomies. Although the use of laparoscopy allows precise placement of these catheters into the cecum under direct vision, the presence of a concomitant ventriculoperitoneal (VP) shunt raises concerns for the potential for a shunt infection. ⋯ Cecostomy catheter placement in patients with preexisting VP shunts may increase the risk of shunt infections. Our series illustrates two different mechanisms by which a VP shunt can become infected after this procedure. In the first case, leakage of enteric content from a poorly sealed tract probably resulted in the shunt infection. More secure fixation of the cecum to the abdominal wall, using intracorporeal sutures rather than T-fasteners, may avoid this complication. The second complication could have been avoided if the cecostomy catheter had been placed further away from the VP shunt.
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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.
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J Laparoendosc Adv Surg Tech A · Apr 2009
Laparoscopic gastric pull-up for long gap esophageal atresia.
Esophageal replacement (ER) is indicated for long gap esophageal atresia (LGEA) when anastomosisis not possible, especially in cases without fistula or when elongation techniques have failed. The authors show their techniques and analyze preliminary results of the laparoscopic gastric pull-up (LGPU) for ERin LGEA. ⋯ Video-assisted esophageal replacement with the stomach for LGEA can be safely performed in children and infants, even after a previous mediastinal operation; however, larger comparative series are required in the future.