Journal of laparoendoscopic & advanced surgical techniques. Part A
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Conservative management of advanced complicated appendicitis in children is becoming more common. Formation of an appendiceal mass or abscess may mitigate against urgent appendectomy during the acute stage, and conservative treatment followed by interval appendectomy has been advocated. We present our experience of interval laparoscopic appendectomy in our institution. ⋯ Interval laparoscopic appendectomy can be safely performed in children, is associated with a short hospital stay and minimal morbidity, analgesia, and scarring following conservative management of appendiceal mass or abscess. Interval laparoscopic appendectomy eliminates the risk of recurrent appendicitis and serves to excise undiagnosed carcinoid tumors. In future it may be possible to perform interval laparoscopic appendectomy as a day-case procedure in selected patients.
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J Laparoendosc Adv Surg Tech A · Apr 2006
Comparative StudyDifferential response of arteries and veins to bipolar vessel sealing: evaluation of a novel reusable device.
A variety of energy-based techniques for arterial and venous vessel ligation have recently been introduced. Using a porcine model we studied the efficacy of the novel reusable BiClamp versus the standard disposable LigaSure bipolar vessel sealing device. We also compared whether arteries respond differently than veins upon sealing. ⋯ Our study indicates that the BiClamp device is as appropriate as the LigaSure instrument to successfully ligate 2-7 mm arteries and veins, demonstrating supraphysiological bursting strengths and adequate lumenal fusion healing. However, veins are more prone to collateral tissue damage and inflammatory wall infiltration.
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J Laparoendosc Adv Surg Tech A · Oct 2005
Case ReportsForceful evacuation of retained pneumoperitoneum mimics an acute recurrent inguinal hernia.
Laparoscopic exploration of the contralateral side during inguinal herniorrhaphy in infants is becoming popular. We present an unusual complication of this technique, namely forceful evacuation of retained pneumoperitoneum mimicking an acute recurrent hernia. ⋯ With the increasing use of laparoscopic contralateral exploration, this case illustrates the need to evacuate the pneumoperitoneum as thoroughly as possible and to consider an airtight closure of the sac.
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J Laparoendosc Adv Surg Tech A · Aug 2005
Randomized Controlled Trial Comparative StudyAnalgesic efficacy of caudal block versus diclofenac suppository and local anesthetic infiltration following pediatric laparoscopy.
To compare the analgesic efficacy of caudal block with diclofenac suppository and local anesthetic infiltration in children undergoing laparoscopy. ⋯ We find the analgesic efficacy of diclofenac suppository combined with local anesthetic infiltration at port sites comparable to caudal block. Given the necessarily invasive nature of caudal block, we suggest the combined use of diclofenac suppository with local anesthetic infiltration at port sites as a useful and more economical alternative for analgesia following pediatric laparoscopy.
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J Laparoendosc Adv Surg Tech A · Jun 2005
Comparative StudyLaparoscopic common bile duct exploration with T-tube choledochotomy for the management of choledocholithiasis.
Although laparoscopic cholecystectomy (LC) has become the gold standard for the management of gallstone disease, the application of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has been slower. The aim of this study is to determine the feasibility and effectiveness of LCBDE. A retrospective cohort study was conducted to compare LCBDE (n = 82) with conventional common bile duct exploration (CCBDE) (n = 75) and endoscopic sphincterotomy (EST) (n = 80) in the management of choledocholithiasis. ⋯ The benefits of LCBDE include minimal invasiveness, concurrent treatment of gallbladder stone and CBD stones in a single session, and a shorter postoperative hospital stay. However a longer learning curve is needed. Selection of the most suitable therapeutic option for individual patients by an experienced surgeon gives the most benefits to patients.