Surgical laparoscopy & endoscopy
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Surg Laparosc Endosc · Jun 1995
Review Comparative StudyLaparoscopic cholecystectomy in obese patients compared with nonobese patients.
Obese patients treated by laparoscopic cholecystectomy currently appear to be the largest risk subgroup amenable to consistent scientific evaluation. Here we report our experience and compare the results in obese patients with those obtained in nonobese patients undergoing the laparoscopic procedure. ⋯ Obese patients present significant anesthesiological complications (p < or = 0.001). The results of this experience and the literature review indicate that the therapeutic advantages proved in nonobese patients can be extended to the obese population.
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Surg Laparosc Endosc · Jun 1995
An alternative technique to create the pneumoperitoneum for laparoscopic surgery.
A method for creating the pneumoperitoneum for laparoscopic surgery in 200 patients used the Lazarus-Nelson technique. A needle half the diameter of the Veress needle was used. A guide wire followed by a catheter with multiple side ports allowed for rapid infusion of CO2. A technique used safely in hundreds of thousands of peritoneal lavages gives the surgeon a safe and rapid technique to create a pneumoperitoneum.
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Surg Laparosc Endosc · Apr 1995
Case ReportsManagement of an abdominal cerebrospinal fluid pseudocyst using laparoscopic techniques.
Abdominal cerebrospinal fluid (CSF) pseudocysts are reported to occur in < 1% of ventriculoperitoneal shunts. Management options include various types of shunt revisions with or without aspiration or excision of the pseudocyst. ⋯ The patient experienced no complications from the procedure, and there has been no recurrence of the pseudocyst after 12 months of follow-up observation. This case report demonstrates a novel approach to the management of CSF pseudocysts that is minimally invasive, allows direct drainage of the pseudocyst, and permits manipulation and optimal repositioning of the shunt catheter.
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Surg Laparosc Endosc · Apr 1995
Case ReportsEndoscopic retrograde cholangiopancreatography and endobiliary stenting in the treatment of biliary injury resulting from liver trauma.
Two patients with the bile duct injury secondary to blunt liver trauma are presented. Endoscopic retrograde cholangiopancreatography (ERCP) proved to be a useful diagnostic and therapeutic modality in the treatment of these patients. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma.
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Surg Laparosc Endosc · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialIntramuscular diclofenac sodium for postoperative analgesia after laparoscopic cholecystectomy: a randomised, controlled trial.
Laparoscopic cholecystectomy is the surgical treatment of choice for symptomatic gallstones. Nonsteroidal antiinflammatory drugs offer effective analgesia, avoiding the central side effects of opiate drugs. To assess intramuscular diclofenac sodium (Voltarol; Ciba-Geigy) after laparoscopic cholecystectomy, 55 consecutive patients (41 female; 14 male; mean age: 50 years) were randomised to receive either diclofenac or placebo in double-blind fashion. ⋯ In 26 patients receiving diclofenac, median scores at 4 h were 1.6 (range 0-7.6) as compared with 4.1 (range 0-7.6) in 23 control patients (p = 0.05, 95% confidence limits 3.2, 0; Mann-Whitney U test). Nausea scores, return to diet, and time to discharge did not differ significantly between the groups. Intramuscular diclofenac significantly reduces early postoperative pain after laparoscopic cholecystectomy and is worthy of consideration if the procedure were ever undertaken as day case surgery.