Surgical laparoscopy & endoscopy
-
Surg Laparosc Endosc · Jun 1993
Case ReportsTrocar site abscess due to spilled gallstones: an unusual late complication of laparoscopic cholecystectomy.
We describe a case of a 31-year-old woman who had an unusual complication after undergoing laparoscopic cholecystectomy. A subcutaneous abscess developed at the site of a 5-mm subcostal accessory port several months postoperatively. When drained, the abscess contained small gallstones that had spilled into the peritoneal cavity upon extraction of the gallbladder during laparoscopic cholecystectomy.
-
Surg Laparosc Endosc · Jun 1993
Case ReportsIntraoperative pneumothorax during laparoscopic cholecystectomy: a complication of prior transdiaphragmatic surgery.
Pulmonary complications of laparoscopic surgery include subcutaneous emphysema, mediastinal emphysema, hypercarbia, and pneumothorax. Pneumothorax is a rare complication that may occur in patients with diaphragmatic defects. We report a case of intraoperative left-sided pneumothorax in a patient who had undergone an esophagogastrectomy for carcinoma 16 years previously. The mechanisms for development of this complication and its management are discussed.
-
Surg Laparosc Endosc · Jun 1993
Preliminary results of laparoscopic repair of perforated duodenal ulcers.
A consecutive series of six patients admitted with perforated anterior duodenal ulcer were operated on using a laparoscopic technique. Only one operation was unsuccessful and required conversion to conventional open laparotomy. ⋯ Early mobilisation and discharge from the hospital (mean, 6 days) were notable features in this series. In conclusion, laparoscopic repair of uncomplicated perforated duodenal is a safe and effective technique.
-
Postoperative discomfort following cholecystectomy has diminished considerably since laparoscopic surgery was introduced. This study assessed the degree of postoperative pain and nausea when, during the operation, the trocar sites had been infiltrated with bupivacaine and antiemetics (ondansetron) had been administered. Postoperative pain intensity was moderate as 20% of the patients were managed without any opiates postoperatively and 88% did not require any opiates after discharge from the recovery room. ⋯ A single dose of ondansetron at the end of the operation seems to reduce postoperative nausea effectively. Two-thirds of the patients had no complaints of nausea, and the majority of the remainder experienced only mild and transitory nausea. We recommend that stab-wound sites be infiltrated with local anesthetics and that antiemetics be administered at the end of the operation.
-
Historically, values of pulmonary function tests, when taken on the day after open upper abdominal surgery and cholecystectomy, show decreases of 45% to 60% compared with preoperative determinations. In a group of 54 consecutive patients in whom many pulmonary function parameters were studied, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), measured the morning after laparoscopic cholecystectomy, revealed a 22% decrease (3.31/2.59 L) and a 21% decrease (2.68/2.11 L), respectively, on average compared with preoperative values, demonstrating better pulmonary function after laparoscopic cholecystectomy. Furthermore, there was no difference between patients above or below 60 years of age and between smokers and nonsmokers. Improved pulmonary function after laparoscopic cholecystectomy may account for the observed reduced rate of pulmonary complications after laparoscopic cholecystectomy.