JSLS : Journal of the Society of Laparoendoscopic Surgeons
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To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. ⋯ A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease.
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Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We present our experience using spinal anesthesia as the first choice for laparoscopic surgery for over 11 years with the contention that it is a good alterative to anesthesia. ⋯ Laparoscopic surgery done with the patient under spinal anesthesia has several advantages over laparoscopic surgery done with the patient under general anesthesia.
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Grade III through V splenic injuries as defined by the American Association for the Surgery of Trauma (AAST) grading scale are associated with hemorrhage and nonoperative failure. Embolization has been reported to reduce splenic bleeding in 50% to 75% of patients with a high-grade injury. However, splenectomy following embolization may be necessary in patients who continue to bleed or develop splenic infarction with abscess formation. ⋯ Our experience suggests that in cases of high-grade splenic injury or angiographic extravasation associated with moderate to large hemoperitoneum, embolization may serve as a bridge to operative therapy and make laparoscopy a safe, less-invasive option for splenectomy.