Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Aug 2015
ReviewMuscle Relaxation in Laparoscopic Surgery: What is the Evidence for Improved Operating Conditions and Patient Outcome? A Brief Review of the Literature.
When neuromuscular blocking agents (NMBA) were introduced into clinical practice in 1942, the event was called the "second revolution in anesthesia." Despite some significant side effects, NMBAs have remained in the anesthetists' repertoire, not at least because muscle relaxation has been claimed to allow or facilitate many surgical procedures. Aim of this literature review was to investigate the evidence for the use of NMBA as well as the optimum depth of neuromuscular blockade during laparoscopic surgery. ⋯ However, the decision to utilize deeper than standard muscle relaxation should currently be based on a risk-benefit analysis for each individual patient. Thus good communication between surgeon and anesthetist remains crucial to achieve best outcomes.
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Surg Laparosc Endosc Percutan Tech · Aug 2015
Randomized Controlled TrialEffectiveness of Local Anesthetics in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.
Laparoscopic cholecystectomy is the gold standard for gallstone disease. Postoperative pain still is considerable and may prevent early discharge. ⋯ Intraperitoneal application of local anesthetics and trocar wound infiltration did not lower the pain scores in comparison with trocar wound infiltration in our study.
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Surg Laparosc Endosc Percutan Tech · Aug 2015
Randomized Controlled TrialXylitol Gum Chewing to Achieve Early Postoperative Restoration of Bowel Motility After Laparoscopic Surgery.
Our objective was to evaluate the effects of postoperative xylitol gum chewing on gastrointestinal functional recovery after laparoscopy. Altogether, 120 patients undergoing elective gynecologic laparoscopy were randomly divided into 2 groups of 60 each (final numbers: 53 controls, 56 patients). Controls underwent a routine postoperative regimen. ⋯ No significant differences were found for first defecation time, hospitalization duration, or mild/severe intestinal obstruction (all P>0.05). Thus, xylitol gum chewing after laparoscopy can effectively shorten the time to first flatus and helps with postoperative gastrointestinal functional recovery. It is simple, convenient, and well tolerated.
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Surg Laparosc Endosc Percutan Tech · Aug 2015
Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy.
Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series. ⋯ In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.
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Surg Laparosc Endosc Percutan Tech · Jun 2015
Meta Analysis Comparative StudyMeta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP).
The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious. ⋯ This meta-analysis demonstrates a significant decrease in complications in patients with severe GSP managed with early ERCP/ES compared with conservative management. As far as the mortality is concerned, no significant decrease was observed in mortality even in severe GSP patients treated with early ERCP/ES.