Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Comparative StudyBiliary tract imaging for retained calculi after laparoscopic cholecystectomy: is risk stratification useful?
The aim of this study was to determine the incidence of common bile duct (CBD) calculi patients undergoing laparoscopic cholecystectomy (LC) without routine intraoperative cholangiography (IOC) and the usefulness of risk stratification in guiding appropriate biliary tract imaging. Five hundred forty consecutive LCs were performed during the 12-month study period. Four hundred fifty-eight (84.8%) patients with low risk of CBD stones proceeded immediately to LC. ⋯ The preoperative incidence of CBD stones was 29/540 (5.4%), while 11 patients (2.04%) were readmitted with retained CBD calculi and underwent successful stone extraction with ERCP. The incidence of retained CBD calculi after LC without IOC is low. Risk stratification helps to accurately predict CBD stones and facilitates appropriate and cost-effective use of ERCP and magnetic resonance cholangiopancreatography.
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Surg Laparosc Endosc Percutan Tech · Oct 2012
Comparative StudyTransanal near-infrared imaging of colorectal anastomotic perfusion.
The influence of perfusion on colorectal anastomotic healing and, conversely, the role of ischemia in anastomotic dehiscence have been reported by many investigators, and yet identifying a modality that can evaluate perfusion in real time and thus guide intraoperative management has proven elusive. This study describes our initial experience using transanal near-infrared (NIR) imaging to evaluate anastomotic perfusion after colorectal anastomoses. Patients undergoing colectomy with an anastomosis within 25 cm of the anal verge were included in this study. ⋯ The rectum was easily navigated under direct vision and the anastomotic staple line visualized. High-quality NIR mucosal angiography was obtained in all subjects, confirming that transanal NIR angiography is feasible and simple to perform. Although NIR mucosal angiography is a promising modality, further study is needed to correlate this technique to the clinical outcome.
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Surg Laparosc Endosc Percutan Tech · Aug 2012
Laparoscopic technique for hernia reduction and mesenteric defect closure in patients with internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass.
Internal hernia is a relatively common complication of laparoscopic Roux-en-Y gastric bypass. Laparoscopic treatment may be a challenge for nonbariatric surgeons if small-bowel obstruction is present. The aim of this paper is to present a systematic laparoscopic technique for hernia reduction and mesenteric defect closure in patients with small-bowel obstruction due to an internal hernia as a postoperative complication of laparoscopic Roux-en-Y gastric bypass. ⋯ After the internal hernia repair patients reported no further abdominal symptoms. Treatment of small-bowel obstruction due to an internal hernia should be attempted by laparoscopy except in the setting of bowel necrosis. The technique presented in this article represents a safe and effective option for the management of this complication.
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Surg Laparosc Endosc Percutan Tech · Aug 2012
Review Meta AnalysisSingle-incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis.
Acute appendicitis remains the common gastrointestinal emergency in adults. Single-incision laparoscopic appendectomy (SILA) has been proposed as the next evolution in minimally invasive surgery. SILA is postulated to reduce postoperative pain and enhance cosmesis, while effectively removing an inflamed appendix. However, the efficacy and benefits of SILA compared with conventional laparoscopic appendectomy (CLA) remain to be determined. Our objectives were to systematically review the literature comparing SILA with CLA for acute appendicitis and perform a pooled analysis on the efficacy of SILA. ⋯ This systematic review and pooled analysis demonstrates that SILA is comparable to CLA for acute appendicitis in adults. However, this review identifies the need for randomized controlled trials to clarify the efficacy of SILA compared with CLA.
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Surg Laparosc Endosc Percutan Tech · Aug 2012
Randomized Controlled Trial Comparative StudyThe comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain.
Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain. ⋯ Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.