Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Dec 2002
Case ReportsRectus sheath hematoma complicating percutaneous endoscopic gastrostomy.
A case is reported of a rectus sheath hematoma occurring as an early consequence of percutaneous endoscopic gastrostomy with hemodynamic compromise. The most likely etiology is damage to the superior epigastric artery intraoperatively. Nonsurgical methods were used to achieve hemodynamic stability. This case illustrates an uncommon complication of gastrostomy tube placement that should be considered early postoperatively for patients with hemodynamic compromise.
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Surg Laparosc Endosc Percutan Tech · Oct 2002
The learning curve in ambulatory laparoscopic cholecystectomy.
Whether laparoscopic cholecystectomy (LC) should be performed as an outpatient procedure is still under discussion. The aim of this study was to evaluate the influence of surgeon's experience in ambulatory management of LC. Three hundred eighty-one consecutive elective LCs were planned as outpatient procedures. ⋯ Readmission rate was 0.01%. Free-opiates anesthetic techniques, preemptive analgesia, and somatovisceral blockade allowed us to obtain over 90% of ambulatory LC. The learning curve related to postoperative evaluation is crucial in obtaining those results.
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Surg Laparosc Endosc Percutan Tech · Oct 2002
Prevention of adhesions by bioresorbable tissue barrier following laparoscopic intraabdominal mesh insertion.
Intraabdominal adhesions represent a significant problem because of the morbidity associated with adhesive disease, including small bowel obstruction, difficulties in reoperative surgery, and possibly chronic pain. Coating solution of sodium hyaluronate (Sepracoat; Genzyme Production-Surgical Products, Cambridge, MA) was studied in New Zealand white rabbits to determine its potential role for prevention of postoperative adhesions following laparoscopic intraabdominal mesh insertion. A 2-cm polypropylene mesh was inserted laparoscopically to the left iliac fossa and fixed to anterior abdominal wall using a single prolen suture. ⋯ Eight of 10 animals in the control group and 5 of 10 animals in the study group had intraabdominal adhesions. The scoring of adhesions revealed that study group had only one (10%) significant adhesion, whereas the control group had eight (80%; < 0.001). Our study suggests that the Sepracoat reduces the incidence and severity of abdominal adhesions following laparoscopic mesh insertion and should be considered as a prophylactic agent, especially in those undergoing laparoscopic transabdominal mesh repair for hernia.
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Surg Laparosc Endosc Percutan Tech · Jun 2002
Hand-assisted laparoscopic ultrasound-guided radiofrequency thermal ablation of liver tumors: a technical report.
Ultrasound-guided radiofrequency thermal ablation has been performed for liver tumors by percutaneous, laparoscopic, or open surgical approaches. Each approach has specific advantages and disadvantages. Herein we describe a new technique for hand-assisted laparoscopic ultrasound-guided radiofrequency thermal ablation of liver tumors. ⋯ A hand-assisted laparoscopic ultrasound-guided method has advantages of both laparoscopic and open surgical approaches for radiofrequency thermal ablation treatment of liver tumors. Accurate cannula insertion is possible with the ultrasound guidance system. The hand-assisted laparoscopic approach can become an additional useful technique, particularly as a valuable alternative to an open surgical method, for performing radiofrequency thermal ablation.
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Surg Laparosc Endosc Percutan Tech · Jun 2002
Laparoscopic suture closure of perforated duodenal peptic ulcer.
The aim of this study was to assess the outcome of a continuous series of 30 patients with perforated duodenal peptic ulcers treated by a laparoscopic approach. Between January 1996 and December 1998, 30 patients (24 males, 6 females) with a mean age of 69.2 years were operated on with a laparoscopic approach. Laparoscopic treatment included peritoneal lavage, suture of the perforation, and omental patching in 24 cases. ⋯ Mortality and morbidity rates were 6.6% (n = 2) and 16.6% (n = 5). With a median follow-up of 12 months, 96% of the patients were in good condition; one patient had recurrent duodenal ulceration. The results of our study show the feasibility of the laparoscopic approach for perforated peptic ulcer repair, with acceptable mortality and morbidity rates.