Rehabilitation after Anterior Cruciate Ligament Reconstruction

The purpose of postoperative rehabilitation after anterior cruciate ligament (ACL) reconstruction is to restore the knee joint function by recovering the joint stability and preventing postoperative complications, such as stiffness and patello-femoral problem. Many accelerated rehabilitation programs have been introduced in order to restore the knee joint function, and performed pre-and post-operatively. Pre-operative rehabilitation programs consistof preparing the operation mentally and physically, especially the patient education is the most important point of this step. Post-operative rehabilitations and methods of the ligament reconstruction should be explained and expectation of the patients also should be fully understood by the surgeon. The main purpose of rehabilitation is to acquire contentable range of motion by regulating painand swelling of the knee joint, and to prevent atrophy of quadriceps muscles. The fundamental concepts of the post-operative rehabilitation are early knee joint extension, early weight bearing and early recover of quadriceps muscle power of the knee joint. Passive knee extension should be achieved completely within 1 week post-operatively to prevent contracture of the posterior capsule and scaring of the femoral condylar notch, but if not attained at least 2 weeks, that could bring a poor outcomes. Partial weight bearing should be started immediately if not painful, and full weight bearing could be allowed after 4 weeks. Quadriceps muscle exercise including isometric contracture should begin to start at the first day after surgery because restoration of quadriceps muscle power is important for return to activity of daily living. Electrical muscle stimulation and biofeedback would be helpful to recover quadriceps muscle power by decreasing pain and swelling of the joint effectively. Two weeks after surgery, patients could begin closed kinetic chain exercise, after that, patients could exercise the quadriceps muscle more effectively adding open kinetic chain exercise. Recently, trainings for proprioception and neuromuscular control have been emphasized in orderto improve dynamic stability of the knee joint. Nowadays, variable post-operative rehabilitation programs are introduced for regain the knee joint function, and can be differed by types of graft, concomitant injuries, and especially methods of surgery, so should be performed individually, not by standardized program.

Endoscopic Cecectomy with Hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) in Canine Models

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new operation technique that utilizes natural orifices of the patient's body with the intention to puncture hollow viscera in order to insert an endoscope into a peritoneal cavity for incisionless surgery. The aim of this study was to evaluate the safety and feasibility of endoscopic cecectomy through the rectum in one dog and the vagina in another dog. METHODS: This study was performed in two beagle dogs for rectal and vaginal approaches. A five-milimeter trocar was inserted into the abdominal cavity by the Hasson method and intra-abdominal pressure was maintained at 5 mmHg with CO2. After pneumoperitoneum was accomplished, the rectum or vagina was incised with a needle knife and a one-channel gastric endoscope was inserted into the abdominal cavity. Counter-traction was performed using a laparoscopic grasper introduced via the 5 mm trocar in the umbilicus. The cecum was dissected from the base by using a needle knife with the aid of laparoscopic counter-traction. The resected cecum was retrieved through the anus or vagina without pouch bag. The incised rectum was closed by using 90-degree endoclips whereas the incised vagina was not repaired. RESULTS: Cecectomies were successfully performed with both transrectal and transvaginal routes. Both cases had no complication and recovered from surgery uneventfully. CONCLUSION: Endoscopic cecectomy with hybrid NOTES are feasible and safe. With the improvement of surgical experiences and further instrumental development, NOTES can be one option for human intestinal surgery.

Assessment of Peritoneal Irrigation and Drainage by Perioperative Leukocyte Count following Gastric Cancer Surgery

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.