ABSTRACT
Objective To investigate the clinical efficacy of laparoscopy combined with cholangioscopic FREDDY laser lithotripsy for the treatment of difficult central type bile duct calculi.Methods Fifty-five patients with difficuh central type bile duct calculi undergoing laparoscopy combined with cholangioscopy were analyzed retrospectively.There were 31 patients in FREDDY laser lithotripsy group (FREDDY group) and 24 patients in routine instrunent group (routine group).Operative time,intraoperative blood loss,conversion rate,time to first flatus,incidence of postoperative complications (such as pancreatitis,hemobilia and biliary leak),postoperative hospital stay and first session bile duct clearance rate were compared.Results Operative time,intraoperative blood loss,time to first flatus,postoperative hospital stay in FREDDY group [( 106.2 ± 49.4) min,(37.7 ± 28.6) ml,(25.8 ± 19.3 ) h,(5.9 ± 3.3 ) d]were significantly lower than those in routine group[( 142.2 ± 64.8 ) min,(60.3 ± 32.1 ) ml,(37.2 ± 21.6 ) h,(8.4 ±4.9) d] (P＜ 0.05 or ＜0.01 ).There were no statistically significant differences in conversion rate,incidence of postoperative complications and first session bile duct clearance rate between the two groups (P ＞ 0.05).There were no dead in both groups.Seven patients with residual bile duct stones were cured by cholangioscopy through T-tube sinus 6 weeks after prior surgery.Forty-three patients were followed up 6 to 12 months with no recurrent bile duct stones and bile duct stenosis.Conclusions Laparoscopy combined with cholangioscopic FREDDY laser lithotripsy is recommendable to treating difficult central type bile duct calculi with good short-term results and has the advantages of minimal invasiveness,safety,efficiency and rare complications.
ABSTRACT
Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower postoperative pain at 3 d[(2.8 ±1.5) scores], earlier time to first flatus [ (25.8 ± 20.1) h] and resumption of diet [ (2.7 ±2.1) d ], shorter time to drainage removal [(2.0±1.5) d], less wound infection (0) and shorter hospital stay[(4.8 ±2.3) d] than those in OR group [(53.2±30.0) ml, (36.9±27.9) h, (3.7±2.0) scores, (3.6±2.3) d,(2.9±2.2) d,9.4%(5/53), (6.6±4.0) d](P< 0.01 or <0.05). There were no significant differences in operative time,postoperative pain at 1 d, incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of less postoperative pain,earlier return of bowel function,less wound infection and shorter hospital stay.