ABSTRACT
Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.
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Objective To investigate the reasons for the changes of serum ALT, AST after laparoscopic cholecystectomy. Methods 69 patients admitted in Oct, 1999 were randomly divided into two groups. The gallbladder was resected with monopolar cautery laparoscopically and cystic bed was routinely coagulated in 35 patients, group a. The gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip in 34 patients, group B. Hepatic tissue in bulk of 1cm X 1cm and close to the gallbladder bed was sampled for histological study for all patients in the two groups. The serum ALT and AST levels were measured on the 1st, 5th ,postoperative day. Results Comparing with group B, the serum ALT and AST levels in group A were significantly higher on the 1th postoperative day ( P
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Objective To report a randomized trial in comparing the clinical outcomes of three-port LC versus standard four-port LC. Methods From March 2001 to August 2004, four hundred consecutive patients who underwent elective LC were randomized to receive either the three-port or the four-port technique. All patients were blinded to the type of operation they underwent. Postoperative overall pain and incisional pain at different sites were assessed on the first day after surgery using the Prince-Henry scale. Other outcome measures included length and success of the operation, analgesia requirements, postoperative complications, postoperative stay, and the cosmetic results. Results There was no difference between the two groups in age, sex, weight or other diseases. In terms of outcome, patients in the three-port group had less pain at individual subcostal port sites and better cosmetic results. Success rate, mean operative time, complications, subxiphoid port and overall pain score, analgesia requirements, and postoperative hospital stay were similar between these two groups. Conclusion Three-port LC resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port LC. The three-port technique is as safe as the standard four-port procedure for LC. Thus, it can be recommended as a routine procedure in elective LC.
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Objective To probe the prevention and management of complications after laparoscopic cholecystectomy (LC). Methods Retrospective study was performed on 13 000 patients, who underwent LCs from September 1991 to February 2005 at our department. Results The complication rate was 1. 66% (216 patients) including intraabdominal hemorrhage in 21 patients (0. 16%),bile duct injury in 11 (0. 08% ),gastrointestinal perforation in 7(0. 05% ) , bile leakage in 26(0. 20% ) , retained abdominal tumor in 10(0. 08% ) , retained common bile duct stones in 47(0. 36% ) , intraabdominal abscess in 4(0. 03% ) , upper gastrointestinal hemorrhage in 2(0. 02% ) , extensive subcutaneous emphysema in 32 (0. 25% ) , port wound infection in 46(0. 35% ) , incisional hernia in 1 (0. 01% ) and deep vein thrombosis in 9 (0.07%). Six patients died postoperatively. Conclusions LC is a safe technique when up-to-date equipment and meticulous dissection techniques are employed. With the routine procedure, LC can be performed more safely.
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Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.
ABSTRACT
Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.