Laparoscopic modified Y-V plasty for recurrent bladder outlet obstruction induced by operation of benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To investigate the clinical effect of laparoscopic modified bladder neck Y-V plasty in the treatment of recurrent bladder outlet obstruction after surgery for prostatic hyperplasia.Methods Seventeen patients with recurrent bladder outlet obstruction after prostatic hyperplasia operation from May 2017 to January 2019 was treated by laparoscopic bladder neck Y-V plasty,with the median age of 71 years old (65-81 years).All had a history of repeated urination obstruction and urinary tract infection,and experienced at least 2 times transurethral stenosis incision,resection or repeated urethral dilatation,with 12 cases of bladder neck stenosis (type Ⅰ) and 5 cases of middle prostate stenosis (type Ⅱ).Three-port laparoscopy surgery was performed with outer-peritoneal route into the Retzius Gap.After revealing the bladder and prostate junction,the "Y" incision of the bladder and stenosis of the prostate urethra was firstly performed,and inverted symmetrical "V" shape suture was performed with two 3-0 Stratifix suture for two layers,including the 1th layer suture of mucosal and inner muscle layer,and the 2nd layer suture of the outer muscle and the serous layer.F22 silicone catheter was indwelled for 2 weeks postoperatively.Urinary flow rate and bladder urethral examination were perfrmed to evaluate the effect of surgery 2 weeks and 3 months after the operation respectively.Results Seventeen operations were completed successfully,with the median operation time of 100 minutes (30-100 minutes),the median operation blood loss of 50 ml (20-100 ml),and the median hospital stay of 5 days (1-7 days).The patient had unobstructed voiding after removing the urinary catheter 2 weeks postoperatively,and had no urinary incontinence.Postoperative median follow-up was 7 months (3-17 months) and no stenosis of the urethra was detected.Conclusions Laparoscopic modified bladder neck Y-V Plasty has the advantages of high success rate,low recurrence rate and minimally invasiveness in the treatment of recurrent bladder outlet obstruction after prostatic hyperplasia surgery,which is worthy of clinical application.

Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis? / 대한외과학회지

PURPOSE: Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermiform appendix in treating acute appendicitis with SPICES. METHODS: We retrospectively reviewed 52 children who underwent SPICES for acute appendicitis between March 2010 and November 2011 in our institution. One group (group A) consisted of 30 patients (mean age, 10.5 +/- 2.5 years) with retrocecal appendix, while the other group (group B) included 22 patients (mean age, 10.9 +/- 2.3 years) with the appendix lying free in the peritoneal cavity. RESULTS: There were no significant differences between groups in terms of patient age, gender, success rate of SPICES, mean operating time, mean follow-up period, overall complication rates or mean postoperative hospitalization period. CONCLUSION: These results suggest that SPICES is a safe and feasible approach even in patients with retrocecal acute appendicitis.

A Prospective Study of Non-Prophylatic Antibiotics for Totally Extraperitoneal Laparoscopic Repair of Inguinal Hernia

PURPOSE: The role of prophylactic antibiotics in totally extraperitoneal (TEP) laparoscopic repair of inguinal hernia is unclear. This study was conducted to evaluate the effects of antibiotic therapy for surgical site infection (SSI) in post TEP laparoscopic repair of inguinal hernia. METHODS: We prospectively reviewed data collected from 280 patients with inguinal hernias who were treated by TEP laparoscopic repair between August 2008 and July 2012. None of the patients received prophylactic antibiotics. Patients with a history of recurrent hernias, immune suppressive disease or diabetes mellitus were excluded from the study. RESULTS: There were 265 male patients and 15 female patients aged 19 to 82 years. There were 240 indirect, 38 direct, and 2 pantaloon hernias. The mean operating time was 49 minutes, and the mean length of hospital stay was 1.4 days. The most frequent complications of TEP laparoscopic repair of inguinal hernia were ecchymosis (32.85%), followed by wound pain (16.42%). Surgery related complications occurred in two cases (0.71%) of SSI and 13 cases (8.65%) of wound hematoma. No additional surgical treatment for complications were required. No mesh infection occurred in patients during the follow up period. CONCLUSION: Non-prophylactic antibiotics for elective TEP laparoscopic repair of inguinal hernia appear to be acceptable. Randomized controlled trials of the efficiency of antibiotic therapy in SSI in patients with inguinal hernia should be conducted.

Laparoscopic surgery for ulcerative colitis / 中国普通外科杂志

Objective To investigate the feasibility and safety of laparoscopic surgical treatment of ulcerative colitis(UC).Methods The clinical data of 5 cases who underwent laparoscopic surgery for the treatment of ulcerative colitis were reviewed.Results All 5 cases successfully underwent laparoscopic surgery.Among them,4 had total proctocolectomy and ileal pouch-anastomosis(IPAA),and 1 had subtotal colectomy plus total proctectomy,and cecum-anal anastomosis.The median operating time was 7.5(6.5-9)h,the median blood loss was 250(150-400)mL,the median time to begin semi-fluid intake after operation was 62(60-86)h,the median time of hospital stay was 12(10-14)d,Postoperative pelvic infection occurred in 1 case,adhesive intestinal obstruction occurred in another case.The median follow-up time was 22(10-34)months,and the average number of daily bowel movement was 6.5(4-10)d;they were relapse-free,and had normal daily living and work at follow-up.Conclusions Laparoscopic surgical treatment of ulcerative colitis is associated with minor trauma and rapid recovery,and is safe and reliable,but further accumulation of cases is required.

A comparative study of hand-assisted laparoscopic versus open hepatectomy for liver cancer / 中国普通外科杂志

Objective To study the feasibility and invasiveness of hand-assisted laparoscopic hepatectomy(HALH) for liver cancer.Methods Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group.Data of patients of two groups,Which included operating time,intraoperative blood loss,length of incision,postoperative flatus time,hospital stay,complications and C-reactive protein(CRP) were compared.Results The mean intraoperative blood loss,length of incision,postoperative flatus time,hospital stay and CRP in HALH group were significantly less than that in OH group;but there was no significant difference in operating time,or complication and recurrence rate.Conclusions HALH for liver cancer is less traumatic,and achieves faster patient recovery.It is feasible and safe in selected patients.