ABSTRACT
Las hernias inguinales son las anomalías más comunes en pediatría que requieren de tratamiento quirúrgico. El 70% desarrolla una hernia inguinal unilateral y el 30% restante desarrolla hernia inguinal contralateral. La finalidad de llevar a cabo una exploración contralateral es disminuir el riesgo de recurrencia de hernias metacrónicas en pacientes de riesgo que tienen persistencia del processus vaginalis, así como evitar el daño a estructuras subyacentes por llevar a cabo una exploración abierta1,2. El objetivo fue determinar la prevalencia de hernias inguinales contralaterales en niños y niñas menores de 5 años con factores de riesgo, identificadas a través de peritoneoscopía del 1 de marzo de 2015 al 31 de marzo del 2018 en el Hospital Roosevelt. El diseño de este estudio fue descriptivo y transversal. Se realizó en el departamento de Cirugía Pediátrica del Hospital Roosevelt en la ciudad de Guatemala. Los materiales y métodos empleados consistieron en un estudio realizado a través de la revisión de 128 expedientes de menores de 5 años del Departamento de Cirugía Pediátrica del Hospital Roosevelt que hayan presentado una hernia inguinal entre el período indicado y a quiénes se les practicó peritoneoscopía. Como resultado se comprobó que la prevalencia de hernia inguinal contralateral diagnosticada por peritoneoscopía fue del 59% IC(44,72), 26 casos, en cuyos casos se efectuó cirugía correctiva bilateral, sin recurrencia. Esto permitió concluir que la prevalencia de hernias inguinales se da con mayor frecuencia en niños y niñas menores. (AU)
Inguinal hernias are the most common anomalies in pediatrics that require surgical treatment. 70% develop a unilateral inguinal hernia and the remaining 30% develop a contralateral metachronous inguinal hernia. The purpose of performing a contralateral examination is to decrease the risk of recurrence of metachronoushernias in risk patients who have persisten tprocessus vaginalis, as well as to avoid damage to underlying structures by conducting an open exploration1,2. The objective was to determine the prevalence of contralateral inguinal hernias in boys and girls under 5 years of age with risk factors, identified through peritoneoscopy from March 1, 2015 to March 31, 2018 at Roosevelt Hospital. The design of this study was descriptive and transversal. It was performed in the Pediatric Surgery department of the Roosevelt Hospital in Guatemala City. The materials and methods used consisted of a study conducted through the review of 128 records of children under 5 years of the Department of Pediatric Surgery at Roosevelt Hospital who presented an inguinal between the indicated period and who underwent peritoneoscopy. As a result, it was found that the prevalence of contralateral inguinal hernia diagnosed by peritoneoscopy was 59% IC(44,72) 26 cases, in which cases bilateral corrective surgery was performed, without recurrence. This allowed us to conclude that the prevalence of inguinal hernias occurs more frequently in boys and girl. (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Hernia, Inguinal/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Laparoscopy , Sex Distribution , Hernia, Inguinal/diagnosisABSTRACT
La viabilidad de un abordaje transgástrico para realizar peritoneoscopia y biopsia hepática ha sido demostrada en estudios previos en animales. Objetivo. Nuestro objetivo fue determinar la viabilidad y seguridad de un abordaje transgástrico peritoneal en una experiencia local. Resultados. El abordaje transgástrico con modelo similar a PEG (gastrostomía endoscópica percutánea) se realizó en 3 cerdos de la especie suis scrofa domesticus; el tiempo promedio del procedimiento fue de 102 minutos, no hubo complicaciones relacionadas con el acceso, y la necropsia no evidenció ningún daño de órganos adyacentes al estómago, aunque el cierre de la pared gástrica no fue exitoso en 2 cerdos. Conclusiones. Este estudio reporta la experiencia local con un abordaje transgástrico peroral a la cavidad peritoneal, técnicamente viable. El abordaje similar a PEG es simple y seguro, el cierre de la pared gástrica requiere destreza y mejor tecnología
Background. The feasibility of peroral transgastric peritoneoscopy and liver biopsy has been demonstrated in prior animal studies.Objective. Our purpose was to determine the feasibility and safety of transgastric peritoneal approach in local experience. Designs. Animal experimental feasibility study. Results. The peritoneal transgastric approach with PEG- like model was used in 3 pigs suis scrofa domesticus specie. The average procedure was 102 minutes, it did no have complications related to the access, and the necropsy did not reveal any damage to organs adjacent to the stomach. Nevertheless the gastric wall close was not successful in 2 pigs. Conclusions. This study report the local experience with peroral transgastric approach to peritoneal cavity, its technically feasible, a PEG- like transgastric model is simple and safe, the close of gastric wall requires skill and best technology.
Subject(s)
Animals , Laparoscopy , Peritoneal CavityABSTRACT
Se realizó un estudio comparativo transversal de 28 pacientes con enfermedades hematológicas a los cuales se les realizó esplenectomía, 14 por la vía convencional y 14 por cirugía de mínimo acceso, con el objetivo de realizar una comparación entre ambas técnicas quirúrgicas, en el Servicio de Cirugía del Hospital Universitario Abel Santamaría, en el período comprendido desde Mayo de1996 hasta Mayo del 2002. Se aplicó una encuesta tomando como fuente las historias clínicas que se encuentran en el archivo del hospital, donde se analizó la edad, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, estadía hospitalaria, y a los resultados les fue aplicado el método estadístico de Chi cuadrado. Los principales resultados encontrados en nuestro trabajo fueron: en el grupo de esplenectomía laparoscópica 12 pacientes se fueron de alta en las primeras 96 horas, se operaron 8 pacientes entre 180 y 240 minutos y este grupo presentó costos hospitalarios menores. En el grupo de Esplenectomía convencional 11 pacientes se fueron de alta entre los 7 y 20 días, 12 pacientes se operaron entre 60 y 180 minutos y presentaron sepsis de la herida quirúrgica 6 casos.
A comparative cross ? sectional study is performed in 28 patients suffering from blood disorders who underwent a splecnectomy (14 using the conventional approach and 14, the minimal access procedures) aimed at performing a comparison between both surgical procedures by Surgical Department at Abel Santamaría University Hospital during May 1996 ? May 2002. A survey was being carried out taking the clinical records from the hospital archive and age, preoperative diagnosis, surgery time, complications, hospital stay were analyzed and it was used the chi ? square statistical method. The main results found in out study were: 12 patients were discharged from the hospital after 96 hours (laparoscopic splenectomy group), the surgery time in patients ranged between 180 and 240 minutes and this group presented the lower hospital cost. In the conventional splenectomy group, 11 patients were discharged ranged between 60 and 180 minutes and presented wound sepsis (6 cases).
ABSTRACT
Recently, video-assisted surgical approaches for achalasia have been adopted by many surgeons. Many reports showed that the minimal invasive video-assisted operations for the achalasia revealed such good results as the conventional operations via thoracotomy. In some studies, among the minimal invasive video assisted surgeries for achalasia, the laparascopic assisted operations have some advantages mainly in respect to patient satisfaction over the thoracoscopic assisted surgeries. In this case, the patient had not responded to repeated balloon dilatation, and we made 5 small incisions over the abdominal wall and performed an esophageal myotomy and partial anterior fundoplication by laparascopic guide. The patient's symptoms were almost relieved, and the postoperative radiologic findings were satisfactory.
Subject(s)
Humans , Abdominal Wall , Dilatation , Esophageal Achalasia , Fundoplication , Laparoscopy , Patient Satisfaction , Minimally Invasive Surgical Procedures , ThoracotomyABSTRACT
Objective To introduce and evaluate the hand assisted transperitoneal laparoscopic technique for living donor nephrectomy. Methods Five cases treated by using the technique of the hand assisted transperitoneal laparoscopic living donor nephrectomy (HLDN) were summaried.The procedure utilized a hand assisted device for laparoscopic technique to increase safety and control of the laparoscopic technique. Results In these 5 cases,only left side nephrectomy were performed.Mean operating time was 116 min,with mean warm ischemia time being 2.8 min.Mean length of renal arteries and renal vein was 1.8 cm and 2.7 cm,respectively.There were no intra or post operative complications. Conclusions HLDN is easier than traditional laparoscopic donor nephrectomy (LDN) for the surgeons,so it can minimize the lear ning curve.HLDN can reduce warm ischemia and operating time,and also facilitate trocar placement.In addition,it can improve the prevention of torsion of the kidney,control of potential bleeding,and in the final stages of vascular stapling and kidney removal.HLDN is a promising new method for living donor nephrectomy.
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0.01). There was no recurrence in both groups. Mean hospitalization stay was 8.1 days in the laparoscopy group, whereas it was 11.8 days in the open surgical group. Post- operative fever lasted a mean of 4.1 and 5.4 days in the two groups respectively ( P
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Objective To present the initial experience and results of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder. Methods Fifteen patients (14 men and 1 women) with invasive bladder carcinoma underwent LRC with orthotopic ileal neobladder.The mean age was 59.5 years(range,39 to 71 years).The LRC with orthotopic ileal neobladder consists of 3 major steps,namely laparoscopic cystectomy,extracorporeal formation of ileal pouch and laparoscopic urethra-pouch anastomosis.With 5 trocars,the surgeon conducted the procedure through the 2 ports on the left side,and the assistants did so on the right side and hold the laparoscope.The bilateral pelvic lymphadenectomy were performed first.The ureters were dissected just outside the bladder.The radical cystoprostatectomy was performed for the male patients.The total bladder, uterus and appendage were removed for the female patient.A 4 to 5 cm median incision in lower abdomen was made to remove the surgical specimens and construct the ileal pouch.A 50 cm ileal loop was taken from the abdominal cavity,isolated,detubularized and reconfigured into “M” shaped pouch with running suture.The anti-refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them.For the first 4 cases,the urethra-neobaldder anastomosis was completed through the abdominal incision;while for the other 11 cases,the anastomosis was done under the laparoscope. Results The mean duration of surgery was 5 to 10 h with a mean of 6.5 h;the blood loss was 200 to 1000 ml with a mean of 387 ml.During a follow-up of 1 to 11 months,all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis.4 to 6 weeks after surgery,all the patients with orthotopic ileal bladder had complete daytime continence,and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery.The laparoscopic cystoprostactomy has a magnified clear vision,which makes meticulous manipulation possible,and reduces bleeding,sphincter injury and nerve bundle injury.Shorter time of intestine exposure during the procedure is good for recovery of intestinal function and for reducing postoperative intestinal adhesion.External construction of ileal pouch shortens operation time remarkably.Ileal segment has long and mobile mesentery,thereby can be easily taken out through a small abdomen incision and anastomosed with urethra stump without tension,so it is more suitable for construction of a pouch.
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ObjectiveTo evaluate the role of laparoscopic ultrasonography (LUS) in laparoscopic ureterolithotomy.MethodsLUS was utilized in laparoscopic ureterolithotomy for 7 cases of ureterolith to locate the ureter and stone.ResultsLUS demonstrated the relationship of the ureter to the adjacent structures and guided the dissection of the ureter in all the 7 patients and precisely localized the position of calculi.The stone could be touched by atraumatic clamps in 5 cases.LUS-demonstrated localizations of the ureter and calculi were verified on laparoscopic ureterotomy in the other 2.The mean operating time for LUS was 14 min (ranging from 9 to 20 min ).ConclusionsLUS is a real adjuvant means for locating the ureter and stone.
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Objective To evaluate retroperitoneal laparoscopic adrenalectomy. Methods From June of 1999 to January of 2001, retroperitoneal laparoscopic adrenalectomy was performed on 52 patients with adrenal diseases, including 34 cases of aldosterone-preducing adenoma,3 nodular hyperplasia bilateral in 1, 5 Cushing's syndrom,1 Cushing's disease, 3 adrenal pheochromacytoma (bila- teral in 1), 4 nonfunctional adrenal adenoma, 1 myelolipoma and 1 metastasis carcinoma. Results 54 sessions of retroperitoneal adrenalectomy have been carried out for 52 patients (2 on both sides) with success in 51 procedures. The procedure was converted to open operation in 3 occasions because of bleeding or adhesion. The mean operation time was 135 minutes (40～270 min), and the estimated blood loss 45 ml (5～150 ml) with no need of transfusion. The postoperative hospital stay was 6 d (3～14 d) and the mean analgesia consumed 8.5 mg (0～50 mg) of morphine equivalents with no need of any analgesic at all in 17 patients. Conclusions Retroperitoneal laparoscopic adrenalectomy was less traumatic to the patients, with less postoperative discomfort and quicker recovery. The procedure should be considered as the first choice of therapy for benign adrenal diseases.
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Objective To study and to analyse the cause of laparoscopic adrenalectomy failure and its complications. Methods 8 of 19 laparoscopic adrenalectomies were converted to open surgery .The cause of failure and its complications were analysed. Results The causes to convert to open surgery were:bleeding of right middle suprarenal vein in 1,adrenal tumor was sheltered of cauda pancreatis in 1,left adrenal cyst was sheltered by spleen in 1,CO 2 pneumoperitoneal pressure can not be maintained during the procedure in 2,tumers could not be found in 2,the telescopic port was inserted into musculus psoas major in the retroperitoneal approach and the bleeding influenced the operation field in 1.3 patients had high fever after operations and 1 had an abscess in the adrenal bed.Reactive pleuritis occurred in 1. Conclusions Fine technique and experiences were needed for laparoscopic procedures and good team work between the operators was very important.Complications were often associated with the initial cause that led to the laparacospic adrenalectomy failure.Laparoscopic adrenalectomy via the retroperitoneal approach has been easier than that via the transperitoneal approach.
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This study describes the anatomotopographic position of horse abdominal viscera using laparoscopy. Three differents approaches were used: retroxiphoid, preumbilical and retroumbilical. Fifty one laparoscopic examinations were performed in 11 geldings and 6 males of differents breeds, and ages ranging from 18 months old to 24 years old. The animals were positioned in dorsal recumbency under general anesthesia. Pneumoperitonium was produced using air for a better visualization of theabdominal cavity. This procedure allowed the examination of the diaphragma, stomach, epiplon, liver, spleen, cecum, large colon, small colon, small intestine, urinary bladder, uterus and inguinal rings. This is a safe method to evaluate abdominal cavity and complement the usual procedures in horse diagnostic laparoscopy.
O presente trabalho descreve a disposição topográfica das vísceras abdominais do eqüino por via laparoscópica, com abordagem mediana ventral, em 3 diferentes vias de acesso: retroxifóide, pré-umbilical e retro-umbilical. Foram realizados 51 exames laparoscópicos, utilizando-se 17 eqüinos, sendo 11 machos e 6 fêmeas, de diferentes raças e idade variando de 18 meses a 24 anos, submetidos a jejum alimentar de 36 horas e hídrico de 12 horas. Os animais foram sedados com acepromazina e para indução ã anestesia foram utilizados éter gliceril guaiacólico, midazolan e cloridrato de quetamina. A manutenção da anestesia foi feita por via inalatória com halotano. Durante o procedimento os animais foram mantidos em decúbito dorsal. Com intuito de melhor observação dos órgãos instaurou-se pneumoperitônio com ar ambiente. Tal abordagem permitiu a observação da cúpula diafragmática, centro frênico, estômago, epiploon, lobos hepáticos, baço, ceco, váriossegmentos do cólon maior, cólon menor e intestino delgado, bexiga, útero e anéis ingüinais. Não ocorrera complicações durante os períodos pré, trans e pós-operatórios, demonstrando ser um método seguro de avaliação da cavidade peritoneal, vindo a ser complementar às abordagens já descritas na literatura para laparoscopia diagnostica em eqüinos.
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Asymptomatic chronic HBsAg carriers with normal liver function tests are, in general regarded as having no liver pathology. Most of the histologic findings in asymptomatic chronic carriers have been reported from areas with low incidence of Hepatitis B virus (HBV) infection, such as North America and Western Europe. It is well known that there are many differences in HBV infection between low and high endemic areas, but there have been few reports on the histologic findings of asymptomatic chronic HBsAg carriers from endemic areas. The present study was undertaken in Korea which is one of the endemic areas for HBV infection and was designed to assess the prevalence of chronic liver disease by peritoneoscopic liver biopsy among asymptomatic chronic HBsAg carriers and to make a basis for the follow-up of asymptomatic chronic HBsAg carriers according to the results obtained. One hundred and ten asymptomatic HBsAg-positive carriers with normal liver function tests and no hepatomegaly were included in the study. Final diagnosis by peritoneoscopic liver biopsy revealed that of the 110 asymptomatic carriers only 27 (24.5%) had a histologically normal liver, while 51 (46.4%) had chronic liver diseases, and the remaining 32 (29.1%) had nonspecific histologic abnormalities (nonspecific reactive changes in 18 cases, cholestasis in 6 cases, and fatty change in 8 cases). Of the 51 patients with chronic liver diseases, 3 had liver cirrhosis, 4 chronic active hepatitis with cirrhosis, 11 chronic active hepatitis and 33 chronic persistent hepatitis. The frequency of liver cirrhosis and chronic active hepatitis with cirrhosis was significantly high in the over 30 years of age group (12.1%) than in the under 30 years of age group (0%; p = 0.011 by Fisher's exact test). In conclusion, 46.4% of the Korean asymptomatic chronic HBsAg carriers with normal liver function tests and no hepatomegaly had chronic liver disease. This finding contrasted with reports from low incidence areas of HBV infection. Our results suggest that in endemic areas, a liver biopsy should be considered to assess the status of liver disease in asymptomatic chronic HBsAg carriers even if liver function tests are normal and hepatomegaly is absent, and the result can be used as a basis for the follow-up of each asymptomatic chronic HBsAg carriers.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Biopsy , Carrier State/pathology , Chronic Disease , Hepatitis B/pathology , Hepatitis B Surface Antigens/analysis , Laparoscopy , Liver/pathology , Middle AgedABSTRACT
Primary gallbladder cancer is a highly malignant tumor and is characterized by early metastasis and rapid progression of disease. Since the majority of patients have unresectable disease, laparotomy, instead of providing relief of symptoms, often adds to the morbidity and needs to be avoided in patients with advanced disease. Clinical features, peritoneoscopic findings, and comparison of peritoneoscopy with radiologic studies were reviewed in 29 patients, who underwent peritoneoscopy, with primary gallbladder cancer at Severaace Hospital, College of Medicine, Yonsei University between Aug. 1982 and Mar. 1994. (continue...)
Subject(s)
Humans , Gallbladder Neoplasms , Gallbladder , Laparoscopy , Laparotomy , Neoplasm MetastasisABSTRACT
Peliosis hepatis is characterized by the presence in the liver of blood-filled cavities, which may or may not be lined with sinusoidal cells. The individual cysts or cavities usually do not exceed several centimeters in diameter. The cysts are typically continuous with adjacent, more normal sinusoids, and they sometimes can be seen in continuity with hepatic venous tributaries. The lesion is usually diagnosed by gross or microscopic examination. When suspected, it can be diagnosed by percutaneous liver biopsy. In the past, peliosis hepatis is primarily associated with wasting diseases, such as tuberculosis, malignancy, and chronic suppurative infection. However, recently peliosis hepatis is seen most commonly in association with the administration of anabolic steroids or HIV infection. We report a case of peliosis hepatis that is diagnosed by peritoneoscopic live biopsy and not associated with known disease.
Subject(s)
Biopsy , HIV Infections , Laparoscopy , Liver , Peliosis Hepatis , Steroids , Tuberculosis , Wasting SyndromeABSTRACT
We compared the histological diagnosis and activity between the right and left lobes in order to assess the sampling variability in HBsAg(+) chronic liver diseases. From May 1987 to September 1991, we prospectively evaluated 23 patients(male 19, female 4, mean age: 32.0+8.8)with HBsAg(-) chronic liver diseases. (continue...)
Subject(s)
Female , Humans , Diagnosis , Laparoscopy , Liver Diseases , Liver , Prospective StudiesABSTRACT
Objective To evaluate laparoscopic radical prostatectomy for prostate cancer. Methods 8 patients presented clinical stages pT 1b to pT 2 prostate cancer.Laparoscopic radical prostatecomy was carried out transperitoneally with combining posterior and anterior approachs to the prostate,transecting the bladder neck,lateral dissection of the prostate and urethrovesical anastomosis. Results The operation time was 5 to 11 h with an average of 7.3 h and the blood loss 200 to 1 100 ml,averaged 620 ml.All the patients recovered well and uneventful with no complications such as urethral stricture or incontinence. Conclusions Laparoscopic radical prostatectomy is a better approach and least invasive.The procedure provides clear anatomic vision that facilitates operative performance and quicker recovery.
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Liver involvement in multiple myeloma has been known to be common in autopsied series. However, since its clinical significance is uncertain yet, invasive procedure confirming plasma cell infiltration of the liver has been rarely performed. We report a case with multiple myeloma which had plasma cell infiltration of a liver. A peritoneoscopic biopsy of the liver for the purpose of disclosing the nature of the aggravating liver function in a carrier of the hepatitis B virus showed infiltration of lymphoreticular cell which were identified later as lambda-light chain producing primitive plasma cells by immunohistochemical stain.
Subject(s)
Adult , Female , Humans , Laparoscopy , Liver/pathology , Multiple Myeloma/pathology , Neoplasm Invasiveness , Tomography, X-Ray ComputedABSTRACT
Primary or isolated chylopericardium of unknown etiology is considered a rare cause of pericardial effusion. Its etiology is obscure but certain communication between the lymphatic system and pericardial sac was suggested. Up to 1991, there was only one case report that successfully showed the direct communication by a lymphangiogram. We report a case of chylopericardium occurring in a nearly asymptomatic 22-year-old man with no apparent history of trauma, infection or mediastinal neoplasm, in which we succeeded in visualizing the communication between the thoracic duct and pericardial sac by lymphangiography and computed tomography of the chest. A review of the previous cases is described also.
Subject(s)
Adult , Humans , Male , Chyle/metabolism , Lymphography , Pericardial Effusion/metabolism , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
We experienced a case of congental hepatic fibrosis in a 21-year-old Korean male. He had frequent episodes of esophageal variceal bleeding. His liver and kidney functions were preserved. He had cystic lesions on both kidneys. A diagnosis of congenital hepatic fibrosis was made by an inferior venacavogram and peritoneoscopic liver biopsy. A Kobayashi operation was performed for esophageal varices. He had no more variceal bleeding and his general condition was good after operation.
Subject(s)
Humans , Male , Young Adult , Biopsy , Diagnosis , Esophageal and Gastric Varices , Fibrosis , Kidney , Laparoscopy , LiverABSTRACT
Tuberculous peritonitis is mainly transmitted via hematogenous spreading of tuberculous bacilli. But sometimes this disease is occured, as the abdominal lymph node infected by the localized tuberculous enteritis was ruptured We pressent the report and the brief review of related literatures, who experienced a case of tuberculous peritonitis confirmed by paracentiesis and peritoneoscopic examination in a 9 years old male patient who was suspected toa malignant tumor because of the recent unexplained abdominal distension.