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RESUMEN Los trastornos pancreáticos, las pancreatitis agudas de etiología biliar son infrecuentes en pediatría y más aún los pseudoquistes pancreáticos, los cuales son colecciones líquidas rodeadas por una cápsula fibrosa sin epitelio, generalmente secundario a una pancreatitis aguda. Presentamos el caso de una paciente femenina de 14 años, con antecedente de pancreatitis aguda de origen biliar hace 10 meses, que presenta dolor abdominal y una masa palpable en epigastrio. Se realizaron estudios imagenológicos, confirmando el diagnóstico de pseudoquiste pancreático y colelitiasis. Se optó por las bondades técnicas y estéticas de la laparoscopía, para esta población. Por lo cual, se realizó una cistogastroanastomosis y colecistectomía laparoscópica, con una evolución favorable. Nosotros reafirmamos que esta técnica, es un método seguro y efectivo, para el manejo de esta patología en pacientes pediátricos, y debería considerarse como primera opción, al no contar con procedimientos endoscópicos. Siendo este, el primer reporte en nuestro medio.
ABSTRACT The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first option in case endoscopic procedures are not available. This is the first report in our settings.
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Objective To explore the clinical effect of laparoscopy combined with choledochoscopy on choledocholithiasis.Methods Totally 134 elderly patients with choledocholithiasis were treated in our hospital from Jan 2013 to Dec 2014, who were randomly divided into observation group and control group (n=67 for each), treated with laparoscopy combined with choledochoscopy, and traditional surgery, respectively.The operation time, bleeding volume, exhaust time, in-hospital stay, complications and residual stones rate were compared between the two groups.Results The operation time was higher in observation group than in control group [(124.6±21.2) min vs.(94.7± 17.9) min, t=8.821, P＜0.001].The bleeding volume were less in observation group than in control group[(43.8±10.4) ml vs.(113.5±37.6) ml, t=14.624, P＜0.001].The exhaust time and in hospital time were decreased in observation group than in control group[(27.6 ±5.5) h vs.(43.4±8.1) h, (7.4±2.4) d vs.(10.3±2.8) d, t=13.209 and 6.437, P＜0.001 for both].The incidences of postoperative pain and other complications were lower in observation group than in control group [6.0％ vs.28.4％, 16.4％ vs.43.3％, x2=11.810and 11.547, P=0.001 for all].Conclusions The laparoscopy combined with choledochoscopy has advantages to minimize the surgical injury, reduce the bleeding volume and promote the postoperative recovery in treating choledocholithiasis in elderly patients.
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Objective To compare the efficacy of the streamlined liner of the pharynx airway (SLIPA) and the proseal laryngeal mask airway (PLMA) in airway management in elderly patients undergoing laparoscopic cholecystectomy.Methods One hundred and twenty patients aged 60-75 years with American Society of Anesthesiologists (ASA) grade] or Ⅱ undergoing laparoscopic cholecystectomy were randomly divided into three groups:the endotracheal intubation group (Group T,n=40),the SLIPAgroup (GroupS,n=40) and the PLMA group (GroupP,n=40).Endotracheal intubation and laryngeal mask airway insertion were conducted after induction of anesthesia.All the patients were ventilated with intermittent positive pressure ventilation.Mean arterial pressure and heart rate were recorded at before induction (T0),successful insertion (T1),ten minutes after pneumoperitoneum (T2),successful extubation (T3),and ten minutes after extubation (T4).The rate of successful placement at first attempt,time taken for placement,airway sealing pressure,and side effects were recorded.The incidences of post-extubation cough,backflow,aspiration,larynogospasm,bleeding,gastric distension and sore throat within 2 days after intubation were also recorded.Results The successful rates of insertion were 92.5 ％,92.5 ％,95.0 ％,respectively,at first attempt and 100.0％ at second attempt in the three groups (x2 =0.268,P＜0.05).Changes in hemodynamic parameters were significantly different between Group T and Group S or P after induction (t=4.076,P＜0.05).Time taken for placement was shorter in Group S than in Groups T and P,meaning that the placement of SLIPA was easier than that of endotracheal intubation or PLMA (t=43.561,P＜0.05).The airway sealing pressure was higher in Group P than in Group S,but had no statistically significant difference between the two groups (t=0.363,P＞0.05).There was no significant difference in post extubation complications,including backflow,aspiration,laryngospasm and gastric distension (t=0.321,P＞0.05),among the three groups,but incidences of postextubation cough and pharyngalgia were higher in Group T than in Group S and Group P (x2 =26.674,10.568,P＜0.05).Conclusions SLIPA and PLMA can both provide adequate ventilation during operation,with few complications.SLIPA placement is the easiest,while PLMA has good airway sealing and thus is more suitable for elderly patients undergoing laparoscopic cholecystectomy.
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Objective To explore the clinical valuation and feasibility of transumbilical abdominal wall within the three-channel single-incision laparoscopic combined cholecystectomy and appendectomy.Methods The clinical data of 40 patients who underwent transumbilical abdominal wall within the three-channel single-incision laparoscopic combined cholecystectomy and appendectomy from January 2011 to March 2013 were retrospectively analyzed.Results Forty patients were successfully completed surgery,no transfer laparotomy and death cases,surgery time was 60-80 min,average 70 min,without postoperative incision infection,wound bleeding,bile duct injury,appendix stump fistula and abdominal residual abscess,neither postoperatively used analgesics,1 month after without incision scar,cosmetic effect was remarkable.Half a year's follow-up,the excellent operation evaluation.Conclusions The performer should have accomplish laparoscopic operation skills,and master the indications and the principle.The method of transumbilical abdominal wall within the three-channel single-incision laparoscopic combined cholecystectomy and appedectomy is safe,feasible and valid.The postoperative wound is more minimally invasive and aesthetic effect is obvious.
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Fundamento: la anestesia general constituye la técnica de elección para la colecistectomía videolaparoscópica. Sin embargo, la anestesia regional ofrece algunas ventajas, una de ellas es que se evita la manipulación de la vía aérea en pacientes con vía aérea anatómicamente difícil. El empleo de la anestesia regional puede implicar varios problemas, debido a complicaciones propias del método anestésico, que muchas veces requiere la permeabilización de la vía aérea; esta situación puede poner en riesgo al paciente si no se toman las debidas precauciones. Caso clínico: se presenta el caso de un paciente masculino de 67 años de edad con el diagnóstico de litiasis vesicular, al cual se le realiza colecistectomía laparoscópica con el empleo de la anestesia epidural con dosis mínima de anestésico local, debido a dificultades con el manejo de la vía aérea. Conclusiones: la cirugía se llevó a cabo de forma exitosa, el paciente egresó en 24h sin complicaciones.
Background: general anesthesia constitutes the election technique for videolaparoscopic cholecystectomy. However, regional anesthesia offers some advantages; one of them is the handling of the airway. In patients with difficult airway anatomically, the use of regional anesthesia may involve several problems, due to own complications of the anesthetic method which often requires the permeability of the airway; this situation might endanger the patient if proper precautions are not taken. Clinical case: a masculine patient of 67 year-old is presented with vesicular lithiasis as diagnosis, who a laparoscopic cholecystectomy using epidural anesthesia with minimal dose of local anesthetic was carried out, due to difficulties with airway management. Conclusions: the surgery was successfully performed; the patient was discharged from hospital in 24 hours since all the necessary measures to avoid complications were taken.
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Objective To observe the postoperative analgesic effects of perioperative intravenous parecoxib in gerontal patients undergoing laparoscopic cholecystectomy. Methods A prospective,randomized, double-blind, placebo-controlled, parallel group study was performed. The 40 American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ patients (aged 60-80 years) undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly allocated to 2 groups (n = 20,each): the parecoxib group received intravenous parecoxib 40 mg at 10 minutes before incision and 12 hours and 24 hours after incision; however, the placebo group received 5 ml normal saline instead of parecoxib at the same time. The intensity of algesia was measured using visual analogue scale (VAS)scores (1-10, 0 = no pain, 10 = worst pain), and was recorded at 2, 4, 6, 12, 24 hours after operation. The patients' global evaluation of postoperative analgesia was recorded and compared between the two groups. Results The VAS scores at the different time points were significantly less in parecoxib group than in placebo group (all P＜ 0.05). The patients' global evaluation of postoperative analgesia was higher in parecoxib group than in placebo group [(8. 1 ± 1.2) scores vs.(5.2± 0. 9 ) scores, t = 7. 402, P ＜ 0. 05]. Conclusions Intravenous parecoxib can effectively relieve postoperative algesia and improve postoperative analgesia after laparoscopic cholecystectomy.
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Objective To investigate the value of combined use of laparoscopic cholecystectomy(LC)and duodenoscopic procedures in the treatment of gallbladder stones with common bile duct stones.Methods We retrospectively analyzed clinical data of 164 cases of gallbladder stones with common bile duct stones treated with laparoscopic cholecystectomy + endoscopic sphincterotomy(EST)from January 2003 to December 2007.Results All the cases underwent ERCP and endoscopic sphincterotomy(EST)followed by LC.In the 164 cases,196 bile duct stones were extracted from 155cases with a success rate of 94.5%.The procedures were unsuccessful in 9 cases,and among them,4 cases had stricture of bile duct more than 2 cm in length,and 5 cases had impacted stones that precluded passage of the guide wire.After EST,6 of the 155 cases had the complication of mild acute pancreatitis and LC was performed after its treatment.The success rate of LC was 96.5% and the average hospital stay was(11?4)d.Conclusions The combined use of EST and ERCP before LC is effective in treatment of gallbladder stones with common bile duct stones,and has broadened the utilization of minimally invasive treatment for bile duct diseases.
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Objective To compare the postoperative changes in immune function of patients undergoing robot-assisted laparoscopic cholecystectomy(RLC) and conventional laparoscopic cholecystectomy(CLC).Methods The clinical data of 52 cases of gallbladder stones and gallbladder polyps treated with RLC(23 cases),and with LC(29 cases) was compared.Blood samples from both groups were taken to measure immune markers(T cells,IgA,IgM,IgG,C3,C4) before operation and in the first postoperative morning.Results The postoperative levels of CD4/CD8 and IgM decreased from 1.56?0.67,1.42 ?0.58 to 1.30?0.53,1.26?0.46 respectively after RLC(all P0.05).Conclusions RLC and CLC showed no significant postoperative effect on cellular immune function,but both had some effect on humoral immune function.
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Objective To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury.Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively.Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases,acute and subacute cholecystitis in 432 cases,cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases.Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis).The average operation time was 43.5 minutes.Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage,and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage,infection or death.The mean hospitalization time after operation was 5.5 days.Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.
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Objective To determine the feasibility and management of the laparoscopic cholecystectomy (LC)for acute cholecystitis. Methods The clinical data of 106 patients with acute cholecystitis underwent LC were reviewed retrospectively. Results Six cases were converted into laparotomy and LC were successfully performed in other 100 cases. No complications occurred in this series. Conclusions LC is feasible for acute cholecystitis;the skill and experience of the operator is the key to the success of the operation.
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Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.
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Objective To determine the advantages of laparoscopic cholecystectomy (LC) by establishing pneumoperitoneum under direct vision. Methods A 1cm incision was made just below the umbilicus; lifting and cutting out of the peritoneum at the line alba abdominis with direct vision; then a 10mm trocar was inserted into the pneumoperitoneum cavity.Results There were 107 patients underwent LC.Of them, 93 patients suffered from chronic cholecystitis with gallstone, 6 from acute cholecystitis with gallstone, and 8 from cystopolyps. Among them, 16 patients had previous abdominal operations. Two patients with atrophic cholecystitis converted to open cholecystectomy(OC) owing to the unclear bile duct anatomy. The average operation time was 45min. Postoperative complications included pulmonary infection in 3 patients, bile leakage in 1( due to the titanic clip falling off),but no bile duct injury or other severe complications occurred;and no mortality in this series. Conclusions Establishing pneumoperitoneum under direct vision has following advantages:rapid and safe,and favorable to avoid the severe trocar-related complications.
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Objective To investigate the systemic stress responses of laparoscopic cholecystectomy(LC). Methods Seventy patients with cholecystolithiasis were randomly divided into two groups: LC and open cholecystectomy(OC). Peripheral blood samples were obtained during the preoperative day and 1, 3, 5, 7 day after operation. Serum cytokines levels (TNF-α, IL-1β and IL-6) and C-reactive protein(CRP) were measured. Results Changes of TNF-α and IL-1β before or after surgery in both groups showed no significant difference(P>0.05). Serum concentrations of IL-6 and CRP after surgery in both groups were significantly higher than those before surgery(P<0.05); but there were no significant difference between the two groups(P>0.05). Conclusions The systemic stress responses of LC have no significant difference comparing with OC.
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Objective To study the feasibility of laparoscopic cholecystectomy(LC)combined with laparoscopic appendectomy(LA).Methods One hundred and thirty patients of cholecystitis with acute appendicitis or chronic appendicitis were treated by LC combined with LA at the same operation.Results One hundred and tweent-nine cases were operated successfully.1 case was converted to open operation .No complications occurred in this series.Conclusions LC combined with LA in treating patients with cholesystitis combined with acute appendicitis or chronic appendicitis is a preferable method.
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Objective To study the effect of laparoscopic cholecystectomy(LC) in the treatment of patients with schistosomiasis hepatic cirrhosis(SHC) complicated with symptomatic gallstone. Methods The clinical data of 256 cases of SHC with symptomatic gallstone underwent cholecystectomy in recent 4 years in our hospital were reviewed retrospectively. Of them, 74 underwent LC , which was compared with the cases who underwent open cholecystectomy(OC) in operation time, operative heamorrage,operative complications, and hospital stay.Results The operation time in LC group and OC group was 63 min and 54 min respectively; the operative bleeding of LC group was 15.6ml, OC group 85 ml;and hospital stay was 1.2days in LC group,8.9 days in OC group。Six cases of LC group was converted to OC.None had postoperative complications in LC group; but 1 case in OC group had bile leakage. Conclusions With strict the operative indications and proper operative method,LC in the treatment of SHC patients with gallstone is safe and feasible.
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Objective To investigate the feasibility of combined laparoscopic resection of gallbladder and other viscera. Methods The clinical data of 69 cases of combined laparoscopic resection of gallbladder and other viscera from January 1999 to July 2004 were reviewed retrospectively. Results The laparoscopic operation was successful in 69cases,and no case was converted to laparotomy.The average operation time was(85.5?18.6)min,and the time of return of gastrointestinal function was(27.3?6.2)h. The average hospitalization time after operation was(3.9?0.8)d.There were no operative or postoperative complications , and the therapeutic results were satisfactory. Conclusions The combined laparoscopic resection of the gall bladder and other viscera is safe and feasible. It is possible to treat gallbladder diseases and associated lesions of abdominal viscera simultaneously. The lesions of several organs can be treated at one operation. This can significantly decrease patients′ pain and lower the cost of treatment, and is worthy of wide usage.
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Objective To study the practical clinical value of laparoscopic cholecystectomy(LC) combined with other laparoscopic surgery. Methods 206 patients treated by LC combined with other laparoscopic surgery were analysed retrospectively. Results Among the 206 cases of LC combined with other laparoscopic surgery, LC was combined with choledochal exploration in 64 patients, with appendectomy in 29 patients, with fenestration of hepatic cyst in 38 patients, with other hepatic operations in 13 patients, with unroofing of kidney cyst in 15 patients, with release of abdominal adhesions in 31 patients, and with other operative procedures in 16 patients. Laparoscopic operations were successful in 204 patients, and 2 patients were converted to laparotomy. Postoperative bile fistula occurred in 2 patients; 1 healed with conservative therapy, and 1 healed after reoperation. Conclusions Laparoscopic cholecystectomy combined with other laparoscopic surgery can adequately present the advantages of microsurgery by safe, effective and economical management of various abdominal diseases.
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BACKGROUND: To evaluate the effects of pneumoperitoneum and posture on total respiratory compliance, peak inspiratory airway pressure and inspiratory minute ventilation during laparoscopic pneumoperitoneum and pelviscopic surgery we monitored continuously with continuous spirometry. METHODS: 20 patients were anesthetized and paralyzed, tracheally intubated and mechanically ventilated at te rate of 12/min and at a tidal volume of 10 ml/kg. Measurements were made before surgery, just before insufflation and 5, 10, 20, 30, 60 min after insufflation under position changed (10o reverse Trendelenburg position in laparoscopic cholecystectomy; group C, 10o Trendelenburg and lithotomy position in pelviscopic surgery; group P), and 5, 10 min after deflation under horizontal position. Compliance, peak inspiratory airway pressure and inspiratory minute volume were monitored continuously with side stream spirometry. RESULTS: Compliance of respiratory system decreased 39.8% and 39.1%, peak inspiratory pressure increased 43.5% and 61.3%, inspiratory minute volume decreased 10.9% and 9.1% under pneumoperitoneum in group C and group P. CONCLUSION: Increased intrabdominal pressure and posture during laparoscopic cholecystectomy and pelviscopic surgery cause significant decreased respiratory compliance and inspiratory minute volume and a significant increased airway pressure. On-line monitoring of respiratory volume, pressure and compliance may be helpful during general anesthesia to avoid the potential harmful effects of increased airway pressure occurring with increased intra-abdominal pressure.
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Humans , Anesthesia, General , Cholecystectomy, Laparoscopic , Compliance , Head-Down Tilt , Insufflation , Pneumoperitoneum , Posture , Respiratory System , Rivers , Spirometry , Tidal Volume , VentilationABSTRACT
PURPOSE: To analyze hemodynamic parameters of electrical bioimpedance on increased blood pressure induced by pneumoperitoneum and compare hemodynamic effects of propofol and isoflurane during laparoscopic cholecystectomy. METHODS: Systemic vascular resistance index(SVRI), index of contractility(IC), end diastolic index(EDI), mean arterial pressure(MAP) and heart rate(HR) were measured after anesthetic induction, 5, 10, 15 and 30 minutes after CO2 insufflation and after CO2 removal. RESULTS: In isoflurane group, MAP, IC, SVRI were increased but EDI was decreased after induction of pneumoperitoneum. In propofol group, MAP, SVRI were increased but IC was decreased after induction of pneumoperitoneum. HR was not changed during operartion. CONCLUSION: After induction of pneumoperitoneum, MAP is increased by increased IC and SVRI in isoflurane. In case of propofol, the MAP is increased by increased SVRI. It seems that increased transmural pressure of lymphatics and splanchnic vasculatures rather than sympathetic stimulation increases SVRI after pneumoperitoneum.
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Blood Pressure , Cholecystectomy, Laparoscopic , Heart , Hemodynamics , Insufflation , Isoflurane , Pneumoperitoneum , Propofol , Vascular ResistanceABSTRACT
Objective To investigate the clinical characteristic of laparoscopic cholecystectomy(LC) for elderly patients with gallstone. Methods A retrospective analysis was made on the clinical data of 310 patients over 60 years old with gallstone treated by LC at our hospital from May, 1993 to March, 2001. Results Of the 310 patients, 193 cases (62.9%) were accompanied by diabetes, cardiovascular diseases and/or bronchitis. During the operation, 49(15.8%) in 310 patients with severe adhesion surrounding gallblader which made LC difficultly. 6 turned to operation, other 304 patients had LC succeessfully without serious complication. Conclnsions Despite the general condition, the organism degeneration and function recession, immunity function decrease accompaned with other diseases in the elderly patient, the LC has less injury, less pain and less complications, So LC is the optimal method for the elderly patients with gallston.