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Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.
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RESUMEN Objetivos: Describir la experiencia de 43 pacientes con fístula vesicovaginal (FVV) y la reparación con técnica laparoscópica entre 2009 y 2020, analizar su comportamiento y evolución. Métodos: Análisis de 43 pacientes diagnosticadas de FVV supratrigonales secundarias a histerectomías, la mismas que fueron resueltas laparoscópicamente. Resultados: La FVV es una complicación que se presenta en mujeres de edad media a menudo en periodo fértil, y claramen-te demostrado con el antecedente de cirugía o procedimiento ginecológico. Las pacientes fueron diagnosticadas de fístula vesicovaginal, las mismas que fueron intervenidas quirúrgicamente mediante técnica laparoscópica. El tiempo operatorio promedio fue de 172 minutos. Ninguna paciente requirió trans-fusión sanguínea y el tiempo de hospitalización promedio fue de 3,7 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 12 meses. Conclusión: La reparación laparoscópica de la fístula vesicovaginal es una técnica segura, poco invasiva y reproducible en manos entrenadas.Palabras claves: Fístula vesicovaginal, reparación laparoscópica
ABSTRACT Objectives: To describe the experience of 43 patients with Vesicovaginal Fistula (VVF) and laparoscopic repair between 2009 and 2020, and analyze its behavior and evolution. Methods: Analysis of 43 patients diagnosed with supratrigonal VVF secondary to hysterectomies, which were resolved laparoscop-ically. Results: The VVF is a complication that happen in middle-aged women often fertile period, and clearly demonstrated by the history of surgery or gynecological procedure. The patients were diagnosed with vesicovaginal fistula, they were operated on by laparoscopic technique. Mean operative time was 172 minutes. No patient required blood transfusion and the mean hospital stay was 3.7 days. No complications or relapses, with an average follow up of 12 months. Conclusion: Laparoscopic repair of VVF is a safe, minimally invasive and reproducible in trained hands
Subject(s)
Humans , Female , Adult , Middle Aged , Vesicovaginal Fistula , Aftercare , Fertile Period , Women , Blood Transfusion , Hospitalization , Length of StayABSTRACT
Background: Incisional hernia is a common complication after laparotomy. Up to now, there is no consensus on the ideal surgical approach of such hernia. The aim of the present study was to compare the surgical outcomes, feasibility and cost effectiveness of the open mesh repair and laparoscopic repair of incisional hernia.Methods: A randomized controlled study conducted between August 2015 and September 2019 in which 64 patients with incisional hernias were randomly selected for either open mesh repair (36 patients) or laparoscopic repair (28 patients).Results: Patients in both groups were similar in their characteristics. The mean operative time was significantly longer in laparoscopic repair than in open mesh repair (128.6±15 minutes versus 89.8±82 minutes, p<0.05). The peri-operative complications and intra-operative blood loss were comparable in the two groups. The use of the drain was significantly higher in open group than in laparoscopic repair group (44.4% versus 10.7%). The overall rate of postoperative complications was similar in both groups, (25% for each group). The rate of wound infection and the length of hospitalization were significantly less in laparoscopic repair group. The results of postoperative pain score, cosmetic outcomes and recurrence rate showed no significant differences between the two groups but patient's satisfaction was significantly higher in laparoscopic repair. p>0.05.Conclusion: Both laparoscopic and conventional open mesh repair of incisional hernia are equivalent and feasible and safe technique. Laparoscopic repair was superior to open mesh repair in term of surgical site infection, hospital stay and patient’s satisfaction only.
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Bochdalek hernia (BH) is the commonest congenital diaphragmatic hernia, caused by the failure of the posterolateral diaphragmatic foramina to fuse properly. It is extremely rare in adults and accounts for 5-10%. Presenting a case of 48 years female with complaints of dry cough and left chest pain for 1 week. Diminished breath sounds and abnormal gurgling sounds heard on auscultation of left chest wall. X-ray chest showed elevated left hemi diaphragm and gastric bubble. Computed tomography (CT) chest revealed left diaphragmatic hernia with splenic flexure, transverse colon, mesocolon, spleen and upper pole of left kidney as content and atelectasis of left lung lower lobe. Patient underwent laparoscopic repair of hernia with mesh plasty. Intraoperatively, the contents were reduced into the abdominal cavity and left lung expansion noted. The defect of size 6×10 cm in the left diaphragm was sutured and composite mesh placed. Post-operative chest x-ray showed expanded left lung. On follow up of patient after 2 weeks and 1 month, patient was asymptomatic. BH in adults is an uncommon. The contents can be reduced via thoracic or abdominal approach, with abdominal approach having easier access. With the advent of minimal access techniques, delineating clear anatomy, more working space, early recovery, and early return to home and work is possible. Thus, laparoscopic repair of adult diaphragmatic hernia is a safe and effective modality of surgical treatment.
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Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality.
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Background: Surgery is the mainstay of the treatment for perforated duodenal ulcer by closing the perforation with or without omental patch. There are no controversies in the surgical treatment of perforated duodenal ulcer but the best approach to surgery is still debatable. Advances in minimal access surgery has made it possible to close the perforated duodenal ulcer laparoscopically. The present study was conducted to compare the results of open and laparoscopic repair of perforated duodenal ulcer in terms of operative time, postoperative pain, hospital stay, and post-operative complications etc.Methods: The study was conducted in Dr. V. M. Government Medical College and Hospital located in Solapur (Maharashtra) from December 2008 to December 2010. It was a prospective comparative study. Patients were randomly divided into 2 groups alternately where group A and B were operated by conventional and laparoscopic techniques respectively and their outcomes were compared.Results: Most commonly affected age in this study was 51 to 60 years with male preponderance. Post-operative pain, analgesic requirement, wound infection, hospital stay, was significantly less in laparoscopic group as compared to open group (p<0.05).Conclusions: Laparoscopic repair of perforated duodenal ulcer is safe and feasible in properly selected patients and has superior results as compared to open surgery.
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Iatrogenic diaphragmatic hernia is a rare complication of esophageal and upper abdominal surgery. The use of the gastric band has been an established and popular surgical treatment for morbid obesity. We describe a rare case of a patient who had undergone laparoscopic surgery to remove an adjustable gastric band, who presented 5 months later with an acute intense thoracic pain. The computed tomography scan revealed a diaphragmatic hernia containing the stomach. The patient required emergent laparoscopic surgery to reduce the hernia, repair the defect and resection of the ischemic stomach. In this case report, we discuss the etiology, diagnosis and treatment of this very rare complication of laparoscopic gastric banding removal.
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Background: Umbilical hernia is one of the most commonly encountered hernia in surgical practice. A variety of repairs have been tried our ranging from open to laparoscopic. However controversy still persists as to which type of repair is the gold standard for umbilical hernia. Open technique comprises of the onlay mesh repair which is known to develop a variety of complications. Even laparoscopic approach also has failure rates as well as local complications. The aim of the study was to evaluate the surgical outcome of open retro rectus mesh repair for adult umbilical hernias.Methods: 50 consecutive cases of umbilical hernia were repaired by open technique with retro rectus placement of mesh.Results: There were no local complications or any recurrence in any of the fifty patients.Conclusions: Retro rectus placement of mesh in open repair of umbilical hernia in adults is a safe and effective modality of treatment.
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Objective To investigate the safety and effectiveness of mesh and non-mesh techniques in laparoscopic repair of large hiatal hernias (LRLHH).Methods A retrospective clinical controlled study of mesh and non-mesh techniques in LRLHH form January 2006 to August 2014 was performed.Results A total of 83 and 36 patients were recruited to mesh and non-mesh group respectively.There were no significant differences in operation time,operation bleeding volume,hospitalization time or complications between the two groups.Main symptoms were significantly improved during the postoperative long-term follow-up in both groups.The improvement of dysphagia in mesh group showed no significant difference [22.9％ (19/83) VS 12.0％ (10/83),P=0.066],however,non-mesh group showed significant difference [30.6％ (11/36) VS 5.6％ (2/36),P=0.006].Rate of dysphagia alleviation in non-mesh group was significantly higher than that in mesh group [25.0％ (9/36) VS 10.8％ (9/83),P =0.048].Mesh-related complications of esophageal erosions occurred in 5 patients (6.0％) in mesh group,including esophageal stenosis in 3 patients,esophageal-cardiac stricture in 1 patient.Recurrent hernia occurred in 1 patient (1.2％) in mesh group and 3 patients (8.3％) in non-mesh group (P =0.082).Conclusion LRLHH with mesh should be individualized.The use of mesh in LRLHH reduces the recurrence rate,but may lead to some complications.
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Background: A Fistula is an extra anatomic communication between two or more epithelial lined body cavities or skin surface. Most of the vesicovaginal fistulas in industrialized and well developed countries are iatrogenic and most of the vesicovaginal fistulas in underdeveloped and developing countries are obstetric. Materials and methods: 10 cases of VVF presented to OGH OPD from October 2013 till September 2016 with age range 22 years to 43 years were included in study. Radiation fistulas, malignant fistulas, complex obstetric fistulas were excluded. Eight of the Ten cases were post hysterectomy (TAH) supra trigonal fistulas (7 single fistulas 1 case had two fistulas side by side), One case was post obstetric trigonal fistula, One case was post caesarean section where the fistula was in the anterior fornix close cervix. Results: Out of 10 patients, we had 1 port site infection, fever in 2 cases, increased drain for initial 2 days in 1 case. None of the 10 cases required blood transfusion, and there was no leak per vagina in all cases before and after catheter removal. All the patients were working patients, and resumed their work as early as 12 days after surgery. Conclusion: Conventional open repair with bivalving of bladder is associated with morbidity in the form of higher pain scores, higher HB % drop, prolonged hospitalization, prolonged catheterizations, and delayed resumption of work. Laparoscopic repair with limited cystotomy overcomes all the disadvantages of the conventional repair with equal results
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Background: Laparoscopic hernia repair has been in use for some time now and has been found to cause lesser postoperative pain and earlier recovery when compared with open methods of hernia repair although they are associated with higher costs and a steep learning curve. The various complications associated with laparoscopic hernia repair needs to be studied and compared with open methods. Aim: The aim of this study was to understand the intraoperative and postoperative complications of laparoscopic inguinal hernia repair and formulate methods to prevent them. Materials and methods: This is an observational study consisting of 50 patients who underwent laparoscopic inguinal hernia repair (TEP, TAPP) in our institution from September 2014 to March 2016. Intra operative and postoperative complications were documented. The following factors were considered: Type of hernia, Type of hernia vs complications, Operation time, Operation time vs complications, Post-operative hospital stay. Results: The mean operative time was 66.8 min. There were no major complications. There were 4 minor complications namely – surgical emphysema, groin pain, shoulder pain, scrotal pain. Surgical emphysema (21 patients, 42%) depends upon operation time. Groin pain (11 patients – 22% all are indirect) depends upon type of hernia mainly in indirect type, because of the dissection carried out for separating indirect sac. Shoulder pain (6 patients, 12%) is directly proportional to the time of surgery (all were >90 min) probably due to retention of CO2 which lead to diaphragmatic indentation. Scrotal edema (6 patients, 12%) depends upon the type of hernia as it occurred only in indirect hernias due to the dissection for indirect sac. All these minor complications subsided with supportive care without any surgical intervention. Mean postoperative hospital stay - 2.6 days. Laparoscopic hernia repair has a steep learning curve and time consuming initially T. Babu Antony, S. Krishna Bharath. A comprehensive study on complications of laparoscopic inguinal hernia repair. IAIM, 2017; 4(2): 6-10. Page 7 Conclusion: Laparoscopic hernia repair has a steep learning curve and fearsome complications but once mastered, it is a safe and effective technique with early postoperative recovery. In our study we encountered only minor complications all those complications were managed conservatively
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Background: Incisional hernia is protrusion of part or whole of abdominal viscus through the weakness in layers of anterior wall in the scar of previous operation. The major predisposing factors being post operative wound infection or hematoma. This incidence increases in the presence of adverse factors (local and systemic) such as wound infection, obesity, hypoproteinemia. In all suture repair techniques the tissues are under tension and this increase the risk of ischemia, suture cut out and repair failure. The studies showed that the complication seen in open incisional hernia repair is seroma, hematoma, wound infection, stitch sinus, and recurrence. To overcome this complications and recurrent rates of open incisional hernia repair the Laparoscopic repair of incisional hernia was introduced in the 1990s, which reports (Olmi study) have showed more improvement in recovery time, hospital stay and complication rate. Objective: The purpose of this study was a prospective study which had been carried out, during the period of July 2010 to September 2012 at a tertiary care centre. A total number of 50 cases were studied and were followed up for a period of 6 months. All patients were operated on by the same surgical team, adapting the type of surgical technique depending on the type of hernia. In the selection process of the technique patients were ranndomly allowed to opt for any of the two modalities after analyzing the biological status of the patient but also the associated his/her comorbidities. Patient selection criteria were as below. Inclusion criteria: Wall defect: >3 cm to <8 cm, Post-surgical and gynecological procedure, BMI < 30 kg/m2, Patient willing for surgery. Exclusion criteria: Complicated hernia, BMI >30 kg/m2, Conversion of laparoscopic repair to open repair. Results: Incidence of incisional hernia was maximum in the age group of 31-50 years (66%) with female preponderance (74%). 25 patients had risk factors like chronic cough (5), hypertension (13), diabetes mellitus (5) and difficulty in micturition (2). 27 had previous emergency surgery while 23 had undergone planned surgery. 60% of patients had undergone gynecological procedures, among complications in previous surgical procedure. Mean operative time for laparoscopic incisional hernia repair was 2 hour 45 minutes and for open hernia it was 2 hour 05 minutes. 46% of patients had duration of return to work (6-10 days) in laparoscopic surgery, 40% of patients had duration of return to work (11-15 days) in open surgery (mean 16 ),4% in laparoscopic surgery (mean 10.24days), 10% of patients had duration of Return to work (16-20 days) in open surgery. Conclusion: An optimal technique for mesh placement has not yet been determined and is still a subject of debate among surgeons. Laparoscopic techniques seem to have many benefits, including decreased length of hospital stay, decreased postoperative pain, and reduce the time to return to work and normal activities, but require long learning curve and are still not very accessible to all surgeons, especially in our country.
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Although rare, traumatic abdominal wall hernia associated with handlebar injury is a well-described entity in the pediatric population with about 40 cases and only one laparoscopic repair reported in children. We present two cases of male patients, 9 and 13 years old, who were assessed in our emergency room for blunt abdominal trauma associated with handlebar injury. The patients showed signs of handlebar trauma in the abdominal wall: one presented with a painful mass, and the other with intermittent pain in the area of trauma with no palpable mass. Neither of the patients were hemodynamically unstable or showed any peritoneal signs. Ultrasound and CT scans were performed in both patients to identify abdominal wall hernias containing bowel content in the absence of other injuries. Laparoscopic repair was performed uneventfully in both patients with interrupted non-absorbable multifilament suture with 2 and 3 ports respectively. Oral intake was initiated one day after surgery and both patients were discharged the following day. In the follow-up visit, the patients were asymptomatic and no signs of abdominal wall hernias were found. Laparoscopic repair of blunt traumatic abdominal wall hernias is safe and technically possible in children and should be considered as the standard initial approach in the stable patient.
Aunque rara, la hernia traumática de la pared abdominal asociada a una lesión en el manubrio es una entidad bien descrita en la población pediátrica, con aproximadamente 40 casos y solo se informó una reparación laparoscópica en niños. Presentamos dos casos de pacientes varones, de 9 y 13 años de edad, que fueron evaluados en nuestra sala de emergencias por un traumatismo abdominal cerrado asociado con una lesión en el manubrio. Los pacientes mostraron signos de traumatismo del manubrio en la pared abdominal: uno presentó una masa dolorosa y el otro con dolor intermitente en el área de trauma sin masa palpable. Ninguno de los pacientes presentaba inestabilidad hemodinámica ni signos peritoneales. Se realizaron ecografías y tomografías computarizadas en ambos pacientes para identificar las hernias de la pared abdominal que contenían contenido intestinal en ausencia de otras lesiones. La reparación laparoscópica se realizó sin incidentes en ambos pacientes con sutura discontinua no reabsorbible interrumpida con 2 y 3 puertos respectivamente. La ingesta oral se inició un día después de la cirugía y ambos pacientes fueron dados de alta al día siguiente. En la visita de seguimiento, los pacientes estaban asintomáticos y no se encontraron signos de hernias de la pared abdominal. La reparación laparoscópica de las hernias de pared abdominal traumáticas romas es segura y técnicamente posible en los niños y debe considerarse como el abordaje inicial estándar en el paciente estable.
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Humans , Hernia, Abdominal , Wounds and Injuries , LaparoscopyABSTRACT
Indirect inguinal hernia containing an ovary is a rare condition, especially in adult women who do not have any other genital tract anomalies. In addition, inguinal hernia containing an ovary and endometriosis is exceedingly rare. In the present report, we describe a case of indirect inguinal hernia containing an ovary, fallopian tube, and endometriosis. Laparoscopic repair was performed successfully using polypropylene mesh for the treatment of the inguinal hernia.
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Adult , Female , Humans , Endometriosis , Fallopian Tubes , Hernia, Inguinal , Ovary , PolypropylenesABSTRACT
Internal hernias cause 1 percent of intestinal obstructions with aproximately 50 percent of these hernias been paraduodenal hernias. Paraduodenal hernias are the product of a malrotation of the midgut during embryogenesis or a non-fusion of the peritoneal folds. These type of internal hernia are more cornmon in males and on the left side of the abdomen. The usual presentation age is in the 4th decade of life. The clinical presentation of these patients is non specific and varies, ranging from mild dyspepsia to intestinal perforation and septic shock. The radiographic studies of these patients show a dumping of the intestinal loops on the upper quadrant of the abdomen with an image of abdominal compartamentalization. The surgical management of these patients should follow three simple principles. The intestines should be reduced, their perfusion and viability must be verified and the hernia sack entrance should be repaired with interrupted non absorbable sutures.
Las hernias internas causan el 1 por ciento de las obstrucciones intestinales. De estas, aproximadamente la mitad son causadas por hernias paraduodenales. Las hernias paraduodenales son producto de una embriogénesis defectuosa, donde el intestino no rota o los pliegues mesentéricos no se fusionan adecuadamente. Estas hernias son más comunes en el género masculino, del lado izquierdo y por lo general se diagnostican en la cuarta década de la vida. La presentación clínica es inespecífica con manifestaciones que varían desde la dispepsia hasta la perforación intestinal y el choque séptico. Los estudios de imagen muestran el agrupamiento de las asas intestinales en el abdomen superior dando una imagen de compartamentalización de la cavidad abdominal. Para el manejo quirúrgico de estos pacientes se debe reducir el intestino herniado, verificar que este sea viable y posea una adecuada perfusión y reparar el orificio hemiario con material no absorbible.
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Humans , Duodenal Diseases/surgery , Duodenal Diseases , Hernia, Abdominal/surgery , Hernia, Abdominal , Duodenal Diseases/complications , Hernia, Abdominal/complications , Laparoscopy , Intestinal Obstruction/surgery , Intestinal Obstruction/etiology , Tomography, X-Ray ComputedABSTRACT
Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option.
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Hernia , HerniorrhaphyABSTRACT
The laparoscopic incisional hernia repair is a safe alternative to open mesh repair. The procedure has the advantages of minimal access surgery and lower recurrence rate. A prospective study of laparoscopic incisional hernia repair of our first 11 patients was performed from July 2008 to December 2009. No serious intraoperative or postoperative morbidity was encountered, only two patients developed seroma. The mean operating time was 90 minutes (60 to 180 minutes). The mean day of discharge after surgery was 3 days (2-7 days). No patient developed a recurrence during mean follow up period of 10 months. Laparoscopic repair of incisional hernia has been shown to be feasible, safe and effective. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.
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Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of pedorated peptic ulcers. Results Five patients were suffered from pedorated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gashie antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operafive time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all deers had healed well by Gastroscopy, we hadn't found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery.
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Obturator hernia is a rare variety of pelvic hernia. The diagnosis frequently is delayed and may be accompanied by dehydration, acute abdominal distress and small bowel strangulation. We report a case of totally extraperitoneal repair of obturator hernia with partial intestinal obstruction. An eighty-two-year old female with intermittent abdominal pain was diagnosed with obturator hernia with partial intestinal obstruction. We did total extraperitoneal laparoscopic repair of the obturator hernia with polypropylene mesh. Total extraperitoneal laparoscopic repair for obturator hernia is a safe and effective treatment.
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Female , Humans , Abdominal Pain , Dehydration , Hernia , Hernia, Obturator , Intestinal Obstruction , PolypropylenesABSTRACT
El objetivo de este trabajo consistió en aplicar por primera vez en nuestro hospital la técnica laparoscópica de reparación de úlcera gastroduodenal perforada con cierre primario y colocación de parche de epiplón mediante la confección de nudos intracorpóreos a 8 pacientes masculinos, con edades comprendidas entre los 28 y los 74 años, que consultaron a la emergencia del Hospital Universitario de Caracas, con cuadro clínico de abdomen agudo sugestivo de perforación gastroduodenal, en el período comprendido entre noviembre de 2003 y septiembre de 2004. La edad promedio fue 48 años. El tiempo de evolución clínica osciló entre 6 y 48 horas, con un promedio de 11,31 horas. El tiempo operatorio promedio fue 160 minutos. En promedio el dolor posoperatorio fue de 2/10 según EVA (escala visualanalógica para dolor). El promedio de hospitalización fue de 7,85 días. El reintegro a las actividades cotidianas fue en promedio de 13 días. No hubo necesidad de conversión a técnica abierta en ningún caso. Se presentaron complicaciones en 2 pacientes, uno de ellos por reapertura del cierre primario y otro quien presentó colección intrabdominal, ambos fueron reintervenidos de forma abierta, sin complicaciones ulteriores. No hubo mortalidad. La reparación videolaparoscópica constituye un método seguro y efectivo, con excelente resultado estético y menor dolor posoperatorio, por lo que se recomienda ampliamente para el tratamiento de emergencia de los cuadros de úlcera gastroduodenal perforada.
The objective of this work consist to apply for first time in our hospital the laparoscopic repair technique for perforated gastroduodenal ulcers with primary closure and ommental patch using intracorporeal knots. Eight male patients were consults to emergency room of Hospital Universitario de Caracas with ages between 28 and 74 years old, presents clinical syndrome of acute abdomen suggest of perforated gastroduodenal ulcer within period of 2003 November to 2004 September. The mean age was 48 years old. The clinical evolution time before surgery was oscillate between 6 and 48 hours with mean of 11.31 hours. Mean surgery time was 160 minutes. Postoperative pain was 2/10 according to VAS (visual-analog scale for pain). Mean hospitalization days was 7.85 days. Reintegration to daily activities was in mean 13 days. There was not need to conversion to open technique in any case. There were complications in two patients, one of them with reopened of repair site and the other with intrabdominal collection, both were operated in open way without posterior complications. No mortality was occurs. Laparoscopic repair method is secure and effective with excellent cosmetic results and less postoperative pain so we recommended for emergency treatment of perforated gastroduodenal ulcer.