Résumé
Highly selective vagotomy was developed to avoid dumping syndrome, diarrhea, bile reflux, and poor gastric emptying; the idea was to avoid vagal denervation of viscera other than the parietal cell mass. Preliminary review of the cases which underwent laparoscopic highly selective vagotomy. Retrospective study. Surgical department, Salmaniya Medical Complex, Bahrain. Cases of laparoscopic surgery for chronic peptic ulcer disease were retrospectively reviewed through their records from 1[st] January 1997 to 31[st] December 2003. Data were obtained about personal characteristics, operative time, complications and length of hospital stay. The average age of these patients was 44.9 years, ranging from 33 to 64 years. Nine patients were males and two patients were females. Five patients had laparoscopic highly selective vagotomy. There were no immediate postoperative complications in this group. The average length of hospital stay was 7.8 days ranging from 3-17days. Five patients had laparoscopic truncal vagotomy with open pyloroplasty. The complications reported in this group were a case of intestinal obstruction and another case of persistent symptoms. The average length of hospital stay was 16 days, ranging from 6 to 46 days. One patient underwent laparoscopic truncal vagotomy with gastro-jejunostomy due to gastric outlet obstruction. The patient had intestinal obstruction postoperatively. Laparoscopic highly selective vagotomy has a significantly lower complication rate than other laparoscopic surgeries for chronic peptic ulcer disease, which makes it a feasible option. However, the hospital stay for these surgeries are higher than reported studies which hinders its cost-effectiveness
Résumé
Controversy still continues about the advantages of laparoscopic appendectomy versus open appendectomy. It is not clear cut compared to laparoscopic cholecystectomy where it has replaced the open method. The aim of this study is to compare laparoscopic and open appendectomy to determine the length of hospital stay and postoperative in-hospital morbidity. Retrospective study. Surgical department, Salmaniya Medical Complex, Bahrain. Five hundred cases of laparoscopic appendectomy compared to 500 similar cases of open surgery between 1st January 2000 and 31st December 2006. The records of these patients were reviewed for personal characteristics, type of the procedure, operative time, length of hospital stay and in-hospital morbidity. Laparoscopic appendectomy [LA] group consisted of 502 cases and the open surgery [OA] group consisted of 500 cases. The average age was 24.4 years ranging from 5 years to 67 years. The length of hospital stay averaged 4.85 days ranging from 2 to 30 days. The average operative time for the laparoscopic group was 45 minutes but ranged from 20 to 90 minutes. The postoperative in-hospital morbidity included port-site wound infection in 5 cases, intra-peritoneal pus collection in 3 cases and one case of iatrogenic jejunal injury identified intra-operatively. The morbidity rate for this group was 1.8%. There were no registered mortalities after laparoscopic appendectomy. In the open surgery group, the average age was 22.6 years ranging from 4 years to 63 years. The length of hospital stay averaged 5.4 days, ranging from 3 to 40 days. The average operative time for the open group was 40 minutes, ranging from 30 to 75 minutes. The postoperative in-hospital morbidity included wound infection in 15 cases, intra-peritoneal collection in 8 cases, enterocutaneous fistula in 3 cases and iatrogenic cecal injury in 3 cases which were repaired immediately. The morbidity rate for this group was 5.8%. There were two mortalities after open appendectomy. Laparoscopic appendectomy has significantly lower morbidity and mortality rates compared to open surgery. However, there is no difference in length of hospital stay or operative time
Sujets)
Humains , Laparoscopie , Complications postopératoiresRésumé
In acute abdomen, sometimes it is difficult to achieve diagnosis by the traditional method of investigation and policy of "Wait and See." To analyze the efficacy of diagnostic laparoscopy in acute abdominal pain. Surgical department, Salmanyia Medical Centre. Retrospective study. A study of 100 consecutive cases of acute non-specific abdominal pain between September 1995 and June 2000 who had diagnostic laparoscopy. The personal characteristics were recorded along with pre-operative diagnosis and final diagnosis. The presenting symptoms and any therapeutic procedure performed were noted. One hundred patients had diagnostic laparoscopy within 48 hours of admission due to acute non-specific abdominal pain. There were 18 males and 82 females. The mean age of this group was 31 ranging from 16 to 62 years. The patients presented with various complaints which included abdominal pain in 39, pain and anorexia in 14, abdominal pain with anorexia and vomiting in 34, abdominal pain and fever in 11 and abdominal mass in 2 patients. The mean hospital stay was 3.9 days +/- 2 days [1-15 days] and the average operative time was 56.8 minutes [35-127 minutes]. A definitive diagnosis was achieved in 98 patients [98%] using diagnostic laparoscopy. Two patients had to be converted to formal open laparotomy. A therapeutic laparoscopic procedure was performed in 78 patients. The laparoscopic findings were acute appendicitis in 73 patients, pelvic inflammatory disease in 14, significant ovarian cysts in 7, endometriosis in 3, ectopic pregnancy in 2 and Meckel's diverticulitis in 1. In this study, the diagnosis was achieved through laparoscopy in 98% of cases