ABSTRACT
BACKGROUND: Laparoscopic ventral hernia repair (LVHR) is gaining acceptance and compares favorably with open repair. Patients who are morbidly obese (MO) traditionally have been considered poor surgical candidates for ventral hernia repair because of their associated comorbidities and risk of postoperative wound infection and hernia recurrence. In this study we evaluated our experience with LVHR in patients who are obese and those who are morbidly obese. METHODS: All 64 patients undergoing LVHR at the University of Kentucky between September 1997 and October 2000, representing 66 hernias, were entered prospectively into a database. Data before, during, and after surgery were collected as well as follow-up data. Patients were divided into three groups on the basis of body mass index (BMI): normal to overweight (BMI < or = 29); obese (BMI 30-39), and MO (BMI > or = 40). RESULTS: There were 16 patients in the MO group, most of them women. The mean BMI was 43.9 (range, 40-60), and the mean age was 45.6 years (range, 25-68 years). The location of defects was similar among the groups, as were the number of prior repairs. The operative time and length of stay for the MO group tended to be longer than for the other two groups. Five minor complications occurred in the MO group. During a follow-up period ranging from 1 to 35 months, there were no recurrences. CONCLUSION: Laparoscopic repair of ventral hernias in patients who are morbidly obese is both safe and feasible, and can be performed with minimal morbidity. At this writing, there have been no recurrences, but long-term follow-up evaluation is required.
Subject(s)
Hernia, Ventral/surgery , Laparoscopy/methods , Obesity/surgery , Adult , Aged , Aged, 80 and over , Body Mass Index , Cellulitis/etiology , Female , Follow-Up Studies , Humans , Intestines/injuries , Intestines/surgery , Intraoperative Complications/etiology , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Obesity, Morbid/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Prospective StudiesABSTRACT
BACKGROUND: In this study of laparoscopic splenectomy (LS), we evaluate prospectively gathered perioperative patient data and review lessons learned in the evolution of this procedure. METHODS: At 2 university medical centers between November 1993 and March 2000, there were 203 patients (122 female patients and 81 male patients) who underwent LS after preoperative evaluation. RESULTS: LS was successfully completed in 197 patients (97%). The mean operative time was 145.5 minutes and the length of stay averaged 2.7 days with 143 (70.4%) staying less than 48 hours. The most common indication was idiopathic thrombocytopenic purpura (ITP). Six patients required conversion to open splenectomy (OS), with only 2 conversions in the last 163 cases. No deaths were attributed to the procedure. Complications occurred in 19 patients (9.3%). Thirty accessory spleens were identified in 25 patients (12.3%). Seventeen patients (8.4%) underwent concomitant procedures, most commonly cholecystectomy. CONCLUSIONS: LS by the lateral approach is both safe and feasible in patients of all ages.
