ABSTRACT
The purpose was to study the features and results of redo laparoscopic antireflux surgery. For the period from 2008 to 2019, in Odessa Regional Hospital laparoscopic antireflux operations were performed in 1164 patients. 57 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n=37), recurrent reflux (n=4), dysphagia (n=8), severe pain (n=5), esophageal stricture (n=3). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11% of patients. Long-term follow up from 6 months to 6 years was observed in 90.74% of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p<0.001). Good results were observed in 91.84% of patients after redo operations. The third operation was needed in 5.6% of patients. Redo laparoscopic antireflux operations are technically difficult surgical interventions and provide good long-term results in 90% of patients.
Subject(s)
Gastroesophageal Reflux , Hernia, Hiatal , Laparoscopy , Fundoplication , Gastroesophageal Reflux/surgery , Hernia, Hiatal/surgery , Humans , Quality of Life , Recurrence , Treatment OutcomeABSTRACT
The main goal of the research was to study echinococcosis liver cyst laparoscopic treatment's effectiveness. The retrospective analysis of liver echinococcosis cyst surgical treatment in the period from 2003 to 2013 years was conducted. 348 patients underwent surgical treatment, among them 283 patients - laparoscopic procedure, 65 - open surgery. Medial age was 42,3±7,9 years. Female - 214, male - 134. 249 patients underwent laparoscopic partial (conservative) cystectomy, 34 - laparoscopic radical cystectomy with liver resection, 3 (1%) - conversion. 47 patients underwent partial (conservative) cystectomy using open approach. 18 - radical cystectomy using either typical or atypical hemihepatectomy. A long term analysis of 226 (79,8%) patients in a period from 6 month to 7 years was conducted. Comparison of the results revealed the advantage of laparoscopic operations. It was manifested in less blood loss, duration of the procedure, pain syndrome, and a smaller number of bed-days. Infections of the residual cavity after open surgery were twice as much comparing to ones after laparoscopic surgery. Complications after open surgery were significantly higher than after laparoscopic procedures due to postoperative wound infections. After open surgery frequency of echinococcosis recurrence was higher than after laparoscopic one (8,5% vs 2,5%) (Ñ<0,05). Nowadays it is possible to say that treatment of choice of noncomplicated liver echinococceal cysts is laparoscopic one. Correctly made laparoscopical procedure has a good long term results, few postoperative compications, less frequent recurrences and the excellent cosmetic effect. From the principles of radical surgical treatment's point of view laparoscopic approach is the same as an open surgery.
Subject(s)
Cystectomy/methods , Echinococcosis, Hepatic/surgery , Echinococcus/isolation & purification , Hepatectomy/methods , Laparoscopy/methods , Laparotomy/methods , Adolescent , Adult , Aged , Animals , Anthelmintics/therapeutic use , Blood Loss, Surgical/physiopathology , Cystectomy/instrumentation , Echinococcosis, Hepatic/parasitology , Echinococcosis, Hepatic/pathology , Echinococcosis, Hepatic/prevention & control , Female , Hepatectomy/instrumentation , Humans , Laparoscopy/instrumentation , Laparotomy/instrumentation , Liver/parasitology , Liver/pathology , Liver/surgery , Male , Middle Aged , Postoperative Period , Recurrence , Retrospective Studies , Surgical Wound Infection/diagnosis , Surgical Wound Infection/physiopathology , Treatment Outcome , UkraineABSTRACT
It is presented our experience and review of literature of pathogenesis, symptomatology, diagnostics and surgical treatment of gastroesophageal reflux desease (GERD). A cohort of 104 patients (67 males and 37 females, median age - 42.5) who underwent "open" A. Chernousov modified Nissen fundoplication was evaluated for an follow-up period more than 10 years. In 23 cases with concomitant duodenal ulcer and gastric hypersecretion selective proximal vagotomy additionally was performed, 3 of them also underwent cholecistectomy and in 1 case - splenectomy because of spleen lymphoma. There were no mortality or major perioperative complication (1 case of iatrogenic splenectomy) in our series. Only 9 patients have transient episodes of mild dysphagia. Postoperative endoscopy an X-Ray revealed a good swallow and functional status of esophagus and stomach. The good and excellent results were achieved in more 90% of cases. No reinterventional surgery was needed.
