ABSTRACT
Laparoscopic colon resection is feasible but not standardized regarding indication and surgical procedure. Indications are mainly benign diseases (diverticulitis, Crohn's disease, ulcerative colitis and sessile dysplastic polyps or adenomas). Rare indications are benign tumors, angiodysplasia of the colon and dolichocolon. Laparoscopic rectopexy and sutural closure of iatrogenic colon perforation have minimal invasive indication, too. Indication for laparoscopic colon resection for malign tumors in T1-stage is still unclear. Use of minimal invasive procedures for palliative reasons (construction of colostomy or bypass anastomoses in malign tumors) is appropriate. In 32 laparoscopic bowel operations we found no lethality. In 5 cases early conversions to laparotomy were necessary. Postoperatively following complications occurred: 1 intraabdominal bleeding, 1 stenosis of anastomosis and 1 wound infection.
Subject(s)
Colonic Diseases/surgery , Colorectal Neoplasms/surgery , Laparoscopy , Rectal Diseases/surgery , Adult , Aged , Aged, 80 and over , Colitis, Ulcerative/surgery , Colonic Polyps/pathology , Colonic Polyps/surgery , Colorectal Neoplasms/pathology , Crohn Disease/surgery , Diverticulitis, Colonic/surgery , Female , Follow-Up Studies , Humans , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Male , Middle Aged , Neoplasm Staging , Palliative Care , Postoperative Complications/etiologyABSTRACT
The symptoms of 100 patients with gall bladder stone disease were prospectively analysed before and after successful treatment with extracorporeal shock wave lithotripsy (ESWL) and oral bile acids. This is of considerable clinical interest because complaints after cholecystectomy persist in 21-47% of patients (postcholecystectomy syndrome). Before ESWL, 37 patients had unspecific abdominal symptoms (feeling of fullness and pressure, or slight pain, or both, in the right upper abdomen, flatulence, nausea, or food intolerance) and 63 patients had typical biliary symptoms (severe steady pain of more than 15 minutes and less than five hours duration in the right upper abdomen, in some cases radiating to the epigastrium or the back) either exclusively or with unspecific abdominal complaints. After becoming stone free, 72 of 100 patients lost the symptoms they had before treatment. All 28 patients with persisting symptoms had unspecific abdominal symptoms before treatment (exclusively unspecific symptoms and unspecific plus typical biliary symptoms). In contrast, patients with typical biliary symptoms before ESWL lost these in 95% of all cases. Although the anatomical structures are left intact after ESWL, the percentages of stone free patients with persisting symptoms are similar to those after cholecystectomy.
Subject(s)
Cholelithiasis/therapy , Lithotripsy , Adult , Aged , Aged, 80 and over , Bile Acids and Salts/therapeutic use , Chemotherapy, Adjuvant , Cholelithiasis/diagnostic imaging , Cholelithiasis/drug therapy , Cholelithiasis/physiopathology , Female , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Prospective Studies , Treatment Outcome , UltrasonographyABSTRACT
The laparoscopic cholecystectomy is fully integrated into the therapy concept of gallstone disease. The laparoscopic procedure was successfully performed in 97.5% of 2200 patients. In 2.5% of the patients the operation had to be converted to open surgery. Complications occurred in 3.6%, containing infections of the umbilicus (2.2%), postoperative bleedings (0.4%) and lesions of the d.hepatocholedochus (0.4%). Mortality rate was 0.1%. During the last 2 years the indication for the laparoscopic approach has been rapidly expanded while the indication for primary open surgery was reduced to 2% of the patients. Laparoscopic cholecystectomy proved to be a rapid and safe procedure for treating gallbladder stones.
