Conservative treatment of recognized laparoscopic colonic injury.

Injuries associated with insufflation needles and trocar insertion have been reported extensively in the literature. Two millimeter laparoscopy is a more recent technique that has been used for laparoscopic cholecystectomy. This case illustrates a 2 mm trocar colonic injury, recognized during a routine laparoscopic cholecystectomy; management was non-operative and ambulatory, with a successful outcome.

The learning curve for laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy (LC) in 1987 has resulted in its wide acceptance by surgeons in the United States. Questions about proper training and learning curve for surgeons wishing to perform laparoscopic procedures have been raised during this period. We retrospectively evaluated 416 consecutive cholecystectomy cases that were performed by eight surgeons in a community teaching hospital. In this report, 374 patients had LC and 42 patients (10%) had an attempted LC, which had to be converted to an open cholecystectomy (CONV). Surgeons A and B performed 40% and 18% of all LC cases, respectively, and were classified as the surgeons with the highest volume of cases. Parameters, including conversion rate, operative time, and complications, were evaluated to define the learning curve. Surgeons A and B experienced 17% and 14% initial conversion rates for the first 35 cases, respectively. These rates dramatically dropped to an acceptable level (4% and 3%) with increased experience. The operative time for surgeon A for the first and last 35 cases improved from 97 +/- 25 min to 74 +/- 32 min (p = 0.01). Although the procedure time for surgeon B improved by 4 min, this difference was not statistically significant. The operative time for all cases was 81 +/- 31 min and 87 +/- 27 min, respectively, for surgeons A and B, which was significantly less than that for other surgeons (p = 0.01). A total of 12 patients experienced complications related to LC. Most of the complications (75%) occurred in the first 30 cases for all surgeons.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective analysis of laparoscopic and open cholecystectomies.

A total of 686 consecutive cases were reviewed for comparison between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC). The procedures were performed by the teaching surgical service of a community hospital. Between March 1989 and December 1992, 381 patients had LC, 262 had OC, and 43 patients had attempted LC that was converted to open cholecystectomy (CONV). Postoperative hospital stay for LC was 2.9 +/- 3.7 days (range 12 h to 28 days) and was significantly less than those for OC (12.4 +/- 23.6 days) or CONV (8 +/- 8.3 days) (p < 0.0001). Patients who had LC revealed meaningfully decreased perioperative or postoperative antibiotic use, postoperative temperature elevations, and hospitalization when compared to OC or CONV (p < 0.0001). Bile duct injury was 0.26% with LC and 0.38% with OC. The percentage of postoperative bile leakage was 0.79% and 0.38% for LC and OC, respectively. LC cases were associated with lower complication rates when compared to OC or CONV (p < 0.005). No deaths were observed with LC (0%). However, the mortality rate for OC was 1.5%. The results of LC were more favorable than those of OC and CONV with respect to complications, morbidity, mortality, and length of hospital stay. Based on our experience, the patient outcome for LC was superior to OC.

Laparoscopic gastrojejunostomy: a case presentation.

Laparoscopic gastrojejunostomy is demonstrated as an alternative to open gastric bypass procedures. We performed the operative procedure safely and with reasonable anesthesia time, using stapling devices. It is hoped that further patient benefit will be obtained from this laparoscopic procedure in the future.

Moxalactam disodium-induced pulmonary hemorrhage.

Fatal pulmonary hemorrhage occurred on the eighth day of moxalactam therapy. No other pharmacologic agent or obvious cause could be attributed to the hemoptysis. Moxalactam-induced pulmonary hemorrhage should be included in the differential diagnosis of an infiltrate when moxalactam is being administered.