ABSTRACT
There are several different techniques for laparoscopic appendectomy (LA), with different material requirements and approach. We present the results from our series, where we employ monopolar hook for mesoappendix dissection and double polyglactin endoloop for ligation of appendicular stump. The appendix is taken out through the Hasson trocar without any contact with abdominal wall, in a completely laparoscopic procedure. We sought to analyze the security of this technique. We reviewed retrospectively every LA for acute appendicitis performed during the last 10 years in our Hospital. We collected data regarding surgical procedure and postoperative outcome, focusing on intraoperative or postoperative complications. A total of hundred and ten (110) LA for acute appendicitis (from simple appendicitis to perforated appendicitis) were performed. Mean operative time was 74.7 minutes (median 70 min, SD 24.43 min, min. 25, max. 130 min). Ten patients (9.09%) had postoperative complications, consisting in intraabdominal abscess in 6 patients (5.4%) and wound infection in 3 patients (2.7%). No major complication was found, as uncontrolled hemorrhage, bowel perforation or stump dehiscence. No patient needed a second surgical procedure in the postoperative time. Laparoscopic appendectomy with polyglactin endoloops is a completely laparoscopic and safe procedure, without any intraoperative complication in our series. Laparoscopic approach with 12 mm Hasson trocar and two 5 mm working trocars allows a nice aesthetic result.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Laparoscopy , Adolescent , Child , Child, Preschool , Female , Humans , Male , Retrospective StudiesABSTRACT
Introducción. Existen diversas técnicas de apendicectomía laparoscópica(AL), con diferentes requerimientos de material y abordaje. Presentamos los resultados de nuestra serie, donde empleamos el ganchomonopolar para disección del mesoapéndice y endolazo doble depoliglact in para la ligadura de la base apendicular, exteriorizando la pieza a través del trócar de Hasson sin contacto con la pared abdominal, en un procedimiento completamente cerrado. Pretendemos analizar la seguridad del procedimiento. Métodos. Se realizó un estudio retrospectivo observacional de AL urgentes realizadas en los últimos 10 años en nuestro centro. Se recogen variables referidas al procedimiento quirúrgico y evolución postoperatoria, haciendo especial hincapié en el estudio de las complicaciones, intraoperatorias y postoperatorias. Resultados. Se realizaron 110 AL urgentes. La duración media dela intervención fue de 74,7 minutos (mediana 70 min, D.S. 24,43 min, mín.25, máx. 130). Surgieron complicaciones postoperatorias en 10 pacientes(9,09%), consistentes principalmente en absceso intraabdominal, 6 pacientes(5,4%) e infección de herida quirúrgica 3 pacientes (2,7%). Ningún (..) (AU)
There are several different techniques for laparoscopic appendectomy(LA), with different material requirements and approach. We present the results from our series, where we employ monopolar hook for mesoappendix dissection and double polyglact in endoloop for ligation of appendicular stump. The appendix is taken out through the Hasson trocar without any contact with abdominal wall, in a completely laparoscopic procedure. We sought to analyze the security of this technique. We reviewed retrospectively every LA for acute appendicitis performed during the last 10 years in our Hospital. We collected data regarding surgical procedure and postoperative outcome, focusing on intraoperative or postoperative complications. A total of hundred and ten (110) LA for acute appendicitis (from simple appendicitis to perforated appendicitis) were performed. Mean (..) (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Appendectomy/methods , Appendicitis/surgery , Laparoscopy/methods , Emergency Treatment/methods , Retrospective Studies , Polyglactin 910/therapeutic use , Suture Techniques , Postoperative Complications/epidemiologySubject(s)
Bronchopulmonary Sequestration/diagnosis , Abdomen , Female , Humans , Infant, Newborn , Prenatal DiagnosisABSTRACT
No disponible
Subject(s)
Female , Infant, Newborn , Humans , Bronchopulmonary Sequestration/diagnosis , Ultrasonography, Prenatal , Bronchopulmonary Sequestration/surgery , Abdominal Neoplasms/surgery , Abdominal NeoplasmsABSTRACT
OBJECTIVE: Heart transplantation (HT) due to valvular cardiomyopathy is rare, namely, about 3% of cases in the Registry of the International Society for Heart and Lung Transplantation (ISHLT). Usually, these patients present some risk factors such as previous valvular operations and pulmonary hypertension. Since there are few studies in the literature, we retrospectively analyzed our early and long-term results. MATERIALS AND METHODS: We studied our experience in 22 HT cases for valvular cardiomyopathy (9.3% of our total experience), namely, 12 men and 10 women, of overall mean age of 52.6 +/- 10 years. Five patients had mitral; 8, aortic; and 1, tricuspid valve disease; 7 had double valve disease and 1, triple valve disease. Nineteen patients (87%) had been operated previously between 1 and 4 times. The mean ejection fraction was 23% +/- 7.3% and the mean New York Heart Association (NYHA) functional class was 3.7. Fifty-three percent of the patients had pulmonary hypertension. Two patients were operated as an emergency "O." We used the standard HT technique. RESULTS: Four patients (18%) were reoperated due to hemorrhage. The hospital mortality was 2 cases (9%). Another patients (9%) died on follow-up due to cardiac allograft vasculopathy. All surviving patients have been followed to the end of 2006. The mean follow-up has been 72 +/- 53 months. They are functional class I or II. CONCLUSIONS: HT for this indication was more frequent in our experience than in the Registry of the ISHLT. The immediate and long-term results were good, with an 82% mean survival at 6 years. HT can be a good treatment for patients with valvular cardiomyopathy and bad ventricular function and/or multiple valvular reoperations.
Subject(s)
Cardiomyopathies/etiology , Heart Transplantation/physiology , Heart Valve Diseases/surgery , Adult , Cardiomyopathies/surgery , Female , Heart Function Tests , Heart Transplantation/mortality , Humans , Male , Middle Aged , Retrospective Studies , Survival Analysis , Survivors , Treatment OutcomeABSTRACT
No disponible
No disponible
Subject(s)
Child , Humans , Jurisprudence , Informed Consent/ethics , Informed Consent/statistics & numerical data , General Surgery/education , General Surgery/methodsABSTRACT
UNLABELLED: The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain. OBJECTIVE: We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation. METHODS: Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12). RESULTS: Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors. CONCLUSION: When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.
