ABSTRACT
Most bile duct injuries result from an incorrect interpretation of bile duct anatomy. In 500 laparoscopic cholecystectomies we used a modified technique of cholecystcholangiography. This method is very easy and needs only 5 minutes. We found variants of bile duct anatomy in 74 cases and occult bile duct stones in 20 patients. We recommend this method which decreases the risk of bile duct injuries and gives the opportunity to approximate the golden standard of conventional cholecystectomy.
Subject(s)
Cholangiography , Cholecystectomy, Laparoscopic , Common Bile Duct/injuries , Cystic Duct/injuries , Gallstones/diagnostic imaging , Intraoperative Complications/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct/diagnostic imaging , Common Bile Duct/surgery , Cystic Duct/diagnostic imaging , Cystic Duct/surgery , Gallstones/surgery , Humans , Intraoperative Complications/surgery , Prospective Studies , Sensitivity and SpecificityABSTRACT
Cholangiography does not prevent bile duct injury, but if performed properly, it can identify impending injury before hand. We present a modified form of laparoscopic cholecystcholangiography; only 5 min are required to perform this technique. Some 408 consecutive peroperative cholangiographies are analyzed. We recommend this method, which decreases the risk of bile duct injuries, reveals occult bile duct stones in 4.2%, and gives the opportunity to approximate the gold standard of cholecystectomies.
Subject(s)
Cholangiography/instrumentation , Cholecystectomy, Laparoscopic/instrumentation , Cholelithiasis/surgery , Postoperative Complications/prevention & control , Bile Ducts/injuries , Cholelithiasis/diagnostic imaging , Gallstones/diagnostic imaging , Gallstones/surgery , Humans , Intraoperative Complications/diagnostic imaging , Intraoperative Complications/prevention & control , Postoperative Complications/diagnostic imaging , Prospective Studies , Risk Factors , Sensitivity and SpecificityABSTRACT
After an operation and once discharged, all patients with tumor diseases have to receive follow-up medical supervision and therapeutic/chemotherapeutic procedures. Tumorstaging and -grading must be considered. All in-patient chemotherapeutic treatment for gastrointestinal-, liver-, breast- and thyroid gland tumors generally takes place in the surgical department. We are convinced that ethical considerations in the treatment of tumor patients are important.
Subject(s)
Aftercare , Neoplasms/surgery , Patient Care Team , Chemotherapy, Adjuvant , Combined Modality Therapy , Germany , Hospitals, Community , Humans , Neoplasm Staging , Neoplasms/drug therapy , Neoplasms/pathology , Surgery Department, HospitalABSTRACT
The laparoscopic technique for cholecystectomy is associated with a increased rate of bile duct injuries. A conscientious preparation, the excessive application of electrocoagulation, anatomical variants and renunciation of cholangiography are reasons for injuries. The technique of operative treatment depends on type, range and location of injury.
Subject(s)
Bile Ducts/injuries , Cholecystectomy, Laparoscopic , Intraoperative Complications/etiology , Biliary Fistula/etiology , Cholangiography , Humans , Postoperative Complications/etiology , Reoperation , Risk FactorsABSTRACT
We compared 140 appendectomies in a prospective study with regard to length of operation, stay in hospital and intra- and postoperative complications. We operated by four methods and made up four groups, 35 patients in each: (1) application of RODER-loop and manual stump-sinking; (2) application of RODER-loop without manual stump-sinking; (3) application of Endo-GIA; (4) conventional appendectomy according to McBurney. Intraoperative complications occurred mainly in laparoscopic appendectomy, while disturbances of wound-healing were observed mainly in conventional appendectomy. The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group (RODER-loop without stump-sinking), while using the Endo-GIA involved only a little risk. In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results.
Subject(s)
Appendectomy/instrumentation , Appendicitis/surgery , Laparoscopes , Surgical Staplers , Suture Techniques/instrumentation , Electrocoagulation/instrumentation , Humans , Intraoperative Complications/etiology , Length of Stay , Postoperative Complications/etiology , Prospective Studies , Treatment OutcomeSubject(s)
Ligaments, Articular/abnormalities , Nerve Compression Syndromes/surgery , Ulnar Nerve/surgery , Adult , Aged , Elbow Joint/pathology , Elbow Joint/surgery , Humans , Ligaments, Articular/pathology , Ligaments, Articular/surgery , Male , Middle Aged , Nerve Compression Syndromes/pathology , Paresthesia/pathology , Paresthesia/surgery , Tissue Adhesions , Ulnar Nerve/pathologyABSTRACT
5 patients with this anatomic abnormality are dealt with. In literature the frequency of visceral inversion is 1:10000. In the GDR this would mean a total of approximately 1700 persons living with visceral inversion. Correct diagnosis is based on clinical examination and X-ray of the thorax. The danger of false diagnosis is especially given in cases of acute abdominal illness.