ABSTRACT
The acute abdominal compartment syndrome (ACS) is most often treated with surgical abdominal decompression. After the acute phase, primary closure of the abdominal wall may not be possible, due to tissue loss and retraction of the abdominal wall and its musculofascial components. This article gives an update of the reconstructive ladder for abdominal wall defects. Because of improved intensive care treatment and wound dressing, reconstruction can usually be delayed until infection and oedema have settled. Recent developments in bioprosthetics and new surgical techniques like component separation make better results with less donor site morbidity possible. However, there is still a place for local and distant flaps.
Subject(s)
Abdomen/physiopathology , Abdomen/surgery , Abdominal Wall/surgery , Compartment Syndromes/physiopathology , Compartment Syndromes/surgery , Decompression, Surgical , Plastic Surgery Procedures/methods , HumansABSTRACT
The acute abdominal compartment syndrome (ACS) is most often treated with surgical abdominal decompression. After the acute phase, primary closure of the abdominal wall may not be possible, due to tissue loss and retraction of the abdominal wall and its musculofascial components. This article gives an update of the reconstructive ladder for abdominal wall defects. Because of improved intensive care treatment and wound dressing, reconstruction can usually be delayed until infection and oedema have settled. Recent developments in bioprosthetics and new surgical techniques like component separation make better results with less donor site morbidity possible. However, there is still a place for local and distant flaps.
ABSTRACT
We describe a laparoscopic technique of pyloric exclusion with gastroenterostomy and common bile duct T tube insertion for obvious perforation at endoscopic retrograde cholangiopancreatography with papillotomy. The patient was operated on immediately after diagnosis of the lesion. The postoperative sequellae were very comparable to those of elective laparoscopic common bile duct exploration. We believe this approach is interesting, especially in the current era of frequent litigation.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Pylorus/surgery , Common Bile Duct/injuries , Gastroenterostomy/methods , Humans , Middle AgedABSTRACT
BACKGROUND: Roux-en-Y gastric bypass (RYGBP) leaves a large blind gastric segment, which is inaccessible for conventional endoscopy. METHOD: A case is reported, describing a variation of laparoscopic RYGBP by partitioning the stomach by an inflatable band rather than by stapling or division. RESULTS: The stomach was partitioned into a proximal 15 cc pouch and a distal part by an adjustable gastric band. A RYGBP was fashioned from the proximal pouch. 9 patients were treated with this technique: 7 as an initial procedure and 2 after previous gastric banding which had been followed by insufficient weight loss. 1 of these latter patients developed erosion of the band through the gastrojejunostomy 7 months postoperatively. CONCLUSION: Laparoscopic proximal RYGBP with inflatable-band gastric partitioning is feasible. Erosion of the band though the gastrojejunostomy, however, might be a serious side-effect of this technique.
Subject(s)
Anastomosis, Roux-en-Y/methods , Gastric Bypass/methods , Gastroplasty/methods , Gastroscopy/methods , Adult , Anastomosis, Roux-en-Y/adverse effects , Anastomosis, Roux-en-Y/instrumentation , Contrast Media , Diatrizoate Meglumine , Feasibility Studies , Female , Gastric Bypass/adverse effects , Gastric Bypass/instrumentation , Gastroplasty/adverse effects , Gastroplasty/instrumentation , Gastroscopy/adverse effects , Gastrostomy/adverse effects , Gastrostomy/instrumentation , Gastrostomy/methods , Humans , Jejunostomy/adverse effects , Jejunostomy/instrumentation , Jejunostomy/methods , Length of Stay/statistics & numerical data , Postoperative Care/methods , Treatment Outcome , Weight LossABSTRACT
OBJECTIVE: To compare the costs and benefits of open versus endovascular repair of abdominal aortic aneurysm (AAA). METHODS: A consecutive series of 29 elective patients (open treatment, N = 20 and endovascular treatment, N = 9) were compared retrospectively. RESULTS: Operating time was significantly shorter for endovascular treatment (mean 90 vs. 125 min, p = 0.026). No endovascular procedure was converted to open surgery; one early endoleak was seen which sealed spontaneously. Endovascular treatment resulted in a shorter ICU and hospital stay (0 days vs. 2 days, p. 0.001 and 5 days vs. 11 days, p = 0.01 respectively). Mean total cost did not differ 361,938 BEF (9,048 Euro) vs. 382,995 BEF (9,575 Euro), p = 0.46. Endovascular treatment generated significantly less hospitalization costs (73,162 BEF or 1,829 Euro vs. 18,2740 BEF or 4,568 Euro, p = 0.001) but required a more expensive implant (153,293 BEF or 3,832 Euro vs. 38,296 BEF or 957 Euro, p = 0.001). Mean total cost for the patient was significantly higher in the endovascular treatment group (66,309 BEF or 1,658 Euro vs. 24,969 BEF or 624 Euro, p = 0.003). CONCLUSION: Our experience confirms the feasibility and safety of endovascular AAA treatment. It is associated with a shorter ICU and hospital stay and less morbidity. Overall cost for society does not differ significantly as the benefit, of lower hospitalization costs is undone by the high cost of the endovascular graft.
