ABSTRACT
This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.
Subject(s)
Cholecystectomy, Laparoscopic/methods , Gallstones/surgery , Sphincterotomy, Endoscopic/methods , Adolescent , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Female , Gallstones/diagnostic imaging , Humans , Male , Middle AgedSubject(s)
Duodenal Ulcer/surgery , Vagotomy, Truncal , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
The authors have compared their early (50 cases) experience on laparoscopic appendectomy for acute appendicitis with a control group treated by open approach. A teaching period is necessary to reduce the converting rate to an open procedure from 22% to 6% p = 0.05 and to obtain an equal median anesthesia time (39 vs 40 mn+/-16) ns). The mean post operative stay for open operation was 5-8 (range 3-23) days and for the laparoscopic route 3.3 (range 1-8) days (p < 0.005). The wound infection rate was 16% (n = 8) for open/ and 0% for laparoscopic appendectomy p = 0.001. The results suggest that emergency laparoscopic appendectomy should be explored further as an alternative to open surgery for acute appendicitis.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Laparoscopy , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative ComplicationsABSTRACT
Puede cuestionarse el interés de realizar la apendicectomía por vía laparoscópica, cuando esta intervención, una de las más antiguas (1986) y la más frecuentemente realizada (24.607 por año en Chile, 120.000 por año en Francia), ha adquirido la reputación de un gesto simple, seguro, rápido y de una gran benignidad. El rápido desarrollo en los últimos años de la cirugía digestiva por vía laparoscópica, es particular de la colicistectomía, apoyada por los extraordinarios progresos de la tecnología, ha planteado la posibiblidad de realizar la apendicectomía por vía laparoscópica. En realidad, ella ha venido realizándose desde 1980 (12), particularmente en Alemania, por Ginecólogos (10), Cirujanos generales (3) y Cirujanos infantiles (5). La experiencia adquirida permite vislumbrar múltiples ventajas
Subject(s)
Humans , Appendectomy , Laparoscopy , Appendicitis/diagnosis , Appendicitis/surgery , Diagnosis, Differential , Laparoscopy , Postoperative Complications/epidemiologyABSTRACT
Epidemiological investigations were carried out during and after a viral hepatitis A outbreak in a mountain town, Geraci Siculo, in western Sicily. Blood samples were obtained through finger prick or by venipuncture from patients, their family contacts and from healthy school children of different age groups (3 to 15 year old). Serum markers for hepatitis A (anti HAV and IgM anti HAV) and hepatitis B (HBsAg and anti HBs) were tested. All but two of 36 cases, which occurred from August through March with a peak in November and December were under 15; 33 of them, in which laboratory data were available, were due to HAV. Seroepidemiological investigations, performed in December 1979 and in May 1980, have shown a low prevalence of anti HAV antibodies: 11.5% only of the children tested were positive in the first sampling and 22% in the second one. Also prevalence of HBV markers was low, as compared with similar observations carried out previously in other different area of Western Sicily.
