RESUMO
Laparoscopic cholecystectomy has been accepted by surgeons in the United States with unprecedented rapidity. Since introduction it has become, in many areas, the standard of care for treating patients with cholelithiasis. However, as with all new surgical procedures, complications are being recognized. Bile duct injuries are a complication of laparoscopic cholecystectomy, perhaps with greater incidence than with traditional cholecystectomy. Routine cholangiography may minimize the incidence of common bile duct injury. We review our experience with laparoscopic cholangiography and suggest methods to avoid common bile duct injury.
Assuntos
Colangiografia , Colecistectomia Laparoscópica , Cuidados Intraoperatórios , Cateterismo/instrumentação , Colangiografia/economia , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/economia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/lesões , Análise Custo-Benefício , Ducto Cístico/diagnóstico por imagem , Fluoroscopia/instrumentação , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Incidência , Cuidados Intraoperatórios/economia , RecidivaAssuntos
Baço/cirurgia , Esplenectomia/efeitos adversos , Adolescente , Adulto , Idoso , Infecções Bacterianas/etiologia , Pré-Escolar , Feminino , Humanos , Masculino , Baço/lesõesRESUMO
Thirty-one aneurysms of the popliteal artery in 23 patients have been studied. Twenty-nine aneurysms were secondary to atherosclerosis, while one was secondary to trauma and one was associated with a coagulopathy. The lesions were bilateral in eight patients and were associated with extra-popliteal aneurysms in ten patients; the abdominal aorta was the most frequent extrapopliteal site. All except two of the 23 patients were over 50 years of age, and many exhibited atherosclerosis and related symptoms in other vessels. Ischemic rest pain was the most common presenting symptom in patients with popliteal aneurysm, but three of the patients were asymptomatic. The most common physical sign was a palpable popliteal mass in 25 patients, with impending gangrene distal to the aneurysm in four. Thrombosis occurred in 11 of the aneurysms, embolism in three, and rupture in two. Amputation was eventually necessary in five patients with thrombosis and in one patient with embolism. Of 16 patients presenting with a complication of popliteal aneurysm, six patients eventually required amputation. All popliteal aneurysms should be treated surgically and arterial continuity restored unless contraindicated by the over-all condition of the patient. The saphenous vein represents the optimal replacement material available at this time, but fabric grafts can be used successfully.
