Completely staple-free hand-sewn laparoscopic anastomosis in colorectal surgery.

Colonic continuity following a laparoscopic left hemicolectomy is usually performed by using a circular stapler to achieve end-to-end colorectal anastomosis. However, not much consideration is given to the costs of this technique and the long-term risk of stenosis. In this paper, we report the first case of a completely staple-free hand-sewn laparoscopic colonic anastomosis (CSHLCA) following a laparoscopic left hemicolectomy for cancer. Total operative time was 170 minutes, and the time to perform the anastomosis was 38 minutes. The postoperative stay was uneventful, with a total hospital stay of 6 days. CSHLCA is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to mechanical staplers.

Role of laparoscopy in the management of visceral injuries following abdominal stab wounds.

BACKGROUND: Laparoscopy offers several advantages in the treatment of abdominal stab wounds. In this paper, we report our experience during 2004, where hemodynamically stable patients with stab wounds were managed laparoscopically. PATIENTS AND METHODS: Between January and December 2004, 8 hemodynamically stable patients (7 men, 1 woman) underwent laparoscopy for anterior abdominal stab wounds. Median age was 28.5 years (range, 17-55). All patients underwent an abdominal computed tomography (CT) prior to the laparoscopy. RESULTS: Exploration of the wound under aseptic conditions, carried out as a part of the physical examination, confirmed peritoneal penetration in 7 of the 8 cases. Abdominal CT revealed positive findings in 7 (87.5%) cases. Laparoscopy was performed after a median time of 60 minutes (range 30-90). Laparoscopic exploration evidenced peritoneal penetration in 100% of the cases and visceral lesions in 87.5% of the cases. All visceral injuries were managed laparoscopically. Median operative time was 135 minutes (range, 45-200). Operative mortality was 0% and early morbidity was 12.5%. Median hospital stay was 5 days (range, 1-11). After a median follow-up of 12 months (range, 1-28), 1 patient complained of persistent chest pain and a ventral hernia at the site of the abdominal stab wound was diagnosed in another patient. CONCLUSIONS: Laparoscopy should be included in management algorithms in patients with anterior abdominal stab wounds who are hemodynamically stable. In addition to its diagnostic ability, this study demonstrates that laparoscopy can be an effective management modality with minimal morbidity and no mortality.

Abordaje laparoscópico en el tratamiento de la colecistitis aguda: estudio retrospectivo en 609 casos / The laparoscopic approach in the treatment of acute cholecystitis. Retrospective study in 609 patients

La colecistectomía laparoscópica (CL) es actualmente bien aceptada como el tratamiento de elección en la colelitiasis sintomática no complicada. La aplicación de la técnica laparoscópica en pacientes con colecistitis aguda (CA) es más controvertida. El exacto papel y los beneficios potenciales de la CL en el tratamiento de la CA no se han establecido claramente, ni existen amplias series clínicas. El objetivo del estudio fue valorar la aplicabilidad, seguridad, beneficios y complicaciones específicas del abordaje laparoscópico en pacientes con CA. Se realizó un análisis retrospectivo de los pacientes admitidos en dos unidades de cirugía digestiva de urgencia entre octubre de 1990 y diciembre de 1997. Se identificaron y evaluaron 609 pacientes que cumplieron los criterios de CA. La tasa de complicaciones fue del 15 por ciento, con 12 fístulas biliares postoperatorias (1,97 por ciento) y 4 lesiones de la vía biliar (LVB) (0,66 por ciento). La mortalidad global fue del 0,66 por ciento. Las complicaciones locales y globales se correlacionaron significativamente con el retraso entre el inicio de los síntomas agudos y la cirugía, pero no así la tasa de complicaciones generales ni la de fallecimientos. Nuestros resultados demuestran la seguridad y la factibilidad de la CL en la CA. La colecistectomía temprana dentro de los primeros 4 días se recomienda ampliamente para minimizar las complicaciones e incrementar las posibilidades de un abordaje laparoscópico con éxito (AU)