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  • 1
    Electronic Resource
    Electronic Resource
    Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 1076-1080 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopic bile duct injury ; Routine intraoperative cholangiography ; Biliary tract
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Controversy over whether intraoperative cholangiography (IOC) should be done routinely has intensified since the advent of laparoscopic cholecystectomy (LC). As yet, no study has demonstrated a clear benefit to its use, although their have been suggestions in the literature that routine use may confer an advantage to detection of injuries. One-hundred seventy-seven biliary tract complications occurring secondary to LC were identified from the combined data of seven institutions. The goal of this retrospective study was to examine the impact of IOC on the occurrence, recognition, and correction of such complications. The complications identified include 39 cystic duct leaks, 69 major ductal leaks or strictures, and 69 major ductal transection or excision injuries. Whether IOC was performed was known in 157 (88%) patients with 53 patients definitely having and 104 not having an IOC. Data concerning IOC were unavailable in 20 cases. More injuries were detected intraoperatively in the group having IOC (P〈0.001). Conversion of the LC to a laparotomy, often for repair of the injury, occurred more commonly in the group having a correctly interpreted IOC (P〈0.001). Conversion resulted in detection of injuries sooner, resulting in fewer operative procedures to correct the injury (P〈0.001). A transecting injury was prevented in at least seven patients when no visualization of the proximal biliary tree was documented by IOC. These partial ductal incisions were treated by t-tube placement. Incorrect interpretation of the IOC occurred in at least eight patients, with no identification of the proximal biliary tree in six. These data suggest routine IOC may offer significant potential advantages in the detection and subsequent correction of these injuries, as well as preventing extension of partial ductal incisions to complete ductal transections. Surgeons must be able to correctly interpret the IOC. Although routine IOC is suggested, careful dissection principles continue to be most important in the prevention of major extrahepatic bile duct injuries during LC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188990
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 272-279 
    Details
    ISSN: 1432-2218
    Keywords: Carbon dioxide ; Fetal acidosis ; Pregnant ewe ; Model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90–120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P〈0.0001). Hemodynamic changes were minimal with all agents but it appeared that there a was greater prevalence of fetal tachycardia and hypertension during CO2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187767
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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