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  • 1
    Electronic Resource
    Electronic Resource
    Mesh configurations in laparoscopic extraperitoneal herniorrhaphy (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 1102-1105 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Hernia — Laparoscopic total extraperitoneal hernioplasty — TEP — Laparoscopy — Mesh
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic total extraperitoneal (TEP) hernia repair utilizes slit mesh that is placed around the spermatic cord to secure the prosthesis and prevent recurrence. Because of concern that encircling of the cord might increase pain and morbidity, we compared patients with mesh repairs using encircled and nonencircled techniques. Methods: The 191 male patients who underwent bilateral TEP repairs were divided into three groups. In 100 consecutive patients (group A), the slit mesh was closed around both spermatic cords; in 56 patients (group B), the slit mesh was tucked under the spermatic cords but not closed; in 35 consecutive patients (group C), the slit was closed around one cord and tucked under the other, in a randomized fashion. Results: The groups had similar operative times (A: 83 ± 25 min; B: 79 ± 21; C; 77 ± 24), use of pain medication (A: 2.7 ± 2.5 days; B: 2.4 ± 1.9; C: 3.1 ± 2.4), and recovery before return to work (A: 7.9 ± 7.0 days; B: 8.2 ± 6.1; C: 6.7 ± 4.8). The incidence of indirect hernias was similar in all groups. Complication rate was 20% in A, 20% in B, and 14% in C (p= NS). Chronic pain was more frequent in A (A: 6, B: 0, p= 0.06). In group C, fluid collections were more common on the closed side (closed: 3, tucked: 0; p= 0.08). There were no recurrences in any group. Conclusions: Closing the slit around the spermatic cord in laparoscopic inguinal hernia repair is not essential for prevention of early recurrence. Fluid collections tended to be more frequent when the mesh was closed around the cord, and chronic pain was more frequent in the group with closed mesh bilaterally.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900540
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  • 2
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy for ITP (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 991-995 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Spleen — Splenectomy — Laparoscopy — ITP — Idiopathic thrombocytopenic purpura — Thrombocytopenia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic purpura (ITP) was performed. Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching hospital between 3/91 and 8/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss, time to oral fluid intake, direct costs, and operating room (OR) costs were analyzed. Results: Age, sex, comorbidity, and spleen size were similar in both groups. LS was successful in 94% of patients in whom it was attempted. Operative times showed a learning curve for LS, with average times for the last ten cases (94 ± 35 min) significantly shorter than for the first ten (p= 0.01) and also shorter than for OS (103 ± 45 min). Postsurgical hospital stay was 2.9 ± 1.3 days for LS and 6.9 ± 3.0 days for OS (p 〈 0.001). Patients tolerated an oral diet 1.2 ± 0.5 days after LS and 3.2 + 0.7 days after OS (p 〈 0.001). Direct hospital cost was $5,509 ± 3,636 for LS and $9,031 ± 12,752 for OS. In the LS group, six patients (21%) had accessory spleens identified and removed, compared with two patients (11%) in the OS group. Platelet counts did not respond in two (7%) patients in the LS group, but no accessory spleens were identified by nuclear scan. One major complication occurred in the LS group. There were no cases of splenosis or mortality in either group. Conclusions: LS is a safe and effective treatment for ITP, with significantly shorter postoperative hospital stay than OS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900221
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  • 3
    Electronic Resource
    Electronic Resource
    Routine cholangiography reduces sequelae of common bile duct injuries (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 1194-1197 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopic cholecystectomy — Bile duct injuries — Cholangiography — Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: An effort was made to determine whether a policy of routine cholangiography affects the incidence, morbidity, and cost of bile duct injuries. Methods: A retrospective review of consecutive 3,242 laparoscopic cholecystectomies was performed. Most patients had routine intraoperative cholangiography. Results: There were 12 bile duct injuries (0.37%). All injuries were Bismuth levels 1 and 2. Eleven of 12 injuries were recognized intraoperatively. Ten were repaired primarily and one required hepaticojejunostomy. All repairs were successful. Average hospital charges were $26,669. One of 12 patients had delayed recognition of a bile duct injury and underwent primary repair over a T-tube on postoperative day 7. Hospital charges were $43,957. Conclusion: Routine cholangiography did not appear to decrease the absolute incidence of bile duct injuries compared to previously published reports. Injury severity, morbidity, late sequelae, and costs were reduced by a policy of routine cholangiography.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900277
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  • 4
    Electronic Resource
    Electronic Resource
    Techniques for intrasplenic hepatocyte transplantation in the large animal model (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 1075-1079 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Cell transplantation — Spleen — Laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The preferred therapy for acute and chronic liver insufficiency and severe heritable disorders of liver metabolism is whole-organ transplantation. However, due to the shortage of organ doproposed, including transplantation of normal allogeneic hepatocytes. Recently, it has been reported that many hepatocytes transplanted into the spleen migrated to the liver. We therefore carried out a series of large-animal experiments to reexamine the intrasplenic route and to develop a method for large-scale hepatocellular transplantation in pigs. Methods: Allogeneic porcine hepatocytes were transplanted using the following routes: (1) retrograde injection of cells via the splenic vein, (2) intraarterial injection of cells, (3) direct intrasplenic injection of cells after laparotomy, (4) percutaneous intrasplenic injection of cells under laparoscopic control, (5) laparoscopic intrasplenic injection of cells. The number of cells injected varied from 2 × 109 to 10 × 109 cells. Results: Of all the methods tested, only direct intrasplenic injection of 2 bln of cells was found to be compatible with survival. However, even with this ``small'' number of cells (2% original liver mass), there was a significant risk of spleen infarction, perisplenic adhesion formation, and portal vein thrombosis. The laparoscopic approach was found to be reliable, simple, and safe. Conclusion: Even though the spleen is considered by many authors the optimal site for hepatocellular transplantation, transplantation of cells in a number needed to support the failing liver may be associated with significant complications, morbidity, and mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900243
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  • 5
    Electronic Resource
    Electronic Resource
    Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi (1993)
    Springer
    Surgical endoscopy and other interventional techniques 7 (1993), S. 514-517 
    Details
    ISSN: 1432-2218
    Keywords: Balloon dilatation ; Sphincter of Oddi ; Common bile duct stones ; Laparoscopy ; Transcystic duct common duct exploration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique as an adjunct to laparoscopic common bile duct stone extraction is warranted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00316692
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  • 6
    Electronic Resource
    Electronic Resource
    Invited commentary (1993)
    Springer
    Surgical endoscopy and other interventional techniques 7 (1993), S. 393-394 
    Details
    ISSN: 1432-2218
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311727
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic trans-cystic-duct common-bile-duct exploration (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1389-1394 
    Details
    ISSN: 1432-2218
    Keywords: Trans-cystic-duct extraction ; Commonbile-duct exploration ; Common-bile-duct stones
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract One thousand seventy-one consecutive laparoscopic cholecystectomies were performed. Routine cholangiography was employed with a 99% success rate. One hundred thirty patients were found to have common duct stones (CBDS). In 48 (37%) patients they were unsuspected. One hundred eleven patients underwent attempted trans-cystic-duct extraction techniques (TCD-CBDE). One hundred three (93%) were successful. The following techniques were employed: 101—biliary endoscopy, 23—ampullary balloon dilation, 2—fluoroscopic basket retrieval. The average operative time was 136 min. The average postsurgical stay was 3.7 days. There were 19 (17%) complications—6 (5%) major. There were 4 retained stones (2 intentional) and 1 death. Patients over 65 years of age had more complications and patients with unsuspected CBDS under 65 years of age had the fewest. TCD-CBDE is a safe, effective way to extract common duct calculi. Endoscopy and basket stone retrieval was the primary technique employed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187342
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  • 8
    Electronic Resource
    Electronic Resource
    One hundred consecutive laparoscopic cholangiograms (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 319-323 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Cholecystectomy — Cholangiograms — ERCP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In 100 consecutive patients who underwent laparoscopic cholecystectomy, the feasibility, reliability, and cost of routine laparoscopic cholangiography were prospectively studied. Methods: Fluoroscopic cholangiograms with multiple exposures were successfully completed in all patients in an average time of 6.9 min. Results: Twenty-one percent were abnormal, and 15 common duct stones and 6 significant anatomic anomalies detected. Thirteen out of 15 patients with common duct stones had preoperative suspicion of common duct stones. Two out of 15 were completely unsuspected. The average cost of cholangiography was $768, and there were no complications related to the procedure. There were no false interpretations. Conclusions: When compared with selective preoperative endoscopic retrograde cholangiopancreatography (ERCP), routine laparoscopic cholangiography is safer, more accurate, and less costly, and may have the added benefit of potentially reducing iatrogenic injuries in patients with anatomic variations. Routine laparoscopic cholangiography should be considered by all surgeons.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649910050
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  • 9
    Electronic Resource
    Electronic Resource
    One hundred consecutive laparoscopic cholangiograms (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 319-323 
    Details
    ISSN: 1432-2218
    Keywords: Cholecystectomy ; Cholangiograms ; ERCP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In 100 consecutive patients who underwent laparoscopic cholecystectomy, the feasibility, reliability, and cost of routine laparoscopic cholangiography were prospectively studied. Methods: Fluoroscopic cholangiograms with multiple exposures were successfully completed in all patients in an average time of 6.9 min. Results: Twenty-one percent were abnormal, and 15 common duct stones and 6 significant anatomic anomalies detected. Thirteen out of 15 patients with common duct stones had preoperative suspicion of common duct stones. Two out of 15 were completely unsuspected. The average cost of cholangiography was $768, and there were no complications related to the procedure. There were no false interpretations. Conclusions: When compared with selective preoperative endoscopic retrograde cholangiopancreatography (ERCP), routine laparoscopic cholangiography is safer, more accurate, and less costly, and may have the added benefit of potentially reducing iatrogenic injuries in patients with anatomic variations. Routine laparoscopic cholangiography should be considered by all surgeons.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187380
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  • 10
    Electronic Resource
    Electronic Resource
    Final score in laparoscopic cholecystectomy (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 1095-1098 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Laparoscopic cholecystectomy — Common bile duct — Cholangiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The role of intraoperative fluorocholangiography (IOC) in laparoscopic cholecystectomy (LC) is controversial. We evaluated the use of IOC at an institution where the study is performed routinely. Methods: Records of all patients undergoing LC during a 3-year period ending January 1, 1996 were reviewed. Results: A total of 1207 patients received IOC, whereas 116 patients did not. IOC findings were categorized as follows: normal, 1016 cases (84%); CBD stone, 149 cases (12.3%); anomalies, 23 cases (1.9%); duodenal diverticula, 10 cases (0.8%); ductal strictures, four cases (0.3%); and CBD diverticula, 5 cases (0.4%). In the 116 patients who did not receive IOC, 35 of the procedures could not be performed, whereas 81 were not attempted. Of the 149 IOC that showed CBD stones, two were false positives. Anomalies included accessory right hepatic ducts (11 cases), cystic ducts joining the right hepatic duct (seven cases), and abnormal cystic duct entries (five cases). Duct injuries occurred in 5 cases (0.4%), three before and two after IOC. Four injuries were minor; IOC prevented CBD transection. Conclusions: Routine IOC is feasible, safe, accurate, and provides critical information of immediate use during LC. By treating ductal stones at operation and identifying patients without CBD stones, IOC minimizes need for postoperative studies, including endoscopic retrograde cholangiography (ERC).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900538
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