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  • Laparoscopic surgery  (2)
  • Key words: Ductal calculi—Endoscopic sphincterotomy— Laparoscopic Ductal Clearance—Randomized controlled clinical trial  (1)
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  • 1
    Digitale Medien
    Digitale Medien
    EAES ductal stone study (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 1130-1135 
    Details
    ISSN: 1432-2218
    Schlagwort(e): Key words: Ductal calculi—Endoscopic sphincterotomy— Laparoscopic Ductal Clearance—Randomized controlled clinical trial
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: The current management of patients with ductal calculi and gallstone disease consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). The advent of techniques of laparoscopic ductal stone clearance has introduced an alternative single stage laparoscopic treatment for these patients. The EAES ductal stone trial was set up to compare the relative efficacy and outcome of these two management options. Methods: The study consists of a prospective randomized controlled clinical trial comparing two management options of patients undergoing LC and suspected of harbouring common duct stones. Patients registered into the trial are randomized to one of two arms: (i) Group A—preoperative ERC with ESE followed by LC during the same hospital admission. (ii) Group B—single stage laparoscopic management consisting of LC and laparoscopic stone extraction either by the trans-cystic duct route or by direct supraduodenal common duct exploration. Results: This preliminary analysis was carried out on 207 randomized patients with comparisons being made on the intention to treat principle. The two groups (A = 106, B = 101) were comparable with respect to clinical features. ASA grade, serum biochemistry and ultrasound findings. Conclusions: These preliminary findings indicate equivalent success rates and patient morbidity between the two management options but a shorter hospital stay (cost benefit) with the single stage laparoscopic treatment. Trans-cystic duct extraction is a more benign procedure than laparoscopic supraduodenal CBD exploration and is accompanied by a significantly shorter hospital stay. The higher incidence of conversion in the single stage laparoscopic group compared to the two-stage arm is due to the preference for open common duct exploration when the laparoscopic attempt failed by the majority of participating surgeons. The results to-date suggest that in fit patients, single stage laparoscopic treatment is the better option and the role of ESE should change to selective use in those patients in whom laparoscopic ductal stone extraction has failed.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004649900264
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  • 2
    Digitale Medien
    Digitale Medien
    Single-stage laparoscopic treatment of gallstones and common bile duct stones in 120 unselected, consecutive patients (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 1070-1075 
    Details
    ISSN: 1432-2218
    Schlagwort(e): Laparoscopic surgery ; Common bile duct stones ; Common bile duct exploration
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Feasibility, success rate, safety, and shortterm results of single-stage, laparoscopic, transcystic—whenever possible—or choledochotomic treatment of gallstones and common bile duct (CBD) stones were evaluated in 120 unselected patients. Of 1095 patients who underwent laparoscopic cholecystectomy, 120 had ductal stones; among those patients, stones were suspected or proven in 72, 27 of whom were referred after failed endoscopic sphincterotomy (ES) performed elsewhere; unsuspected CBD stones were discovered in 48. The procedure was successful in 116 patients. Four patients required conversion to open surgery. The transcystic access was feasible in 77 patients; a choledochotomy was required in 39. Incidence of retained CBD stones was 4.3%. Minor complications, major complications, and mortality were observed in 6.8%, 1.7%, and 0.8% of patients, respectively. Single-stage laparoscopic treatment of gallstones and CBD stones in unselected patients is safe and feasible in the majority of cases, with success rates and short-term results that are not inferior to reported results of ERCP/ES and cholecystectomy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00188989
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  • 3
    Digitale Medien
    Digitale Medien
    Laparoscopic intra-arterial catheter implantation for regional chemotherapy of liver metastasis (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 449-452 
    Details
    ISSN: 1432-2218
    Schlagwort(e): Liver metastasis ; Locoregional chemotherapy ; Port-a-cath ; Laparoscopic surgery ; Laparoscopic intra-arterial catheter implantation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract In patients with unresectable metastatic disease confined to the liver, intra-arterial regional chemotherapy with implantable systems is an attractive option. Since April 1992, laparoscopic colorectal resections have been performed in our institution. Within this series of patients, three cases with bilateral liver metastasis from colon cancer were observed and underwent laparoscopic intra-arterial catheter implantation in the gastroduodenal artery for regional chemotherapy. In two patients the metastases were synchronous, and in both cases a laparoscopic colon resection was also performed, for tumors located in the cecum and in the sigmoid colon, respectively. The laparoscopic surgical technique for intra-arterial catheter implantation is described in detail. In this limited experience the procedure, from a purely technical point of view, was not considered difficult and was completed in 70 min on average. No complications were observed and the patient with metachronous liver metastasis was discharged on 3rd postoperative day.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00191639
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