Results Of Laparoscopic Treatment Research Articles

РЕЗУЛЬТАТЫ ИСПОЛЬЗОВАНИЯ МЕТОДА ПОЛНОГО ЭКСТРАПЕРИТОНЕАЛЬНОГО ЭНДОСКОПИЧЕСКИ АССИСТИРОВАННОГО ЛИГИРОВАНИЯ ГРЫЖЕВОГО МЕШКА У ДЕТЕЙ С ПАХОВОЙ ГРЫЖЕЙ (PHELPS)

The aim of the study was to evaluate the effectiveness of the new technology for laparoscopic treatment of inguinal hernia (IH) in children (PHELPS) in comparison with the popular extraperitoneal SEAL technique. Materials and methods of research: a retrospective comparative single-center non-randomized study was carried out. The analysis of the results of laparoscopic treatment of 680 patients with IH was performed, out of them 206 patients were operated on using the new PHELPS technique, in 474 cases the laparoscopic extraperitoneal SEAL technique was used. The gender composition of patients in the groups did not differ statistically significantly (m/f: 151/55–73.3%/26,7% versus 349/125–73.6%/26,4%, p=0,929). The median age of children in the PHELPS group was 169,5 [80,8; 261,3] days, in the SEAL group – 210,5 [78,0; 258,0] days (p=0,137). The difference between the new technique for treating IH in children consisted in the method of carrying out a hernial ligature around the neck of the hernial sac in such a way that the knot after percutaneous tying was located at the level of the peritoneum and did not include the tissues of the abdominal wall (aponeurosis and muscles). At the end of the study, a comparison of demographic data, intra- and postoperative results in the two groups of patients was made. Results: the median of the total duration of inguinal herniorrhaphy, including the operation time in patients with single and double sided hernia localization, confirmed statistically unchanged values of this indicator in the comparison groups (20,0 [15,0; 20,0] min versus 15,0 [15,0; 20,0] min, р=0,518). The study demonstrated a faster recovery of patients after using the PHELPS technique for the treatment of IH, with a statistically significantly lower number of doses of postoperative analgesia (1,0 [1,0; 1,0] versus 1,0 [1,0; 2,0 ], p<0,001) and a shorter hospital stay (8,0 [6,0; 8,0] hours versus 8,0 [8,0; 9,0] hours, p=0,031). Despite the fact that there were no statistically significant differences in the frequency of formation of dropsy of the testicle (0 (0,0%) versus 6 (1,3%), p=0,185), a statistically significantly better condition of patients was revealed as a result of the use of the innovative PHELPS technique, consisted in the absence of the return of symptoms of the disease – 0 (0,0%) versus 17 (3,6%), p=0,003. Conclusion: the new PHELPS method of treating IH in children allows to improve the quality of known extraperitoneal methods of treating the disease. The placement of a hernial ligature node at the level of the hernial sac neck, rather than over the aponeurosis, is expected to lead to a decrease in the number of relapses after surgery.

Laparoscopic surgery for urachal remnants in pubescent children: a case series

BackgroundVarious techniques are applied in laparoscopic surgery for the treatment of urachal remnants, which are less invasive and associated with lower morbidity. We herein report a case series in which we treated urachal remnants and medial umbilical ligaments using a laparoscopic approach.Case presentationFrom 2015 to 2019, seven patients (male, n = 5; female, n = 2) with a urachal remnant were treated by laparoscopic surgery in our institute. Five boys and two girls with a median age of 11 years (range 10–15 years) were enrolled in this series. The clinical results of laparoscopic treatment, the perioperative records, and the pathologic results were evaluated. The operation was performed with the use of three ports and an EZ access® (Hakko Medical, Nagano, Japan), which is a silicon cap for the wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan). The removal of the urachal remnant and medial umbilical ligaments was completed with a median operative time of 92 min (range 69–128). The median hospital stay after surgery was 4 days (range 2–5). No patients developed intra-postoperative complications or recurrence.ConclusionsAlthough our data are preliminary, complete laparoscopic removal of symptomatic urachal remnants and medial umbilical ligaments was a safe and effective minimally invasive approach, with better cosmetic outcomes.

Outcome of Laparoscopic Treatment in Patients with Endometriosis

Outcome of Laparoscopic Treatment in Patients with Endometriosis

Laparoscopic treatment of varicocele within adolescents in two African countries.

Varicocele is often ignored by adolescents and their parents, in our context. The aim of the study is to present the indications and results of laparoscopic treatment in a population of adolescent students.Subjects and Methods:It is a descriptive and analytical prospective study over a period of 9 months (January to September 2013), focussed on cases of varicocele Grade 3 found in adolescents during a screening, and who underwent surgical treatment by laparoscopy. The laparoscopic treatment was done as part of a training mission to paediatrics surgeons, through a European Non-governmental organisation in two university hospitals in Africa. Of 2724 adolescent students examined, 149 (5.47%) had a varicocele. The average age was 16.39 ± 2.05 years (12 and 19). The side was unilateral (79.19%) with 76.51% left or bilateral (20.81%) (P = 0.00). According to the classification of Dubin and Amelar, there were 58 (38.92%) cases of Grade 1, 66 (44.30%) were Grade 2 and 25 (16.78%) were Grade 3.Results:The laparoscopic treatment was performed in 23 patients with varicocele Grade 3, by modified Palomo's technique, sectioning a segment of vessels between clips (15) between nodes (2) or after coagulation without clips and ligation (6). The hospital stay was 36 h. It has been observed one case of post-operative moderate vaginal hydrocele and 11 cases testicular hypertrophy.Conclusion:The laparoscopic treatment of varicocele in adolescents reduces post-operative morbidity related to conventional open surgery. This technique has been available in two poor African countries through partnership north-south.

Laparoscopic Management of Ovarian Dermoid Cysts in Birat Medical College, Teaching Hospital

Introduction: Spillage of contents of the dermoid cyst during surgery may cause chemical peritonitis and spillage is more likely to occur during laparoscopic surgery for the removal of the ovarian dermoid cyst. Thorough washing of peritoneal cavity with physiological solution greatly reduces the incidence of chemical peritonitis.Objective: To study the outcome of laparoscopic treatment of ovarian dermoid cysts.Methodology: This is a hospital based cross-sectional study conducted at Birat Medical College and Teaching Hospital from 2012 April to 2016 April. All patients being operated by laparoscopy for ovarian dermoid cysts were enrolled in the study. Occurrence of spillage of dermoid contents during surgery and development of symptoms and signs of chemical peritonitis in postoperative period were main outcome measures. The collected data was entered in Microsoft Excel and analyzed by SPSS software version17.Results: Eighty nine ovarian dermoid cysts from 82 patients were managed by laparoscopy. Among 89 cysts, 54(60.76%) cysts were removed by laparoscopic cystectomy, 21(23.59%) cysts were removed by laparoscopic salpingo-ophorectomy and 14(15.73%) cysts were removed by salpingo-ophorectomy with hysterectomy. Spillage of dermoid content occurred in 50 (56.17%) cysts removal. There was no conversion to laparotomy and no case of chemical peritonitis.Conclusion: The risk of chemical peritonitis is negligible with spillage of dermoid content during laparoscopic procedure when peritoneal cavity is washed thoroughly. Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 273-276

Outcome of Laparoscopic Treatment of Anorectal Malformations in Children.

Operative correction of anorectal malformations (ARMs) remains a challenge in pediatric surgery. The study aimed to evaluate the outcomes of laparoscopic treatment of ARM in children. From 2007 to 2014, we performed 104 laparoscopic-assisted anorectal pull-through procedures in children with a mean age of 11.3±0.4months and ARMs. Clinical assessment, surgical durations, complications, and postoperative outcome were investigated. The mean duration of the operation was 126.5±17.2min. Mean intraoperative bleeding was 20±5.7g. Three (2.9%) children required conversion to laparotomy. One (0.9%) child developed a pelvic abscess, requiring an additional intervention. Three to six months after laparoscopic-assisted anorectal pull-through, 72 patients were hospitalized for stoma closure. Good functional results were achieved in 39 (54.2%) patients. On examination of the perineum, 11 (15.3%) patients were found to have mucosal prolapse. The circular symmetric anal reflex to tactile stimulation was confirmed in 53 (73.6%) patients and a tactile weakened anal reflex in 5 (6.9%) children. At the 1-year follow-up, constipation was present in nine (12.5%) patients and soling in two (2.8%) patients. A barium enema study performed after the operation showed good outcomes in 67 (93.1%) patients and fair outcomes in 5 (6.9%) patients. None had a poor outcome. Our experience confirms that laparoscopic-assisted anorectal pull-through enabled complete correction of ARM in the meanwhile avoiding damage to the rectum and anus. Also, the technique of double bipolar myostimulation of muscle complex in laparoscopic ARM might lead to these better results.

Laparoscopic Treatment of Acute Gastric Volvulus

IntroductionGastric volvulus is an uncommon clinical condition and is associated with type II–III hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methodsA retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. ResultsA total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48 and 72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. ConclusionLaparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk.

Laparoscopic Management of Perforated Peptic Ulcer in Early and Late Presentation: A Comparative Study

Aim: To compare results of laparoscopic treatment of perforated peptic ulcer (PPU) in early and late presentation. Materials and methods: Fifty-eight patients of age ranging from 18 to 55 years underwent laparoscopic closure of PPU over a period of 4 years between 2008 and 2011 of which 43 were male, 15 were female. In our study we took early presentation as 3 days and late presentation as 3 to 7 days (time taken for seeking treatment from the onset of symptoms). Thirty-seven presented early whereas other 21 presented late. All patients were compared for variables like operating time, intraoperative complications, risk of anesthesia, rate of conversion to open surgery, postoperative pain and the opiate analgesic requirements, postoperative morbidity and mortality, hospital stay. Results: Mean operating time for patients with early presentation was 60 vs 90 minutes for delayed presentation. Conversion rate was 0 in early presentation 47.6% (10 cases) in late presentation. Thorough abdominal toileting was possible in all cases of early presentation. In late presentation it was possible only in 6 out of 11 cases after excluding conversion rate because of intestinal matting. No patients had any anesthesia problem in early presentation but 3 out of 11 cases had delayed recovery from anesthesia requiring treatment in intensive care unit. Postoperatively Opioid analgesia was required for mean of 3 days in early presentation vs mean of 4 days in late presentation. Nasogastric tube was removed on 3rd day in early presentation vs 4th day in late presentation which coincided with return of bowel sounds. Port site infection was seen in 5 out of 37 cases in early presentation and 2 out of 11 in late presentation. Intraperitoneal localized abscess was seen in 2 out of 11 cases in delayed presentation and none in early presentation which was then managed by aspiration. Mean hospital stay was 5 days in early presentation and 7 days in late presentation. Conclusion: Laparoscopic treatment of PPU is safe, feasible done with ease in patients presenting less than 3 days and also in some cases of late presentation, with anesthetic complication, postoperative complications and conversion rate increasing with delayed presentation.

Tratamiento del vólvulo gástrico agudo mediante abordaje laparoscópico

IntroductionGastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methodsA retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. ResultsA total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. ConclusionLaparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk.

Surgical treatment of complicated right colonic diverticulitis: laparoscopic versus open surgery

Complicated right colonic diverticulitis is more common in Eastern countries. Although this disease entity is treated primarily with surgery, it is uncertain whether the outcomes of laparoscopic treatment also are comparable with those of open surgery. This study aimed to evaluate the outcome for laparoscopic surgical management of complicated right-sided colonic diverticulitis compared with that for open surgery. Between 1999 and 2011, 59 patients who underwent extensive surgery for complicated right colonic diverticulitis were enrolled from two hospitals. All the patients were suspected of having a large abscess or perforation with peritonitis symptoms preoperatively. Laparoscopic surgery was performed for 28 consecutive patients in the one hospital, and open surgery was performed for 31 consecutive patients in the other hospital. There was no conversion in the laparoscopic surgery cases. Clinical outcomes were analyzed and compared between the two groups. Laparoscopic surgery had a longer operating time (165 min) than open surgery (132 min) (p = 0.003). The two groups did not differ significantly in terms of postoperative hospital stay (laparoscopy 9.8 ± 2.7 days versus open surgery 12.8 ± 8.8 days; p = 0.234) or resumption of diet (laparoscopy 5.5 ± 2.4 days versus open surgery 6.3 ± 3.0 days; p = 0.286). Five patients in the laparoscopy group (17.8 %) had complications such as ileus, abscess, and bleeding, one of whom was treated with surgery. Nine patients in the open surgery group (29 %) had complications, two of whom were treated with surgery. The laparoscopic approach to complicated right colonic diverticulitis may be feasible. The clinical outcomes were comparable with those for open surgery.

Long-term results of laparoscopic treatment of Spigelian hernias with mesh

Introduction: Spigelian hernias are exceptional. They often present with vague signs and symptoms, and the diagnosis can be problematic. Most Spigelian hernias are treated with open surgery and without mesh; little is known of the laparoscopic treatment and the long-term follow-up with mesh. The aim of this study was to prospectively evaluate the safety and effectiveness of the laparoscopic treatment of Spigelian hernias with mesh at the Texas Endosurgery Institute. Methods: From February 1991 through April 2008, all Spigelian hernias treated laparoscopically with mesh were prospectively followed. The technique was essentially the same for each procedure and involved (1) lysis of adhesions, (2) reduction of hernia contents, (3) closure of the defect, (4) 3–5 cm circumferential mesh coverage beyond the original edges, and (5) transfascial fixation of the mesh. Results: Eighteen patients were analyzed, all of them having Spigelian hernia. The subjects included eight women (44%) and 10 men (56%), with a mean age of 65 years (range, 39–89 years). The mean height of patients was 1.69 cm (range, 1.44–1.98 cm), with a mean weight of 84.6 kg (range, 63–103.5 kg). The mean operative time was 91 min with a range of 75–120 min. The estimated blood loss was 30 ml (range 10–50 ml). The mean postoperative hospital stay was 2 d (range from same-day discharge to 5 d). The overall postoperative complication rate was 16.6%. No conversions to open approach were required. The mean follow up was 84.6 months (range, 13–176 months); no recurrence has been observed. Conclusion: The laparoscopic treatment of Spigelian hernias is safe and effective.

Outcomes After Laparoscopic Treatment of Complicated Versus Uncomplicated Acute Appendicitis: A Prospective, Comparative Trial

Laparoscopic treatment of simple acute appendicitis (AA) is a safe procedure; however, there are doubts about its safety in cases of complicated AA. The aim of this study was to determine the differences in results of laparoscopic treatment between cases of complicated versus simple AA. We prospectively included all patients treated for suspected AA by two surgeons of our service between May 2002 and May 2007. Of 221 patients, 20 were excluded from the study because the laparoscopic approach was not possible; 116 of 201 had uncomplicated AA, 57 complicated AA, 12 gynecologic ethiology, 11 negative appendectomy, and 5 other causes; patients without acute appendicitis were also excluded from the study. In all cases, laparoscopy was the first treatment option. The following variables were considered: mean surgical time, reconversions, emergency readmissions, emergency reinterventions or invasive procedures, mean postoperative hospital stay, and postoperative complications (i.e., infectious or noninfectious). Our results showed statistically significantly worse results, in terms of surgical time, postoperative stay, reconversions, and infectious complications, for patients with complicated versus uncomplicated AA; however, no differences were observed regarding noninfectious complications, emergency readmissions, and emergency reinterventions or invasive procedures. We consider that laparoscopic treatment of complicated AA may be safely used, despite worse results than in cases of simple AA, since the differences in numbers of severe postoperative complications requiring emergency readmission, reintervention, or invasive procedures were not statistically significant.

Distant 10 years results of laparoscopic operative treatment in patients with varicocele

Abstract Varicocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair

Results of laparoscopic treatment of endometriosis in infertility patients

Results of laparoscopic treatment of endometriosis in infertility patients

The Effect of the Learning Curve on the Outcome of Laparoscopic Treatment for Gastroesophageal Reflux

The laparoscopic treatment for gastroesophageal reflux (GR) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period, during which the rate of complications, conversions, and duration of surgery and hospitalization are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in three groups of consecutive patients to determine the effect of the learning period on outcome. One hundred and fifty-six patients (88 men and 68 women) with an average age of 52.3 years (range, 18-78) were included. Surgery was indicated for failure or early relapse after the end of medical treatment or a symptomatic sliding hernia. The preoperative workup (endoscopy, barium meal, or esophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of patients were chronologically defined. The parameters that were examined were the type of preoperative exploration, the type of fundoplication, the operative technique, the conversion rate, the mortality and morbidity rates, the duration of surgery and hospitalization, and the results at short- and medium-term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GR. All patients had an endoscopy, 91% had a barium meal, 77.5% underwent esophageal manometry, and 67% had pH monitoring. One hundred and thirty-six patients had a TF and 20 had a PF. Rossetti type TF became the reference procedure (67% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between groups I and groups II and III (140, 100, 80 minutes, respectively). The rate of conversion, due to a variety of causes, decreased from 9.8% to 3.8%, and then to 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 15% to 3.8%, and then to 0%. There were seven cases of relapse (4.6%), five in group I (10%) and two in group II (4%), with no cases in group III, although the follow-up in group III was shorter. There is an effect of the learning curve on the outcome of treatment for GR, and this must be taken into account in the training of surgeons (training within experienced departments and guidance during their initial interventions) and also in publications to allow a more accurate comparison of this technique with other treatments for GR.

Long-term results of laparoscopic treatment of rectosigmoid endometriosis

Long-term results of laparoscopic treatment of rectosigmoid endometriosis