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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A new method of laparoscopy have been designed: a laparoscope is introduced through a ventral hernia. The method can be used in patients with contraindications for a regular laparoscopy. Umbilical hernia with the hernia orifice less than 3 cm is a contraindication for "herniolaparoscopy". The method was used in 32 patients, including 17 patients with the acute cholecystitis. In 12 patients besides of umbilical hernia there were other contraindications, including postoperative scarring, obesity etc. There were no any complications with the use of the new method. In all cases pneumoperitoneum was preserved till the end of a procedure.
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PMID:[Method of laparoscopy in ventral hernia]. 875 20

Laparoscopic surgery in over-75-year-olds. Surgery in the elderly is becoming increasingly frequent and in some series accounts for around 40% of operations performed. Morbidity and mortality are still high in relation to the type of surgery and anesthesiological risk, with complications linked above all to respiratory and thromboembolic pathologies. The use of a laparoscopic technique in elective and emergency digestive tract surgery may reduce the problems linked to the onset of cardiorespiratory failures and parietal infections. This prospective study aims to evaluate the results of laparoscopic surgery in over-75-year-old patients hospitalised in the Department of Laparoscopic Surgery at Bellvitge Hospital compared to data reported in the literature. Out of 379 patients undergoing laparoscopic surgery, 32 were over-75-year-olds (range 75-89). Ten patients had been diagnosed with gallstones, 9 with acute cholecystitis, 10 with biliary pancreatitis, 2 with iatal hernia and 1 with cancer of the sigma. A total of 29 cholecystectomies were performed, of which 10 in association with pancreatic drainage, 2 Nissen and one left hemicolectomy. Overall mortality was 6.2% following the death of 2 patients: 1 patient, who had been admitted for acute cholecystitis and had undergone laparoscopic cholecystectomy, presented an acute pulmonary edema three days after surgery with cardiac tamponade which represented the cause of death; another patient, admitted for acute biliary pancreatitis, presented a cerebral thromboembolism on the sixth day after surgery leading to death. Other complications included: parietal abscess, basal atelectasis, 2 residual choledochal calculosis and one case of external biliary fistula, with an overall mortality of 9.3%. The results reported in the literature do not report extensive series of over-75-year-olds undergoing laparoscopic surgery. Some authors report high percentages of laparotomic conversion, others a slightly higher morbidity rate with nil mortality. The present results are comparable to those of other authors with regard to the lower morbidity (3.1%) of laparoscopic compared to laparotomic (18.3%) surgery in elderly, high-risk patients. Even if the present series is relatively small (32 patients), the results obtained encourage the use of laparoscopic techniques in over-75-year-old patients so as to reduce mortality and morbidity compared to conventional surgery.
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PMID:[Laparoscopic surgery in patients over 75 years of age]. 906 67

Surgical literature around 1980 has emphasized the technical challenge and the risks of cholecystectomy in cirrhotic patients reporting discouraging results. The aim of this study is the retrospective analysis of laparoscopic cholecystectomy in cirrhotics. The collected laparoscopic experience of 3 surgical groups for the last 5 years is reported. Cirrhotics were classified according to Child-Pugh criteria. Postoperative complications were classified using Clavien's rules. Forty patients were recruited; 31 received successful laparoscopic cholecystectomy. Liver cirrhosis was preoperatively diagnosed in all Child-Pugh B (n = 11) and in 11/20 Child-Pugh A patients. Compared with 989 noncirrhotics undergoing laparoscopic cholecystectomy, cirrhotics were similar in terms of age (59.9+/-10.3 vs. 58.1+/-10.9) and sex (male: 51.6% vs. 50.1%). Acute cholecystitis has a similar frequence in cirrhotics and noncirrhotics (3.2% vs. 4.1%, respectively). Bile duct stones and acute pancreatitis were significantly more frequent in cirrhotic patients (6.4% vs. 3.7%, p < 0.001; and 6.4% vs. 0.3%, p < 0.001, respectively). Endoscopic papillotomy and stone extraction combined with laparoscopic cholecystectomy was performed in 2 patients. Intraoperatively, technical problems occurred in 5 (16.1%) patients: liver bed bleeding (n = 4) was significatively more frequent in cirrhotics vs. noncirrhotics (p < 0.001). Mean operative time was 90 min, range 50-180, and it was not significantly longer than in noncirrhotics (85 min, range 30-200). Conversion rate was also similar (3%). Seven patients presented 8 postoperative complications (Class II): right side lung effusion (n = 2), ascites (n = 2), temporary worsening of Child-Pugh status (n = 2), hyperosmotic coma (n = 1), and umbilical hernia (n = 1). Mean hospital stay in noncomplicated cases was the same for noncirrhotics (3+/-1). The authors suggest a more liberal use of laparoscopic cholecystectomy for symptomatic gallstones in selected Child-Pugh A and B patients.
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PMID:Gallstones in cirrhotics revisited by a laparoscopic view. 944 15

The authors discuss the etiology of situs viscerum inversus partialis (SVIP), the associated anomalies and the malformations and the relative clinical problems, reviewing the international literature. The present a case of a 51 years old female with a diagnosis of umbilical hernia and cystocele. During hospitalization the patient complained a typical acute cholecystitis pain. The patient underwent ultrasonography, CT scan, and MNR that allowed us to diagnosis a calculous cholecystitis with SVIP and was elected for an open cholecystectomy. The Authors describe the surgical technique in relation to the anatomic anomalies, in particular vascular ones, that were discovered with the imaging studies and confirmed at laparotomy.
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PMID:[Traditional cholecystectomy in a patient with situs viscerum inversus partialis]. 1039 Sep 25

The authors retrospective analyze the role of golden standard laparoscopic cholecystectomy for the treatment of acute cholecystitis. They make a comparison between the results of 50 early cholecystectomy and 44 "a froid" cholecystectomy (operation was postponed until 6 weeks after acute cholecystitis had healed). From January 1997 to December 1998 536 laparoscopic cholecystectomies were performed. In 491 cases (91.6%) laparoscopic, and in 45 cases (8.4%) traditional (opening) method was indicated. Converted cholecystectomies were in 36 cases (7.3%). Agreeing to the literature they can determine the optimal timing of the operation in 72 hours from the onset of acute cholecystitis [2, 4]. In this group (first group) there were 50 cases, with 14 conversions (28%). In the second group (postponed, so called "a froid" phase) there were 44 patients. From this group was the intraoperative diagnosis serious acute-subacute cholecystitis in 24 cases (54.54%) causing complicated laparoscopic cholecystectomy and resulting in 11 conversions (11/44: 25%). The causes of the higher rate of conversion were the grave inflammation and slow dissection of central formation. There were no serious complication and mortality in both groups. It was diagnosed bile leak (two cases) which ceased spontaneously, one haematoma in abdominal layers, and one trocar's hernia. The authors have recommended the laparoscopic cholecystectomy for early diagnose acute cholecystitis in order to prevent the complications and reduce the sick-leave. Supporting their viewpoint the most important clinical end economical facts are: the recurrence of inflammation forced urgent surgery and caused more complication in the course of "a froid" phase there were scrutable anatomical situation the patients recovered in a shorter time.
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PMID:Laparoscopic cholecystectomy in acute cholecystitis. 1059 14

Early cholecystectomy is the best policy in the case of acute cholecystitis. The aim of this retrospective study is to evaluate the current treatment of choice of acute calculous cholecystitis, as seen in our experience and in the literature data. Between January 1997 and July 2000, 150 patients were operated on for cholecystectomy. In the group of 30 patients (20%) with acute cholecystitis, 15 patients (50%) were managed with laparoscopic approach while 15 patients (50%) with traditional operation. At the beginning the Authors chose the open via for understand the pathologic findings of acute cholecystitis, then they always preferred the laparoscopic approach. Comparison between two groups concerned the interval between onset of symptoms and operation, postoperative mortality and morbidity rates, postoperative hospital stay and follow up. Statistical analysis was performed by the Student's t-test and the chi-square test. Both groups were homogeneous with regard to sex, age and onset of symptoms. There were no deaths and morbidity rate in the laparoscopic group was 20% versus 40% (p = ns). The average postoperative hospital stay in the laparoscopic group was 5.6 days versus 10.5 days (p = 0.046). The conversion rate into laparotomy was 6.6% (1 case). There has been one case of incisional hernia in the open group at a mean follow up of 20 month. Early laparoscopic cholecystectomy is the treatment of choice of acute cholecystitis because of a lower postoperative morbidity rate and a significant shorter hospital stay.
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PMID:[Urgent cholecystectomy in acute cholecystitis: laparoscopy or laparotomy?]. 1128 73

The aim of this retrospective study was to compare the results of laparoscopic and open early cholecystectomy in patients with acute cholecystitis. From January 1997 to October 2000, 168 patients underwent cholecystectomy in our institution. Of the 35 patients (20.8%) with acute cholecystitis, 20 patients (57.1%) were operated on laparoscopically and the other 15 patients (42.9%) with the traditional open approach. The two groups were similar in terms of age, sex and onset of symptoms. The postoperative morbidity was 15.0% in the laparoscopic group versus 40.0% in the open group. The average postoperative hospital stay in the laparoscopic group was 5.1 days as compared to 10.5 days in the open group (P = 0.013). The conversion rate to laparotomy was 5.0% (1 case). At follow-up there has been one case of incisional hernia in the open group. Early laparoscopic cholecystectomy for acute cholecystitis was associated with a lower postoperative morbidity rate and significantly earlier patient discharge.
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PMID:Early surgical treatment of acute cholecystitis. A retrospective comparative study of the laparoscopic and open approaches. 1139 62

Most cases of malignant mesothelioma present with obvious diffuse tumor, and the presence of grossly visible diffuse tumor is usually cited as an important criterion for making the diagnosis. We report four cases of unsuspected malignant mesothelioma of the peritoneum presenting as localized acute inflammatory lesions. The clinical diagnoses were acute appendicitis in two cases, acute cholecystitis in the third case, and incarcerated umbilical hernia in the fourth case. In all cases tumor was not evident at initial surgical exploration or on gross pathologic examination, and the diagnosis was only made on microscopic examination of the resected specimens. All cases showed a tubulopapillary form of epithelial mesothelioma with obvious tissue invasion, but the foci of tumor were too small to be seen grossly or were present deep in fibrous tissue. On follow-up all patients developed grossly evident tumor, and one of these patients is alive without evidence of disease 5 years after presentation. We conclude that peritoneal mesotheliomas may occasionally present as inflammatory processes without grossly evident tumor and can be diagnosed by microscopic findings alone.
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PMID:Malignant mesothelioma of the peritoneum presenting as an inflammatory lesion: a report of four cases. 1254 73

Perforation of the gallbladder with spillage of stones into the abdominal cavity is relatively common during laparoscopic cholecystectomy. We report a patient presenting with a symptomatic groin hernia 10 days after laparoscopic cholecystectomy for acute cholecystitis. The hernia sac was found to contain a gallstone. The patient underwent an uneventful hernia repair. Various complications due to retained gallstones have been described as case reports emphasizing how important it is to prevent perforation of the gallbladder or else make an effort to retrieve spilled stones from the abdomen.
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PMID:Gallstone in a hernia sac. 1258 77

The present article is the first in the literature reporting short- and medium-term results using a totally laparoscopic technique for aortoiliac disease.Forty-nine patients, 6 having an associated small aneurysm, were scheduled for totally laparoscopic surgery (TLS) for aortoiliac occlusive disease and 2 for treatment of aortic aneurysmal disease (AAA). Patients' characteristics, intraoperative, postoperative data and mid-term data were recorded.TLS was successfully completed in 45 patients. Of those patients, 41 received an aortobifemoral bypass; three, an iliofemoral bypass; and one, an aortoaortic bypass. Five patients were converted from TLS to video-assisted laparoscopic surgery using incisions varying in size from 7 cm to 11 cm. One patient underwent conversion to standard open surgery. One death occurred unrelated to the technique. Major perioperative complications related to the technique were few and presented in the early phase of the study: One intraoperative embolization to the lower limbs that needed embolectomy, and one acute aortic false aneurysm. Midterm results were favorable, demonstrating two limb graft thromboses. Hernias at trocar sites occurred in only 3.9%. The patients benefited from this procedure, which is considered definitive like its standard open counterpart. The conversion rate is lower than that reported for acute cholecystitis. Selection of patients has been less stringent during the second half of the study in term of inclusion of patients with AAA and of more TASC IV patients. Surgeons willing to learn this technique should attend dedicated courses. In the future, as this surgical innovation matures, controlled randomized studies should be initiated.
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PMID:Early and mid-term results of totally laparoscopic surgery for aortoiliac disease: lessons learned. 1559 96


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