scholarly journals Hot Topics in Surgical Management of Acute Diverticulitiss

2020 ◽  
Vol 28 ◽  
pp. 29-34 ◽  
Author(s):  
Gian Andrea Binda ◽  
Alfredo Papa ◽  
Roberto Persiani ◽  
Ricardo Escalante ◽  
Enio Chavez De Oliveira ◽  
...  
Keyword(s):  
Surgical Management ◽  
Peritoneal Lavage ◽  
Elective Surgery ◽  
Laparoscopic Approach ◽  
Sigmoid Resection ◽  
Open Approach ◽  
Hartmann Procedure ◽  
Elective Resection ◽  
Laparoscopic Peritoneal Lavage ◽  
Operation Rate

In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

scholarly journals OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Victor Vaello ◽  
Angela Santana ◽  
Diego Oto ◽  
Luz Juez ◽  
Raquel Arranz ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Right Hemicolectomy ◽  
Postoperative Recovery ◽  
Preperitoneal Space ◽  
Open Approach ◽  
Emergency Procedures ◽  
Peritoneal Flap ◽  
Ventral Incisional Hernia

Abstract Aim to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures Material and Methods we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia. Results laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD. Conclusions laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.

scholarly journals Laparoscopic approach for inflammatory bowel disease surgical management

2012 ◽  
Vol 59 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Léon Maggiori ◽  
Yves Panis
Keyword(s):  
Surgical Management ◽  
Laparoscopic Approach ◽  
High Rate ◽  
Open Approach ◽  
Previous Surgery ◽  
Inflammatory Lesions ◽  
Potential Benefits ◽  
Inflammatory Bowel ◽  
Frequent Presence

For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

scholarly journals P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Joan Ricard Soler Frias ◽  
Anabel García León ◽  
Luis Tallon-Aguilar ◽  
Jose Tinoco González ◽  
Alejandro Sánchez Arteaga ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Elective Surgery ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Reoperation Rate ◽  
Open Group ◽  
Open Approach

Abstract Aim Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center. Material and Methods Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach. Results 385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group. In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years. Conclusions Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.

scholarly journals LAPAROSCOPIC PERITONEAL LAVAGE IN TREATMENT OF PURULENT AND FECAL PERITONITIS AS COMPLICATIONS OF THE COLONIC DIVERTICULAR DISEASE

2020 ◽  
pp. 51-53
Author(s):  
M. A. Kashtalian ◽  
O. B. Tymchuk ◽  
I. P. Kurachenko
Keyword(s):  
Peritoneal Lavage ◽  
Bowel Resection ◽  
Primary Anastomosis ◽  
Laparoscopic Approach ◽  
Perforated Diverticulitis ◽  
Early Recovery ◽  
Research Results ◽  
Laparoscopic Peritoneal Lavage ◽  
Purulent Peritonitis ◽  
Colonic Diverticular Disease

Summary. The incidence of diverticular colon disease has increased significantly. Complications are found in 40-42 % of patients, the frequency of perforation of the diverticulum is about 3.3 %. Materials and methods. The article presents the results of the treatment of 129 patients who were operated on for peritonitis complicated forms of diverticular colon disease . Research results. The study found that surgical treatment of patients with complication in the Hinchey III-IV stage is best performed by the method of laparoscopic peritoneal lavage. Discussion of research results. The laparoscopic approach has demonstrated a number of advantages: a smaller wound size, a shorter period of disability, an early recovery of enteral nutrition, and a shorter hospital stay. Conclusions. Performing laparoscopic peritoneal lavage in patients with perforated diverticulitis complicated by purulent peritonitis is an alternative to Hartmann surgery or bowel resection with primary anastomosis.

Early Experience with Laparoscopic Lavage in Acute Complicated Diverticulitis

2015 ◽  
Vol 32 (2) ◽  
pp. 108-111 ◽  
Author(s):  
Nir Horesh ◽  
Andrew P. Zbar ◽  
Avinoam Nevler ◽  
Nadav Haim ◽  
Mordechai Gutman ◽  
...  
Keyword(s):  
Peritoneal Lavage ◽  
Acute Diverticulitis ◽  
Complicated Diverticulitis ◽  
Elective Resection ◽  
Symptomatic Disease ◽  
Recurrent Diverticulitis ◽  
Laparoscopic Peritoneal Lavage ◽  
Purulent Peritonitis ◽  
Long Term Follow Up ◽  
Feasible Option

Background: Contemporary surgical management of complicated diverticulitis is controversial. Traditionally, the gold standard has been resection and colostomy, but recently peritoneal lavage and drainage without resection in cases of purulent peritonitis have been suggested. This study aims to review our initial experience with laparoscopic peritoneal lavage for complicated diverticulitis. Methods: Retrospective review of all patients who underwent emergent peritoneal lavage and drainage for acute complicated diverticulitis. Results: Five-hundred-thirty-eight patients admitted for acute diverticulitis between 2007 and 2012 were recorded in the database. Thirty seven underwent emergent surgery of which 10 had peritoneal lavage and drainage without colonic resection for complicated diverticulitis causing peritonitis. Peritoneal lavage and drainage resulted in the resolution of acute symptoms in all cases. In long-term follow-up, 3 (30%) patients required elective resection owing to symptomatic disease, two of these due to recurrent diverticulitis, and one owing to complicated fistula following the procedure. Conclusion: Peritoneal lavage is a feasible option for complicated diverticulitis with purulent non-fecal peritonitis, but a significant portion of the patients may require elective resection. Comparative studies with emergent resection are needed to determine the role of peritoneal lavage in complicated diverticulitis.

scholarly journals Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

2019 ◽  
Author(s):  
Chong-Chi Chiu ◽  
Wen-Li Lin ◽  
Hon-Yi Shi ◽  
Chien–Cheng Huang ◽  
Jyh-Jou Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Metastatic Colorectal Cancer ◽  
Tumor Recurrence ◽  
Statistical Significance ◽  
Laparoscopic Approach ◽  
Open Approach ◽  
Elective Resection ◽  
Significant Difference

The oncologic merits of laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by only one surgeon in a medical institution were randomized to either laparoscopic or open treatment. During this period, total 188 patients received laparoscopic surgery and other 163 patients to open approach. The primary endpoint was cancer-free 5-year survival after operative treatment and secondary endpoint was the tumor recurrence incidence. We found there was no statistically significant difference between open and laparoscopic groups regarding average number of lymph nodes dissected, overall mortality rate, cancer recurrence rate or cancer-free 5-year survival. Nevertheless, laparoscopic approach was more effective for colorectal cancer treatment with shorter hospital stay and less blood loss despite operation time was significantly longer. Meanwhile fewer patients receiving laparoscopic approach developed postoperative urinary tract infection, wound infection, pneumonia or anastomosis leakage, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes whether in total complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free 5-year survival and tumor recurrence, we favor patients receiving laparoscopic surgery if not contraindicated.

scholarly journals Role for laparoscopic adrenalectomy in patients with Cushing's syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1349-1354 ◽  
Author(s):  
William F. Young, Jr. ◽  
Geoffrey B. Thompson
Keyword(s):  
Surgical Management ◽  
Cushing’S Syndrome ◽  
Patient Selection ◽  
Laparoscopic Adrenalectomy ◽  
Laparoscopic Approach ◽  
Cushing's Syndrome ◽  
Open Adrenalectomy ◽  
The Past ◽  
Tissue Handling

Laparoscopic adrenalectomy is one of the most clinically important advances in the past 2 decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach to the adrenal is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients with corticotropin (ACTH) dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.

Redo Surgery after Failure of Antireflux Surgery

2018 ◽  
Vol 84 (11) ◽  
pp. 1819-1824 ◽  
Author(s):  
Alberto Vilar ◽  
Pablo Priego ◽  
Ana Puerta ◽  
Marta Cuadrado ◽  
Francisco GarcÍA Angarita ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Laparoscopic Approach ◽  
Long Term Results ◽  
Complication Rates ◽  
Open Approach ◽  
Redo Surgery ◽  
Primary Surgery ◽  
Satisfactory Outcome ◽  
Symptomatic Outcome ◽  
Recurrent Hiatal Hernia

Surgery for refractory gastroesophageal reflux disease (GERD) has a satisfactory outcome for most patients; however, sometimes redo surgery is required. The Outcome and morbidity of a redo are suggested to be less successful than those of primary surgery. The aim of this study was to describe our experience, long-term results, and complications in redo surgery. From 2000 to 2016, 765 patients were operated on for GERD at our hospital. A retrospective analysis of 56 patients (7.3%) who underwent redo surgery was conducted. Large symptomatic recurrent hiatal hernia (50%) and dysphagia (28.6%) were the most frequent indications for redo. An open approach was chosen in 64.5 per cent of patients. Intraoperative and postoperative complication rates were 18 per cent and 14.3 per cent, respectively. Mortality rate was 1.8 per cent. Symptomatic outcome was successful in 71.3 per cent. Patients reoperated because of dysphagia and large recurrent hiatal hernia had a significantly higher failure rate (32.3% and 31.2%, respectively; P = 0.001). Complication rate was significantly lower in the laparoscopic group (0% vs 22.2%; P = 0.04). There were no statistical differences between expert and nonexpert surgeons. Laparoscopic approach has increased to 83.3 per cent in the last five years. Symptomatic outcome after redo surgery was less satisfactory than that after primary surgery. Complications were lower if a minimally invasive surgical approach was used.

scholarly journals Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
C. G. Ker ◽  
J. S. Chen ◽  
K. K. Kuo ◽  
S. C. Chuang ◽  
S. J. Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Average Length ◽  
Survival Rates ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Open Approach ◽  
Full Diet ◽  
Or Groups ◽  
Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

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