Surgical endoscopy
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Blunt and penetrating chest traumas continue to be associated with a high mortality rate. The related morbidity rate is a also cause for concern because it may result in extended hospitalization and permanent disabilities. The aim of this study was to retrospectively review a series of consecutive patients treated for chest trauma between 1 January 2000 and 31 December 2005, focusing particularly on cases of pneumothorax and hemothorax. alone or in combination, and to critically assess the treatment protocol adopted. ⋯ In light of their own experience and of reports in the literature confirming both the diagnostic and therapeutic efficacies of VATS in chest trauma with pneumothorax and/or hemothorax, the authors propose a treatment protocol prescribing its use 48 h from the traumatic event in all cases of uncontrolled air and/or blood loss. This protocol yielded excellent results, including an uneventful postoperative course, rapid resolution of the signs and symptoms of the chest problem, and no disabling sequelae (empyema and fibrothorax), as well as a relatively shorter hospital stay and hence lower costs than with conservative treatment.
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Randomized Controlled Trial
Prevention of postoperative nausea and vomiting with a small dose of propofol alone and combined with dexamethasone in patients undergoing laparoscopic cholecystectomy: A prospective, randomized, double-blind study.
A small dose of propofol is directly antiemetic, and is effective for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (LC). However, this regimen cannot entirely control PONV after LC. ⋯ Propofol 0.5 mg/kg combined with dexamethasone 8 mg is more effective than propofol alone for the prevention of PONV during the first 24 hours after anesthesia in patients undergoing LC.
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Laparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy. ⋯ Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.
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Randomized Controlled Trial
Heating of carbon dioxide during insufflation alters the peritoneal fibrinolytic response to laparoscopic surgery : A clinical trial.
Laparoscopic surgery is evolving rapidly. It involves the creation of a pneumoperitoneum, mostly using carbon dioxide. Cooling of the peritoneum, due to insufflation, might traumatize the peritoneum and disturb peritoneal fibrinolysis, important in peritoneal healing processes. The current study was performed to elucidate the effects of the temperature of insufflation gas on the peritoneal fibrinolytic response to laparoscopic surgery. ⋯ The temperature of carbon dioxide used for insufflation of the abdominal cavity affects peritoneal biology. Cooling of the peritoneum by unheated carbon dioxide causes increased peritoneal PAI-1 levels, important in peritoneal healing processes.
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The laparoscopic Nissen fundoplication has become a frequently performed procedure in infants and children who suffer from gastroesophageal reflux disease (GERD). In this study we describe our 8-year experience with 106 consecutive laparoscopic Nissen fundoplications. ⋯ The laparoscopic Nissen fundoplication can safely be performed with a low conversion rate and no surgical mortality in neurologically normal and neurologically impaired children. Neurologically impaired children are more susceptible to per- and postoperative complications. A good quality of life and a high index of satisfaction could be achieved in most patients.