Surgical laparoscopy & endoscopy
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Surg Laparosc Endosc · Jan 1999
Meta AnalysisMeta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy.
We performed a meta-analysis to determine whether laparoscopic or open appendectomy gives better outcomes for patients with suspected acute appendicitis. Studies were selected from the MEDLINE database, personal files, and meeting abstracts. Eleven of 21 randomized controlled trials were included in the meta-analysis. ⋯ Operating time was increased by 17.12 min (95% CI 14.19 to 20.03; p < 0.0001). There was no difference between the two surgeries for length of hospital stay, readmission rate, and intra-abdominal abscess formation. Laparoscopic appendectomy improves patient outcomes.
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Surg Laparosc Endosc · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialStress hyperglycemia in minimally invasive surgery.
This study examined the selected hormonal responses to, and hormone-mediated glucose metabolism during minimally invasive surgery in, patients undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Thirty-two patients with symptomatic gallstone disease were included in this study and scheduled for open or laparoscopic procedure in a randomized trial. Results are expressed as mean and standard error of the mean. ⋯ The glucagon-mediated increase in hepatic glucose production is excluded by the posttraumatic insulin levels from the insulin-sensitive tissues. A bihormonal setting favors a greater rate of hepatic glucose production in both open and laparoscopic surgery. Hormonal changes do reflect the degree of surgical stress, but their metabolic consequences are not parallel to the grade of surgical trauma in minimally invasive surgery.
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Surg Laparosc Endosc · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialIntraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy.
After laparoscopic cholecystectomy, CO2 remains within the peritoneal cavity, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal normal saline and bupivacaine infusion on postoperative pain after laparoscopic cholecystectomy. Three hundred patients were randomly assigned to one of six groups of 50 patients each. ⋯ Postoperative pain was reduced significantly in the patients of the treatment groups vs. the controls. Between treatment groups, patients in groups B, E, and F had the best results, while those in groups C and D had significantly greater pain than those in groups B, E, and F. It is concluded that postoperative pain after laparoscopic cholecystectomy can be significantly reduced by intraperitoneal normal saline infusion subdiaphragmatically and after its postdeflation suction, bupivacaine infusion in the same area, or without bupivacaine in case a subhepatic drainage has been needed.
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Surg Laparosc Endosc · Oct 1998
Case ReportsSuspected appendicitis in situs inversus totalis: an indication for a laparoscopic approach.
We report a case of acute appendicitis in situs inversus treated by laparoscopy. In our opinion, diagnostic laparoscopy is indicated if acute appendicitis is suspected in a patient with situs inversus totalis, either because the pain can be referred to the right iliac fossa in about 50% of the patients, or because the incision in open surgery cannot be sufficient to allow complete exploration of the abdomen. The operation can then be carried out laparoscopically if possible; if not, an appropriate surgical incision can be made.
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Surg Laparosc Endosc · Aug 1998
Comparative Study Clinical TrialTransabdominal or totally extraperitoneal laparoscopic hernia repair?
Laparoscopic repair of inguinal hernias follows some principles that have already proven its efficiency, as a posterior approach and the prosthetic repair that allows a "tension-free" repair with consequent early return to work and low recurrence rate. To determine the most appropriate laparoscopic repair, we compared the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP) approach. Patients undergoing TAPP and TEP were compared regarding technical feasibility and difficulties, time until return to work and follow-up, including intraoperative and postoperative complications. ⋯ Both techniques are safe and have the same advantages, but TAPP is easier: a better view of the anatomy is achieved, shortening the learning curve. We suggest that TAPP can be an adequate laparoscopic approach to groin hernias. A longer follow-up period and more cases are needed to determine recurrence rates.