Speciality
Spotlight

   




   


Surgery


   

 





Laparoscopic
Surgery

       

  • L.
    Bardram, P. Funch-Jensen and H. Kehlet [ Department of
    Surgical Gastroenterology, 435, Hvidovre University
    Hospital, DK-2650, Hvidovre, Denmark

    Rapid Rehabilitation
    in Elderly Patients after Laparoscopic Colonic
    Resection

    Br.
    Jour. of  Sur.
    Volume 87, No.11, November 2000, Pgs- 1540-1545

       

    This
    study combines the laparoscopic approach with a
    perioperative multimodel rehabilitation protocol.

       

    After
    laparoscopy assisted colonic resection, patients were
    treated with epidural anaesthesia for 2 days, early
    mobilization and enteral feeding. Routine use of
    drains, traditional tubes;
    bladder catheterization and morphine was
    avoided.

       

    Recovery
    after such an approach was good.

  • L. Sarli, R. Costi, G. Sansebastiano*, M. Trivelli and L. Roncoroni [ Institute of General Surgery and Surgical Therapy and * Institute of Hygiene, Parma University School of Medicine, Parma Italy]

    Prospective Randomized Trial of Low-Pressure Pneumoperitoneum for Reduction of Shoulder-tip Pain Following Laparoscopy

    Br.Jour. of Surg. Volume 87, No.9, September 2000, Pgs. 1161-1165

       

    The aim of this study was to evaluate the efficacy of low pressure carbon dioxide pneumoperitoneum during laparoscopy in reducing postoperative shoulder pain.

       

    90 patients were divided into 2 groups group A [n=46] had a 9 mmHg carbon dioxide pneumoperitoneum and group B [ n=44] had a 13 mmHg carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. The shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12,24 and 48 hours after operation.

       

    11% of Group A patients had shoulder pain as opposed to 32% in Group B. Mean shoulder tip pain scores and analgesia requirements were also lower in group A. There were no differences in the duration or ease of surgery or complications in the two groups.

  • D.K. Beattie, R.J.E. Foley and M.J. Callam [ Department of Surgery, Bedford Hospital, Bedford, UK]

    Future of Laparoscopic Inguinal Hernia Surgery

    Br. Jour. of Sur. Volume 87, No.12, December 2000, Pgs-1727-1728



    Despite low recurrence rates [< 1%] with open mesh repair, laparoscopic repair has been promoted as having significant advantages. It has been noted that it is less painful and has a quicker recovery. A randomized comparison reported more recurrences and complications after laparoscopic repair. A postal survey was conducted to determine current operative practice.



    374 surgeons responded to the questionnaire. Tension free open mesh repair are preferentially used by 261 surgeons [76.8%] for primary hernia repair. 5.6% [19 surgeons] prefer Shouldice repair and 5% [17 surgeons] advocate laparoscopic repair. The remainder use combinations of mesh, Shouldice, Bassini, plug, darn and laparoscopic repair.



    25% currently perform laparoscopic repair [1/3rd for primary repair, 2/3rds for recurrent or bilateral repair]. Roughly half of this favour a transabdominal approach and the others an extraperitoneal approach, some were undecided. An equal number have ceased performing laparoscopic hernia repair in view of its cost, complications, increase in operating time and recurrence rate. Some have never undertaken laparoscopic repair.



    65.6% feel that it is unlikely that laparoscopic repair will become the standard technique. Laparoscopic hernia repair has a tenuous foothold in current practice, this survey suggests that this is unlikely to change.

  • FJ Berends, MA Cuesta, G Kazemier, et al (Univ. Hosp. Rotterdam Dijkzigt, The Netherlands; Vrije Universiteit, Amsterdam)

    Laparoscopic Detection and Resection of Insulinomas

    Surgery 128: 386-391, 2000



    This article reviews a 3-year experience of 10 patients requiring surgery for organic hyperinsulinism caused by solitary insulinomas.



    8 women and 2 men underwent laparoscopic US to localize the insulinomas.



    Laparoscopic resection was possible in 6 patients by enucleation in 5 and by resection of the pancreatic tail in one.



    The remaining patients required conversion to open laparotomy, 3 because the tumour was located too near the portal vein or pancreatic duct and one patient, because the tumour could not be localized.



    The authors feel the technique is safe, with low morbidity and a quick recovery time.

        



 

   

Speciality Spotlight

   

   
Surgery
   

 

Laparoscopic Surgery
       

  • L. Bardram, P. Funch-Jensen and H. Kehlet [ Department of Surgical Gastroenterology, 435, Hvidovre University Hospital, DK-2650, Hvidovre, Denmark
    Rapid Rehabilitation in Elderly Patients after Laparoscopic Colonic Resection
    Br. Jour. of  Sur. Volume 87, No.11, November 2000, Pgs- 1540-1545
       
    This study combines the laparoscopic approach with a perioperative multimodel rehabilitation protocol.
       
    After laparoscopy assisted colonic resection, patients were treated with epidural anaesthesia for 2 days, early mobilization and enteral feeding. Routine use of drains, traditional tubes; bladder catheterization and morphine was avoided.
       
    Recovery after such an approach was good.

  • L. Sarli, R. Costi, G. Sansebastiano*, M. Trivelli and L. Roncoroni [ Institute of General Surgery and Surgical Therapy and * Institute of Hygiene, Parma University School of Medicine, Parma Italy]
    Prospective Randomized Trial of Low-Pressure Pneumoperitoneum for Reduction of Shoulder-tip Pain Following Laparoscopy
    Br.Jour. of Surg. Volume 87, No.9, September 2000, Pgs. 1161-1165
       
    The aim of this study was to evaluate the efficacy of low pressure carbon dioxide pneumoperitoneum during laparoscopy in reducing postoperative shoulder pain.
       
    90 patients were divided into 2 groups group A [n=46] had a 9 mmHg carbon dioxide pneumoperitoneum and group B [ n=44] had a 13 mmHg carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. The shoulder tip pain was recorded on a visual analogue pain scale 1,3,6,12,24 and 48 hours after operation.
       
    11% of Group A patients had shoulder pain as opposed to 32% in Group B. Mean shoulder tip pain scores and analgesia requirements were also lower in group A. There were no differences in the duration or ease of surgery or complications in the two groups.

  • D.K. Beattie, R.J.E. Foley and M.J. Callam [ Department of Surgery, Bedford Hospital, Bedford, UK]
    Future of Laparoscopic Inguinal Hernia Surgery
    Br. Jour. of Sur. Volume 87, No.12, December 2000, Pgs-1727-1728

    Despite low recurrence rates [< 1%] with open mesh repair, laparoscopic repair has been promoted as having significant advantages. It has been noted that it is less painful and has a quicker recovery. A randomized comparison reported more recurrences and complications after laparoscopic repair. A postal survey was conducted to determine current operative practice.

    374 surgeons responded to the questionnaire. Tension free open mesh repair are preferentially used by 261 surgeons [76.8%] for primary hernia repair. 5.6% [19 surgeons] prefer Shouldice repair and 5% [17 surgeons] advocate laparoscopic repair. The remainder use combinations of mesh, Shouldice, Bassini, plug, darn and laparoscopic repair.

    25% currently perform laparoscopic repair [1/3rd for primary repair, 2/3rds for recurrent or bilateral repair]. Roughly half of this favour a transabdominal approach and the others an extraperitoneal approach, some were undecided. An equal number have ceased performing laparoscopic hernia repair in view of its cost, complications, increase in operating time and recurrence rate. Some have never undertaken laparoscopic repair.

    65.6% feel that it is unlikely that laparoscopic repair will become the standard technique. Laparoscopic hernia repair has a tenuous foothold in current practice, this survey suggests that this is unlikely to change.

  • FJ Berends, MA Cuesta, G Kazemier, et al (Univ. Hosp. Rotterdam Dijkzigt, The Netherlands; Vrije Universiteit, Amsterdam)
    Laparoscopic Detection and Resection of Insulinomas
    Surgery 128: 386-391, 2000

    This article reviews a 3-year experience of 10 patients requiring surgery for organic hyperinsulinism caused by solitary insulinomas.

    8 women and 2 men underwent laparoscopic US to localize the insulinomas.

    Laparoscopic resection was possible in 6 patients by enucleation in 5 and by resection of the pancreatic tail in one.

    The remaining patients required conversion to open laparotomy, 3 because the tumour was located too near the portal vein or pancreatic duct and one patient, because the tumour could not be localized.

    The authors feel the technique is safe, with low morbidity and a quick recovery time.
        

 

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