From the March of 1993 to the May of 1994, we had performed laparoscopic cholecystectomy (LC) for 200 patients of the age ranged 19-77 years. In these cases, 12 had previous abdominal surgery; 3 cases had hepatic cysts; 11 cases had stones in the neck of gall bladders. We had successfully performed LC for 190 cases (95%). But we also had some unsuccesful experiences, including accidental injury to the stomach or duodenum, and bleeding from cystic arteris of the gallbladder. Operation (LC) was abandoned in one patient because of severe cardiac arrhyshmia developed during operation, and billiary tract injury was found postoperatively in three patients with no postoperative death. The operative indications and technical problems of LC are discussed in detail and measures in avoiding injury to billiary or GI tract from LC are introduced.
Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine (EBM), which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking. Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
ObjectiveTo compare the clinical efficacy of abdominal preperitoneal laparoscopic hernia repair with 3DMax patch and plain film for treatment of inguinal hernia. MethodsThe clinical and follow-up survey data of 120 patients with inguinal hernia in The Second Affiliated Hospital of Harbin Medical University, between January 2009 and May 2014, which were treated by laparoscopic transabdominal preperitoneal repair (TAPP) were retrospectively analyzed. One hundred and twenty cases were divided into two groups:plain film group (45 cases) and 3DMax group (75 cases) according to the intraoperative use of different patchs. The patches of 3DMax group were not fixed, the patches of plain film group were fixed with metal nails. The postoperative clinical effect of two groups were analyzed. ResultsThe operative time, intraoperative blood loss, and postoperative hospitalization days of two groups were no statistical significance (P > 0.05). The postoperative off bed activity time of patients in 3DMax group and plain film group was (20.2±8.1) h and (26.3±9.2) h, respectively, the average off bed activity time in 3DMax group was significantly earlier than that in plain film group (P=0.041). The material expenses and hospitalization expenses of the 3DMax group were significantly lower than those of the plain film group (P=0.001, P=0.038). The incidence of foreign body sensation of inguinal region in 1, 3, and 9 months after operation of 3DMax group were lower than those of plain film group (P=0.045). The VAS score in 1 and 3 months after operation of 3DMax group were lower than those of plain film group (P < 0.05), but there was no statistically significant in 6 months after operation of 2 groups (P > 0.05). There was no recurrence case in two groups. ConclusionsThe use of 3DMax patch in laparoscopic TAPP operation have more simple operation, hospitalization expenses decreased, recovery faster, postoperative inguinal nerve pain and foreign body sensation more lighter, and complications more less. It is worthy of clinical popularization and Application.
ObjectiveTo compare the advantages and disadvantages of transumbilical single port (TUSP) and conventional laparoscopic cholecystectomy (LC). MethodsThe clinical data of 45 patients underwent elective LC were analyzed, 20 patients with TUSP LC (TUSP-LC group), 25 patients with conventional LC (conventional LC group). The operation time, Child-Pugh score and painkiller application frequency within three days after operation, the first time of out of bed and hospital stay after operation, intraoperative blood loss, chronic pain within one month after surgery were compared between two groups. ResultsAll cases were operated successfully except one patient in the conventional LC group. The frequency of painkiller application within three days after operation and postoperative hospital stay in the TUSP-LC group were better than those in the conventional LC group (Plt;0.05). There were no significant differences on postoperative chronic pain of surgical area within 1 month and Child-Pugh score between two groups (Pgt;0.05). The operation time and intraoperative blood loss in the conventional LC group were less than those in the TUSP-LC group (Plt;0.05, Plt;0.01). ConclusionTUSP LC has the advantages of small wound, slight pain, and fast recovery.
ObjectiveTo evaluate the feasibility and surgical techniques of laparoscopic subtotal cholecystectomy （LSC) in treatment for patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy. MethodsThe clinical data of 83 patients with cholecystolithiasis combined with severe gallstone gallbladder inflammation, adhesion, or atrophy admitted to this hospital between January 2006 and April 2010 were analyzed retrospectively. ResultsEighty-one patients were performed LSC, 2 patients were converted to laparotomy. In which 39 patients with the part of wall residual of the fundus and (or) body of the gallbladder, 26 patients with residual of part of gallbladder neck, 18 patients with residual of part of gallbladder body and neck. Fifty-one cases were followed-up for 3 months to 4 years, there were 2 patients with the change like “mini gallbladder” by B ultrasound and no obviously clinical symptoms. There was no ostcholecystectomy syndrome in the patients with follow-up. ConclusionsLSC is a safe, effective, feasible procedure for severe gallstone gallbladder inflammation, adhesion, or atrophy, which can effectively prevent bile duct injury, bleeding, or other serious complications. While it can also reduce the rate of conversion to laparotomy.
To analyse the causes of biliary injuries and summuarize the experience of prevention of biliary injury during laparoscopic cholecystectomy (LC). Twenty-three patients with biliary duct injury were diagnosed and treated at our center between September 1992 and August 1998. The main causes were either misidentification of the bile duct or aberrant right duct as the cystic or injudicious use of thermal energy (cautery) to dissect, control bleeding, or divide tissue. Conclusion: The causes of biliary duct injury are complex. Training and experience of sugeon, the meticulous dissection of the calot′s triangle and preoperative or operative cholangiography are three key factors in prevention of biliary duct injury during LC.
ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.
Objective The survival data of patients with colon cancer who were treated by laparoscopic-assisted surgery and open surgery three years after operation were analyzed and contrasted, which provided data to support the future treatment. Methods The 217 patients who were cured by laparoscopic-assisted surgery and 193 patients who were cured by open surgery were followed up, and the rates of local recurrence, metastasis, implantative, and survival were contrasted and analyzed. Results Three years after laparoscopic-assisted surgery and open surgery, the disease-free survival rate was 86.2% （187/217） and 85.5% （165/193）, respectively, and the overall survival rate was 91.2% （198/217） and 92.7% （179/193）, respectively, the difference between the two groups was not statistic significance（P＞0.05）. The differences of the rates of local recurrence, metastasis, and implantative between the two groups were not statistic significance（P＞0.05）. Conclusions Laparoscopic-assisted surgery is similar with open surgery in the rates of local recurrence, forward metastasis, and overall survival. So laparoscopic-assisted surgery is a safe and radical curative surgery.