A decade has passed since laparoscopy became a popular tool in general surgery. New technologies continue to surface, and surgeons are still trying to expand the applications of this technique. Parallel to the development of new techniques, we are also measuring the presentation of new complications. Incisional hernias are not new complications. Although their avoidance has been one of the proposed benefits of laparoscopy, several cases of port-site hernias have been reported. Current surgical wisdom suggests closure of 10-mm or larger port sites to avoid herniation. Most surgeons do not routinely close 5-mm port sites, believing that such fascial defects are not large enough to create a significant risk of hernia formation, thus not justifying the extra time and effort needed to close them. Although this practice may be reasonable for most cases, it should be reconsidered in lengthy procedures, particularly if the port has been used for active operative instruments. Under these circumstances, the repetitive motions in different directions may cause the 5-mm defect to enlarge significantly, allowing a hernia of considerable size to develop, with the obvious clinical implications of such a complication. We present a case of a hernia through a 5-mm port site presenting as small-bowel obstruction in the early postoperative period after a laparoscopic paraesophageal hernia repair.
Findings from this study show that ETS is a safe and effective procedure that can be performed routinely on an outpatient basis. The use of miniendoscopic (2-mm) instrumentation is safe and effective in most patients and a helpful adjunct in providing these patients with minimally traumatic surgery. Long-term results should be evaluated on the basis of specific indications for sympathectomy.
Two points, measured a horizontal distance of 6.0 cm from the GEJ, symmetrically placed on the anterior (point a) and posterior (point b) fundus can be brought anterior (a) and posterior (b) to the esophagus and sutured to the right of the anterior vagus nerve to reliably and reproducibly create a "floppy" 360 degrees fundoplication.
Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.
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