Both THD and PPH appear to be safe procedures for haemorrhoidal disease, and they appear to have similar short-term outcomes. In particular, THD seems to be associated with a lower pain score than PPH, an earlier return to normal daily activities, and similar rates of complication and recurrence.
Ileal-pouch anal anastomosis (IPAA) is most commonly performed after total proctocolectomy for ulcerative colitis and familial adenomatous polyposis. Small-bowel obstruction is one of the complications that can occur years after the operation, but intestinal obstruction due to volvulus of the J pouch is a rare condition. We report a case of recurrent volvulus in a patient who had undergone IPAA after total proctocolectomy for cancer of the rectum and multiple colonic polyps. The patient underwent laparoscopic rectopexy and had no recurrence of volvulus.
Objective:There is concern about the limitation in right-sided tumour due to the more demanding surgical technique. We aimed to compare right versus left laparoscopic adrenalectomy in terms of operative outcome. Methods: This is a review of medical records from 1999 to 2003 in a district hospital. Patients' records were retrieved from the computer system under procedure name of adrenalectomy (ICD code 07.22). Primary outcome measures included complication and mortality. Other outcome measures included operation time, blood loss and length of stay. Results: Thirty-two consecutive cases (left = 18 vs right = 14) of laparoscopic adrenalectomy were performed from 1999 to 2003. The median age of patients was 45 years. Twenty-four of them were Conn's Syndrome (left 14 vs right 10). Median size of tumour was 2 cm (range 0.5-5 cm, left = 2 cm vs right = 1.7 cm; P = 0.87; MannWhitney U-test). One left-sided tumour was complicated with perinephric haematoma requiring needle aspiration. There was no operative mortality in both groups. There was no difference in operation time (median time; left = 127 min vs right = 120 min; P = 0.91). There were two conversions (right = 1 vs left = 1) due to bleeding and unclear anatomy. The majority of them had minimal blood loss with none above 200 mL. All patients resumed full diet and were ambulatory within 2 days after the operation. There was no difference in hospital stay (right 4.5 days vs left 5 days; P = 0.28 Mann-Whitney U-test). There was no significant difference between the outcomes of left and right-sided tumour. Conclusions: There is no difference in clinical outcomes between left and right laparoscopic adrenalectomy.
We report the use of operative cholangiography in two-port needlescopic (minilaparoscopic) cholecystectomy. A prospective series of 11 patients underwent two-port needlescopic cholecystectomy with operative cholangiography. In ten cases, operative cholangiography was successfully performed. There were no conversions. No additional ports were required. No related complications were noted. Two cases positive for common bile duct stones were identified. The median operative time was 92.5 minutes. Operative cholangiography in two-port needlescopic cholecystectomy is safe and feasible.
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