The aim of this prospective study was to judge the efficiency of laparoscopic adhesiolysis: 52 patients have been treated laparoscopically either for obstruction (group 1: 17 patients) or for chronical abdominal pain (group 2: 35 patients). Two out of five peroperative complications required a laparoconversion whereas two postoperative complications required a laparotomy for intestinal obstruction. Six patients of group 1 developed a recurrence of obstruction treated by laparoscopy in four and by laparotomy in two cases. At the time of the study (among 50 patients with a mean follow-up of 24 months), 32 patients were asymptomatic, 13 found that their symptoms had lessened, and finally, five patients were not improved. We concluded that laparoscopic adhesiolysis is an attractive surgical procedure, allowing a clinical improvement in 45 out of 50 patients in our study.
BackgroundOver the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder.Methodsgall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus.ResultsBetween October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury.ConclusionThe number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.
Jean Rives technique is a relatively easy technique to perform, requires shorter operating time when compared to laparoscopic TEP technique. JR technique should be taken into consideration while planning surgical treatment of inguinal hernia.
Purpose: The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs). Methods: The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with χ2 test or the Fisher exact probability. P-values <0.05 (2 sided) were considered statistically significant. Statistical analyses were conducted with SPSS, version 18. Results: Of the 3496 patients, 1691 were male individuals (48.4%) and 1805 (51.6%) were female individuals. Diverticulosis was present in 12.6% of patients. A total of 870 polyps were detected in 716 patients. A total of 170 polyps (19.5%) were classified as ANLs. CRC was diagnosed in 112 (3.2%) patients. A significant relationship between diverticulosis and colorectal polyps (odds ratio: 1.99; 95% confidence interval: 1.59-0.2.48, P<0.001) was found. Similarly, adenomas and ANLs were more frequent in diverticulosis (P<0.05). There was no significant relationship between diverticulosis and CRCs (P=0.243). Conclusions: Adenomatous polyps and ANLs were more frequently observed in patients with diverticulosis, but no significant relationship was found between CRC and diverticulosis. The results of this retrospective cross-sectional study need to be confirmed by longitudinal prospective cohort studies.
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