Laparoscopic repair of incisional hernias. Experience in 21 patientsBackground: Ventral hernias are one of the most common complications of open abdominal surgery and can be repaired laparoscopically. Aim: To assess the feasibility, safety and efficacy of the laparoscopic repair of incisional hernias. Patients and Methods: Retrospective study of the patients undergoing laparoscopic ventral hernia repair from march 2006 to october 2008 at a surgical department of a clinical hospital. We analyzed patient's characteristics, surgical variables, perioperative results, complications and short term follow up. Results: Twenty-one patients aged 54 ± 14 years (16 females) underwent laparoscopic ventral hernia repair during this period. Their mean body mass index was 32.2 ± 6.5 kg/m 2 . One patient was converted to open surgery. The mean hernia ring diameter was 8.4 ± 3.9 cm (range 3-17). Median operative time was 92 minutes (range 45-300). Mean hospital stay was 3.0 ± 1.6 days. During the procedure, two patients were simultaneously subjected to a sleeve gastrectomy and cholecystectomy, respectively. A pulmonary atelectasis and a seroma occurred in two patients (10%) as early minor complications. As late complications, two patients (10%) experienced continuing pain in the area in both operations. No patient died. Follow up was 100% with a mean of 14 months (range 4-36), without hernia recurrence during this period. Conclusions: Laparoscopic incisional hernia repair is a feasible technique to perform, without serious complications.
Totally laparoscopic pancreaticoduodenectomy: Surgical technique and initial experienceIntroduction: Nowadays the utility of laparoscopic pancreatic surgery is accepted for a wide variety of indications. However pancreaticoduodenectomy has been considered beyond the possibilities of laparoscopy by the majority of surgeons. The objective of this report is to show our surgical technique and initial experience with totally laparoscopic pancreaticoduodenectomy. Material and Methods: Between november of 2007 and june of 2008, a laparoscopic technique was offered to patients with indication of pancreaticoduodenectomy for different pathologies. We describe the surgical technique, perioperative care, intraoperative complications, need for conversion to open technique, mortality, and early postoperative complications. Results: A total of three patients were subjected to laparoscopic pancreaticoduodenectomy. The surgical indication was an ampullar adenocarcinoma in a 52 years old woman, a pseudopapilar tumor of the pancreatic head in a 17 years old woman, and a duodenal gastrointestinal stromal tumor in a 63 years old man. There was no need for conversion to open technique. There was no mortality. The operative time ranged from 300 to 360 min. The first patient presented an upper gastrointestinal bleeding, from pancreatic anastomoses requiring surgical hemostasis. The last patient developed a self-limited biliary fistula, managed successfully with drains. The hospital stay varied from 8 to 25 days. Discussion: Totally laparoscopic pancreaticoduodenectomy is a feasible procedure, replicating the same steps of open surgery in a reasonable operative time, and with surgical results comparable with open technique.
Laparoscopic treatment of adhesive small bowel obstruction Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 ± 16 years, 47% male. 53% had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82%), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.
Laparoscopic gastrectomy in gastric carcinoidIntroduction: Gastric carcinoid is a very low frequency tumor. A proportion of them require surgery to control the disease. The ideal surgical treatment is controversial. Aim: To describe the perioperative and follow-up course of patients with gastric carcinoid subjected to laparoscopic gastrectomy. Materials and Methods: Retrospective study of patients undergoing some type of laparoscopic gastrectomy for gastric carcinoid the last 10 years. We collected demographic background, preoperative evaluation, type of surgery, complications and follow-up. Results: During the study period were operated 7 patients, 5 were men. The average age was 54 years. In three patients the diagnosis was a finding, while the rest had abdominal pain associated with nonspecific symptoms. Four patients had a type I gastric carcinoid associated with chronic gastritis and hypergastrinemia, and the others had a type III gastric carcinoid. Six patients underwent laparoscopic total gastrectomy while in the remaining patient (type III) was subtotal. There were no postoperative complications. During follow-up one patient required a reoperation for mechanical ileus secondary to adhesions and one patient required endoscopic dilatation because esophagoyeyunostomy stenosis. At 32 months of median follow-up (1-52) no patient has relapsed. Conclusion: Laparoscopic gastrectomy is an alternative in the surgical treatment of patients with gastric carcinoid. It´s safe and represent adequate oncological results in the short and medium term.
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