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RESUMEN Antecedentes: Las hernias de línea media asociadas a diástasis de los músculos rectos anteriores (DRA) son frecuentes y se ha propuesto el tratamiento de ambas patologías simultáneamente para reducir la recurrencia. Las técnicas mínimamente invasivas permiten el tratamiento adecuado con reducción de complicaciones asociadas a la herida quirúrgica; sin embargo, aún no hay consenso acerca de cuál es la mejor técnica. Objetivo: Evaluar los resultados posoperatorios a corto y mediano plazo de una serie de pacientes con defectos de línea media y DRA tratados con la técnica Trans-umbilical Endoscopic Sublay Repair (TESuR). Material y método: Se realizó un estudio observacional descriptivo retrospectivo de pacientes a quienes se les aplicó técnica TESuR entre diciembre de 2020 y marzo de 2023, con un seguimiento posoperatorio mínimo de 6 meses. Se analizaron variables demográficas y perioperatorias. Resultados: En el período de estudio se realizaron 24 reparaciones. Todos los pacientes fueron varones. La edad promedio fue de 57 años (rango 41-81) y el índice de masa corporal (IMC) de 28,9 (21,7- 36,1) kg/m². El área del defecto fue de 8,8 (4-25) cm2, con una DRA de 5,1 (3-9) cm. La tasa de complicaciones a 30 días posoperatorios alcanzó el 17% (4/24); todas fueron Clavien-Dindo I. Con un promedio de seguimiento de 18,6 meses (rango 6-25) no se detectaron recidivas herniarias, aunque dos pacientes (8%) presentaron recidiva de la DRA. Conclusiones: La técnica TESuR presentó una baja morbilidad sin recidivas, por lo que la consideramos una alternativa segura y eficaz para el tratamiento de la DRA asociada a defectos de la línea media.
ABSTRACT Background: Midline hernias associated with diastasis recti abdominis (DRA) are common. Simultaneous treatment of both conditions has been recommended to reduce recurrence. Minimally invasive techniques allow adequate treatment while reducing surgical site complications. However, there is still no consensus regarding the optimal technique. Objective: The aim of this study was to evaluate the short and mid-term outcomes of Trans-umbilical Endoscopic Sublay Repair (TESuR) in patients with midline defects and DRA. Material and methods: We conducted a retrospective descriptive observational study of patients undergoing TESuR between December 2020 and May 2023, with a minimum postoperative follow-up of 6 months. The demographic and perioperative variables were analyzed. Results: A total of 24 procedures were performed during the study period. All the patients were men. Mean age was 57 years (range 41-81) and body mass index (BMI) was 28.9 (21.7- 36.1) kg/m². Mean size of the defect was 8.8 cm2 (4-25) with a mean diastasis width of 5 cm (3-9). The rate of complications at 30 days was 17% (4/24) and were all are grade 1 of the Clavien-Dindo classification. After a mean follow-up of 18.6 months (range 6-25), there were no hernia recurrences, although 2 patients (8%) had a recurrence of DRA. Conclusions: TESuR showed low morbidity rate and absence of recurrences, constituting a safe and effective option for the management of DRA associated with midline defects.
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Resumen: Es frecuente que, durante el postoperatorio inmediato, el anestesiólogo se enfrente a pacientes con dolor posterior a una colecistectomía laparoscópica. La nebulización de anestésicos locales en la cavidad abdominal durante la cirugía laparoscópica parece ser un procedimiento prometedor para reducir el dolor en el postoperatorio, y de esta manera disminuir la cantidad de analgésicos y opioides administrados a los pacientes. Presentamos el caso de una mujer de 35 años de edad que fue sometida a una colecistectomía laparoscópica, a la cual se nebulizó ropivacaína en la cavidad abdominal al término de ésta, con lo que se redujo notablemente el dolor en el postoperatorio hasta el egreso de la paciente.
Abstract: It is common for the anesthesiologist to cope with patients in the immediate postoperative period with moderate to severe amount of pain after laparoscopic cholecystectomy. The nebulization of local anesthetics in the abdominal cavity during laparoscopic surgery seems to be a promising procedure to reduce pain in the postoperative period thus reducing the number of analgesics and opioids administered to patients. We present the case of a 35-year-old woman who underwent a laparoscopic cholecystectomy, nebulizing ropivacaine in the abdominal cavity at the end of it, significantly reducing postoperative pain until the patient's discharge.
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Objective To investigate the effects of the laparoscopic surgery and open surgery on the postoperative intestinal function recovery time in elderly patients with colorectal cancer(CRC).Methods 66 elderly patients with CRC and treated in the 2nd People's Hospital of Kunming from January 2021to July 2022 were chosen and divided into the control group(n = 33)and the study group(n = 33)according to different operation ways.And the postoperative bowel function recovery time,radical,complications and surgical index were compared between the two groups.Results The recovery time of intestinal function in the study group was significantly shorter than that in the control group(P<0.05),but there was no significant difference in radical indicators between the two groups(P>0.05).The incidence of complications in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).The operation time of the study group was longer than that of the control group and there was the statistically significant difference(P<0.05),while the bleeding was less than that of the control group and there was the statistically significant difference(P<0.05).Conclusion Compared with the open surgery,laparoscopic surgery can more effectively shorten the recovery time of postoperative intestinal function,reduce the incidence of complications and intraoperative blood loss in elderly patients with CRC.Although there is no significant difference between two kinds of operation mode in terms of radical,it should be considered when it is applied in the specific operation time and other factors.
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Objective:To compare the outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in the treatment of tumors in isolated kidney, and analyze the factors influencing postoperative renal function and long-term survival in patients.Methods:A retrospective analysis was conducted on clinical data of 67 patients with tumors in isolated kidney who underwent surgery at the Chinese PLA General Hospital from November 2010 to January 2022. There were 48 males and 19 females, with an average age of (58.6±10.1) years old. The patients were divided into RAPN group (43 cases) and LPN group (24 cases) based on the surgical approach. The RAPN group had a higher R.E.N.A.L. score than the LPN group [(8.7±1.5) vs. (7.9±1.7), P=0.042]. There were no statistically significant differences between the two groups in terms of age [(57.4±10.2) years old vs. (60.9±9.8) years old, P=0.185], body mass index (BMI) [(25.7±3.5) kg/m 2 vs. (25.1±3.6) kg/m 2, P=0.518], and preoperative serum creatinine [(102.9±31.6) μmol/L vs. (102.3±22.4) μmol/L, P=0.930]. Twelve cases underwent hypothermic treatment during surgery, with 9 cases(20.9%) in the RAPN group and 3 cases(12.5%) in the LPN group( P=0.596). Surgical time, intraoperative warm ischemia time, intraoperative blood loss, postoperative fasting time, perioperative complication rate, postoperative serum creatinine, and other indicators were compared between the two groups. Multiple linear regression analysis was used to identify factors affecting postoperative serum creatinine. Kaplan-Meier curves were employed to analyze patient prognosis, and log-rank tests were performed to compare the differences between the two groups. Multiple Cox regression analysis was used to identify factors influencing patient prognosis. Results:All surgeries were completed successfully with negative pathological margins. There were no statistically significant differences between the RAPN and LPN groups in terms of surgical time [(136.6±47.6) min vs. (125.3±34.4) min, P=0.311], intraoperative ischemia time [23.0 (16.0, 30.0) min vs. 19.0 (13.5, 27.5) min, P =0.260], intraoperative blood loss [50.0 (50.0, 100.0) ml vs. 50.0 (22.5, 100.0) ml, P=0.247], postoperative hospital stay [(6.6±3.5) days vs. (7.7±4.2) days, P=0.244], time to drain removal [4(3, 5) days vs. 5(3, 6) days, P =0.175], postoperative fasting time [(2.1±0.7) days vs. (2.2±1.0) days, P=0.729], perioperative complication rate [18.6% (8/43) vs. 16.7% (4/24), P=1.000], postoperative serum creatinine [145.2 (128.3, 191.3) μmol/L vs. 157.8 (136.2, 196.3) μmol/L, P =0.229], and pathological staging [T 1a/T 1b/T 2a/T 3a/T 4 stage: 32/7/1/3/0 case vs. 17/5/0/1/1 case, P=0.804]. Kaplan-Meier survival curves showed that the total survival rates at 1, 3, and 5 years after surgery were 94.7%, 84.9%, and 84.9% for the RAPN group, and 100.0%, 95.5%, and 95.5% for the LPN group, with no statistically significant difference in the log-rank test ( P=0.116). Excluding 10 patients with preoperative tumor metastasis (7 in the RAPN group and 3 in the LPN group), the progression-free survival rates at 1, 3, and 5 years after surgery were 84.8%, 81.1%, and 81.1% for the RAPN group, and 100.0%, 95.0%, and 90.0% for the LPN group, with no statistically significant difference in the log-rank test ( P =0.142). Multiple linear regression analysis showed that the use of hypothermic treatment during surgery significantly reduced postoperative serum creatinine ( B=-72.191, P=0.048). Multiple Cox regression analysis revealed that BMI ( HR=0.743, P=0.044), pathological T stage ( HR=4.235, P=0.018), and preoperative metastasis ( HR=18.829, P=0.035) were independent factors affecting patient overall survival time. A smaller BMI, higher pathological stage, and preoperative metastasis were associated with poorer prognosis. Conclusions:Despite the higher R. E.N.A.L. score and greater surgical difficulty in the RAPN group, RAPN achieved similar perioperative and prognostic results as the LPN, indicating RAPN advantages in treating tumors in isolated kidney. Appropriate intraoperative hypothermic treatment can better protect postoperative renal function. BMI, pathological T stage, and preoperative metastasis are independent factors affecting overall survival time.
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When partial nephrectomy is performed by posterior abdominal approach, the surgical field is poorly exposed, resulting in increased surgical difficulty and risk of injury.In this study, 28 patients with T 1a stage kidney tumors underwent retroperitoneal laparoscopic partial nephrectomy. Intraoperatively, exposure of the surgical field was achieved using the percutaneous puncture of the renal fascia suspension technique. There were no dissatisfactory exposures due to peritoneal damage during the surgery, no additional tubes were inserted, and no conversions to open surgery were needed. The operation time was (76.5±20.3) minutes, blood loss was (92.1±18.7) ml, renal artery clamping time was (19.5±4.3) minutes. Postoperatively, there were no complications such as bleeding, infection, or hematuria.
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Objective To investigate the feasibility and clinical significance of membrane anatomy theory in the application of thoracoscopic and laparoscopic radical esophageal resection.Methods A retrospective analysis was performed on 142 cases of thoracoscopic and laparoscopic radical esophagectomy based on membrane anatomy theory from December 2018 to October 2021.The esophageal mesangium,esophageal cancer,and nerves,blood vessels,lymphatic system,adipose tissue,upper stomach,left mesangium,and left gastric lymph nodes in the esophageal mesangium were removed as a whole.During the surgery,the space containing loose connective tissue around the esophagus was seen to be the esophageal fascial fusion space.The first 10 cases were labeled with nanocarbon tracer markers,showing esophageal lymphatic drainage to the left gastric lymph node.Results All the 142 patients had smooth surgery.The operation time was 150-230 min(mean,184.6±21.3 min),the intraoperative blood loss was 20-100 ml(mean,46.7±16.8 ml),the number of lymph nodes dissected was 12-41(mean,23.5±7.3),and the positive lymph nodes were found in 97 cases.The postoperative chest drainage time was3-10 d(mean,7.1±2.5 d),the postoperative oral intake time was 5-10 d(mean,7.6±1.7 d),and the total hospital stay was 9-20 d(mean,14.0±4.6 d).The total incidence of postoperative complications was 21.8%(31/142),including 7 cases(4.9%)of anastomotic leakage,9 cases(6.3%)of anastomotic stenosis,9 cases(6.3%)of hoarseness,and6 cases(4.2%)of residual gastritis.There was no postoperative bleeding,chyllevial leakage,infection,or death within 30 d after surgery.The follow-ups of the 142 patients lasted for 11-35 months,with a median of 26 months,and there was no recurrence and death.Conclusions There is a mesangial structure that constitutes an"envelope"around the esophagus.The membrane anatomy theory is suitable for the treatment of esophageal cancer,and radical resection of esophageal cancer based on the theory is safe,effective,and feasible.
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【Objective】 To explore the clinicopathological characteristics and comprehensive treatment strategies of prostate mucosa adenocarcinoma under multidisciplinary diagnosis and treatment (MDT) mode. 【Methods】 Data of two patients with typical prostate mucosa adenocarcinoma treated in our hospital during Sep.2020 and Apr.2023 were retrospectively analyzed. 【Results】 In case 1, the clinical manifestation was macroscopic hematuria; multiparametric magnetic resonance imaging (mpMRI) indicated solid prostatic nodules, clinical stage T4N1Mx; initial prostate specific antigen (PSA) was 1.2 ng/mL; 6868Ga-prostate specific membrane antigen PET/CT (68Ga-PSMA PET/CT) suggested abnormal uptake of nuclear lesions in the prostate (SUV4.2-5.3); biopsy results indicated invasive mucinous adenocarcinoma.After prostate and pelvic field radiotherapy + androgen deprivation therapy (ADT) + antihypertensive treatment, lesions were significantly reduced, and hematuria symptoms were relieved.In case 2, the clinical manifestation was dysuria; initial PSA was 91.78 ng/mL; mpMRI suggested invasion of prostate mass into the bladder and clinical stage of T4N1M1b; 68Ga-PSMA PET/CT indicated prostate and pelvic lymph nodes, and multiple bone lesions showed increased nuclide uptake; biopsy results indicated prostate adenocarcinoma with mucinous adenocarcinoma.Initial endocrine treatment was performed.After 3 months, PSA was reduced to 0.083 ng/mL, and imaging showed the tumor was significantly reduced.Robotic-assisted laparoscopic tumor prostatectomy with extended pelvic lymph node dissection was performed, and endocrine adjuvant therapy was continued after surgery. 【Conclusion】 Prostate mucosa adenocarcinoma has different clinicopathological characteristics and prognosis from conventional acinar adenocarcinoma, and the whole-process management under MDT mode is of great value in the diagnosis and treatment of this disease.
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OBJECTIVE To observe the efficacy and safety of goserelin combined with estradiol valerate in the treatment of endometriosis （EMs） in patients of childbearing age after laparoscopic surgery. METHODS The clinical data of 144 patients with EMs of childbearing age who underwent laparoscopic surgery in our hospital from January 2020 to December 2022 were collected retrospectively， and those patients were divided into control group （70 cases） and combination group （74 cases） based on different postoperative medication regimens. Control group was given Acetate goserelin sustained-release implant on the 1st to 5th day of their first menstrual cycle after laparoscopic surgery， while combination group was additionally given Estradiol valerate tablets on the basis of control group. The short-term and long-term efficacy of 2 groups were observed； preoperative and postoperative pain scores， ovarian reserve function， and the incidence of adverse reactions were all recorded in 2 groups. RESULTS There was no statistically significant difference in short-term total effective rate， 1-year postoperative recurrence rate and the incidence of decreased libido， vaginal dryness， gastrointestinal reactions， rash， or arrhythmia between two groups （P＞0.05）. The natural pregnancy rate of combination group was significantly higher than control group at 1 year after surgery， while the incidence E-mail：wanghuiling0518@126.com of early miscarriage， hot flashes and sweating， emotional fluctuations， insomnia and fatigue， joint muscle pain， dizziness and headache were significantly lower than control group （P＜0.05）. However， at 6 months after surgery， pain scores and the levels of anti-Müllerian hormone， follicle stimulating hormone， luteinizing hormone， estradiol of both groups were significantly lower than before surgery in the same group， while the number of antral follicle count was significantly higher than before surgery in the same group； the levels of anti-Müllerian hormone， luteinizing hormone， estradiol， and the number of antral follicles in the combination group were significantly higher than control group， while pain score and follicle stimulating hormone level were significantly lower than control group （P＜0.05）. CONCLUSIONS The combination of goserelin and estradiol valerate after laparoscopic surgery has a significant therapeutic effect and good safety in the treatment of EMs of childbearing age.
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Objective:To explore the technical focus of robotic-assisted laparoscopic surgery for the treatment of horseshoe kidney combined with renal tumor.Methods:The clinical data of a patient with horseshoe kidney combined with renal tumor treated by robot-assisted laparoscopic partial nephrectomy in the Second Hospital of Dalian Medical University in September 2021 were retrospectively analyzed. PubMed, CNKI, Wanfang and VIP databases were searched for all the literature on the use of robot-assisted laparoscopic nephrectomy or partial nephrectomy for the treatment of horseshoe kidney combined with renal tumor from the time of establishment to December 2022.Results:A total of 11 patients from 10 articles were retrieved and 12 patients were enrolled. Among the 12 patients, 4 cases used the retroperitoneal approach and 8 cases used the transperitoneal approach. Two cases were operated by traditional laparoscope, and the arteries were searched for and controlled before the robotic arm was placed to perform the partial nephrectomy and suture; and 10 cases were operated with the robotic-assisted laparoscopic approach throughout the whole procedure. Five cases of nephrectomy were performed on one side, and 7 cases were performed in the partial nephrectomy. Postoperative pathological diagnosis was clear cell carcinoma in 8 cases, chromophobe cell carcinoma in 1 case, eosinophilic cell carcinoma in 1 case, renal cell carcinoma in 1 case, and renal abscess in 1 case. The patient in the Second Hospital of Dalian Medical University was 38 years old female who was admitted to the hospital with a fever. After CT arteriography and three-dimensional reconstruction, robotic-assisted laparoscopic partial nephrectomy of right kidney and isthmus dissecting was performed. During the operation, tumor trophoblast vessels were ligated and dissected one by one by using single-use tissue closure clips, and the isthmus was dissected using endoscopic cutting anastomosis on the left side of the tumor, with the tumor edges sharply resected and completely dissected. The operation time was 240 min, without thermal ischemia time, and the bleeding volume was about 300 ml. The patient recovered well after the operation, and the postoperative pathological diagnosis was renal abscess.Conclusions:Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor is safe and effective, and has more advantages than traditional laparoscopic surgery. Preoperative CT arteriography or three-dimensional reconstruction examination should be applied to fully evaluate the variant vessels. The surgical access and plan should be decided according to the size and location of the tumor. The variant vessels should be properly handled during operation. The use of endoscopic cutting anastomosis to deal with the isthmus can be more conducive to the surgical operation.
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Objective:To compare the training effect between the laparoscopic simulated uterine model (LSUM) with multi-angle suture and the traditional surgical model and to identify a laparoscopic model more suitable for gynecological resident training.Methods:Forty-eight residents who were trained in Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from February 2021 to February 2023 were selected. They were trained in batches, with each batch randomly divided into two groups of the same size. The observation group was trained with the traditional surgical model and general surgical videos, while the experimental group was trained with a self-developed LSUM with multi-angle suture and corresponding surgical videos. Finally, the two groups were compared for the assessment results, and a questionnaire survey was conducted in the experimental group. The statistical software SPSS 20.0 was used for t-test or chi-square test of the results. Results:There were no significant differences between the two groups in age, gender distribution, education level, and clinical experience. In theoretical assessment results, no significant difference was shown between the experimental group and the observation group [(82.63±3.93) vs. (85.00±6.15), P>0.05]. In skill assessment results, there was no significant difference between the two groups in the anterior wall assessment [(83.08±4.47) vs. (82.79±3.58), P=0.804]. However, in the assessment of the lateral and posterior walls, the proficiency, accuracy, and degree of coordination between two hands of the experimental group were better than those of the observation group, with the total score being significantly different [(64.13±3.34) vs. (46.75±3.50), (62.25±4.41) vs. (45.00±2.89), P<0.001]. In the questionnaire survey, the experimental group had a high degree of satisfaction with the LSUM and thought that the highly simulated model was beneficial to their training. Conclusions:Compared with the traditional surgical model, the LSUM with multi-angle suture can effectively improve the operation level of residents, which provides a new idea for the laparoscopic simulation training of gynecological residents in the future.
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Objective To compare the effects of laparoscopic surgery with various approaches on intestinal barrier function,red blood cell immunity,and prognosis in patients with right hemicolectomized colon cancer.Methods A prospective selection of 110 patients with right hemicolectomized colon cancer admitted to our hospital from April 2019 to April 2021 was conducted.Patients were divided into groups A(n= 55)and B(n= 55)using a simple randomization method.During the treatment period,two cases of loss of follow-up occurred in Group A and three in Group B.Finally,53 from Group A and 52 participants from Group B completed the study.Both groups underwent laparoscopic surgery.Group A underwent a cephalic approach,whereas Group B underwent an intermediate approach.The periopera-tive indexes,complications,prognosis,intestinal barrier function(endotoxin,D-lactic acid,and diamine oxidase),red blood cell immune complex rate(RBC-ICR),RBC-C3b receptor rosette rate(RBC-C3bRR),and erythrocyte adhesion to tumor cell rosette rate(TRR)of the two groups were determinedd.Results Group A had less intraoperative bleeding,shorter central lymph node dissection time,shorter operative time,and lower complication rate(P＜0.05)than Group B.Endotoxin,diamine oxidase,and D-lactate levels in both groups were higher 3 d after surgery than before surgery(P＜0.05).Three days after surgery,the RBC-ICR of both groups was higher than before surgery,whereas the TRR and RBC-C3bRR were lower than before surgery(P＜0.05).After 1 year of follow-up,no statistically sig-nificant difference in distant metastasis,local recurrence,and survival rates were observed between the two groups(P＞0.05).Conclusion The two approaches used in this study have similar effects in right hemicolectomized colon cancer.The cephalic approach for laparoscopic sur-gery shortened the surgical time and reduced complications.
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Abstract Background: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. Methods: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. Results: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. Conclusion: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.
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Abstract Objectives To investigate the impact of Three-Dimensional (3D) laparoscopy compared to traditional laparotomy on serum tumor markers and coagulation function in patients diagnosed with early-stage Endometrial Cancer (EC). Method The authors retrospectively analyzed the clinical data of 75 patients diagnosed with early-stage EC and categorized them into two groups based on the surgical techniques employed. The 3D group consisted of 36 patients who underwent 3D laparoscopic surgery, while the Laparotomy group comprised 39 patients who underwent traditional laparotomy. The authors then compared the alterations in serum tumor markers and coagulation function between the two groups. Results Postoperatively, serum levels of CA125, CA199, and HE4 were notably reduced in both groups on the third day, with the levels being more diminished in the 3D group than in the Laparotomy Group (p < 0.05). Conversely, FIB levels escalated significantly in both groups on the third-day post-surgery, with a more pronounced increase in the 3D group. Additionally, PT and APTT durations were reduced and were more so in the 3D group than in the laparotomy group (p < 0.05). Conclusions When juxtaposed with traditional laparotomy, 3D laparoscopic surgery for early-stage EC appears to be more efficacious, characterized by reduced complications, and expedited recovery. It can effectively mitigate serum tumor marker levels, attenuate the inflammatory response and damage to immune function, foster urinary function recovery, and enhance the quality of life. However, it exerts a more significant influence on the patient's coagulation parameters, necessitating meticulous prevention and treatment strategies for thromboembolic events in clinical settings.
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Bochdalek hernia (BH) is the most common congenital diaphragmatic hernia, however in adults the clinical presentation and diagnosis is rare. Intestinal malrotation (IM) is a congenital anomaly that results in an alteration in intestinal anatomy secondary to inadequate intestinal rotation, which occurs at the end of the first trimester of embryonic development, some digestive anomalies may be related, such as diaphragmatic hernia, its Diagnosis is made in the neonatal period although it can be diagnosed in older children and adults, debuting with symptoms of intestinal obstruction or being an incidental finding. Below we present a case report of an adult patient with a diagnosis of Bochdalek congenital diaphragmatic hernia (CDH) in whom an incidental diagnosis of IM was made, who underwent elective surgery, performing laparoscopic diaphragmatic plasty with favorable results.
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RESUMEN La diverticulosis es la presencia de divertículos en el tránsito intestinal, diverticulitis es la inflamación de los divertículos y ocurre en menos del 5% de pacientes con diverticulosis. El tratamiento quirúrgico de la diverticulitis aguda se aplica en los casos complicados. Tradicionalmente la operación de Hartmann es el procedimiento estándar en los casos de Diverticulitis aguda Hinchey III y IV, actualmente se recomienda individualizar el tratamiento quirúrgico en los casos de peritonitis purulenta no fecaloidea siendo el lavado peritoneal laparoscópico una opción factible. Objetivo : Describir los resultados del tratamiento quirúrgico de 4 pacientes con el diagnóstico de diverticulitis aguda Hinchey III sometidos al Lavado peritoneal en un centro privado. Material y métodos: Estudio descriptivo retrospectivo tipo serie de casos. Se recopiló información de historias clínicas para la descripción de los casos. Resultados: En los 4 pacientes intervenidos mediante el Lavado peritoneal laparoscópico, ninguno tuvo complicaciones postoperatorias ni mortalidad. Conclusiones: A juicio de los autores los beneficios del lavado peritoneal laparoscópico repercuten en una adecuada evolución postquirúrgica y generan calidad de vida en los pacientes intervenidos.
SUMMARY Diverticulosis is defined as the presence of diverticula in the intestine, when these diverticula become inflamed diverticulitis occurs, but this complication happens in less than 5% of these patients. Surgical treatment is indicated in complicated diverticulitis cases. Traditionally, the Hartmann procedure is carried out in patients with Hinchey III and IV acute diverticulitis. Currently, individualized surgical procedures are indicated in patients with non-fecal purulent peritonitis with laparoscopic peritoneal lavage as an optional choice. Objective: To report the results of laparoscopic peritoneal lavage in four patients with Hinchey III acute diverticulitis performed at a private clinic. Methods: Case series for which a review of patient clinical files was done. Results: No post-operative complications or mortality was found. Conclusions: based on authors judge, laparoscopic peritoneal lavage leads to an adequate post-operative evolution resulting in better quality of life.
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Hiatus hernia is a condition in which part of the stomach protrudes into the chest cavity through the esophageal hiatus, a hole in the diaphragm. The condition is often asymptomatic but can cause gastroesophageal reflux disease (GERD), dysphagia, chest pain, and other complications in some cases. The diagnosis of hiatus hernia is typically made using imaging tests such as endoscopy or radiography and confirmation done using esophageal motility studies. Management of hiatus hernia depends on the severity and symptoms of the condition. Mild cases may be managed with lifestyle modifications such as weight loss, dietary changes, and avoiding certain trigger foods. Medications such as proton pump inhibitors (PPIs) and histamine receptor antagonists may also be used to control GERD symptoms in maximum number of cases. Surgical intervention will be necessary for more severe cases or cases that do not respond to conservative management. The two main types of surgery for hiatus hernia are conventional/open Nissen fundoplication and laparoscopic fundoplication. These procedures aim to strengthen the lower esophageal sphincter and prevent stomach acid from flowing back into the esophagus. Overall, the management of hiatus hernia requires a multidisciplinary approach involving gastroenterologists, surgeons, and primary care providers. The optimal management will be an individualized approach addressing severity of symptoms and responses to drugs. This study aims to review the drug refractory cases of hiatus hernia in a select group of adult patients not eligible for standard laparoscopic approach diagnosed endoscopically and managed by open Nissen’s fundoplication.
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Introducción: La cirugía laparoscópica ginecológica permite intervenir a la paciente sin tener que abrir el abdomen, pues consiste en realizar pequeñas incisiones. Actualmente se emplea en enfermedades como el cáncer o en la extracción de quistes y miomas, por lo que se puede aplicar en casi cualquier intervención de cirugía ginecológica. Objetivo: Caracterizar los procedimientos laparoscópicos del Servicio de Ginecología en el Hospital Materno-Infantil Ángel Arturo Aballí en el período comprendido entre enero del 2018 y diciembre del 2021. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal con el fin de describir la actividad asistencial laparoscópica. La muestra fue de 180 pacientes, según el criterio de selección no probabilístico de los investigadores. Resultados: La edad promedio fue 41,6 años. Según los antecedentes, predominó el tamaño del útero con 91,1 por ciento (n = 164). Dentro de las indicaciones quirúrgicas, se encontró la paridad satisfecha en un 34,4 por ciento, seguido del tumor de ovario (18,9 por ciento), las neoplasias intraepiteliales cervicales (13,4 por ciento) y el fibroma uterino sintomático. En cuanto a la cirugía mayor, se encontró la histerectomía abdominal laparoscópica en un 49,0 por ciento (n = 78), seguido de la salpingectomía con un 38,9 por ciento, resultados con significación desde el punto de vista estadístico (p = 0,004). En cuanto a la cirugía menor, el 11,6 por ciento de la muestra recibió la ablación de los focos endometriales. Las complicaciones fueron escasas. Conclusiones: Los procederes laparoscópicos del Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí se consideraron adecuados de acuerdo a los indicadores quirúrgicos(AU)
Introduction: Laparoscopic gynecological surgery allows for the patient to undergo surgery without having to open their abdomen, since it consists in making small incisions. It is currently used in diseases such as cancer or in the removal of cysts and myomas; therefore, it can be applied in almost any gynecological surgery. Objective: To characterize the laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí, in the period from January 2018 to December 2021. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in order to describe the laparoscopic assistance activity. The sample consisted of 180 patients, according to the researchers' nonprobabilistic selection criteria. Results: The mean age was 41.6 years. Concerning antecedents, uterine size predominated, with 91.1 percent (n = 164). Among surgical indications, satisfied parity was found in 34.4 percent , followed by ovarian tumor (18.9 percent ), cervical intraepithelial neoplasms (13.4 percent ) and symptomatic uterine fibroid. With respect to major surgery, laparoscopic abdominal hysterectomy was found in 49.0 percent (n = 78), followed by salpingectomy, with 38.9 percent ; such results are statistically significant (p = 0.004). Regarding minor surgery, 11.6 percent of the sample received ablation of endometrial focuses. Complications were rare. Conclusions: The laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí are considered adequate according to the surgical indicators(AU)
Assuntos
Humanos , Feminino , Adulto , Procedimentos Cirúrgicos em Ginecologia/métodos , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos Observacionais como AssuntoRESUMO
Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.
Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.
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Background: This study was conducted to compare and evaluate the effectiveness of I-gel over endotracheal tube with regards to respiratory and hemodynamic parameters in laproscopic surgeries. Methods: In this study 60 adult patients of either sex, of ASA status I or II, aged 16 to 60 years, undergoing laparoscopic surgeries under general anesthesia were randomly studied. In Group-A (I-gel) appropriate sized I-gel was inserted, and in Group-B (ETT) patient’s airway was secured with laryngoscopy-guided endotracheal intubation. Monitoring of PR, MBP, SpO2 and EtCO2 was done throughout the peri-operative period. Haemodynamic and ventilatory parameters were recorded before induction (baseline), just after intubation, then at 1, 3 and 5 min after I-gel insertion/intubation, after pneumoperitoneum, after change of position, before and 5 min after release of pneumoperitoneum and after I-gel removal/extubation. Results: Following the insertion of airway device there was significant rise in PR (3 min after intubation [P = 0.011, df-58, CI-95%]) and MBP (3 min after intubation [P = 0.02, df-58, CI-95%], 5 min after intubation [P = 0.04, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Following insertion of airway device there was no significant difference in EtCO2 (3 min after intubation [P = 0.778, df-58, CI-95%]), 5 min after intubation [P = 0.75, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Conclusions: I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel can be a safe and suitable alternative to ETT for laparoscopic surgery.
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Background: This study was conducted to compare and evaluate the effectiveness of I-gel over endotracheal tube with regards to respiratory and hemodynamic parameters in laproscopic surgeries. Methods: In this study 60 adult patients of either sex, of ASA status I or II, aged 16 to 60 years, undergoing laparoscopic surgeries under general anesthesia were randomly studied. In Group-A (I-gel) appropriate sized I-gel was inserted, and in Group-B (ETT) patient’s airway was secured with laryngoscopy-guided endotracheal intubation. Monitoring of PR, MBP, SpO2 and EtCO2 was done throughout the peri-operative period. Haemodynamic and ventilatory parameters were recorded before induction (baseline), just after intubation, then at 1, 3 and 5 min after I-gel insertion/intubation, after pneumoperitoneum, after change of position, before and 5 min after release of pneumoperitoneum and after I-gel removal/extubation. Results: Following the insertion of airway device there was significant rise in PR (3 min after intubation [P = 0.011, df-58, CI-95%]) and MBP (3 min after intubation [P = 0.02, df-58, CI-95%], 5 min after intubation [P = 0.04, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Following insertion of airway device there was no significant difference in EtCO2 (3 min after intubation [P = 0.778, df-58, CI-95%]), 5 min after intubation [P = 0.75, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Conclusions: I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel can be a safe and suitable alternative to ETT for laparoscopic surgery.