ABSTRACT
BACKGROUND: Incisional hernias are treated laparoscopically in an increasing number of cases. The simplest technique is the peritoneal onlay technique. Composite mesh, consisting of one layer of polypropylene mesh, destined to face the abdominal wall, and one layer of less adhesion-inducing material, destined to face the bowel, has been developed in an effort to avoid intraperitoneal adhesion formation and viscus erosion. While probably superior, this type of mesh is very bulky, easily damaged, and hence extremely difficult to be safely introduced through conventional trocars. METHODS: We present a simple technique to safely introduce intraperitoneally large sheets of composite mesh, without the need for larger-bore cannulas. After temporarily removing one of the 10 mm trocars, the mesh is rolled as tightly as possible and placed in a sterile bag, which is then easily introduced intraperitoneally through the trocar opening. RESULTS: Between September 1999 and January 2000 the technique was successfully used in 12 patients. CONCLUSION: This simple trick protects the mesh while making its intraperitoneal introduction straightforward. It is quick, cheap, and easily reproducible.
Subject(s)
Herniorrhaphy , Laparoscopy/methods , Surgical Mesh , Adult , Aged , Drainage/methods , Female , Humans , Male , Middle Aged , Polypropylenes , Prostheses and Implants , Treatment OutcomeABSTRACT
BACKGROUND: Roux-en-Y gastric bypass (RYGBP) leaves a large blind gastric segment, which is inaccessible for conventional endoscopy. METHOD: A case is reported, describing a variation of laparoscopic RYGBP by partitioning the stomach by an inflatable band rather than by stapling or division. RESULTS: The stomach was partitioned into a proximal 15 cc pouch and a distal part by an adjustable gastric band. A RYGBP was fashioned from the proximal pouch. 9 patients were treated with this technique: 7 as an initial procedure and 2 after previous gastric banding which had been followed by insufficient weight loss. 1 of these latter patients developed erosion of the band through the gastrojejunostomy 7 months postoperatively. CONCLUSION: Laparoscopic proximal RYGBP with inflatable-band gastric partitioning is feasible. Erosion of the band though the gastrojejunostomy, however, might be a serious side-effect of this technique.
Subject(s)
Anastomosis, Roux-en-Y/methods , Gastric Bypass/methods , Gastroplasty/methods , Gastroscopy/methods , Adult , Anastomosis, Roux-en-Y/adverse effects , Anastomosis, Roux-en-Y/instrumentation , Contrast Media , Diatrizoate Meglumine , Feasibility Studies , Female , Gastric Bypass/adverse effects , Gastric Bypass/instrumentation , Gastroplasty/adverse effects , Gastroplasty/instrumentation , Gastroscopy/adverse effects , Gastrostomy/adverse effects , Gastrostomy/instrumentation , Gastrostomy/methods , Humans , Jejunostomy/adverse effects , Jejunostomy/instrumentation , Jejunostomy/methods , Length of Stay/statistics & numerical data , Postoperative Care/methods , Treatment Outcome , Weight LossABSTRACT
OBJECTIVE: To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device. SUMMARY BACKGROUND DATA: In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases. METHODS: A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. RESULTS: Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%. CONCLUSIONS: The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.
Subject(s)
Laparoscopy/methods , Abdomen/surgery , Feasibility Studies , Female , Humans , Male , Middle Aged , Pneumoperitoneum, Artificial , Postoperative Complications/epidemiology , Prospective Studies , Surgical InstrumentsABSTRACT
Splenic hydatidosis is a rare condition. We performed a hand-assisted laparoscopic splenectomy for a large hydatid cyst localized in the center of the spleen. We discuss the advantages of the "helping hand."
Subject(s)
Echinococcosis/surgery , Laparoscopy/methods , Splenic Diseases/surgery , Adult , Echinococcosis/diagnosis , Echinococcosis/physiopathology , Humans , Male , Splenectomy/methods , Splenic Diseases/diagnosis , Splenic Diseases/physiopathologyABSTRACT
Laparoscopic hernioplasty was performed in a prospective fashion in 100 inguinal hernias in 66 patients. When available, a self-expanding prosthesis of Mersilene, strengthened with a cross- or star-shaped wire of Nitinol, was used without fixation (group B, 43 hernias). When this prosthesis was not available, a "classic" Prolene prosthesis was used, placed preperitoneally, and stapled according to the technique of Corbitt (group A, 57 hernias). This study compares the results of the two techniques. The use of a mesh-expanding Nitinol frame significantly shortens the operating time. Since two recurrences appeared in this group, we suggest that this modified mesh should also be stapled in place.
Subject(s)
Hernia, Inguinal/surgery , Laparoscopy , Prostheses and Implants , Surgical Mesh , Alloys , Female , Humans , Male , Polyethylene Terephthalates , Polypropylenes , Postoperative Complications/epidemiology , Prospective Studies , Recurrence , Surgical Staplers , Time FactorsABSTRACT
The umbrella-like repair of inguinal hernia via the laparoscope was performed without major complications in 25 patients. The technique involves the preperitoneal placement of a self-expandable patch of polypropylene that incorporates a nitinol wire. This innovation considerably reduces the difficulty of the laparoscopic hernioplasty procedure, saving time and technical effort for the surgeon without sacrificing any of the advantages of a laparoscopic operation for the patient.
Subject(s)
Hernia, Inguinal/surgery , Laparoscopy/methods , Prostheses and Implants , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications , RecurrenceABSTRACT
The choice of approach is still one of the most controversial points in the surgical treatment of recent rupture of the diaphragm. Most authors agree, however, about the use of thoracotomy in the late cases with strangulation. From 1970 to 1982 inclusive, 40 patients were operated on within a week of closed rupture of the diaphragm. The following data appear from these operations: 1. In 29 patients (73 per cent) one or more subdiaphragmatic organs needed repair. Only 4 patients (10 per cent) required operation for a thoracic lesion. 2. The hernia was easily repaired in the 34 cases treated by laparotomy only. For this reason when confronted by a recent diaphragmatic rupture, we almost always use an abdominal incision knowing that it, can easily be extended into the chest if this becomes necessary for the treatment of an injury there. In our experience, this policy needed to be changed in only a very few special cases.