Laparoscopic treatment of anterior sacral meningocele.

BACKGROUND: Anterior sacral meningocele is a rare congenital malformation, whose open surgical treatment is well accepted. We present a laparoscopic approach as an adjunctive approach. METHODS: Five women who underwent laparoscopic transperitoneal surgery were clinically, radiologically, and surgically evaluated. RESULT: All 5 patients underwent laparoscopic transperitoneal surgery and showed satisfactory results. They had no major complications. Three patients had headaches as minor complications, but it was gone in at most 3 days. Decrease in operative time, blood loss, and length of hospitalization were the advantages of the procedure. CONCLUSIONS: The laparoscopic approach to treating anterior sacral meningocele was feasible and safe, with only minor complications.

Total laparoscopic gastrocystoplasty: experimental technique in a porcine model.

OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8) hours: 84.5 (range 62 - 110) minutes for the gastric dissection, 56 (range 28 - 80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.

Total laparoscopic gastrocystoplasty: experimental technique in a porcine model

OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8) hours: 84.5 (range 62 - 110) minutes for the gastric dissection, 56 (range 28 - 80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.

Transmesenteric laparoscopic pyeloplasty.

PURPOSE: Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We assessed transmesenteric laparoscopic pyeloplasty to correct ureteropelvic junction obstruction and compared results to those in patients undergoing traditional retrocolic laparoscopic pyeloplasty. MATERIALS AND METHODS: Between August 1999 and July 2005, 188 consecutive transperitoneal laparoscopic pyeloplasties were performed at our institution. A total of 18 patients underwent a transmesenteric approach and 170 underwent the classic retrocolic approach. Patient selection for the transmesenteric approach was at surgeon discretion with the inclusion criterion of recognition of the renal pelvis and/or ureter through the descending colonic mesentery. RESULTS: Compared to patients undergoing traditional retrocolic procedure the transmesenteric approach was more commonly applied in younger individuals and males, and for pathological conditions on the left side and malrotated kidneys. The transmesenteric approach lowered operative time by a mean of 22.5% and decreased hospital stay by 19.2%. The patency success rate was 100% at a mean followup of 18.6 months for the transmesenteric approach and 94.1% at a mean followup of 22 months for the retrocolic approach. CONCLUSIONS: In a select group of patients transmesenteric pyeloplasty may represent a more rapid alternative to the transperitoneal retrocolic approach and speed convalescence with similar success rates.

Tratamento cirúrgico dos pseudocistos de pâncreas / Surgical treatment of the pancreatic pseudocysts

Os autores apresentam os resultados do tratamento de 56 pacientes portadores de pseudocisto de pâncreas. A drenagem interna da lesão foi o tratamento preferencial, tendo sido realizado em 32 (67 por cento) casos, sendo 18 (37 por cento) citogastostomias e 14 (29 por cento) citojejunostomias. A drenagem externa foi efetuada em 12 (25 por cento) doentes, sendo a principal indicação a presença de lesão cística infectada. A ressecção do pseudocisto foi realizada em 5 (10 por cento) casos , sendo três duodenopancreatectomia cefálica e duas pancreatectomia caudal. A resolução espontânea da coleção ocorreu em 8 (14 por cento) dos casos. Em 52 por cento dos casos houve pelo menos alguma intecorrência no pós-operatório e, 4 (8 por cento) pacientes evoluíram ao óbito em decorrência de sepsis, sendo três após a drenagem externa e uma após cistogastrostomia. A drenagem interna persiste como alternativa terapêutica de eleição no pensamento dos autores, com baixas taxas de morbimortalidadee, deveria ser sempre efetuada quando as condições locais a permitirem.

Comparação entre Bupivacaína Tópica e Infiltrativa na Analgesia Pós-Operatória da Herniorrafia Inguinal / A Comparison Between Topical and Infiltrative Bupivacaine for Postoperative Analgesia Following Inguinal Herniorrhaphy

Objetivo: O presente estudo deseja comparar a analgesia pós-operatória oferecida pela simples instilação de anestésico local e a infiltração do mesmo anestésico sobre a ferida operatória. Este é um estudo prospectivo. Quarenta pacientes foram alocados nos dois grupos de analgesia a serem estudados, sendo a dor quantificada através de escala análogo-visual. Foram observados níveis de analgesia similares em ambos os grupos nas primeiras 24 horas, com diferenças significativas nas 24 horas seguintes. O grupo que recebeu a infiltração do anestésico local obteve um maior número complicaçöes no pós-operatório, favorizando a diferença de analgesia após as primeiras 24 horas ao grupo em que foi somente instilado o anestésico local...