Laparoscopic Treatment of Morgagni Hernia: Report of Three Cases.

We report on three cases of diaphragmatic (Morgagni) hernia with different clinical presentation. It is important to consider the possibility of this rare but potentially very dangerous condition in patients with respiratory problems and pain in the upper abdomen. Before laparoscopy, two different approaches were used in diaphragmatic hernia operations (abdominal and thoracic approach). Laparoscopy has brought significant changes in the treatment of diaphragmatic hernia. It is important to stress that laparoscopic diaphragmatic surgical therapy uses stronger mesh than the mesh used to repair an inguinal hernia.

First Croatian transvaginal laparoscopically assisted cholecystectomies.

BACKGROUND/AIMS: The aim of this study was to determine the feasibility and technical aspects of a new endoluminal surgical procedure: transvaginal laparoscopically assisted endoscopic cholecystectomy. METHODOLOGY: Three female patients underwent transvaginal laparoscopically assisted endoscopic cholecystectomy (aged 40, 61 and 33 years). Pneumoperitoneum was created through a 5mm supraumbilical incision. Through the posterior fornix of the vagina the second 10mm trocar, laparoscope and 5mm laparoscopic grasper were introduced. The gallbladder was dissected using standard 5mm laparoscopic grasper, hook, electrocoagulation and harmonic shears introduced supraumbilically. The dissected gallbladder was removed in a specimen retrieval bag. RESULTS: Transvaginal laparoscopically assisted endoscopic cholecystectomy was feasible in all patients. No intraoperative or postoperative complications were observed and there was no need for extra-umbilical skin incisions. Total operative time ranged between 60 and 75 minutes. Median length of hospital stay was 1 day. CONCLUSIONS: This was the first clinical application of transvaginal laparoscopically assisted cholecystectomy in Croatia. The initial clinical application of this technique in 3 female patients was feasible, effective and safe when performed by experienced laparoscopic surgeons using standard laparoscopic instruments.

[Laparoscopic cholecystectomy in patients with ventriculoperitoneal shunt]. / Laparoskopsko odstranjenje zucnog mjehura u bolesnika s ventrikuloperitonealnim kateterom.

Because of development of laparoscopic surgery and by knowing of its pathophysiological effects on organism, indications for laparoscopic surgery have become more extensive, so this method is today used for therapeutic and diagnostic procedures. Although ventriculoperitoneal shunt is not normally considered a contraindication for laparoscopic surgery, pneumoperitoneum is described as a cause of raised intracranial pressure. Since 1992 when the first laparoscopic cholecystectomy was done at the University Department of Surgery of Sveti Duh Clinical Hospital in Zagreb, three patients with implanted ventriculoperitoneal shunt were managed successfully laparoscopically. In all three patients, there were no complications during and after the surgery. In this paper we present our experience of three cases and short review of the literature.

[Effects of pneumoperitoneumon liver function]. / Ucinci pneumoperitoneuma na jetrenu funkciju.

Effects of pneumoperitoneum on liver function during laparoscopic procedures in most patients have no clinical relevance. However, with increasing number and types of surgical procedures the laparoscopic operation is now performed in high-risk patients, including patients with pre-existing liver disease. In these patients laparoscopic procedures may lead to serious complication, including acute liver failure. Because postoperative liver damage induced by pneumoperitoneum has been underestimated, the aim of this article is to review the numerous factors influencing liver damage during laparoscopy and review of therapeutic options for their reduction.

Cosmetic laparoscopic cholecystectomy.

BACKGROUND: The cosmetic outcome and recovery time of laparoscopic cholecystectomy has been improved by modifying the operation technique and reducing the number and size of trocars. The next step to improve cosmetic results is moving two trocars below the pubic hairline. We describe our experience in performing cholecystectomy by a combination of European technique using three trocars and moving two ports below the pubic hairline. MATERIALS AND METHODS: The results of 72 patients, ASA physical status I and II, who underwent cosmetic laparoscopic cholecystectomy between January 2002 and May 2005 are presented. RESULTS: The median operating time was 33.3 +/- 9.9 min and postoperative hospital stay was 2.2 +/- 0.6 days. No patients required additional trocars or conversion to open cholecystectomy. There were no intraoperative or postoperative complications, and all patients reported satisfaction with their postoperative cosmetic results. CONCLUSION: According to our experience, cosmetic laparoscopic cholecystectomy is a safe procedure with good cosmetic results; however, its use should be based on careful evaluation in each individual case.

Prophylactic antiemetics for laparoscopic cholecystectomy: droperidol, metoclopramide, and droperidol plus metoclopramide.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most significant problems in laparoscopic surgery. The antiemetic effects of metoclopramide and droperidol used alone or in combination for prevention of PONV after laparoscopic cholecystectomy (LC) were assessed in this prospective, double blind, placebo controlled randomized study. PATIENTS AND METHODS: A series of 140 patients, ASA physical status I or II, were included in the study. Patients were randomized to one of the following groups: 1, placebo; 2, metoclopramide 10 mg after the induction of anesthesia and placebo at 12 h postoperatively; 3, droperidol 1.25 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively; and 4, droperidol 1.25 mg plus metoclopramide 10 mg after the induction of anesthesia and droperidol 1.25 mg at 12 h postoperatively. Patients were observed for 24 hours for PONV, pain, need for rescue analgesics, and adverse events. RESULTS: Data were analyzed using the Student's t-test and chi-square test, with P < 0.05 considered statistically significant. The mean incidence of PONV was 54% with placebo, 42% with metoclopramide, 14% with two doses of droperidol alone, and 11% with a combination of metoclopramide plus droperidol. The patients receiving a combination of metoclopramide and droperidol had a significantly lower rate of PONV than those administered metoclopramide alone (P < 0.05) or placebo (P < 0.001). Those receiving two-dose droperidol alone also had a significantly lower incidence of PONV compared with metoclopramide (P < 0.05) and placebo (P < 0.001). There was no statistically significant difference between the metoclopramide and placebo groups. Sedation was significantly greater in patients administered droperidol 12 h postoperatively. CONCLUSION: The combination of metoclopramide and droperidol, and two-dose droperidol alone, were found to significantly decrease the incidence of PONV after LC, whereas metoclopramide alone proved inefficient.

[Laparoscopic surgery during pregnancy]. / Laparoskopski kirurski zahvati u trudnoci.

UNLABELLED: With the development oflaparoscopic surgery, number of contraindications has become less and less. At the beginning of laparoscopic surgery pregnancy was considered an absolute contraindication to laparoscopic surgery, because of unknown influence of CO2-pneumoperitoneum on fetus. Over the past few years, in literature there have been several case reports of successful laparoscopic surgery in pregnancy. Since 1992 when the first laparoscopic cholecystectomy was done at the University Department of Surgery of Sveti Duh General Hospital in Zagreb, three pregnant women were managed successfully laparoscopically. Two laparoscopic cholecystectomies, and one laparoscopic appendectomy during pregnancy, were performed. RESULTS: In all three patients, there were no complications during and after surgery. Pregnancies were completed at term spontaneously, delivering healthy children.

[Harmonic scalpel in laparoscopic surgery]. / Primjena visokofrekventno titrajuceg rezaca u laparoskopskoj kirurgiji.

Harmonic scalpel for the tissue cutting and coagulating is a replacement for the high frequency current, which can be connected with diverse complications. The principle is transforming of the electric power into mechanical longitudinal movement of the working part of the instrument, by piezoelectrical transducer situated in the hand piece. Between October 2000 and June 2001, one hundred and three patients were operated using harmonic scalpel. The average age was 50.2 years. Laparoscopic cholecystectomy, appendectomy and abdominal cyste fenestration was performed in 86, 12 and 4 patients respectively. In one patient laparoscopic cholecystectomy and abdominal cyste fenestration were done during the same operation. The average hospital stay was 2.8 days. Laparoscopic cholecystectomy, appendectomy and cyst fenestration using the harmonic scalpel are safe and successful operations, with good results and advantages of the minimally invasive surgery.

[Education in endoscopic surgery: courses of endoscopic surgery in Split, Croatia]. / Edukacija u endoskopskoj kirurgiji: tecajevi endoskopske kirurgije u Splitu.

Education is very important in endoscopic surgery. It can be performed on endoscopic trainers, live animals, and animal organs, using tissue samples or non-natural materials. Practical work and education can also be performed during the assistance or operating under the supervision. Endoscopic training courses have the important rule, too. We organized three endoscopic courses in Split up to date. The last one lasted 5 days, covered six different topics and included operations on pigs. In comparison with the course in the year 2001, the last course had more participants and lecturers. Lectures, practice and operations took longer time. The interest for attendance was high. The participants were very satisfied, and rated the lectures, practice and operations with the average grade between 4.1 and 4.7 on the anonymous questionnaire at the end of the course. It can be concluded that indispensable education in endoscopic surgery can be performed during endoscopic courses, where participants can reach basic theoretical and practical knowledge and skills. The courses should be permanently improved and modernized, providing a good quality, with interest and engagement of the attendees.

[Catheter placement for peritoneal dialysis using videoendoscopy]. / Postavljanje katetera za peritonejsku dijalizu videoendoskopskim nacinom.

From December 1993 to December 2000 at the Department of Surgery, General Hospital "Sveti Duh", and University, Hospitals Split and Osijek the catheter for peritoneal dialysis was placed in 128 patients, in 137 cases. Videoendoscopic procedure, with the trocar made precisely for that purpose, was used. All surgical procedures, performed in the completely equipped operation room and in general anesthesia, were done without any intraoperative or postoperative complications. The procedure showed to have all advantages of endoscopic or minimally invasive surgery. The patients recovered quickly with low consumption of analgesics, got out of the bed and started with feeding sooner. There were no wound complications. It was possible to start with the dialysis 2-3 days after the procedure. Most important, the results showed that using this approach in comparison to others, there were no more dialysis solution leakages, catheter drainage problems, or more tunnel, exit site or peritoneal infections. Along with placing the catheter, other surgical procedures could be also done without increasing the complication rate. Therefore, laparoscopic cholecystectomy was done in 12 cases, adhesiolysis in 25 cases, and right adnexectomy, open hernioplasty and umbilical hernioplasty in one case. Videoendoscopic approach of placing the catheter is a simple, short and patient convenient procedure, with quick recovery and without any increase in complication rate.

[Helicobacter pylori in biopsy specimen of gastric mucosa: frequency and correlation of rapid urease test with histology]. / Helicobacter pylori u biopsijskom uzorku zelucane sluznice: ucestalost i usporedba brzog testa ureaze s histoloskim pregledom.

Between December 1999 and May 2000, general, age and sex distribution of Helicobacter pylori and rapid urease test sensitivity and specificity in correlation with histology were performed on 125 patients after gastroscopy. The average patients' age was 54.98 +/- 15.74, range 20-86 years. There were 71 (57%) of females and 54 (43%) males. Seventy seven (62%) patients were Helicobacter pylori positive on histology, and differences between the sex and age were not statistically different (p = 0.58 and p = 0.07). Sensitivity of the rapid urease test after 30 minutes, 3 and 24 hours was 23, 57 and 81% respectively, specificity was 100, 98 and 94% respectively, positive predictive values were 100, 98 and 95% respectively, and negative predictive values were 45, 59 and 75% respectively. In conclusion, it can be recommended to do biopsy of two specimens, from the antrum and body of the stomach. Distribution of Helicobacter pylori positive is higher in older patients. Rapid urease test has low sensitivity and negative predictive value with high specificity and negative predictive value. The additional advantage can be if the test is positive after 30 minutes, because the therapy can be prescribed immediatelly after the endoscopy.