Laparoscopy-assisted colonoscopic polypectomy.

One of the most feared complications in the removal of moderate-sized or large sessile polyps is colonic perforation. Complete colonoscopic total excision of these kinds of polyps can be safely undertaken using laparoscopic assistance, which enables prompt diagnosis and treatment of perforation. Laparoscopy-assisted endoscopic polyp excision can be safely performed, avoiding critical septic complications and can also help in the selection of patients to appropriate colonic resection without increasing morbidity or mortality.

Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.

BACKGROUND: Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. METHODS: Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy. RESULTS: Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor. CONCLUSIONS: Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.

Laparoscopic extraperitoneal repair of inguinal hernias.

The world of surgical laparoscopy is evolving. Laparoscopic prosthetic inguinal hernia repair is gaining rapid and wide acceptance. This experience consisted of 144 hernia repairs in 105 patients (40 bilateral, 31 recurrent, and 33 unilateral nonrecurrent hernias), treated through an extraperitoneal laparoscopic repair. When compared with transabdominal repair, operative time and postoperative recovery were similar, with some advantages related to the avoidance of intraabdominal manipulation and potential related complications. In spite of a relatively short follow-up (up to 40 months), there were no recurrences in this series. Morbidity rate was acceptable (16.1%), mainly reported as minor complications. Anatomical and technical skills to perform the operation are required and achieved through training. Extraperitoneal hernia repair with synthetic mesh is safe and feasible, with the advantages of being associated with less pain, rapid return to full activities, and the already proven milder systemic responses following interventional laparoscopy.