RESUMEN
Objective: The coeliac artery compression syndrome, first described by Harjola und Dunbar, results from the coeliac artery and plexus being compressed by the arcuate ligament at their origin. The clinical symptoms are postprandial pain and weight loss and the syndrome significantly restricts patients' quality of life. In rare cases, an epigastric bruit is detected on clinical examination. Laparoscopic division of the arcuate ligament is a successful option for the treatment of the coeliac artery compression syndrome. Indications: Laparoscopic decompression is indicated for patients with a symptom triad of postprandial pain, weight loss and epigastric bruit and radiologic confirmation of coeliac artery compression by duplex sonography, computed tomography angiography or magnetic resonance angiography. Procedure: The operative strategy is based on the division of the arcuate ligament following its visualisation above the origin of the coeliac artery from the abdominal aorta. Conclusion: The laparoscopic division of the arcuate ligament and the resection of the coeliac plexus are a largely uneventful, minimally-invasive option to treat the coeliac artery compression syndrome and restore patients' quality of life.
Asunto(s)
Arteria Celíaca/anomalías , Constricción Patológica/cirugía , Laparoscopía/métodos , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/cirugía , Angiografía por Tomografía Computarizada , Constricción Patológica/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Angiografía por Resonancia Magnética , Síndrome del Ligamento Arcuato Medio , Persona de Mediana Edad , Ultrasonografía Doppler DúplexRESUMEN
UNLABELLED: The persistent air leak is a common and sometimes difficult to manage complication after major pulmonary resections. Especially in cases with lung emphysema spontaneous sealing of the lung surface under conservative therapy can be prolonged or even fail and a reoperation to close the damaged visceral pleura might be necessary. An ideal surgical solution to deal with this problem is not known, all of the techniques have advantages but also limitations and additional operations should be avoided in this group of frail patients. In this paper a new surgical method to seal the lung surface is presented based on two exemplary cases and our clinical experience. Basically, two stripes of fleece bounded fibrin based sealant are put on the visceral pleura parallel to the wound, which will be then closed by multiple stitches of absorbable suture line inserted through the stripes. Afterwards, a second layer of the same sealant will be placed over it to cover the suture with a narrow overlapping in all directions to the adjacent visceral pleura (Sandwich-Technique). In our experience, this technique can be used to successfully prevent or treat persistent air leaks especially in patients with lung emphysema in whom otherwise treatment options are limited. ABBREVIATIONS: VATS = video-assisted thoracoscopic surgery POD = postoperative day LVRS = lung volume reduction surgery FEV1 = forced expiratory volume in the first second DLCO = diffusing capacity of the lung for carbon monoxide.
Asunto(s)
Adhesivo de Tejido de Fibrina/administración & dosificación , Neumonectomía/métodos , Enfisema Pulmonar/cirugía , Cirugía Torácica Asistida por Video/métodos , Adhesivos Tisulares/administración & dosificación , Adulto , Anciano , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del TratamientoRESUMEN
Laparoscopic colon and rectum operations expose peripheral nerves to risk due to extreme patient positions needed to achieve gravity displacement during the surgical procedures. The general incidence of position-caused nerve injuries in surgery is not well known and is estimated to be about 0.5â% in the literature. There are no current data concerning laparoscopic operations. This study assesses the incidence and outcome of surgery-associated neurological symptoms after laparoscopic colon and rectum surgical procedures. We analysed the number of position-caused nerve injuries and their outcome from 1992-2010 in a prospectively managed data base. Risk factors like age, BMI, procedure duration and abduction of the upper extremities were analysed. There were 19 (0.7â%) position-caused nerve injuries among 2698 laparoscopic operations on the colon and rectum. The incidence of surgery-associated neurological symptoms was 1.08â% after laparoscopic rectum and 0.54â% after laparoscopic colon surgical procedures. Both operation time (267 vs. 185 minutes) and BMI (27.93 vs. 25.79 kg/m(2)) were revealed as risk factors for position-caused nerve injuries. Adduction of the upper extremities reduced the incidence of positioning nerve injuries from 0.23â% to 0.1â%. Postoperative neurological symptoms were in most cases reversible (89.47â%). The incidence of postoperative nerve injuries since 2007 is low after laparoscopic rectum and colon operations and is mostly completely reversible. Both procedure duration and BMI are probable risk factors for surgery-associated nerve injuries. Adduction of the upper extremities provides an opportunity to reduce position-caused nerve injuries.