RESUMEN
At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today, the increased experience allows to apply this method in certain selected cases of small intestine obstruction. We realised a retrospective study, over a period of 7 and a half years (January 1997 - June 2004), regarding the patients admitted and treated in our department for small intestine obstruction, both by open surgery (88 cases) and by laparoscopic surgery (11 cases). We compared the preoperative characteristics of the two subgroups, highlighting the importance of a careful selection of the cases for the success of the laparoscopic approach. We analysed the postoperative evolution of these patients (return of bowel function, postoperative wound evolution, hospital stay, socioeconomic reintegration), which allowed us to draw the conclusion that some of the patients with obstruction of the small intestine may benefit from the advantages of the mini-invasive surgery.
Asunto(s)
Obstrucción Intestinal/cirugía , Intestino Delgado , Laparoscopía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Obesity is one of the biggest health problems nowadays with growing prevalence. Co morbidities and decreasing life-expectancy have imposed various treatments, of which surgery has the best efficiency. Bilio-pancreatic diversion modified with duodenal switch represents the procedure with both malabsorbtive and restrictive effects. This procedure has the best results in reducing excessive body mass and in maintaining this loss. Complexity of this procedure, early and late complications suggests that the main operative indication is for morbid obesity patients (body mass index BMI > 50 kg/mp). The procedure that we have done was a success in efficiency and in quality of life, but for conclusions is necessary more experience.
Asunto(s)
Desviación Biliopancreática/métodos , Duodeno/cirugía , Obesidad Mórbida/cirugía , Índice de Masa Corporal , Femenino , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Due to its overwhelming benefits, laparoscopic cholecystectomy represents the "gold standard" for the treatment of symptomatic gallbladder stones. Allowing us to quickly solve an easy to diagnose pathology (by ultrasonography), in some cases it may lead us to mis-diagnose some major intraabdominal pathology, perhaps by a superficial interpretation of our clinical examination and para-clinic investigation data. Studying the archives of our clinic from January 1995 up to December 2003, we found 15 cases of intraabdominal neoplasia diagnosed in the year that followed laparoscopic cholecystectomy: 7 colorectal cancers, 4 pancreatic cancers, 2 gastric carcinomas, one uterine and one adrenocortical malignancies. Among these, 6 cases were in an advanced stage--because of local invasion or distant metastases--without the possibility of radical, curative surgery. Only 4 of the 15 cholecystectomies were performed for acute cholecystitis. The average age was 56.3 years, under the age when such malignancies have the maximum incidence.
Asunto(s)
Neoplasias Abdominales/diagnóstico , Colecistectomía Laparoscópica , Errores Diagnósticos , Neoplasias de la Corteza Suprarrenal/diagnóstico , Adulto , Anciano , Neoplasias Colorrectales/diagnóstico , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Uterinas/diagnósticoRESUMEN
Intraoperative incidents of laparoscopic surgery resulting in cavitary viscera injuries are analyzed, based on a series of 6308 patients (6800 operations) operated during a period of 9 years. This retrospective study includes 11 cases: 6 intraoperative cavitary viscera perforations (esophagus, gastric fornix, ileum, sigmoid) have been recognized and solved in the same laparoscopic operation or after conversion. In 5 cases the diagnosis was established in the postoperative period as fistulas (urinary bladder) or diffuse peritonitis caused by various types of injuries (esophagus, small and large bowel) and required reoperations. We present a global view of these cases and also analyze the determinant causes of the complications, emphasize the importance of intraoperative identification of such injuries and specify the place of minimally invasive surgery in the treatment of such accidents with an optimum healing and low rate of postoperative morbidity and mortality.