AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless...AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless,surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients.A systematic review of Medline was embarked on,up to June 2013.Studies which provided outcome data on patients aged 65 years or older,subjected to laparoscopic or open cholecystectomy were considered.Mortality,morbidity,cardiac and pulmonary complications were the outcome measures of treatment effect.The methodological quality of selected studies was appraised using valid assessment tools.Τhe random-effects model was applied to synthesize outcome data.RESULTS:Out of a total of 337 records,thirteen articles(2 randomized and 11 observational studies)reporting on the outcome of 101559 patients(48195in the laparoscopic and 53364 in the open treatment group,respectively)were identified.Odds ratios(OR)were constantly in favor of laparoscopic surgery,in terms of mortality(1.0%vs 4.4%,OR=0.24,95%CI:0.17-0.35,P<0.00001),morbidity(11.5%vs 21.3%,OR=0.44,95%CI:0.33-0.59,P<0.00001),cardiac(0.6%vs 1.2%,OR=0.55,95%CI:0.38-0.80,P=0.002)and respiratory complications(2.8%vs 5.0%,OR=0.55,95%CI:0.51-0.60,P<0.00001).Critical analysis of solid study data,demonstrated a trend towards improved outcomes for the laparoscopic concept,when adjusted for age and co-morbid diseases.CONCLUSION:Further high-quality evidence is necessary to draw definite conclusions,although bestavailable evidence supports the selective use of laparoscopy in this patient population.展开更多
Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we int...Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.展开更多
AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosi...AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.展开更多
文摘AIM:To investigate the comparative effect of laparoscopic and open cholecystectomy in elderly patients.METHODS:Laparoscopic cholecystectomy has induced a revolution in the treatment of gallbladder disease.Nevertheless,surgeons have been reluctant to implement the concepts of minimally invasive surgery in older patients.A systematic review of Medline was embarked on,up to June 2013.Studies which provided outcome data on patients aged 65 years or older,subjected to laparoscopic or open cholecystectomy were considered.Mortality,morbidity,cardiac and pulmonary complications were the outcome measures of treatment effect.The methodological quality of selected studies was appraised using valid assessment tools.Τhe random-effects model was applied to synthesize outcome data.RESULTS:Out of a total of 337 records,thirteen articles(2 randomized and 11 observational studies)reporting on the outcome of 101559 patients(48195in the laparoscopic and 53364 in the open treatment group,respectively)were identified.Odds ratios(OR)were constantly in favor of laparoscopic surgery,in terms of mortality(1.0%vs 4.4%,OR=0.24,95%CI:0.17-0.35,P<0.00001),morbidity(11.5%vs 21.3%,OR=0.44,95%CI:0.33-0.59,P<0.00001),cardiac(0.6%vs 1.2%,OR=0.55,95%CI:0.38-0.80,P=0.002)and respiratory complications(2.8%vs 5.0%,OR=0.55,95%CI:0.51-0.60,P<0.00001).Critical analysis of solid study data,demonstrated a trend towards improved outcomes for the laparoscopic concept,when adjusted for age and co-morbid diseases.CONCLUSION:Further high-quality evidence is necessary to draw definite conclusions,although bestavailable evidence supports the selective use of laparoscopy in this patient population.
文摘Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.
基金Supported by Grant from the West China Hospital at Sichuan University
文摘AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.
