No abstract available.

No abstract available.
Child* ; Gallbladder* ; Humans

No abstract available.
Breast Neoplasms* ; Breast*

No abstract available.

INTRODUCTION: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation. PURPOSE: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH. METHODS: In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted. RESULTS: Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group (22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group). CONCLUSIONS: Early ambulation has important implication on reducing the incidence of urinary retention after anal surgery under spinal anesthesia, without causing PDPH.
Anesthesia, Spinal ; Bed Rest ; Bupivacaine ; Catheterization ; Catheters ; Cerebrospinal Fluid ; Early Ambulation* ; Headache ; Humans ; Incidence ; Meperidine ; Needles ; Pain, Postoperative ; Post-Dural Puncture Headache ; Prospective Studies ; Urinary Retention*

We report herein our surgical experience of Hartmann's procedure reversal using laparoscopic technique in a 72-year-old woman who underwent Hartmann's procedure for an obstructing sigmoid colon cancer 6 month earlier. The purposes of this report are to describe our technique of laparoscopic reversal of Hartmann's procedure, to introduce several technical tips in avoiding pitfalls, and to review its safty and efficacy. In brief, the colostomy was freed from the abdominal wall using a conventional technique, then a center rod and an anvil of a circular stapler were inserted into the colon. CO2 insufflation was performed through this insertion. Using a five-cannula technique, rectal stump was mobilized, then colorectal anastomosis was performed laparoscopically via a transanal stapled approach. The operating time was 130 minutes and blood loss was 50 ml. There were no intra- and postoperative complications. Up to now, with a 4-month follow-up period, the patient has been well without having any problems associated with this operation
Abdominal Wall ; Aged ; Colon ; Colostomy ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Laparoscopy ; Postoperative Complications ; Sigmoid Neoplasms

Laparoscopic colorectal surgery is rapidly gaining acceptance for the management of colorectal cancer. However, laparoscopic colorectal surgery is technically more challenging than conventional surgery. This challenge is more profound for laparoscopic rectal cancer, where there is a need to perform a total mesorectal excision (TME), in the confines of the pelvis, with the limitations of the laparoscopic system. The Da Vinci robotic surgical system was designed to overcome the pitfalls of laparoscopic surgery, hence the use of this novel system in colorectal surgery seems logical, in particular with regards to rectal cancer surgery. Recently, there have been an increasing number of reports in the literature on robotic colorectal surgery. The advantages of the robotic surgical system include; 7 degrees of movement, 3 dimensional views, tremor filtration, motion scaling and superior ergonomics. These advantages when applied to robotic TME for rectal cancer surgery may potentially translate to better outcomes. The aim of this review is to summarise the current evidence on clinical and oncological outcomes of robotic rectal cancer surgery.
Humans ; Rectal Neoplasms ; surgery ; Robotics ; Surgery, Computer-Assisted

No abstract available.
Humans ; Laparoscopy

PURPOSE: We assessed the feasibility and efficacy of a laparoscopic approach in surgically managing various conditions of the acute abdomen. METHODS: This report presents preliminary data from our ongoing prospective study. Sixty patients underwent a diagnostic or a therapeutic laparoscopy for acute or subacute abdominal conditions between July 1997 and September 1998. RESULTS: Conditions were classified into trauma (n=8), peritonitis (n=41), and obstruction (n=11). Trauma included 5 blunt (2 small bowel perforations, 1 spleen rupture, 2 mesenteric ruptures) and 3 stab injuries. Peritonitis included 23 duodenal ulcer perforations, 10 acute cholecytitis/empyema, 3 colon perforations, 1 tuberculous peritonitis, 1 ectopic pregnancy, 1 ruptured corpus luteum, 1 appendicitis, and 1 ruptured liver abscess. Obstruction included 5 intussusceptions (4 Children, 1 adult), 2 intestinal adhesions; and 4 congenital hypertropic pyloric stenoses. Among the 54 cases of therapeutic laparoscopy, 9 cases were converted during the procedure (conversion rate: 16.7%). There were 2 intraoperative (bowel perforation) and 4 postoperative (1 subphrenic abscess, 1 incomplete adhesiolysis, 1 port site hernia, 1 port-site seroma) complications. CONCLUSION: Our preliminary data may justify further clinical study to clarify the role of laparoscopy in managing acute or subacute abdominal conditions.
Abdomen, Acute* ; Appendicitis ; Child ; Colon ; Constriction, Pathologic ; Corpus Luteum ; Duodenal Ulcer ; Female ; Hernia ; Humans ; Intussusception ; Laparoscopy* ; Liver Abscess ; Peritonitis ; Peritonitis, Tuberculous ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Rupture ; Spleen ; Subphrenic Abscess

At present, laparoscopic colon resection for benign and early malignant lesions is quite acceptable because of fast recovery and minimal morbidity. Laparoscopic curative surgery for advanced colorectal cancer, however, remains controversial because long-term oncologic outcomes are yet unavailable from multicenter randomized trials. Very recently, a timely important randomized study, focusing on the long-term survival and recurrence, was published. It showed laparoscopic resection had low risks of tumor recurrence and cancer-related death compared with open resection, especially in patients with stage III disease. The important message in this paper is not just that the laparoscopic approach is better, but that it may be better when performed by experienced hands. In this review, oncologic issues of laparoscopic cancer resection will be discussed, then the current role of laparoscopy for benign colorectal diseases will be briefly described. Finally, the proven and potential advantages of laparoscopic colectomy over open colectomy will be discussed. This article clearly reviews the current status and future perspectives of laparoscopic surgery for both benign and malignant colorectal indications.
Colectomy* ; Colon ; Colorectal Neoplasms ; Hand ; Humans ; Laparoscopy ; Recurrence