Biomedical subjects
Publications and source records attributed to M A Machado.
We present a case report of laparoscopic splenectomy in two patients with congenital spherocytosis. A 23-year-old man and a 25-year-old woman with splenomegaly due to congenital spherocytosis underwent laparoscopic splenectomy. Their postoperative course was uncomplicated and they were discharged on the second and fourth postoperative day, respectively.
We present a case report of laparoscopic cholecystectomy in patient with Mirizzi's syndrome. A 48-year-old woman with symptomatic cholelithiasis underwent laparoscopic cholecystectomy. During the procedure we found an unexpected type I Mirizzi's syndrome. Meticulous dissection was needed to avoid injury to the biliary tract. The postoperative course was uncomplicated and she was discharged on the second postoperative day.
Laparoscopic cholecystectomy has recently become a popular alternative to traditional laparotomy and cholecystectomy in the management of patients with gallbladder disease. Elective surgical treatment of cholelithiasis in patients with sickle cell anemia has been followed by frequent postoperative complications. We present a case of elective laparoscopic cholecystectomy in a patient with sickle cell anemia followed by severe postoperative complications related to the hematological disease.
Laparoscopic cardiomyotomy has recently became a popular alternative to traditional laparotomy in the management of patients with nonadvanced achalasia. The laparoscopic approach for this disease is encouraging due to the low rate of complications associated with a shorter recovery period and reduced postoperative pain. This article describes an alternative technique in the laparoscopic treatment of achalasia with introduction of a supplementary 5 mm port in order to facilitate the cardiomyotomy and the construction of the valvuloplasty.
BACKGROUND/AIMS: Cicatricial biliary strictures are usually associated with high morbidity and mortality rates, frequently related to technical difficulties of their surgical repair, mainly in hilar lesions. Interference with bile duct blood supply during surgical attempts for correction is a major factor for unsuccessful results. The aim of this study is to evaluate, after an extended follow-up period, the results obtained with a modified technique for surgical correction of cicatricial biliary strictures. METHODOLOGY: The medical records of 57 patients surgically treated for cicatricial biliary strictures between January 1984 and July 1995 were reviewed and the immediate and long term results retrospectively analyzed. Patients consisted of 46 females and 11 males. The average age was 43 years. The etiology of the biliary lesion was: cholecystectomy alone (23); cholecystectomy with duct exploration (8); T tube CBD drainage (6); Biliary-enteric anastomosis stricture (16); choledochoplasty (2) and trauma (2). In 28 cases (49.1%) the stricture was located in the upper third of the bile duct, in 28 (49.1%) in the middle third and in one case (1.7%) it was low. All patients were submitted to longitudinal Roux-en-Y hepaticojejunostomy with mucosa apposition after dissection of the anterior aspect of the biliary tract. No transanastomotic stents were used. RESULTS: Ten patients (17.5%) presented 11 postoperative complications: biliary fistula (4), duodenal fistula (1), wound infection (5), and acute pancreatitis (1). Average hospital stay was 11 days and there were no postoperative mortalities. The follow-up study was possible in 54 patients and ranged from one to ten years, with an average of 2.9 years. Four patients of 28 (14%) with hilar lesions developed stricture recurrence and cholangitis episodes, whereas no patients bearing lesions below the biliary junction had such complications. CONCLUSION: Roux-en-Y hepaticojejunostomy with mucosa apposition without transanastomotic stent performed after minimal dissection of the biliary duct, thus avoiding major interference with the bile duct blood supply, is a safe and efficient method for the surgical repair of cicatricial biliary strictures. Using this technique excellent results can be obtained in the lesions below the biliary junction and acceptable results may be achieved in patients with hilar lesions.
Laparoscopic cholecystectomy has become a routine surgical procedure. Complications related to use of the laparoscope frequently result from insertion of a Veress needle or blind introduction of the primary cannula on its trocar. This risk is clearly higher in patients who have undergone previous surgical operations. Open insertion with visualisation of abdominal cavity before the introduction of the primary cannula reduces the risk of major vascular and visceral injury. Nevertheless, open laparoscopy has rarely been adopted mainly due to gas leak from the wound and because it is time-consuming. A simple, quick and effective technique is described. The authors experience with this technique in the last 500 cases has shown that it has no effect on the duration of operation, and does not involve a larger skin incision. This technique has been associated with no operative difficulty.