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Biomedical subjects

M E Arregui

Publications and source records attributed to M E Arregui.

26 records · Page 2Linked to original sources
PubMed1992

Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report.

From October 1990 to December 1991, we performed 61 laparoscopic preperitoneal mesh repairs of inguinal hernias on 52 patients, including 22 direct, 38 indirect, and one femoral hernias. The laparoscopic technique employs the same principles as open preperitoneal mesh repair of replacing and reinforcing attenuated transversalis fascia. After entering the peritoneal cavity through the umbilicus, the preperitoneal space is entered by excising the hernia sac. The preperitoneal space is bluntly dissected and the transversalis fascia exposed. For a direct or recurrent hernia, the defect in the transversalis fascia is closed with a pursestring or running suture without tension. For an indirect hernia, the internal ring is tightened with an interrupted suture. Next a piece of mesh approximately 2.5 x 4.5 inches is trimmed to fit over the internal ring, the testicular vessels, and spermatic cord laterally, Hesselbach's triangle medially, and Cooper's ligament inferiorly, which covers potential sites for a new hernia or recurrence. The mesh (Prolene or Marlex) is then sutured with 3-0 vicryl to the transversalis fascia and transversus abdominis aponeurosis superior-medially, to the iliopubic tract or Cooper's ligament inferiorly, and to the transversalis fascia and transversus abdominis lateral to the internal inguinal ring. Upon completion of the tensionless repair, the peritoneum is reapproximated. Compared with the open procedure, laparoscopic repair reduces postoperative pain and shortens convalescence. No lifting restrictions are imposed on the patient. We have had three minor complications and no recurrences to date, but follow-up is too short to make firm conclusions.

Adolescent↗
PubMed1992

Laparoscopic cholecystectomy: the St. Vincent experience.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for the management of patients with symptomatic gallbladder disease. Since December 1989, a total of 622 patients have undergone laparoscopic gallbladder surgery. The operative technique we employ requires the insertion of only three laparoscopic cannulas and uses monopolar electrocautery to dissect the gallbladder from the liver bed. Average operating room time was 90.5 min. Twenty-six (4.2%) of the 622 patients required conversion to open laparotomy. A total of 24 (3.8%) operative complications occurred, including one common bile duct injury. Eight patients required readmission to the hospital. Eighteen percent of patients were discharged on the same day as the operative procedure, and overall average hospital stay was 1.8 days (range, 0 to 59 days).

Adolescent↗
PubMed1991

In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges.

The safety of laparoscopic cholecystectomy has been demonstrated through its increased use, and we have performed 114 of these operations as outpatient procedures. These patients have done well and hospitalization charges have been reduced substantially. Of 622 laparoscopic cholecystectomies performed from November 1989 to March 1991, 114 were done on an outpatient basis if the patients were generally healthy, lived nearby, and the operative procedure was uneventful. Other patients were admitted as 23-h observation or as inpatients. Records of 106 outpatients were reviewed and hospital charges obtained. These charges were then compared with those of 337 patients who underwent standard open cholecystectomy as morning admissions and who had no comorbid conditions nor complications. Comparisons are also made with 23-h observation and inpatient laparoscopic cholecystectomies as well as with all standard open cholecystectomy patients. The technique employed is with three punctures using electrocautery and a minimum of disposable products. Of the 106 outpatients, one required admission for postoperative ileus and pain control; 21 (19.8%) experienced nausea and 14 (13.2%) experienced vomiting but were treated successfully with antiemetics; none required admission. One patient required outpatient catheterization for urinary retention. Of the last 100 laparoscopic cholecystectomies performed by three surgeons (M.E.A., C.J.D., A.A.), 43 were performed as outpatients using the above selection criteria. 44 were held for 23-h observation, and 13 were inpatients. The average hospital charge for 377 uncomplicated morning-admitted inpatient standard cholecystectomy patients was $4,250.00, compared with $2,293.02 for 106 outpatient laparoscopic cholecystectomy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Role of laparoscopic ultrasound in cancer management.

Laparoscopic ultrasound (LUS) has become an important tool in the staging of hepatic, pancreatic, and gastrointestinal malignancies. It also plays an important role in the palliation and treatment of these malignancies. The use of laparoscopy and LUS in diagnosis, staging, palliation, and treatment of intra-abdominal malignancies is discussed, with a focus on the literature and our own experience.

Endosonography↗
PubMedDate not supplied

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis.

Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile duct stones; 19 patients had negative studies. Of the 17 patients with choledocholithiasis, 15 had successful cannulation of the common bile duct, and, of these, 10 underwent laparoscopic cholecystectomy plus endoscopic sphincterotomy and extraction of the common duct stone(s). In one high-risk elderly patient, we extracted the stone from the common duct and left the gallbladder in situ. Two patients failed endoscopic cannulation and underwent open cholecystectomy with common bile duct exploration. Four additional patients, cannulated successfully, had unsuccessful endoscopic stone removal because the stones were too large or were impacted. Two of these patients underwent open cholecystectomy and common duct exploration. The two other patients underwent laparoscopic cholecystectomy and choledochoscopy through the cystic duct with the flexible choledochoscope. An electrohydraulic lithotripsy probe was then inserted through the choledochoscope to fragment the stones, and stone fragments were allowed to pass through the previously created sphincterotomy. We believe our data, supported by data in the literature, show that these alternative methods for treating choledocholithiasis are safe and effective and should be considered primary modalities for treating this condition now that laparoscopic cholecystectomy is the treatment of choice for cholelithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Complications of laparoscopic herniorrhaphy.

Anterior inguinal hernia repair is the second-most-commonly performed abdominal operation and has been associated with low morbidity and mortality rates. The principle of laparoscopy has been applied to this surgical problem in a series of 762 patients with 841 inguinal hernias. Four types of laparoscopic repairs were conducted: (1) high ligation of the indirect inguinal hernia sac and closure of the internal ring (87 patients with 89 hernias); (2) plug and patch of the internal ring (74 patients with 87 hernias); (3) transperitoneal suture repair of the transversalis fascia to the iliopubic tract or Cooper's ligament (28 patients with 30 hernias); and (4) placement of a large prosthesis over the myopectoneal orifice (563 patients with 635 hernias). These early results indicate that the overall complication rates were low, especially when a large prosthesis was used to reinforce the myopectoneal orifice. It is concluded that laparoscopic inguinal herniorrhaphy is a safe and effective procedure with which to manage this surgical problem.

Hernia, Inguinal↗