Obesity as a factor in laparoscopic cholecystectomy.
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Acute Disease↗
Biomedical subjects
P K Raj
Publications and source records attributed to P K Raj.
Laparoscopic cholecystectomy: fundus-down approach.
BACKGROUND AND PURPOSE: Laparoscopic cholecystectomy (LC) is the primary treatment of gallstone disease. Although refinements have made it safer, bile duct injury remains more common than with the open approach. The major difference in these techniques is that open cholecystectomy approaches the gallbladder from the fundus downward, whereas conventional laparoscopic cholecystectomy proceeds in the reverse direction. A handful of fundus-down techniques appear in the literature. The use of special instruments or port sites is common. We present a technique that is safe and utilizes instruments familiar to the surgeon performing conventional LC. PATIENTS AND METHODS: Fifty consecutive LCs were included in the study. The variables monitored were age, comorbidities, postoperative diagnosis, pathologic diagnosis, length of operation, hospital length of stay, and complications. RESULTS: The average operating time for chronic cholecystitis was 1 hour, and the average time for acute cholecystitis was less than 2 hours. Except for one early case of bleeding, in which the procedure was completed using the familiar conventional method, no complications and no unusual technical difficulties were encountered. There were no differences between conventional and fundus-down LC with regard to time and complications. CONCLUSIONS: This technique is safe and has several benefits: (1) standard trocar sites that offer the surgeon flexibility in the approach; (2) the ability to resect as much cystic duct as desired; and (3) utilization of standard instruments familiar to the surgeon, thus avoiding costly special instruments. The approach may offer the benefit of reducing the rate of common bile duct injury to that of open cholecystectomy.
Bile Ducts↗
Laparoscopic management of pseudomyxoma peritonei secondary to adenocarcinoma of the appendix.
Pseudomyxoma peritonei is a rare disease in which the abdominal cavity fills with thick mucoid material secondary to either benign or malignant conditions. We discuss a case where pseudomyxoma peritonei secondary to adenocarcinoma of the appendix was diagnosed and managed laparoscopically. The laparoscopic approach allows thorough exploration of the abdomen, as well as irrigation and aspiration of the thick mucinous material using a 10-mm suction cannula and the instillation of mucolytic agents such as 5% dextrose solution. Appendectomy or right hemicolectomy can be performed with minimal disturbance of the anterior abdominal wall, thus minimizing future adhesions as well as possible tumor-cell implantation. Intraperitoneal catheters for chemotherapy can be placed easily through the port sites. These measures offer an alternative to radical peritoneal dissection and can be accomplished during the initial laparoscopic exploration.
Adenocarcinoma↗
An inexpensive laparoscopic specimen retrieval bag.
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Humans↗
Laparoscopic cholecystojejunostomy: a technical application in unresectable biliary obstruction.
Laparoscopic cholecystojejunostomy was accomplished utilizing an endoscopic gastrointestinal stapler in 2 patients with biliary obstruction and jaundice secondary to inoperable pancreatic carcinoma. This technique was performed on patients judged to be poor candidates for an open resection, due to medical conditions and associated comorbidities. The actual operating time, taking into account delays not related to the operation or technique, was 45-60 min. Both patients experienced immediate significant overall clinical improvement with minimal operative sequelae. The first patient was eating and ready for discharge in 4 days, and the second was prepared for discharge in less than 24 h. This operative procedure offers the patient excellent palliation with many advantages over traditional open surgery.
Aged↗
Intussusception of the appendix.
Two cases of intussusception of the appendix are reported--one caused by adenocarcinoma and adenomatous polyp and the other by an endometrioma. Appendiceal intussusception and adenocarcinoma are both uncommon entities and this is the first report of the two occurring concomitantly. Due to variable symptoms, the correct diagnosis of appendiceal intussusception has rarely been made preoperatively. Classification, symptoms, radiographic appearance, and differential diagnosis are discussed, and the authors suggest a new classification for intussusception of the appendix.
Adenocarcinoma↗