PubMed Health⌕ Search

Biomedical subjects

V L Vallina

Publications and source records attributed to V L Vallina.

8 recordsLinked to original sources
PubMed1998

Postlaparoscopic small bowel obstruction. Rethinking its management.

BACKGROUND: Patients with early postoperative small bowel obstruction (SBO) are usually managed nonoperatively with nasogastric suction, intravenous fluids, and observation. The majority of early postoperative SBO resolve without an operation. METHODS: We performed a retrospective review of patients who had been diagnosed with postlaparoscopic SBO at three Chicago area teaching hospitals. RESULTS: The patients were initially managed nonoperatively for up to 7 days. However, all of them subsequently required an operation. In every case, the postlaparoscopic SBO was caused by the small bowel being incarcerated in a peritoneal defect created either by trocar placement or peritoneal incision for herniorrhaphy. CONCLUSION: In contradistinction to the approach used for early SBO after laparotomy, prompt operative intervention for postlaparoscopic SBO is recommended.

Adult↗
PubMed1998

Laparoscopic herniorrhaphy in the geriatric population.

Laparoscopy has brought controversy to herniorrhaphy, particularly in the elderly. We reviewed our experience with this technique in patients older than 65 years at a single teaching institution. Data include demographics, American Society of Anesthesiologists (ASA) class, operative time, hernia type, type of repair, hospital stay, and complications. A telephone questionnaire was used to assess return to normal activity, recurrence, and reason for choosing the laparoscopic approach. From March 1992 through March 1996, 110 of 328 patients were eligible. Mean age was 73 +/- 5.6 years; 34 patients had bilateral and 20 had recurrent hernias; 73 patients (66.4%) were ASA-2, and 22 (20%) were ASA-3. The extra-abdominal and transabdominal preperitoneal approaches were used in 64 and 46 patients, respectively; mean operative time was 87.9 +/- 34 minutes. The overall complication rate was 15 per cent, with 71 per cent of these being urinary retention. Patients were discharged the same day (59%) and at 1 day (33%). Follow-up was available in 84.5 per cent. Recurrence rate was 9.7 per cent, which was not significantly influenced by complication rate, hernia repair type, or ASA class. Median return to normal activity was 7 days. ASA classification correlated with hospital stay (P = .02), but not with complications, recurrence, or return to normal activities (P = not significant). Laparoscopic herniorrhaphy appears safe in the elderly.

Aged↗
PubMed1996

The influence of laparoscopy on lymphocyte subpopulations in the surgical patient.

BACKGROUND: Surgical stress is known to disturb the immune system so that the overall picture is one of generalized immunosuppression proportional to the degree of stress. It has been suggested that minimally invasive procedures, i.e., laparoscopic cholecystectomy, should be accompanied by decreased surgical stress. METHODS: The present study utilized a panel of monoclonal antibodies to identify peripheral blood lymphocyte subpopulations in 11 patients scheduled for elective laparoscopic cholecystectomy. These were obtained immediately preoperatively, one day postoperatively, and one week postoperatively. RESULTS: The results demonstrated a significant (p < 0.05) decrease in T-helper to T-suppressor cell ratios the first day postoperatively compared to the preoperative ratios; the mean decrease was 13% below the preoperative ratios. There was no significant change in the ratios one week postoperatively. CONCLUSIONS: Even though laparoscopic cholecystectomy has been documented to have less disability and postoperative pain than open cholecystectomy, alterations in immune function, although attenuated, do persist.

Adult↗
PubMed1996

Preperitoneal bilateral inguinal herniorrhaphy evolution of a technique from conventional to laparoscopic.

BACKGROUND: Simultaneous repair of bilateral inguinal hernia remains controversial. METHODS: Seventy-two consecutive patients underwent a preperitoneal prosthetic repair of bilateral groin hernia; 25 via laparoscopy. ASA classification, Nyhus type, hospitalization, convalescence time, and cost were examined. Mean follow-up was 36 and 12 months for the conventional and laparoscopic group respectively. RESULTS: Sixty-nine patients were available for long-term follow-up. Average hospital stay, recurrence rate, perioperative urinary retention, transient thigh neuralgia, and return to normal activities were 48 hours, 5%, 9%, 6%, and 22 days as compared to 4 hours, 6%, 20%, 12%, and 9 days for the conventional and laparoscopic group respectively. The cost for laparoscopic repair was $500 greater. CONCLUSIONS: The preperitoneal approach to repair of bilateral hernias demonstrates an acceptable recurrence rate with low long-term morbidity. Experience with conventional preperitoneal technique greatly facilitates transition to laparoscopic repair.

Costs and Cost Analysis↗
PubMed1994

A technique for laparoscopic retraction of the acutely inflamed thick-walled gallbladder.

Utilizing the described technique, we have been able to obtain adequate cephalad retraction of the acutely inflamed, tense, and thick-walled gallbladder with minimal trauma. This has made it possible to more adequately identify key anatomical landmarks and to more safely perform the dissection in this area. We believe that the benefits of a shorter hospital stay, decreased postoperative pain, and earlier return to normal activity that patients realize when having an elective laparoscopic cholecystectomy for chronic cholecystitis can be made available as well to more patients presenting with acute cholecystitis.

Acute Disease↗
PubMed1994

Laparoscopic cholecystectomy in acute cholecystitis.

Between January 1991 and December 1992, 220 patients underwent laparoscopic cholecystectomy and were monitored prospectively. Twenty-seven patients (12.3%) had acute cholecystitis, according to strict clinical and pathologic criteria. Their average age was 60.4 years. The average operative time was 121 min. Two of the 27 patients (7.4%) required conversion to open laparotomy. The postoperative morbidity rate was 11%. The average hospital stay was 1.9 days. This series provides further evidence that laparoscopic cholecystectomy can be used safely and effectively to treat acute cholecystitis when performed by experienced surgeons.

Acute Disease↗
PubMed1993

Laparoscopic versus conventional appendectomy.

OBJECTIVE: The goal of this study was to prospectively define the impact of laparoscopy on the management of patients with a presumed diagnosis of appendicitis. SUMMARY BACKGROUND DATA: While the role of laparoscopy in the management of cholelithiasis is well established, its impact on the management of acute appendicitis needs to be objectively defined and compared to that of conventional management. Several authors have predicted that laparoscopic appendectomy will become the preferred treatment for appendicitis. METHODS: Two groups of consecutive patients with similar clinical characteristics of acute appendicitis were compared. Data on the laparoscopic group were compiled prospectively on standardized forms; data on the conventional group were collected retrospectively. Operative time, hospital stay, analgesia, cost, and return to normal activities were noted. RESULTS: Seventeen consecutive patients who underwent appendectomy were compared to 18 consecutive patients who underwent laparoscopy (16 of these 18 had laparoscopic appendectomy). There was no significant difference between the two groups in terms of clinical characteristics and appendiceal histopathology. The mean operative times were 61 +/- 4.1 minutes and 46 +/- 2.9 minutes for the laparoscopy and conventional groups, respectively (p < 0.01). Hospital stay was significantly shorter in the laparoscopic appendectomy group, with 81% of patients being discharged on their first postoperative day (p < 0.001). The laparoscopic appendectomy patients required significantly less narcotic analgesia (p < 0.02). Return to normal activity was not significantly different between the two groups. The average total cost of laparoscopic appendectomy was 30% greater than that of conventional appendectomy. CONCLUSIONS: Laparoscopy is a useful adjunct to the management of patients with a presumed clinical diagnosis of acute appendicitis.

Acute Disease↗