Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
Objective
To systematically review the efficacy and safety of totally laparoscopic total gastrectomy (TLTG) versus laparoscopic-assisted total gastrectomy (LATG) for patients with gastric cancer.
Methods
Databases including PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI were searched to collect cohort studies about TLTG vs. LATG for gastric cancer from inception to February 28th 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.
Results
A total of six cohort studies were included, of which 407 cases were in the TLTG group, and 315 cases were in the LATG group. The results of meta-analysis showed that compared with LATG group, patients in TLTG group had shorter operation time (MD=–8.97, 95%CI –16.21 to –1.73, P=0.02), and initial postoperative feeding time (MD=–0.30, 95%CI –0.57 to –0.03, P=0.03). However, the anastomic time, bleeding volume, the number of dissected lymph nodes, proximal resection margin, initial flatus time, postoperative hospital stay, overall postoperative complications, anastomotic fistula, and anastomotic stenosis were similar between two groups (all P values>0.05)．
Conclusions
Compared with LATG, TLTG has shorter operation and recovery time for patients with gastric cancer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the correlated risk factors of deep venous thrombosis (DVT) after the laparoscopic surgery. Methods Clinical records of 16 patients with DVT and 148 patients without DVT after laparoscopic surgery in Huashan hospital from Mar.2007 to Jan.2008 were analyzed retrospectively. Results There were several factors which could induce DVT after the laparoscopic surgery, including operation time ＞1 h 〔OR=4.15 （95% CI： 1.36-12.68）〕, operative site located in hypogastrium 〔OR=2.94 （95% CI： 1.07-8.08）〕 and the number of high risk factors ≥3 〔OR=3.94 （95% CI： 1.38-11.23）〕. Conclusions The long time of operation， hypogastric operation of laparoscopic surgery and high risk factors could induce DVT. Prevention measures should be made in preoperative period.
Objective To investigate the impact of laparoscopic versus. open hepatic resection for liver cancer on clinical rehabilitation and humoral immune function in patients organism. Methods Forty-four patients of laparoscopic and open left-lateral sectionectomy from January 2010 to June 2012 were selected， including 22 patients of laparoscopy group and 22 patients of conventional laparotomy group. The levels of IgG， IgA， IgM， C3， C4， C reactive protein （CRP）， IL-2， IL-6， and TNF-α in peripheral blood of patients on the last day before operation， first day and 5th day after operation were determinated by using ELISA assay. At the same time， the operative time， intraoperative bleeding， hospitalization time， and complications after operation between two groups were compared. Results The postoperative analgesic using time， first time eating， and hospitalization time in laparoscopic group were （1.9±0.8） days， （2.2±0.5） days， and （6.3±1.3） days， respectively， they were shorter than that in conventional laparotomy group （P＜0.05）. The operative time， intraoperative bleeding， complication rate， and mortality in two groups were not significant differences（P＞0.05） . Compared with before operation， the levels of C3， C4， IgA， IgG， IgM， and IL-2 on the first day after oper-ation in two groups were obviusly reduced， the levels of CRP， IL-6， and TNF-α on the first day after operation in two groups were significantly increased. The levels of C3， C4， lgA， IgG， lgM， and IL-2 on the first day after operation in conventional laparotomy group were significantly decreased than that in laparoscopic group （P＜0.05）. On the 5th day after operation， the levels of C3， C4， lgA， IgG， lgM， and IL-2 of laparoscopy group increased， the levels of CRP， IL-6，and TNF-α were reduced，that were no difference compared with before operation. Compared with before operation，the levels of C3， C4， lgA， IgG， lgM， and IL-2 of conventional laparotomy group were still at a low level state， and the levels of CRP， IL-6， and TNF-α were still at a high level state on the 5th day after operation. Conclusions Laparoscopic resection of liver cancer after operation， the patients’ recovery are quickly， and the impact on humoral immune function of laparoscopic radical resection for liver cancer patients is significantly less than that conventional laparotomy.
ObjectiveTo summarize the clinical experience on combination of laparoscopy, choledochoscopy, and duodenoscopy in treatment of cholecystolithiasis with small diameter of choledocholith during the same period via multiple approach.
MethodsThe clinical data of 71 cases of cholecystolithiasis with small diameter(The internal diameter of common bile duct was 4-8 mm)of choledocholith underwent laparoscopic cholecystectomy(LC)plus laparoscopic and endoscopic cholelithotomy plus laparoscopic and endoscopic sphincterotomy(LC+LEC+LEST)from February 2001 to December 2013 in this hospital were analyzed retrospectively. Firstly, the LC and common bile duct exploration was performed, then the ureteral catheter or zebra guide wire was inserted into the common bile duct and duodenum cavity through cystic duct or common bile duct incision. Under the guidance of ureteral catheter or zebra guide wire, the choledochoscope was inserted into the common bile duct and cholelithotomy was performed by stone net or electrohydraulic lithotripsy. Then, the duodenoscope was inserted into the papillary of duodenum, the papillary of duodenum was cut by the pin-headlike electro-knife along the ureteric catheter or zebra guide wire, choledocholith was removed with the reticulation of choledochoscopy and duodenoscopy.
ResultsLC+LEC+LEST was successfully performed on 71 cases of cholecystolithiasis with small diameter of choledocholith. The placement of a catheter via cystic incision was in 59 cases, via common bile duct incision was in 22 cases. The common bile duct stones of 64 patients were completely removed under the choledochoscope, of 12 patients were completely removed under the combination of choledochoscope and duodenoscope. No case was converted to laparotomy. The bile leakage occurred in 5 cases and cured by patent drainage. The slight pancreatitis occurred in one case after operation. There was no patient with residual stones, perforations of intestine and bile duct, hemorrhoea, severe pancreatitis, or death.
ConclusionIf patients are indicated, LC+LEC+LEST is safe and effective to remove the cholecystolithiasis with small diameter of choledocholith.
Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
Objective?To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia.?Methods?Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture.?Results?The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred.?Conclusion?The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
【Abstract】Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia. Methods From June 1995 to June 2005, 222 patients with hernia were treated with laparoscopy. Transabdominal preperitoneal hernia repair (TAPP) were performed in 166 patients. Totally extraperitoneal hernia repair(TEP) were performed in 25 patients. Closure of the internal orifice of hernia was performed in 21 patients. Furthermore, incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy. In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy. Results All cases were operated successfully. The span of operation reduration was 42.5 min 〔(10～180 min)〕. The average length of postoperative hospital stay were 4.6 days. There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
Objective To investigate the curative effect of peritoneal drainage tube fixation with titanium clamp in 210 patients during laparoscopic operations. Methods The clinical data of 210 patients with peritoneal drainage fixation via titanium clamp during laparoscopic operations in this hospital were analyzed retrospectively. Results In 210 patients, drainage tube placement lasted for 5-20 d with an average of 8.5 d. No complications such as drainage tube drifting, position changing or obstructed drainage occurred, and all the patients were successfully extubated. Conclusion During laparoscopic operations, the method that drainage tube fixed with titanium clamp is simple with reliable drainage results, affirmed curative efficacy and obviously decreased operative complications, which is worthy of clinical practice and generalization.
ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor.
MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared.
ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
