Relaparoscopy

BACKGROUND: Overweight and obesity are the most significant risk factors for the development of hepatic steatosis, non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) in children and adults. Both have been increasingly implicated in the genesis of hepatic fibrosis and cirrhosis. However, no consensus exists about whether weight reduction may reverse this process. METHODS: To assess the effect of obesity surgery on the histological evolution of NASH, diagnosed in 284 morbidly obese patients by routine liver biopsy ('first' biopsy) performed during bariatric surgery, we performed a 'second' biopsy after 18...

PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is the preferable method to provide enteral nutrition for a longer time period. Safe placement of a PEG tube requires passage of the esophagus and transillumination of the stomach through the abdominal wall. Surgical placement of a PEG tube has been shown to be feasible although the local complication rate ranges above the endoscopic procedure. We are presenting a new technique (percutaneous laparoscopically assisted gastrostomy, PLAG) to provide enteral access for patients with pharyngoesophageal obstruction not suitable for PEG placement...

We report a rare drain-related complication leading to small bowel obstruction after laparoscopic colectomy. An 82-year-old man developed small bowel obstruction on the second day after laparoscopic anterior resection. Emergency relaparoscopy found herniation of the small bowel mesentery into the side holes of the silicon intraabdominal drain, which led to a 90-degree acute turn of the small bowel and mechanical obstruction. The herniation was reduced, and the drain was removed laparoscopically.

This article discusses various indications for reoperation and how employing laparoscopy at primary operation might affect the incidence, presentation, and treatment of common complications. The abdomen is likely to be far less hostile after laparoscopic surgery than after laparotomy. Adhesions to the anterior abdominal wall are minimal or absent. As a result, relaparoscopy is a reasonable diagnostic and often successful treatment modality in patients suspected of having intra-abdominal complications following laparoscopic operation...

PURPOSE: Laparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh; WL Gore, Flagstaff, AZ, USA). METHODS: The medical records of all 695 patients who had LVIHR at our hospital were reviewed. Patients who underwent SAO for various indications were identified (n = 72) and analyzed...

BACKGROUND/AIMS: Laparoscopic hepatectomy (LH) has gained increased acceptance for the treatment of selected hepatocellular carcinoma (HCC). The technical consideration and long-term follow-up data of LH for hepatocellular carcinoma are limited. The current study presents the experience of 17 LH for HCC with a mean follow-up of 23 months. METHODOLOGY: From April 2003 to December 2005, we successfully performed 17 LH for patients with HCC. Patient demographics, peri-operative parameters and outcomes of the 17 patients were assessed retrospectively...

BACKGROUND AND METHODS: The aim of this study was the evaluation of the management of cholecysto- and choledocholithiasis and outcome of -laparoscopic as well as open cholecystectomy (CHE) and common bile duct (CBD) exploration in Bavaria, Germany. A written questionnaire -in-cluding 201 structured items was sent to all 180 hospitals and departments performing gen-eral or abdominal surgery in Bavaria. RESULTS: The response rate was 60 %. A total of 16 615 operations for gallstone disease including 16 051 cholecystectomies and 453 CBD explo-ra-tions with or without cholecystectomy were -reported...

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BACKGROUND: We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair. CASE REPORT: We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac...

Laparoscopic approach to rectal cancer is technically challenging even for experienced laparoscopic surgeons. Therefore, in a locally recurrent rectal cancer not many surgeons would be keen to adopt the relaparoscopy approach. In this video article, we present a case of salvage laparoscopic abdominoperineal resection performed for an isolated anastomotic recurrence developed 13 months after a laparoscopic ultralow anterior resection.

BACKGROUND: There is no unequivocal attitude to a laparoscopy as to the means in the diagnosis and treatment of postoperative surgical complications. Our study sought to determine the role of laparoscopy in the management of suspected postoperative complications. METHODS: We performed a retrospective review of the patients who underwent laparoscopy for complications of previous surgery over a 6-year period. RESULTS: Sixty-four patients underwent laparoscopy for complications during the study period including 49 laparoscopies, 14 laparotomies, and 1 endoscopic procedure...

BACKGROUND: Diagnosis of complications after laparoscopic surgery is difficult and sometimes late. METHODS: We compared the outcome of patients who had early (<48 h) relaparoscopy for suspected postoperative complication to those where relaparoscopy was delayed (>48 h). RESULTS: During the study period, 7726 patients underwent laparoscopic surgery on our service. Of these, 57 (0.7%) patients had relaparoscopy for suspected complication...

An analysis of experiences with endovideosurgical sanation of the abdominal cavity was analyzed in 168 patients with diffuse peritonitis which complicated the course of different acute diseases. Relaparoscopy might be programmed and "on request". Programmed laparoscopy allowed adequate sanation of the abdominal cavity in most cases. It was impossible in 11.3% of cases associated with a pronounced commissural process and uncared peritonitis with formed pyogenic abscesses in the abdominal cavity. The indications and contraindications to laparoscopic sanation of the abdominal cavity are described...

INTRODUCTION: In recent years prosthetic cruroplasty with PTFE has been advocated as the optimal way to reduce hernia recurrence when repairing large hiatal hernia. However, we have found in our series a significant incidence of rejection and mesh erosion. MATERIALS AND METHODS: Standard, tension-free ePTFE hiatal hernia repair was performed in 15 patients with large hiatal hernia. Three of these patients subsequently went on to develop complications with the mesh...

BACKGROUND: Biliary injuries during laparoscopic cholecystectomy (LC) are complications better avoided than treated. These injuries cause long-lasting morbidity and can be fatal. The authors present their experience with biliary injury in LC during a period exceeding 13 years. METHODS: Between January 1992 and December 2005, 13,305 LCs were performed at the authors' institution. The biliary injuries in these cases were recorded and analyzed retrospectively. RESULTS: A total of 52 biliary injuries were identified in 13,305 LCs, for an overall incidence of 0...

Some patients who have undergone laparoscopic repair of ventral and incisional hernia have persistent postoperative pain, assumed to be caused by the presence of transabdominal sutures (TAS). We investigated whether removal of these sutures relieves discomfort. Of 375 patients who underwent laparoscopic repair of ventral and incisional hernia, 6 patients (1.6%) had persistent pain resistant to conservative therapy. These patients underwent relaparoscopy and removal of TAS at all apparent pain sites. Postoperatively, 3 patients had complete pain relief...

Diagnostic and therapeutic laparoscopy for acute abdomen has been widely reported in the literature. Diagnostic laparoscopy has an accuracy of 99.08% and 1% morbidity. The usefulness of relaparoscopy in acute abdomen has also been reported. We describe a patient with acute abdominal pain who underwent diagnostic laparoscopy. Ischemic segment of small bowel was found and it was decided not to resect but to go in for a second look 48h later. Relaparoscopy revealed the ischemic segment to regain vascularity, so nothing further was done...

OBJECTIVES: A considerable percentage of morbidity and mortality after esophagectomy and gastric pull-up is due to leakage of the esophagogastrostomy, which is mainly caused by ischemia of the gastric fundus. Previous clinical studies demonstrated that impaired microcirculation of the gastric conduit almost recovers within the first 5 postoperative days. Therefore, this study was designed to improve gastric perfusion by laparoscopic ischemic conditioning of the stomach. METHODS: The study group consisted of 83 patients with 44 esophageal adenocarcinomas and 39 squamous cell carcinomas...

Overall 3457 laparoscopic procedures after open and laparoscopic abdominal operations have been performed including 270 relaparoscopies due to intraabdominal postoperative complications. Basing on their own experience, the authors give methodological and technological recommendations allowing to increase diagnostic and surgical efficacy of relaparoscopy and to reduce the rate of complications.

In the field of visceral surgery, complications requiring reintervention following laparoscopy are currently most likely to be approached with conventional laparotomy. However, relaparoscopy has the theoretical advantage of maintaining the reduced morbidity allowed by the first procedure. Essential to the success of relaparoscopy is a clear understanding of the various specific complications. Should the surgeon decide on relaparoscopy, then prompt action is of central importance. Following laparoscopic cholecystectomy, it is fundamentally technically possible through renewed laparoscopy to treat not only subhepatic abscesses but also smaller lesions of the bile duct, for example from the gall bladder fossa...