Gastric volvulus with a large bochdalek hernia in an adult successfully treated with emergency endoscopic reduction followed by elective laparoscopic mesh repair: A case study

We report a case of gastric volvulus with a large Bochdalek hernia successfully treated with emergency endoscopic reduction followed by elective laparoscopic mesh repair. The patient was a 71‐year‐old woman with no history of trauma. She was referred to our hospital because of nausea and vomiting after eating. Thoracic and abdominal CT showed gastric volvulus and a large Bochdalek hernia. The patient underwent emergency endoscopic reduction and elective laparoscopic surgery. The defect (10 × 12 cm) was reinforced with a Dual Mesh (expanded polytetrafluoroethylene) and fixed to the diaphragm with nonabsorbable sutures. The postoperative course was uneventful, and no complications or recurrence was found at the 2‐year follow‐up. The endoscopic reduction and elective laparoscopic procedure was performed successfully and resulted in significant clinical improvement in this case.     

Laparoscopic repair of a Bochdalek hernia in an adult woman

Bochdalek hernia (BH) is a congenital defect of the diaphragm that usually presents in the neonatal period with life threatening cardiorespiratory distress. It is rare for BH to remain silent until adulthood. A 51‐year‐old woman presented with progressive dyspnea and abdominal symptoms, but without a history of trauma. The diagnosis of BH was made based on chest X‐ray and CT. The hernia was repaired by the laparoscopic technique, and the patient made an uneventful recovery. This report validates the feasibility of laparoscopic repair of BH in an adult, which should be within the capability of an advanced laparoscopic surgeon.     

Delayed left traumatic diaphragmatic hernia repaired by laparoscopic surgery

A 77-year-old man injured himself when he fell heavily on the left side of his chest. He had massive subcutaneous emphysema, bleeding, and left hemopneumothorax. He also fractured his seventh through tenth ribs; a fragment of the ninth rib was displaced into the thoracic cavity. The severity of the damage and the patient's pain was assessed using the Abbreviated Injury Scale 1990 (1998 update) as level 3. He was treated with conservative therapy and discharged on the 16 days after the injury. However, the following day, he had acute upper abdominal pain, his blood pressure dropped to 40 s, and he was readmitted. A chest CT showed the transverse colon was prolapsed in the thoracic cavity. The patient was diagnosed as having a delayed traumatic diapharagmatic hernia. A laparoscopic repair was performed. The rupture was classified as a IIIb-type diaphragmatic injury according to the Japanese Association for the Surgery of Trauma's classification system. It is believed that a fragment of a fractured rib that had been displaced in the thoracic cavity ruptured the diaphragm sharply. Since traumatic diapharagmatic hernia rarely occurs, it is relatively difficult to diagnose at the first examination. This condition has a high mortality rate because of the associated injuries. Surgery is the only treatment, but it should only be considered after a second examination. Herein, I report my experience with a case of delayed diaphragmatic hernia repaired by laparoscopic surgery.     

Adult Bochdalek hernia following living donor left hepatectomy repaired by thoracoscopy-assisted surgery: A case report

Bochdalek hernia is a congenital diaphragmatic hernia (DH). Herein, we report a case of adult Bochdalek hernia following living donor hepatectomy repaired by thoracoscopy-assisted surgery. A 36-year-old man underwent living donor left hepatectomy. Four months later, the patient presented with acute epigastric pain. Computed tomography found the left-sided DH in which the stomach was incarcerated into the pleural cavity without ischemic changes. As endoscopic intervention was unsuccessful, the herniated stomach was repositioned by thoracoscopy-assisted surgery. The 3-cm hernia orifice was found to have a smooth edge with no hernia sac, suggesting Bochdalek hernia, and the defect was primarily closed. The patient was followed up for 20 months without hernia recurrence. This is the first presentation of a case of Bochdalek hernia following donor hepatectomy. In cases of early detected DH, primary repair via a transthoracic approach with thoracoscopy-assisted surgery is safe and feasible.     

Reduced-port surgery for right paraduodenal hernia in an adult patient: A case report and review of the literature

Paraduodenal hernia (PDH) is a congenital internal hernia caused by an abnormal rotation of the midgut during embryotic life; it is characterized as right- or left-sided according to the hernial sac location. Herein, we describe a case of a 30-year-old male patient who was preoperatively diagnosed with right PDH and underwent successful laparoscopic repair using reduced-port surgery (RPS). The patient presented with postprandial nausea, vomiting, and upper abdominal pain. Contrast-enhanced CT and an upper gastric series led to the preoperative diagnosis of right PDH associated with intestinal malrotation. Thereafter, laparoscopic repair using RPS was performed. After the small bowels were reduced from the hernial sac, the hernial orifice was opened widely and laterally. The postoperative course was uneventful. This is the first report of a successful laparoscopic surgery on right PDH using RPS.     

内镜切除术与腹腔镜切除术治疗非微小胃间质瘤的对比研究

目的 对比分析内镜下切除和腹腔镜手术切除非微小胃间质瘤（直径大于1 cm且小于5 cm）的疗效及安全性。方法 回顾性分析2012年1月－2017年12月在苏州大学附属第一医院和苏州大学附属张家港医院行内镜下切除和外科腹腔镜手术治疗、并经术后病理及免疫组化确诊为非微小胃间质瘤患者的临床资料。根据手术方式将患者分为内镜切除组和腹腔镜手术组,比较两组患者术后住院时间、并发症、治愈性切除率等。结果 内镜切除组术后进食时间、术后排气时间、住院时间较腹腔镜手术组短,住院费用较腹腔镜手术组少,两组患者比较,差异有统计学意义（均P < 0.05）。术后对所有患者进行随访,内镜切除组平均随访时间为32个月,有1例出现复发;腹腔镜手术组平均随访时间为35个月,有1例出现复发,1例出现转移,两组患者比较,差异无统计学意义（P > 0.05）。结论 内镜下切除直径大于1 cm且小于5 cm的非微小胃间质瘤,具有肿瘤切除率高、术后恢复快、并发症少等优势,且与腹腔镜手术相比,复发率无明显差异。     

腹腔镜与开腹手术治疗成人腹壁疝临床疗效及对白细胞介素-6和C反应蛋白水平影响的研究

目的比较腹腔镜与开腹手术治疗成人腹壁疝临床疗效及预后情况。方法选取2011年1月-2014年4月于该院接受手术治疗的129例成人腹壁疝患者作为研究对象,回顾性分析其临床资料,按照手术方式分为对照组62例和观察组67例。对照组患者行开腹疝修补术,观察组患者行腹腔镜疝修补术。比较对照组和观察组患者手术情况、术后并发症、炎性因子水平及复发率。结果所有患者均手术成功,与对照组相比,观察组患者术中出血量减少[(21.60±5.80)vs(61.60±10.30)ml]、术后疼痛时间、下床活动时间及住院时间缩短[(30.60±6.30)vs(45.20±7.40)h,(14.70±2.50)vs(20.80±4.60)h,(5.30±0.90)vs(8.70±1.30)d],组间比较差异均有统计学意义(均P0.05),而手术时间两组间比较差异无统计学意义[(75.50±11.60)vs(79.70±16.40)min,P0.05)]。术后观察组患者并发症总发生率低于对照组(14.9%vs 33.9%,P0.05)。术后24和48 h,观察组患者血清白细胞介素-6(IL-6)、C反应蛋白(CRP)等炎性因子水平较对照组降低,组间比较差异均有统计学意义(均P0.05)。随访2年,两组患者腹壁疝复发率差异无统计学意义(1.5%vs 6.5%,P0.05)。结论腹腔镜和开腹疝修补术均是成人腹壁疝的有效手术方式,但腹腔镜疝修补术创伤小,在降低术后并发症发生率、减轻手术带来的炎症损伤方面具有更明显的优势,临床上值得应用。     

Single‐incision laparoscopic totally extraperitoneal obturator hernia repair in a patient on antiplatelet therapy: A case report

An 83‐year‐old woman who complained of right lower limb discomfort was diagnosed with a right obturator hernia by CT scan. On examination, she had a soft and flat abdomen without signs of peritoneal irritation. The Howship–Romberg sign was present. She had a history of vasospastic angina and paroxysmal supraventricular tachycardia, and took aspirin and dipyridamole until she was admitted to the hospital. Exploratory laparoscopy identified a spontaneously reduced small bowel from the right obturator canal, but there were no signs of ischemic and necrotic bowel. The patient underwent SILS for totally extraperitoneal obturator hernia repair without a dissection balloon. The patient recovered without perioperative complications such as hemorrhage and thrombotic episodes. She remains well, and CT scans showed no signs of obturator hernia recurrence at the 7‐month follow‐up.     

An approach to the assessment and management of the laparoscopic adjustable gastric band patient in the emergency department

Objective: As the number of obese people in Australia continues to increase, laparoscopic adjustable gastric banding (LAGB) surgery will become increasingly common. It is important for practitioners involved in the care of such patients to be able to accurately diagnose, and initially manage, pathology relating to the LAGB. Methods: A retrospective review of 56 presentations in 41 patients with LAGB, who presented to the ED of a major tertiary hospital, was performed. Note was made of presenting symptoms, investigations undertaken, subsequent diagnosis, and initial and definitive management. Results and Discussion: The commonest presenting symptoms included abdominal pain, nausea, vomiting and dysphagia. The ultimate diagnosis was food bolus obstruction (18 presentations; 32.1%), port infection (11 presentations; 19.6%), band prolapse (9 presentations; 16.1%), band erosion (2 presentations; 3.6%) and subacute bowel obstruction (1 presentation; 1.8%). Food bolus obstruction was best diagnosed clinically. Plain abdominal X‐ray was useful to identify prolapse. Infection was best diagnosed with the combination of clinical picture and wound swab. CT scan was helpful when suspecting a deep source of infection. From these data, two algorithms were developed, which can be used as a clinical aide to help practitioners in diagnosing and treating such complications appropriately. Conclusion: It is important that health‐care professionals are aware of the common presentations of problems following LAGB and have a basic paradigm for initial care. The present study identifies the presenting picture of various complications that can arise postoperatively, and describes an approach to the assessment and management of the LAGB patient in the ED.     

经肛拖出式全腹腔镜直肠癌前切除在直肠癌患者中的临床价值

目的比较经肛拖出式全腹腔镜直肠癌前切除和腹腔镜辅助直肠癌前切除在直肠癌患者中的临床价值。方法 2012年1月-2014年1月前瞻性收集低位直肠癌患者120例,将患者随机分为研究组(n=60)和对照组(n=60)。研究组采用经肛拖出式全腹腔镜直肠癌前切除术治疗,对照组采用腹腔镜辅助直肠癌前切除术。主要观察指标为两组患者术中情况、术后并发症和术后恢复情况。结果与对照组比较,研究组手术时间明显缩短[(132.32±14.92)vs(154.73±17.65)min,P=0.000];术后引流量明显减少[(299.93±56.49)vs(365.24±68.94)ml,P=0.000)];胃肠功能恢复时间明显缩短[(57.42±5.84)vs(61.85±7.40)h,P=0.002];住院时间明显缩短[(12.54±2.76)vs(14.75±2.10)d,P=0.000]。两组患者术中出血量、淋巴结清扫数目、肺炎、下肢动静脉血管血栓、切口感染、吻合口瘘、肠梗阻、2年复发率和死亡率等差异均无统计学意义(P0.05)。结论经肛拖出式全腹腔镜直肠癌前切除术有助于加快患者术后恢复。     

腹腔镜胃癌手术与开腹手术对凝血功能的影响对比

目的：探讨腹腔镜胃癌手术对患者凝血功能的影响。方法选择71例胃癌患者为研究对象,按手术方式不同分为腹腔镜手术组（n＝34）和开腹手术组（n＝37）。分别于手术前、手术结束即刻以及术后24 h测定2组患者的D-二聚体（D-D）、纤维蛋白原（FIB）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）,并计算凝血酶原国际标准化值（INR）,观察2组患者凝血功能的变化。结果腹腔镜手术组和开腹手术组手术结束即刻及术后24 hAPTT、INR较术前无显著差异（P＞0．05）;术后24 h PT显著低于术前（P＜0．05）,但2组间无显著性差异（P＞0．05）;术后即刻及术后24 h 2组患者FIB以及D-D较术前均显著升高,且2组间差异有统计学意义（P＜0．05）。结论患者在进行腹腔镜胃癌手术及常规开腹手术后,血液均呈高凝状态,有术后发生血栓的风险,且腹腔镜胃癌手术对患者凝血功能的影响更为明显,应在围术期采取相应的预防措施。     

腹腔镜与传统开腹手术治疗小儿腹股沟疝的临床效果对比分析

目的 探讨腹腔镜与传统开腹手术治疗小儿腹股沟疝的效果差异.方法 回顾性选取2018年1月至2020年1月重庆市南川区人民医院收治的接受腹腔镜疝修补术治疗的54例腹股沟疝患儿作为腔镜组,同期采用传统开腹手术治疗的35例腹股沟疝患儿作为传统组.比较2组患儿的手术时间、手术出血量、切口大小、术后下地时间、住院时间、术后2、4...     

超声评估Ⅰ-gel喉罩对妇科腹腔镜手术患者胃内进气及术后转归的影响

目的:通过超声监测评估在妇科腹腔镜手术中应用Ⅰ-gel喉罩对患者胃内进气以及术后转归的影响。方法:选取全身麻醉下行妇科腹腔镜手术且手术时间不超过3 h的60例患者,年龄20~65岁,BMI<35 kg/m2,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级。根据手术中使用的通气工具将患者随机分为Ⅰ-gel喉罩组(Ⅰ组)和气管导管组(T组)。静脉推注咪达唑仑、舒芬太尼、依托咪酯、顺式阿曲库铵进行麻醉诱导,待意识消失后,容量控制下面罩通气120 s,按照分组分别插入喉罩或气管导管。记录基础值(T0)、插管/喉罩前(T1)、插管/喉罩时(T2)、手术结束(T3)、拔管/喉罩时(T4)的血流动力学参数(血压、心率),使用超声在麻醉诱导前(T5)、诱导后(T6)及手术结束(T7)时采集胃窦部横径、纵径计算其横截面积(cross sectional area,CSA)以及术后患者恶心、呕吐、咽痛、声嘶的发生率。结果:与Ⅰ组比较,T组在T2和T4时的SBP,DBP和HR均显著增加(P<0.05)。与T0时比较,两组SBP,DBP和HR均显著降低(P<0.05);与T1时比较,T组T2时SBP,DBP和HR明显增加(P<0.05);与T3时比较,T组T4时SBP,DBP和HR明显增加(P<0.05)。T组的胃窦CSA在手术结束时(T7)明显少于Ⅰ组(P<0.05)。与Ⅰ组比较,T组术后咽痛、声嘶的发生率明显增加(P<0.01)。结论:Ⅰ-gel喉罩的应用可能会导致少量气体进入胃内,但未引起返流误吸等严重并发症的发生,可以安全应用于妇科腹腔镜手术患者。     

后腹腔镜与开放手术行肾及肾上腺肿瘤切除临床对比研究

目的探讨经后腹腔镜行肾及肾上腺肿瘤切除术的临床疗效及安全性。方法回顾性分析2005年10月至2013年12月253例肾及肾上腺肿瘤切除术患者临床资料,其中后腹腔镜组125例,开放手术组128例,比较两组手术时间、术中出血量、术后疼痛强度、术后住院时间情况。结果后腹腔镜组122例手术获得成功,3例中转开放手术。后腹腔镜组手术时间、术中出血量、术后疼痛强度、术后住院时间与开放手术组比较差异均有统计学意义(P<0.05)。结论后腹腔镜手术治疗肾及肾上腺肿瘤具有创伤小、并发症少、术后恢复快、住院时间短等优势,疗效满意,安全性及应用价值高,值得在基层医院推广应用。     

自固定补片与生物补片对成人腹股沟疝腹腔镜术后炎症因子及并发症的影响

目的探讨自固定补片与生物补片对成人腹股沟疝(IH)腹腔镜术后炎症因子和并发症的影响。方法选取2017年1月-2019年9月该院收治的IH患者80例,随机分为对照组和观察组,每组各40例。对照组给予生物补片治疗,观察组给予自固定补片治疗。比较两组手术情况、术前与术后第1天外周血炎症因子水平[C-反应蛋白(CRP)、白细胞介素-10(IL-10)和白细胞介素-6(IL-6)]、术前与术后第1、7和15天视觉模拟评分(VAS)、术后6个月并发症和复发情况。结果观察组手术时间和术中出血量明显少于对照组,两组比较,差异有统计学意义(P 0.05);两组住院时间比较,差异无统计学意义(P 0.05)。术后第1天,观察组IL-6和CRP水平明显低于对照组,两组比较,差异有统计学意义(P 0.05);两组IL-10水平比较,差异无统计学意义(P 0.05)。观察组术后第1、7和15天VAS评分明显低于对照组,两组比较,差异有统计学意义(P 0.05)。两组术后6个月并发症发生率比较,差异无统计学意义(P 0.05),两组均无复发。结论与生物补片相比,腹腔镜术中使用自固定补片治疗成人IH可以减少术中出血量、缩短手术时间、减轻术后炎症反应,有效缓解疼痛,不增加并发症发生率和复发率,安全性较高。     

腹腔镜手术治疗子宫内膜癌的临床观察及癌组织中Bcl-2、Ki-67的表达

目的 观察腹腔镜手术治疗子宫内膜癌的临床疗效及癌组织中Bcl-2、Ki-67的表达.方法 将84例子宫内膜癌患者随机分为2组,腹腔镜组进行腹腔镜广泛子宫切除联合双附件切除术,开腹组进行腹式广泛子宫切除联合双附件切除术.结果 腹腔镜组术中出血量、肠道功能恢复时间及术后住院时间均显著少于开腹组,而手术时间较开腹组明显增加,差异均有统计学意义（P＜0.01）.腹腔镜组术后Bcl-2阳性表达率（51.1％）及术后以Ki-67为代表的细胞增殖指数PI[（28.09±15.60）％]与开腹组比较无显著差异（P＞0.05）.结论 腹腔镜手术治疗子宫内膜癌具有损伤小、术后恢复快等优点,但在常规手术时间内并不影响子宫内膜Bcl-2、Ki-67的表达.