جستجوی مقالات مرتبط با کلیدواژه « لاپاراسکوپی » در نشریات گروه « پزشکی »

Laparoscopic cholecystectomy is one of the surgical procedures for cholecystectomy, which may be associated with difficulty and complications in people with high body mass index (BMI). In this study, we investigated the location of the portal infection following laparoscopic cholecystectomy and its association with BMI in hospitals affiliated with Babol University of Medical Sciences in 2012-2015.

In this cross-sectional analytical study, all patients who underwent laparoscopic cholecystectomy surgery (n=801) were included after obtaining informed consent. Demographic (e.g., gender, age, and BMI) and clinical (e.g., type of disease, number of gallstones, port site infection, and duration of surgery) information were evaluated.

Most patients were female (87%), with a mean age of 43.38 ± 14.23 years. The average BMI of the patients was reported as 31.72 ± 6.86 kg/m2; most of them were in the range of 30-39.9 (44.8%), and at least a few patients had a BMI greater than or equal to 40 (12.5%). The mean BMI of patients was 31.72 ± 6.86 kg/m2. The majority of patients had chronic cholecystitis (70.2%) and colic bilirubin (18.6%). The duration of surgery was 35.18 ± 10.59 minutes. Around 2% of the patients had an infection site of the port (1.2%), the cases of umbilical epigastric (0.5%), or both sites (0.2%). The BMI of patients with port umbilical infection was 41.48±3.45 and epigastric 30.38±5.87, and patients with port umbilical infection had significantly higher BMI than patients with epigastric infection (P<0.001). Individuals with a BMI higher than 30 were significantly more likely to have an umbilical portal infection (P<0.001).

According to the findings of this study, patients with an umbilical port site infection had a higher BMI.

Several studies show that prophylactic drains in simple laparoscopic cholecystectomy are unnecessary and even harmful. Considering that the drainage of the gallbladder bed after laparoscopic cholecystectomy can be free of complications, the aim of this study is to compare the effectiveness of prophylactic drainage in patients undergoing laparoscopic cholecystectomy and the effectiveness of subhepatic drain.

This prospective study was conducted in Al-Imamain Alkadhumian medical city during the period from first of January 2019 to the end of December 2020. During the study period, 61 adult patients undergoing elective cholecystectomy participated after written consent was taken from them. 31 of them received subhepatic drain and 30 patients did not. The level of pain and complications was compared in the two groups.

In the group that had a drain, the average pain scale was 16.5±0.9 degrees, and hospitalization after surgery was 2.1±0.6 days. They had subhepatic collection of 29.4±4.8 ml and 19.4% of patients had complications. However, people without drains had an average pain score of 2.3±1.1, hospitalization days of 0.633±0.61, subhepatic collection of 20.6±4.08 ml, and 33.3% of patients had complications. There was a positive and direct relationship between postoperative pain scale and drainage (p<0.05). In addition, the subhepatic collection of the first group was significantly different from the subhepatic collection of the second group (p<0.05). However, no statistically significant relationship was found between age and drain.

Based on the results of this study, routine drainage tube placement during laparoscopic cholecystectomy increases post-operative discomfort, hospital stay, and sub hepatic collection without reducing complications from operation.

Due to the prevalence of laparoscopic cholecystectomy, controlling common problems after this surgery is essential. This study aimed to determine the factors affecting pain after laparoscopic cholecystectomy.

In this cross-sectional study, 222 patients over 18 years old with symptomatic gallstones who underwent laparoscopic cholecystectomy from March 2021 to February 2022 in Mashhad Medical Sciences of Islamic Azad University Hospitals, were included. The amount of analgesic received after surgery was the same for all patients (Acetaminophen 1 gram intravenously every 8 hours and diclofenac 100 mg rectal every 8 hours). Demographic information of patients, body mass index, history of abdominal surgery, duration of surgery, carbon dioxide pressure, type of surgery (elective or emergency), number of surgical incisions, and pain intensity six and 24 hours after surgery (using a visual analog scale) were collected, and finally, the findings were statistically analyzed by SPSS version 26.

Out of 222 patients, 179 cases were women (80.6%), and their average age and body mass index were 44.68±12.27 years and 27.08±4.7 kg/m2, respectively. In our study, 110 people (49.5%) had a history of abdominal surgery, of which cesarean section was the most common delete. Pain six and 24 hours after the operation was more common in women than in men, and surgery with three incisions was more painful than surgery with four incisions (P<0.05). In patients with a history of surgery, the pain was greater in six hours after surgery (P<0.05). Pain 24 hours after the operation in patients with gas pressure less than or equal to 14mmHg was greater than in patients with gas pressure greater than 14 mmHg (P<0.05). Pain six and 24 hours after surgery according to age, body mass index, type of surgery (emergency or elective), and duration of surgery had no statistically significant difference (P>0.05).

In our study, female gender, use of three incisions for surgery, and history of previous surgery were associated with more pain after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a standard procedure for cholecystectomy, although there are fewer complications in this method, but complications such as intestinal and bile duct damage may result in lethal consequences. In this study, in order to identify and take appropriate measures to reduce these injuries during surgery, as well as timely diagnosis and treatment, it has been investigated the prevalence of intestinal injuries in patients who underwent surgery with this method.

In this cross-sectional study, 1223 patients underwent laparoscopic cholecystectomy in hospitals affiliated to Babol University of Medical Sciences in 2007-17. Demographic and clinical data were evaluated. The data was entered into the SPSS software version 23 and was analyzed with Fisher exact and t-test. The significance level was less than 0.05.

The majority of patients, 1051 (85.9%) were women. The age of 386 patients (31.6%) was over 50 years old. The majority of patients, 829 people, equivalent to 67.8%, had chronic cholecystitis. The average and standard deviation for the duration of surgery was 33.26±10.52 minutes and for the duration of hospitalization was 1.10±0.52 days. The prevalence of intestinal damage in patients was generally 0.6% (7 cases). There was a significant relationship between intestinal damage and age, longer hospitalization and longer surgical duration. Most of the patients with intestinal damage had previous history of abdominal surgery and intra-abdominal adhesion.

The prevalence of intestinal damage in patients with laparoscopic cholecystectomy was low and this damage was significantly associated with the age of the patients. The most common findings were intestinal injuries of the intra abdominal adhesions and the history of previous abdominal surgery. Therefore, it is recommended that surgeons should be more careful or patients should preferably undergo open cholecystectomy surgery in these cases.

In this study, the effect of intravenous dexamethasone on pain, nausea and vomiting after laparoscopic ovarian surgery was investigated.

This randomized clinical trial was conducted from June 2019 to March 2019 on patients undergoing laparoscopic ovarian cystectomy in Beheshti Hospital, Isfahan. In this study, 88 patients aged 18 to 45 years were included in the study. Patients were randomly divided into two groups receiving dexamethasone (D) and normal saline (S). Two minutes before induction of anesthesia, the first group received 8 mg (2 ml) of dexamethasone and the second group received normal saline (2 ml). The duration of surgery and stay in recovery, the frequency of pain and nausea and vomiting, the need for analgesic and anti-nausea drugs, and the cardiovascular response during the study were evaluated and recorded.

 No significant difference was seen in terms of demographic characteristics between the two groups (P>0.05). The frequency of pain during recovery (P=0.4) was not significantly different between the two groups, but at 2 hours (P=0.005), 12 hours (P<0.001) and 24 hours after the operation (P=0.005) (P=0) was significantly lower than S group. The frequency of nausea in group D during recovery (P=0.003), 2 hours later (P<0.001), and 12 hours (P=0.002) was significantly lower than group S, but 24 hours after the surgery, there was no significant difference between the two groups (P=0.15). During recovery, there was no vomiting in both groups (P=1), the frequency of vomiting in 2 hours (P=0.003), 12 hours (P<0.002) and 24 hours after the operation (P=0.48) in group D was lower than S. At the time of the study, the dose of diclofenac and metoclopramide received in group D patients was lower than group S. There was no significant difference in cardiovascular response between the two groups during the study (P>0.05).

Dexamethasone with a dose of 8 mg before induction of anesthesia can be effective in reducing pain, nausea and vomiting after laparoscopic ovarian surgery and reducing the need for analgesics and anti-nausea drugs.

Today, with the spread of the tendency to non-invasive methods, laparoscopic surgery has been used progressively and with acceptable results. The aim of this study was to investigate the effects of carbon dioxide insufflation on hemodynamic parameters in laparoscopic gynecological surgery.

This cross-sectional analytical study was performed on patients undergoing laparoscopic surgery in Al-Zahra Hospital during 2021. Hemodynamic parameters were recorded before the gas insufflation, after 5, 15, and 30 minutes and immediately and 15 minutes after the gas exsufflation, the data were entered into SPSS software version 19.

The trend of changes in hemodynamic parameters including mean SBP, DBP and HR from T0 to T5, was statistically significant which was ascending following gas insufflation and the highest mean SBP, DBP and HR were observed within 15 minutes after gas insufflation (P &lt; 0.0001). In addition, following the gas insufflation the trend of changes in ET-CO2 values and SaO2 was statistically significant (P &lt; 0.0001), No adverse events were reported in any of the patients.

According to the standard protocols of anesthesia and surgery in this center, laparoscopic surgery was associated with some degree of hemodynamic fluctuation including increased systolic blood pressure, diastolic blood pressure, heart rate and end-expiratory carbon dioxide which was well tolerated by our study population who were in good medical condition.

The simultaneous occurrence of ectopic pregnancy in both fallopian tubes and a live intrauterine fetus is very rare. The increase in the use of reproductive technology methods has caused an increase in the prevalence of this type of pregnancy. The aim of this study is to report a case of simultaneous occurrence of ectopic pregnancy in both fallopian tubes and live intrauterine fetus following the use of ovulation induction medications.

Case Report: 

The patient was a 29-year-old pregnant woman in her 7th week of pregnancy with a one-year history of infertility and the use of ovulation induction medications, with a transvaginal ultrasound report a week ago, live intrauterine pregnancy (6th week) and normal fallopian tubes, and complaints of vaginal bleeding. In repeated ultrasound, a live fetus was seen in the uterus (7 weeks and three days) and a live fetus in the left adnexa (7 weeks and three days), and the right adnexa was normal. The patient underwent laparoscopy. An incidental finding during surgery was the presence of ectopic pregnancy in both tubes. Left salpingectomy and right salpingostomy were performed and progesterone suppositories were prescribed to maintain intrauterine pregnancy. One week after the surgery, the fetus was observed without a heartbeat in the control ultrasound.

Based on the results of this report, the correct use of assisted reproductive methods, control of infertile patients under the supervision of infertility centers, and accurate ultrasounds due to the possibility of heterotopic pregnancy in high-risk patients are necessary.

A better understanding of the mechanism and / or pathophysiology of shoulder pain syndrome after laparoscopic gynecological surgery leads to an increase in the number of clinical trials to prevent this complication. Therefore, the present study was conducted with aim to define the mechanism and prevention methods of shoulder pain syndrome after laparoscopic gynecology surgeries.

In this narrative review study, to find the articles related to shoulder pain syndrome after laparoscopic gynecology surgeries, the published articles from 2000 including observational and clinical trials, descriptive and correlational studies were searched in the electronic databases of PubMed, Scopus, EMBASE, PEDro, Google Scholar, CINAHL , SID and Magiran with the keywords of shoulder pain syndrome, shoulder pain, surgery, laparoscopy, gynecology, postoperative and gynecology laparoscopy.

The main searched mechanisms included the pain mechanism, pain due to surgical incision, causes of shoulder pain syndrome after laparoscopic surgery in women, use of an alternative blowing gas to reduce shoulder pain syndrome, use of low pressure pneumoperitoneum to reduce the shoulder pain syndrome, gas-free laparoscopy and active gas excretion to reduce shoulder pain syndrome, use of heated or heated and humidified CO2 to reduce shoulder pain syndrome, use of sub-diaphragmatic intraperitoneal anesthesia or localized intraperitoneal anesthesia to reduce tip shoulder pain and use of pulmonary recurrence maneuvers in reducing shoulder pain syndrome.

Shoulder pain syndrome in laparoscopic gynecological surgeries can be minimized with preventive measures such as the use of hot and humid gas, intraperitoneal administration of local analgesics and pulmonary recovery maneuver.

Laparoscopic surgery has been developed recently. In this method, CO2 is insufflated in peritoneal space, rises intra-abdominal pressure, and causes hemodynamic changes. Capnography and non-invasive end-tidal CO2 (ETCO2) measurement are the most important and helpful monitoring methods.

In this semi-experimental study, 60 patients candidated for laparoscopic gynecological surgery were included. After induction of anesthesia by the same method, end-tidal CO2 monitoring was performed using capnography. Mean arterial pressure (MAP), and heart rate (HR) of the patients were measured in these intervals: Immediately after intratracheal intubation, before blowing CO2 into the abdominal cavity, immediately after blowing CO2 into the abdominal cavity, 10 minutes and 20 minutes after blowing gas into the abdominal cavity, 10 minutes after CO2 gas exits the abdominal cavity, and before extubation of the patient.

ETCO2, MAP, and HR in the 10th and 20th minutes after gas blowing, as well as before extubation were statistically higher compared to other times (P <0.05).

According to the present study, it was concluded that end-tidal CO2 changes during laparoscopic surgery are helpful in the early diagnosis of complications, and the highest increase in end-tidal CO2 and hemodynamic changes are evident in the 10th and 20th minutes after blowing CO2 into the abdominal cavity.

Controversy exists over the preferred surgical method for inguinal hernia repair between the open and laparoscopic methods. This clinical trial was performed to compare the rate of early complications and recurrence rates of inguinal hernia between laparoscopic (TAPP) and open methods (Lichtenstein).

In this clinical trial, 84 patients who were candidates for elective inguinal hernia repair at Imam Hossain Hospital were randomly divided into two groups: TAPP and Lichtenstein groups. Spinal anesthesia was used for both groups. Patients were followed for short-term complications (e.g. infection, seroma, hematoma, postoperative pain), hospitalization stays, and recurrence within the first year. Data were analyzed using SPSS software (version 16).

There were no significant differences between the two groups in terms of age and gender. Unfortunately, in the TAPP group, 23 patients (54.8%) received general anesthesia due to lack of co-operation, excessive abdominal wall stiffness, and failure of spinal anesthesia. We found shorter hospitalization stay (P <0.001), less postoperative pain in the first 24 hours (P <0.001), and longer operative time (P <0.001) in the TAPP group compared with those in the Lichtenstein group. There were no significant differences between the two groups in terms of infection and recurrence rates in the first year. Seroma was seen only in 16.7% of the patients in the Lichtenstein group (P <0.012). Pain intensity measured in the first 24 hours at three-time points (1, 8, and 24 hours) was lower in the TAPP group with spinal anesthesia than in the TAPP with GA and Lichtenstein groups (P <0.001).

The results of this study showed that TAPP with spinal anesthesia is associated with reduced postoperative pain in the first 24h, and irrespective of the  type of anesthesia TAPP is associated with lower risk of seroma formation

Introduction & Objective:

Laparoscopic cholecystectomy is known as the selective treatment of gallbladder disease. This new technique can also cause complications despite its advantages for the patient. The aim of this study was to investigate the relationship between the duration of preoperative pain with the type of pathology and symptoms in patients undergoing laparoscopic cholecystectomy in hospitals affiliated to Babol University of Medical Sciences during 2013-2017.

Materials & Methods:

This is a descriptive-analytical study. From the community of laparoscopic candidates for gallstones caused by gallstones who underwent surgery in the affiliated hospitals of Babol University of Medical Sciences during 2013-2017, 253 patients were selected by convenience sampling method. Demographic information of patients (age group, sex, BMI and education), type of pathology, duration of pain and clinical symptoms before, two weeks and 2 months after surgery were collected in the form of a checklist and data using SPSS 22 software and Kruskal-Wallis, Mann-Whitney and Chi-square tests were examined.

The mean age of the patients was 38.36±14.16 years and the less than 30 years (41.5%), female (78.3%) and overweight (45.1%). The difference between the mean duration of preoperative pain was significant based on the age group (P = 0.02) and the type of pathology (P &lt; 0.001) of the patient; the longest duration of pain was observed in the age group of 31 to 50 years and also in patients with chronic cholecystitis. After grading the duration of pain, the relationship between the duration of pain and the occurrence of classic pain during 2 weeks and 2 months after surgery was significant (P &lt; 0.001), while the relationship with other symptoms of the disease (Sourness, bloating and nausea and vomiting) were not significant (P &lt; 0.05).

According to the results of the present study, the most common complaint of the patient before laparoscopic cholecystectomy was pain, which was significantly reduced after surgery. Also, the duration of pain was longer in the 30-50 of people and in patients with chronic cholecystitis. Also, the duration of pain (graded) was not significantly associated with the symptoms of sourness, bloating, nausea and vomiting, but the presence of longer pain before surgery despite pain during the period of 2 weeks and 2 months after surgery was significantly associated.

Left Upper Quadrant (LUQ) cysts are often discovered by accident. Due to the lack of specific methods for the definitive diagnosis of premalignant lesions, the management of LUQ cysts is of great importance. In this regard, Awareness of differential diagnoses (such as adrenal and pancreatic cysts), the use of imaging techniques, and surgical indications are very important.

A 56-year-old woman with a history of the left adrenal cyst was referred to the Department of Surgery for LUQ pain after eating. Abdominal ultrasound and CT scan showed a 120 mm cystic lesion of the left adrenal gland. The patient was a candidate for laparoscopic surgery. During surgery and contrary to the initial diagnosis, a large cyst about 150 mm in the tail of the pancreas was detected by the involvement of the splenic vein and artery. Distal pancreatectomy and splenectomy were performed. Pathological examination revealed a mucinous tubulopapillary neoplasm with high-grade dysplasia along with an undifferentiated pancreatic carcinoma that was as small as 5 mm.

Current imaging techniques are not able to pinpoint the origin of large LUQ cysts, which can lead to errors in the management of malignant lesions of the pancreas or adrenal. Therefore, it seems that the use of the laparoscopic method not only has advantages such as less pain, reduced hospitalization period, and faster return to daily activities but also can help make the correct diagnosis during surgery and allow the surgeon to make the right decision.

Although laparoscopic cholecystectomy gains wide acceptance as a treatment of choice, but it is a controversial case of routine drain insertion after laparoscopic surgery. Therefore, the aim of this study was to evaluate the efficacy and outcome of drainage after laparoscopic cholecystectomy surgery in Babol University of Medical Sciences hospitals during 2014-2017.

A total of 219 patients candidate for cholecystectomy surgery were evaluated after meeting the inclusion criteria in hospitals affiliated to Babol University of Medical Sciences during 2014-2017. In this case-control study, patients undergoing laparoscopic cholecystectomy were enrolled with informed and available. The surgeon accidentally inserted a drain during surgery. The case and control groups were reviewed to gather the following different parameters: age, sex, BMI, length of stay, pain level, bile leak, abscess, bleeding, infection, and Hematoma.

In this study, 109 patients (49.8%) were received a drain and 110 patients (50.2%) were without drain. Of the 109 patients who were received drain, only 6 patients (5.5%) had suffered from drain site infection and 103 patients (94.5%) had no infection. Comparison of pain and complications of surgery revealed that there was no significant difference between cases of pain, bleeding and bile leakage in patients with and without drain. There was no statistically significant difference between the time of operation between patients with drain and without drain (P=0.35). However, the duration of hospitalization of patients with drain was significantly longer than patients without drain (P= 0.009).

The present study showed that the use of drain in patients undergoing laparoscopic cholecystectomy had no significant effect on prevention of bile leaks, bleeding and pain reduction.

Laparoscopic cholecystectomy is the treatment of choice for cholecystitis. The aim of this study was to evaluate the frequency of complications in patients referring to educational centers in Rasht.

In this descriptive cross-sectional study, the records of 132 patients referred to Poursina and Razi Hospitals of Rasht in 2006 were studied. Complications such as the need for open surgery, surgical site infection, and bile duct injury were evaluated in subsequent visits.

The subjects aged between 19 and 80 years with a mean of 14.65 ± 53.06 years. An open surgical procedure was reported in 8.2% of the subjects. Biliary duct injury and surgical site infections in patients undergoing laparoscopic cystectomy were estimated 4.1% and 8.2%, respectively. 2% of the subjects suffered from a surgical abscess. Vomiting and fever were reported in 16.3% and 8.2% of the cases, respectively. The mean age of the subjects with the surgical site infection was significantly higher than others. In addition, the open surgery rate in men was significantly higher in women.

Laparoscopic cholecystectomy is a safe and effective method with low complications and, as a standard method of cholecystectomy, in the conditions and facilities available in our country, has a high success rate.

Postoperative pain is an unpleasant experience. This process causes physiological disorders in all systems of the body. Clonidine as an alpha dual agonist is one of the drugs used to control pain after laparoscopic cholecystectomy. Therefore, this study was performed to evaluate the effect of oral clonidine on pain control and opioid use after laparoscopic cholecystectomy.

In this randomized double-blind clinical trial study, 50 patients with class I and II anesthesia underwent laparoscopic cholecystectomy. Patients were randomly divided into oral and control clonidine groups. Systolic and diastolic blood pressure, mean arterial pressure and intraoperative heart rate were recorded. Pain was measured in recovery, 6, 12 and 24 hours after surgery. Postoperative drug use was recorded in both groups. Data analysis was performed using SPSS software version 21 and using descriptive and inferential statistical tests.

The studied groups are similar in terms of demographic variables of age, weight, height, body mass index and gender. The results of chi-square test showed that there was a significant difference between clonidine and control groups in terms of pain at zero, 6 hours, 12 hours and 24 hours. (P<0.001). The results of chi-square test showed that there was a significant difference between the control and clonidine groups in receiving pethidine.

The results of the present study showed that oral clonidine is more effective in controlling pain intensity and drug use than the control group. Oral clonidine laparoscopic cholecystectomy surgery seems to be effective in controlling pain and postoperative drug use.

Percutaneous Nephrolithotomy (PCNL) in the ectopic pelvic kidney is highly challenging due to the presence of pelvic bone structures behind the kidneys and intestine loops in the anterior. Therefore, combining PCNL with laparoscopy will help prevent undesirable complications.

This case series was performed on eight patients with pelvic kidneys. Patients became candidates for PCNL, which was performed by an intra-abdominal laparoscopic guide, under fluoroscopic control. The best tract for access to the pyelocaliceal system was obtained and renal stones were completely crushed and removed. The stone clearance status was assessed with a plain X-ray and postoperative ultrasound.

The mean scores of maximum diameter of the stones, duration of the surgery, and hospitalization length were estimated at 23.5 mm, 114 min, and 3.3 days, respectively. There were no major complications during or after the surgery. All eight patients became stone-free and none of them needed to be readmitted.

Laparoscopic-assisted PCNL in ectopic pelvic kidneys is a safe and feasible technique with good results. This combined technique requires sufficient experience and expertise in both laparoscopic and endourologic fields since it has potential side effects of both methods.