Navegando por Palavras-chave "cholecystectomy"

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    Monopolar Electrosurgery on the Extrahepatic Bile Ducts During Laparoscopic Cholecystectomy An Experimental Controlled Trial
    (Lippincott Williams & Wilkins, 2009-07-01) Portella, Antonio Olivio Valoria [UNIFESP]; Trindade, Manoel Roberto Maciel [UNIFESP]; Dias, Luciano Zogbi; Goldenberg, Saul [UNIFESP]; Trindade, Eduardo Neubarth; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Sul
    Introduction: The purpose of this study is to investigate the occurrence of thermal injury in the extrahepatic bile ducts when monopolar electrosurgery is used to perform dieresis of the cystic duct and cystic vessels in laparoscopic cholecystectomy.Methods: Female pigs (n = 40) of the Large White breed were separated into 2 groups of 20 animals. In the experimental groups dieresis of the cystic duct and cystic vessels was performed with monopolar electrosurgery using a hook-like dissector using a power setting of 20 W, whereas in the control group this procedure was performed with a pair of Metzenbaum scissors disconnected from any kind of thermal energy Source. Occurrence of distal thermal injury was evaluated on 2 occasions, on the 3rd and 28th days postoperatively. It consisted of exploratory laparotomy, cholangiography and both macroscopic and microscopic examination of the surgical specimen, which included cystic duct slump, hepatic duct and choledochus.Results: The presence of distal thermal injury, classified as second degree, 1.2 mm in the portion near the clipping area, was observed in only one of the cystic duct Stumps after microscopic examination. Without statistical significance. No thermal injury was observed it) the extrahepatic bile ducts.Conclusions: Monopolar electrosurgery produced negligible thermal injury in the extrahepatic bile ducts after laparoscopic cholecystectomy.
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    Trombose mesentérica como complicação da colecistectomia videolaparoscópica
    (Colégio Brasileiro de Cirurgiões, 1998-08-01) Figueira, Antonio [UNIFESP]; Apodaca-Torrez, Franz Robert [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; Triviño, Tarcisio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16 mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during penumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it.