BACKGROUND: Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery, yet performing better in some short-term variables. The technique, however, does not allow palpation of intra-abdominal organs and the liver in particular. This prospective study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver (L-IOUS) and compare its findings with pre-operative staging data. METHODS: In total 70 patients, 53 men and 17 women, who were recruited into the study, were indicated for primary laparoscopic resection for colorectal carcinoma, with laparoscopic intra-operative ulrasonographic examination of the liver (L-IOUS) being used during the initial part of the operation. Before surgery, all patients underwent abdominal and pelvic contrast CT examinations. Ultrasonographic examination of the liver was included. RESULTS: In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings. Furthermore, CT-positive metastases in three patients were not confirmed by L-IOUS. Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment, e.g. haemangioma in 5 vs 2 patients, focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients. CONCLUSION: Results of the presented prospective study substantiate the use of laparoscopic intra-operative ultrasound of the liver (L-IOUS) within the standard staging protocol, as this seems to appropriately supplement the results of the pre-operative staging. In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy.
- MeSH
- adenokarcinom chirurgie patologie MeSH
- dospělí MeSH
- játra ultrasonografie MeSH
- kolorektální nádory chirurgie patologie MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jater diagnóza sekundární MeSH
- peroperační péče MeSH
- počítačová rentgenová tomografie MeSH
- předoperační péče MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cieľ: Autori prezentujú výsledky laparoskopickej a otvorenej apendektómie u pacientov indikovaných k urgentnej operácii. Materiál a metóda: Do retrospektívnej štúdie boli vybraní 214 pacienti operovaní za 18 mesiacov (november 2004 – apríl 2006) na pracovisku autorov, u ktorých bola vykonaná urgentná apendektómia. Operovaní boli zaradení do dvoch základných skupín podľa zvoleného prístupu do brušnej dutiny – laparoskopicky vs. klasicky. V jednotlivých skupinách je hodnotená dĺžka operačného výkonu, histopatologický nález, peroperačné a pooperačné komplikácie, dĺžka operačného výkonu a trvanie pooperačnej hospitalizácie. V podskupine pacientov operovaných laparoskopicky je zvlášť hodnotená nutnosť konverzie v otvorenú operáciu. Výsledky: Z výsledkov vyplýva skrátenie doby hospitalizácie u laparoskopicky operovaných pacientov s histopatologicky pokročilým nálezom. U histopatologicky menej pokročilého nálezu sa výhody miniinvazívneho prístupu na dĺžku hospitalizácie stierajú. Záver: Pre všeobecné výhody laparoskopickej operácie je na pracovisku autorov laparoskopický prístup preferovaný ako metóda prvej voľby v liečbe akútnej apendicitídy.
Aim: The authors present results of laparoscopy versus open appendectomy in patients indicated for urgent procedures. Materials and Methods: 214 patients, who underwent urgent appendectomy during a 18-month period (November 2004 – April 2006) were included in the retrospective study. The subjects were assigned to two main study groups according to the chosen abdominal approach – laparoscopic versus classical method. Within the respective study groups, duration of the procedure, histopathological findings, peroperative and postoperative complications, duration of postoperative hospitalization were assessed. Furthermore, in the laparoscopic subgroup, requirement for conversion to open surgery is assessed. Results: The results proved that the laparoscoic approach reduced hospitalization period in patients with histopathologicaly advanced findings. The positive effect of miniinvasive methods on hospitalization duration is diminished in subjects with less advanced findings. Conclusion: Considering overall benefits of the laparoscopic procedures, the authors themselves prefer the laparoscopic method as the method of choice in management of acute appendicitis.
- MeSH
- apendektomie MeSH
- chirurgie operační metody MeSH
- laparoskopie metody MeSH
- lidé MeSH
- pooperační komplikace MeSH
- reoperace MeSH
- Check Tag
- lidé MeSH
