Health

What are the benefits and drawbacks of laparoscopic versus open inguinal hernia repair?  Attempts at laparoscopic inguinal hernia repair immediately followed the success of laparoscopic cholecystectomy. Initial studies demonstrating increased recurrence rates dampened this enthusiasm. The learning curve for surgeons to become proficient at laparoscopic inguinal hernia repair is significant.  More recent studies have demonstrated …

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What are the advantages of single incision laparoscopic cholecystectomy versus conventional four port laparoscopic cholecystectomy?  The principal advantage of SILS is satisfaction with the cosmetic result because of a reduced number of scars. Length of stay is not significantly decreased, nor is postoperative pain. Interestingly, a recent study concluded that although cosmetic result was preferred …

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When should an intraoperative cholangiogram be performed?  Selective versus routine IOC remains controversial. A critical review of the literature demonstrates that routine IOC trends toward a decrease in the incidence of bile duct injury, but does not reach statistical significance. IOC may also identify unsuspected common bile duct stones that can then be removed via …

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What is the critical view of safety in laparoscopic surgery?  When performing a laparoscopic cholecystectomy, it is imperative to achieve the critical view of safety before dividing any structures. Only two structures remain attached to the gallbladder when the critical view of safety is achieved: the cystic duct and the cystic artery. Additionally, the cystic …

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Key strategies for safe laparoscopic cholecystectomy Dissection of the infundibulum down toward the cystic duct Dissection from lateral to medial Adequate inferolateral traction to open the triangle of Calot Dissection to develop continuity both laterally and medially from the neck of the gallbladder onto the cystic duct Achievement of the “critical view of safety” before …

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What are the hemodynamic effects?  Intraabdominal hypertension greater than 15 mm Hg can result in significant changes in central hemodynamics and even more pronounced changes in splanchnic circulation. Mean arterial blood pressure and systemic peripheral resistance are increased (up to 35% and 160%, respectively) at operative levels of pneumoperitoneum (12 to 15 mm Hg), presumably …

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What are the respiratory effects of pneumoperitoneum (planned intraabdominal hypertension)?  Pneumoperitoneum alters respiratory mechanics. Intraabdominal hypertension results in elevation of the diaphragm, decreases in functional residual capacity and total lung volume, ventilation-perfusion inequalities, and atelectasis. Some patients may require increased peak inspiratory pressure to compensate for decreased respiratory compliance. No significant change occurs in arterial …

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