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Laparoscopic Management of Symptomatic Renal Cysts

Author: Saad D. Farhan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 163-168
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Simple renal cysts are common, with incidence increasing with age. Symptomatic renal cysts have traditionally been initially treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.Open surgical cyst decortication for pain relief through a flank or chevron incision is associated with considerable morbidity and protracted convalescence.OBJECTIVE:To assess the efficacy of laparoscopic Surgery in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population.METHODS:From April 2007 to July2009 ,11patients (7 males and 4 females) underwent laparoscopic decortications of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan.RESULTS:Of the 11 procedures were completed laparoscopically , the mean operative time was 100 minutes (range 80 to 120). Symptomatic and radiographic success was achieved in 90.9% of patients, with a median follow-up of 12 months (range 6 to 18).CONCLUSION:Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.


Article
EVALUATION OF PRE-OPERATIVE ULTRASOUND FINDINGS IN PREDICTING DIFFICULTIES IN LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS

Author: Ali J Awad علي جليل عواد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 1 Pages: 59-66
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications.Objectives:To study the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to open cholecystectomy.Methods:A prospective study of 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. Pre-operative abdominal ultrasound was done. The diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings.Results:In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22(61.1%) of them. Thick wall gall bladder > 4mm has the highest sensitivity (69%) and the presence of pericholecystic fluid has the highest specificity (100%) in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of (100%). Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings (4.3%) and (1.2%) respectively.Conclusion:Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy.Keywords:Laparoscopic surgery, Cholecystectomy, Ancillary ultrasound findings.

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