Browsing by Author "Milicevic, M. (7005565664)"

BACKGROUND: Identification of preoperative factors that indicate difficulties in the operation are in the function of primary prevention of intraoperative complications and require selection of an experienced surgical team, planning of operating program and timely provision of information to patients about the increased likelihood of conversion. AIM: Identification of preoperative factors of operative difficulties by analysis of routine clinical parameters. PATIENTS AND METHODS: A prospective cohort study of patients who underwent laparoscopic cholecystectomy from February 2005 to December 2009. All patients were operated by the same surgeon. There were 369 operated patients. Conversion was done in 10 patients. Main outcome measures were: duration of stages of laparoscopic cholecystectomy and conversion; identification of predictive parameters; assesment of their predictive value; assesment of the predictive value of individual parameters in respect to the duration of stages of laparoscopic cholecystectomy; correlation of parameter predictive value and duration of laparoscopic cholecystectomy stage. RESULTS: Multivariate stepwise linear regression analysis showed that previous history of acute cholecystitis, gallbladder wall thickness □ 4 mm, acute cholecystitis to admission, size of calculus < 2 cm, < 5 attacks of pain that lasted longer of 4 hours, diabetes mellitus, duration of symptoms longer then 36 months and pericholecystic fluid collection were significant for prediction of difficulties of laparoscopic cholecystectomy. CONCLUSIONS: Based on clinical, laboratory and ultrasonographic parameters without the use of highly sophisticated diagnostic procedures and increasing medical costs it is possible to predict difficulties in the laparoscopic cholecystectomy.

Purpose: Only a few series of patients with a spigelian hernia managed on an outpatient basis have been reported in the literature. The aim of this prospective study was to evaluate the results of the elective spigelian hernia repair as an ambulatory procedure. Methods: From June 2007 to June 2010, 8 patients with 9 spigelian hernias were electively operated on under local anesthesia as a day case. Four patients had unilateral spigelian hernia, 1 had spigelian and inguinal on the same side, 1 had spigelian and epigastric, 1 had spigelian and umbilical, and 1 patient had bilateral spigelian and umbilical hernia. Spigelian hernia was managed by the "open preperitoneal flat mesh technique." In patients with several ventral hernias at different sites, "the open preperitoneal flat mesh technique" was performed using one separate flat mesh for each of the hernias; for the patient with inguinal hernia, the Lichtenstein procedure was performed in addition. Results: No complications and recurrences were recorded during a mean follow-up of 23.5 months (range: 11-35). Conclusion: The elective spigelian hernia can be successfully repaired under local anesthesia as a day-case procedure. The "open preperitoneal flat mesh technique" provides excellent results under these conditions. © 2012 Springer-Verlag France.