2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
method uses traditional laparoscopy (LAPD). OBJECTIVE: To
justify the increase in medical resources for laparoscopicassisted
peritoneal dialysis catheter placement. METHODS:
This was a retrospective chart review of the LAPD group and
the most recent consecutive STPD. The Chi-square test was
used to compare the two groups. RESULTS: 25 patients had
LAPD from 9/13/02 through 6/30/04. One patient was lost to follow-up
and another patient?s records were not available, making
this group 23 patients. 25 patients from 2/21/01 through
2/21/03 had STPD. Three of these patients were lost to followup,
and two of these patients’ records could not be retrieved,
making this group 20 patients. 16 of 23 (69.6%) and 9 of 20
(45%) patients in the LAPD and STPD groups respectively had
had previous abdominal surgery. 5/23(21.7%) and 6/20(30%) of
the LAPD and STPD respectively had PDC malfunction post
placement. Other complications are listed in the table:
CONCLUSIONS: Although statistical significance was not
obtained with this small sample size, STPD trended to an
increased complication, malfunction, and PDC removal rate.
More malfunctioning catheters in LAPD were able to be salvaged
via a repeat laparoscopic procedure than in STPD. LAPD
trended to an increased rate of dialysate leak, but this was easily
repaired, salvaging the PDC. LAPD can be used to place
PDC in more patients with previous abdominal surgery. LAPD
seems to be superior to STPD.
P341–Minimally Invasive Other
COSMETIC LAPAROSCOPIC CHOLECYSTECTOMY-A 7 YEAR
REVIEW OF RESULTS, Michael Bozuk MD, Nicole Fearing
MD,Phillip P Leggett MD, Department of Surgery, Houston
Norwest Medical Center, University of TX-Houston
Abstract
Background: Today?s patients expect more attention to cosmesis
in their surgical incisions. In 2001 we described a case
report of a cosmetic laparoscopic cholecystectomy. Our goal
was to improve the cosmetic results for patients while performing
a safe cholecystectomy. We report here our results of
43 cosmetic laparoscopic cholecystectomies over the last 7
years.
Method: A retrospective review of all cosmetic laparoscopic
cholecystectomies was performed. The procedure was accomplished
with three, five millimeter ports. A port was placed in
the umbilicus. Two additional ports were placed to the right
and left of midline just above the pubic hairline.
Results: Forty-three cosmetic laparoscopic cholecystectomies
were performed between June 1997 and July 2004. All
patients were female with an average age of 31years old (15-
50yo). The average BMI was 23 (18-27). The indications for
cholecystectomy were biliary dyskinesia in 22 patients, symptomatic
cholelithiasis in 16 patients, gallbladder polyps in 2
patients and acute cholecystitis in 3 patients. No conversion to
standard trocar placement or open cholecystectomy was necessary.
Blood loss was minimal in all cases and no intraoperative
complications were noted. Three patients had other procedures
performed concurrently including appendectomy, lysis
of adhesions, and tubal ligation. Two major complications
were noted in our series. The first was a bile leak which was
treated conservatively. The second was a partial bile duct
occlusion secondary to a clip which was treated with ERCP.
Gallbladder pathology was abnormal in all patients. Chronic
inflammation was found in 23 patients, cholelithiasis in 16,
smooth muscle hypertrophy in 10 and 3 had acute cholecystitis.
Conclusion: We propose that cosmetic laparoscopic cholecystectomy
can be safely performed in a carefully selected patient
population. It can be performed for a variety of diagnoses,
with minimal morbidity. It adds to the laparoscopic armamentarium,
especially in patients concerned with their cosmetic
results.
P342–Minimally Invasive Other
SYMPTOMATIC ADRENAL HEMORRHAGE FOUND DURING
216 http://www.sages.org/
ELECTIVE ADRENALECTOMY, Johelen Carleton MD, Michael S
Gold MD,Steven J Heneghan MD, Mary Imogene Bassett
Hospital
Objective: The purpose of this study was to examine the relationship
between preoperative pain and preoperative hemorrhage
in patients with adrenal tumors. Although nontraumatic
adrenal hemorrhage is rarely described, it is a relatively common
finding in our series.
Methods: Consecutive adrenalectomies done by a single surgeon
from 2000 to 2004 were reviewed retrospectively for presenting
symptoms, biochemical function, imaging, surgical
indications, operative technique, pathology, complications and
postoperative symptoms.
Results: Twelve cases of adrenalectomy were performed.
Indications for surgery were biochemical function or size.
Pathology confirmed four pheochromocytomas, five cortical
adenomas, one cortical hyperplasia, one aneurysm, and one
paraganglioma. Five patients undergoing adrenalectomy gave
a history of flank, back, or abdominal pain prior to resection.
Four out of the five patients presenting with pain were found
to have pathologic evidence of previous hemorrhage within
the adrenal gland. The specimens with hemorrhage included
two adenomas, a pheochromocytoma, and an aneurysm. The
only patient with preoperative pain who did not have evidence
of preoperative hemorrhage was found to have an intrinsically
painful paraganglioma. All patients had resolution of pain following
adrenalectomy
Conclusion: Patients with pathologic evidence of previous
hemorrhage were more likely to present with pain.
Presentation with pain appeared independent of tumor characteristics
or patient demographics. Laparoscopic adrenalectomy
was done safely in all cases and produced relief of the preoperative
pain symptoms. Hemorrhage within an adrenal gland
should be considered in patients found to have an adrenal
mass on imaging and have a history of abdominal or flank
pain. Based on our limited series, underlying adrenal pathology
should be considered likely in cases of nontraumatic bleeding.
P343–Minimally Invasive Other
LAPAROSCOPIC FUNCTION PRESERVING SURGERY FOR
NON-PARASITIC SPLENIC CYST, yoo shin Choi MD, hyung ho
Kim PhD, Department of Surgery, Seoul National University,
College of Medicine,
INTRODUCTION: Concerns about overwhelming postsplenectomy
sepsis have led to the development of splenic preservation
procedures, so splenic preservation and conservative
management is now accepted norms when dealing with
pathologic benign splenic conditions and traumatic splenic
injuries. Recently, we performed successfully laparoscopic
function preserving procedures in two splenic pseudocysts.
These procedures are rarely published in English literature in
worldwide. A thorough understanding of splenic anatomy permits
laparoscopic partial splenectomy or cyst unlooping
hemisplenectomy with the resultant benefits including a
decreased risk of postsplenectomy sepsis by preserving
splenic function, short hospital stay, smooth convalescence,
superior cosmoses and non-recurrence.
METHODS AND PROCEDURES: Case1. A 53-year-old man presented
with left upper-quadrant abdominal pain. He had no
history of trauma or tropical travel. MRI demonstrated 6cm
sized cyst at lower pole of spleen. Laparoscopic partial
splenectomy underwent successfully. Case2. A 24-year-old
woman presented with left upper-quadrant abdominal palpable
mass. She had no history of trauma or tropical travel. CT
demonstrated 20cm sized huge mass with wall calcification at
upper pole of spleen. Laparoscopic cyst unlooping procedure
with sagital hemisplenectomy was performed without any
events.
RESULTS: In all two cases, pathologic findings were splenic
pseudocyst. Operative times were 120 minute in case 1 and
156minute in case 2. In case 1, he discharged at postoperative
day 5th and in case 2, at postoperative day 3rd. On the CT
checked 3 month after operation, we confirmed that cysts
were completely excised without operation related complication
and there were no evidence of recurrence in all two cases.
Also splenic function is preserving completely normally.