2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
Under direct visualization, the tip of the catheter is brought
thru a tunnel within the abdominal wall deep to the pelvis and
sutured to the parietal peritoneum using a 3-0 absorbable
suture with intracorporeally tying a surgeon?s knot.
During 2003, five patients with a mean age of 61 (range 37-91)
years underwent laparoscopic suturing of Tenckhoff catheter.
A 91-year-old man underwent the procedure under local anesthesia.
All five patients underwent immediate discharge and
dialysis with no complications. Mean operative time was 24.6
(range 15-45) minutes. All patients have been followed-up over
the past year with no complaints of pain and with functioning
Tenckhoff catheters.
Laparoscopic placement of Tenckhoff catheter with suturing its
tip to the pelvis seems an effective way to prevent re-operations
for displacement.
P363–Minimally Invasive Other
FASCIAL AND PERITONEAL INJECTION OF LOCAL ANALGE-
SIA AT TROCAR SITES PRIOR TO INCISION SIGNIFICANTLY
DECREASES POST-OPERATIVE PAIN AFTER LAPAROSCOPIC
SURGERY, Ragui w Sadek MD, sanam ahmed MD,micheal
castellano MD,sabido frederick MD,anthony kopatsis MD,gene
f coppa MD, staten island university hospital
ABSTRACT
Background:
since the introduction of laparoscopic cholecystectomy in
1986,amajor benefit has been the reduction in Postoperative
pain in patients undergoing this common procedure. This has
been manifest by the reduction in use of pain medications particularly
narcotics. standard pain medications in our institutinafter
laparoscopic cholecystectomy is Oxycodone/APAP or
Hydrocodone/APAP.There are however, a number of patients
with complaints of pain in the region of trocar placement after
laparoscopic procedure.A number of studies have evaluated
the use of local injections of anasthetic medications into skin
incision in order to further lower postoperative pain.this study
evaluates the use of fascial and peritoneal injection as well as
skin injection in the relief of postopertaive pain.
METHODS:
A retrospective analysis of two groups of patients was performed
using a pain scale to quantify the variation in pain
level.Group A patients recieved local analgesia.The skin, fascia
and the peritoneum were injected under direct visualization
with local ansthesia prior to incision and introduction of the
laparoscopic trocars.Group B patients did not recieve local
analgesia.the records of 98 consecutive patients who underwent
laparoscopic cholecystectomy in our ambulatory center
during the period of 2003-2004 were examined retrospectively.There
were 48 in group A and 50 in Group B.Patients in each
group were selected consecutively.pain postoperatively was
evaluated by a telephone call made on the first postoperative
morning.An incremental scale begining with 0 as the lowest
possible degree of pain,and ending with 10 as the most was
used as the pain assessment tool.
RESULTS:
Group A patients with the local anasthetic infilteration had significantly
less complaints of postoperative pain as compared
to the Group B( p < 0.5).In addition Group A returned to normal
activities of daily living more quickly than Group B
patients (p < 0.5).
P364–Minimally Invasive Other
TIMING OF LAPAROSCOPIC APPENDECTOMY IN ACUTE
APPENDICITIS IN CHILDREN - A COMMUNITY HOSPITAL
EXPERIENCE., Radhakrishnan Satheesan MD, Peter S Midulla
MD,Edward Shlasko MD, Division of Pediatric Surgery,
Department of Surgery, Maimonides Medical Center, Brooklyn,
NY 11219
Appendicitis is the most common condition requiring surgery
in the pediatric population. Most surgeons in the United States
consider emergent or urgent appendectomy the standard of
care. There is a significant body of evidence that demonstrates
antibiotic therapy to be highly effective as well. Various factors
affect the scheduling of surgical intervention, such as availability
of Operating Rooms (OR), availability of surgeons, and
staffing of the OR. Surgeons often justify timing and classification
of surgery (as medically emergent) based on satisfying
those exigencies. In our institution we schedule patients with
acute appendicitis for laparoscopic appendectomy for the next
available time during regular OR hours, even if this means
waiting until the next day. We reviewed a series of 299 consecutive
laparoscopic appendectomies during the period January
2000 to June 2004 to correlate the timing of surgery the perforation
rate, the occurrence of complications, and influence on
length of stay. No patient clinically diagnosed to have acute
non-perforated appendicitis was found to have a perforation at
operation. Our review did not reveal any increase in adverse
outcome, nor was hospitalization significantly prolonged. A
prospective study is underway to confirm these findings.
P365–Minimally Invasive Other
100 LAPAROSCOPIC ADRENALECTOMIES - A CRITICAL
APPRAISAL, Stefan Schmidbauer MD, Felix Hohenbleicher
MD,Sybille Lüderwald MD,Thomas Mussack MD,Klaus K
Hallfeldt MD, Chirurgische Klinik Innenstadt, Ludwig-
Maximilians Universitaet, Munich, Germany
Objective: Laparoscopic adrenalectomy is today widely accepted
as the gold standard for the resection of benign adrenal
tumors. However questions remain open such as up to which
size tumors should be resected laparoscopically. In the present
study we also focuse on the resection of solitary metastasies,
partial adrenalectomy, diagnostic problems regarding the
treatment of large adrenal cysts and report on one patient who
died following bilateral adrenalectomy for Cushing?s desease.
Methods and procedures: Between 1997 and 2004, 100 laparoscopic
adrenalectomies using a lateral approach were carried
out in 93 patients. Indications for surgery were benign adrenal
tumors < 8 cm ( 30 aldosterone producing-adenomas, 30 operations
for Cushing?s syndrome, 21 pheochromocytomas, 13
incidentalomas, 2 cystic tumors) and in 4 cases solitary metatstases
of bronchial carcinoma. 7 patients underwent bilateral
adrenalectomy. Two cystic tumors caused diagnostic problems,
as it was impossible to determine preoperatively
whether the lesions originated from the liver or the adrenal
gland. Results: Mean tumor size was 3,7 cm with a maximum
tumor size of 9 cm and 11 tumors > 6 cm. Mean operating
time was 135 min with an average bloodloss of 250 ml. In 3
cases partial adrenalectomy was carried out, preserving the
unaffected adrenal cortex. There were 3 conversions to open
adrenalectomy due to diffuse bleeding, all in patients with
Cushing?s desease. We observed 2 major complications (postoperative
bleeding from the spleen necessitating a laparotomy
and one patient with Cushing?s desease and severe COPD
who died 16 days after bilateral adrenalectomy due to pulmonary
complications). All tumors >6cm were resected laparoscopically
without complications. Resection of metastases
included in all cases local lymphadenectomy. 3 of 4 patients
are free of disease after a mean followup of 16 months.
Conclusions: Laparoscopic adrenalectomy is a safe and reliable
procedure, displaying all the common advantages of minimal
access surgery. However, special attention should be
given to patients with Cushing?s desease and concomitant
COPD. In these cases we refrain from bilateral adrenalectomy
in one session. Benign tumors > 6 cm as well as large cystic
lesions can be resected without technical problems. Partial
adrenalectomy is indicated in selected cases. The resection of
adrenal metastases may be beneficial in selected patients.
P366–Minimally Invasive Other
THE UTILITY OF LAPAROSCOPY IN THE DIAGNOSIS AND
MANAGEMENT OF VENTRICULOPERITONEAL SHUNT COM-
PLICATIONS: A CASE SERIES AND REVIEW OF THE LITERA-
TURE., Ross D Segan MD, Michelle D Taylor MD,J. Scott Roth
MD, University of Maryland Baltimore
Minimally invasive approaches for placement ventriculoperitoneal
(VP) shunts have been well described. Multiple case
series have demonstrated excellent results for shunt placement,
revisions and management of abdominal complications.
We present our series of 13 patients who underwent de novo
placement or revision of VP shunts. 100% of our patients had
successful interventions with laparoscopic techniques.
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