2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
Paganini MD, Mario Guerrieri MD,Jlenia Sarnari MD,Giancarlo
D’Ambrosio MD,Luigi Solinas MD,Emanuele Lezoche MD,
Department of General Surgery, University of Ancona, Ancona,
Italy; *II Clinica Chirurgica , Università La Sapienza, Rome,
Italy.
Aim: to compare the results of Cryosurgical Ablation (CSA) of
hepatic tumors in two consecutive series of patients (pts) treated
with two different instruments both using liquid nitrogen.
Methods: between February 1996 and August 2004, 86 pts (41
males, 45 females, mean age 57.3 years, range 30-79) were
treated with the CMS AccuProbe System (Rockville, MD, USA)
using 5-8 mm probes (laparoscopically 29%, open surgery
71%) (group A); 7 pts (3 males, 4 females, mean age 57,1,
range 38-73) were treated with the Cryo 6 Erbe (Tuebingen,
Germany) using 3 mm probes (open surgery).
ResultsGroup AGroup B
Intra operative Transfusions, pts47 (55%)1 (14%)
Post operative Transfusions, pts36 (42%)0
Major Complications21 (24%) 0
Minor Complications44 (51%)0
Local recurrence 0 0
Mortality 4 (6%)0
Group B pts were then matched with 7 group A patients based
on age, sex, type of tumor, number of lesions, liver segments,
Child/ASA classification.
ResultsGroup AGroup B
Intra operative Transfusions, pts 3 (43%)1 (14%)
Post operative Transfusions, pts 4 (57%)0
Major Complications 2 (29%)0
Minor Complications 4 (57%) 0
Local recurrence 00
Mortality 0 0
Conclusions:the Cryo 6 Erbe instrument was equally effective
as compared to the CMS AccuProbe System but with less intra
or postoperative bleeding, lesser need for blood transfusions
and lower morbidity.
P207–Hepatobiliary/Pancreatic
Surgery
ACUTE ACALCULOUS CHOLECYSTITIS: INCIDENCE, TREAT-
MENT OPTIONS AND EVENTUAL OUTCOME, Brian J Schmidt
MD, Heidi K Chua MD, Mayo Clinic Jacksonville
ACUTE ACALCULOUS CHOLECYSTITIS: INCIDENCE, TREAT-
MENT OPTIONS AND EVENTUAL OUTCOME.
Brian J. Schmidt, M.D., Heidi K. Chua, M.D.
Department of Surgery, Mayo Clinic Jacksonville
Jacksonville, FL 32224
Introduction:
Percutaneous cholecystostomy is a reasonable treatment alternative
in patients with acute acalculous cholecystitis. Our
objective was to determine if percutaneous cholecystostomy
was a reasonable treatment option for these patients and if so,
what percentage ultimately required cholecystectomy, either
open or laparoscopically.
Methods and Procedures:
We examined all patients at our institution over an eleven-year
period with the diagnosis of acute acalculous cholecystitis to
evaluate the demographics, optimal therapeutic sequence and
outcomes in patients with the diagnosis of acute acalculous
cholecystitis. We identified 18 patients with this diagnosis. Of
these, 83% were male and 33% occurred in patients who had
recently undergone non-biliary tract surgery. We examined the
patients in regards to initial therapy (percutaneous cholecystostomy
vs. surgery), eventual outcome and whether or not
the interval cholecystectomy could be completed laparoscopically.
Results:
Preoperative laboratory testing was non-specific, while presenting
signs or symptoms ranged from abdominal pain to
sepsis in the critically ill. Eighty-nine percent of patients whose
initial therapy was percutaneous cholecystostomy tube placement
did not require interval cholecystectomy. Many of these
patients had severe systemic illness, which limited their survival.
Of the patients who required early surgical intervention,
78% underwent laparoscopic cholecystectomy. The in-hospital
mortality rate was 22%.
Conclusions:
We conclude that percutaneous cholecystostomy is a reasonable
treatment alternative in patients too ill to undergo surgical
therapy. The majority of these patients will not require surgical
therapy after resolution of the presenting comorbid illnesses.
In those who undergo early surgical therapy, a majority
of these cases can be completed laparoscopically.
P208–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC ENUCLEATION OF PANCREATIC INSULINO-
MAS, Alberto Goldenberg MD,Jose Francisco de Matos Farah
MD, Vladimir Schraibman MD, Edson J Lobo MD, Discipline of
Gastric Surgery, Federal University of Sao Paulo, Brazil
Insulinomas are rare endocrine pancreatic tumors. It´s incidence
is increasing in the last years due to early detection by
clinical and tomographic (CT) findings. The classical treatment
consists of open surgical resection that is associated to relative
morbidity and mortality.
The objective of this work is to present 4 patients diagnosed
with pancreatic insulinomas that were treated by laparoscopic
resection.
Four patients, ranging from 14 to 45 years-old, presenting classical
Whipple Triad had lesions ranging from 1,5 to 2,5 cm by
CT (body and tail of the pancreas) diagnosed as insulinomas.
Eco-endoscopy showed no combined lesions. They were treated
by laparoscopic resection, using four trocars (2 of 10 mm
and 2 of 5 mm), 10mm 30º optic and ultrasonic scalpel.
Surgery consisted of opening of the greater omentum, identification
of the superficial lesions and dissection using ultrasonic
scalpel, without complementary suture. Abdominal drainage
was made using JP drain. Glicemic levels were controlled during
surgery with expected glucose raise. All patients had an
uneventfull recovery. Mean follow-up is 10 months (2 to 24
months)
Laparoscopic resection of pancreatic insulinomas using just
ultrasonic scalpel is reliable in superficial lesions in the body
and tail of the pancreas.
P209–Hepatobiliary/Pancreatic
Surgery
INFLUENCE FOR HEMODINAMICS OF THE HEPATIC ARTERIAL
BLOOD CIRCURATION BY PNEUMOPERITONEUM IN LAPARO-
SCOPIC CHOLECYSTECTOMY., Masamori Shimabuku MD,
Toshiomi Kusano PhD,Kazuyuki Tachibana MD,Hiroyuki
Yuzawa MD,Masahiro Kamachi MD, Department of Surgery,
Digestive Disease Center, Tenjin-kai Koga Hospital, Kurume,
Japan
The influence due to pneumoperitoneum on respiratory and
circulatory kinetic during laparoscopic cholecystectomy (LC)
has been was reported thus far. However, there were few
reports regarding the hepatic arterial circulation. The purpose
of this study was to investigate the influence due to pneumoperitoneum
on the hepatic blood flow during LC. The subjects
were 32 cases undergoing LC for 6 months. In this study,
an arterial keton body ratio (AKBR) which was proportional to
the hepatic arterial blood flow. Furthermore a partial pressure
of carbon dioxide (PaCO2) were measured. During surgery,
under anesthesia with neuroleptic analgesia, a muscle relaxant
was administered at a sufficient dose; quantitative ventilation
was performed at a laughing gas-oxygen ratio of 2:1. Average
operation time was 1 hour and 47 minutes. Influence with the
pneumoperitoneum included the temporarily lowered AKBR
just after the pneumoperitoneum under anesthesia. However,
when AKBR could be kept at a pressure of 10 mmHg or lower,
AKBR remained in the safety range. PaCO2 stayed around 30
mmHg until 180 minutes, when the pressure due to pneumoperitoneum
was maintained low, but it is measured at over
14mmHg, at 120 minutes later PaCO2 exceeded 40 mmHg.
In conclusion, if maneuvered at a low pneumoperitoneum
pressure, LC is a safe operative procedure with a slight negative
general influence.
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