Laparoscopy Versus Laparotomy in The Surgical Treatment of Perforated Duodenal Ulcers
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There is no clear consensus about whether laparoscopy or laparotomy is more beneficial in managing perforations of duodenal ulcers.The aim of the study was a retrospective analysis of operative procedures, laparoscopy or laparotomy, carried out in cases of benign adolescent ovarian tumours.A retrospective review of 709 patient charts with ovarian tumours, who had undergone surgical interventions at The Department of Surgical Gynaecology and Endoscopy of The Polish Mother's Memorial Hospital--Research Institute in Łódź--has been conducted. Among groups of girls treated either with laparoscopy or laparotomy, the following parameters were analysed: age of the patients, character of the tumour (based on the pathological result), size of the lesion, type of the surgical procedure, duration of the hospitalisation and postoperative complications.109 girls had ovarian tumours operated--54 times laparoscopy and 55 laparotomy times were performed. An average age of patients who underwent laparoscopy was 16.2 years, in case of laparotomy: 15.3 years (p > 0.05). An average size of tumours excised in laparotomy was 82 mm (60-190 mm), whereas in laparoscopy 64 mm (30-80 mm) (p > 0.05). The most common laparotomic procedure was the ovarian cystectomy (63%) and cystovariectomy (32%), while during laparoscopy the cystectomy was performed in 92% (p > 0.05). Duration of the laparoscopy was shorter, average was 46.7 min, whereas mean time of laparotomy was 49.2 min (p > 0.05). Also duration of postoperative hospitalisation was longer in case of laparotomy, its average time was 5.4 days in comparison with laparoscopy--2.8 days (p < 0.05).Laparoscopy performed in adolescents due to benign ovarian tumours seems to be a very safe way of the surgical treatment. Moreover, laparoscopy reduces duration of hospitalisation and convalescence, also giving a nice cosmetic effect.
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To compare the results, complications, and hospital charges associated with laparoscopy versus laparotomy in second-look operations for epithelial ovarian cancer. We conducted a retrospective chart review of 109 patients with invasive epithelial ovarian cancer who underwent a second-look operation between July 1, 1992, and June 30, 1995. Thirty-one patients (28.4%) underwent laparoscopy, 70 patients (64.2%) underwent laparotomy, and eight patients (7.3%) underwent both procedures at the same operation. The majority of patients (60.6%) presented with stage IIIC disease. Persistent ovarian cancer was found in 65 of 109 (59.6%) patients, including 17 of 31 (54.8%) evaluated by laparoscopy, 43 of 70 (61.4%) by laparotomy, and five of eight (62.5%) by both procedures. Significantly lower mean blood loss was noted in patients undergoing laparoscopy (27 mL) compared with laparotomy (208 mL) (P < .01). In addition, the mean operating time for laparoscopy (129 minutes) was significantly shorter than that for laparotomy (153 minutes) (P < .01), and mean hospital stay was shorter for patients undergoing laparoscopy (1.6 days) compared with laparotomy (6.8 days) (P < .01). All intraoperative and immediate postoperative complications were noted in patients who underwent laparotomy. There was no difference in day of surgery charges between the two procedures; however, total hospital charges were significantly lower for patients undergoing laparoscopy ($9448) compared with laparotomy ($17,969) (P < .01). With a median follow-up of 22.0 months, recurrence after negative second-look surgery was noted in four of 27 (14.8%) patients evaluated by laparotomy and two of 14 (14.3%) patients evaluated by laparoscopy. Laparoscopy may be an acceptable alternative to second-look laparotomy for interval evaluation of epithelial ovarian cancer. Second-look laparoscopy probably results in less morbidity, shorter operating time, shorter hospital stay, and lower total hospital charges. These results require confirmation in a randomized clinical trial.
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The aim of our study was to compare laparoscopy with laparotomy for the removal of ovarian dermoid cysts. Thirty-eight women with benign ovarian dermoid cyst were allocated for either laparoscopy (18 patients) or laparotomy (20 patients). The two groups were compared for operative and hospitalization times and postoperative course. Operating time was longer (93.6 +/- 23.8 min) and hospitalization time significantly shorter (22.4 +/- 6.6 h) in the laparoscopy group. No complications were reported in either group. We conclude that operative laparoscopy is a safe procedure for the removal of dermoid ovarian cysts and is as effective as laparotomy.
Dermoid cyst
Ovarian Teratoma
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To assess the cost of two procedures for the removal of ovarian cysts, 200 pre-menopausal women were recruited for the surgical removal of ovarian cysts by laparoscopy (n = 100) and laparotomy (n = 100) according to case-control criteria. Patients operated by laparoscopy (mean age ± SD 32.22 ± 9.98 years) and laparotomy (mean age ± SD 29.57 ± 6.62 years) for ovarian cysts (mean diameters ± SD 4.98 ± 3.62 and 4.83 ± 2.78 cm) had a post-surgical hospital stay of 3.12 ± 0.41 and 735 ± 1.08 days (P < 0.001) respectively. The total rate of complications occurring in patients operated by laparoscopy was 9 versus 53% (P < 0.001) of those operated by laparotomy; body temperature >38°C was recorded in 52/100 of patients operated by laparotomy versus 6/100 of those operated by laparoscopy. The mean cost for each pure surgical treatment performed by laparoscopy was US $498.17 versus US $642.47 when it was performed by laparotomy (P < 0.001). The laparo-scopic surgical approach is more expensive in the first 36 operations, thereafter becoming cheaper. The mean of the entire overall expenditure was US $1142.08 and US $2138.72 for laparoscopy and laparotomy (P < 0.001) respectively. The entire expenditure for laparoscopy is higher than laparotomy only until eight operations. In conclusion, laparoscopy versus laparotomy has resulted in a saving of US $14 4293 for 100 operations while the saving on entire costs was US $99 664.8.
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Objective:To explore the advantages,disadvantages,and safeties of laparoscopy and laparotomy for treatment of patients with tubal pregnancy. Methods:A total of 90 patients with tubal pregnancy were selected as study objects,including 53 patients receiving laparoscopy(laparoscopy group) and 37 patients receiving laparotomy(laparotomy group);the operation times,the amounts of blood loss during operation,the mean temperatures within three days after operation,the anal exhausting times,the postoperative times leaving beds,the total hospitalization times,the intraoperative and postoperative complications in the two groups were observed. Results:The amount of blood loss during operation,the mean temperature within three days after operation,the anal exhausting time,the postoperative time leaving beds,the hospitalization expense,and the total hospitalization time in laparotomy group were statistically significantly longer(higher) than those in laparoscopy group,but the operation time in laparoscopy group was statistically significantly longer than that in laparotomy group(P0.05).In laparotomy group,the blood β-human chorionic gonadotropin(β-HCG) levels of two patients didn't decrease after operation,then they returned to normal levels after drug treatment. Conclusion:The advantages of laparoscopy for treatment of tubal pregnancy include rapid recovery and minimal invasion,but the expense is high,the total clinical curative effect of laparoscopy is superior to laparotomy.
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[Objective]To compare the effectiveness and safety of surgical treatment of ovarian teratoma by either laparoscopy or laparotomy. A total of 297 conservative cases of ovarian teratoma treated by either laparoscopy or laparotomy in our hospital from Jan. 1998 to Dec.2002 were reviewed retrospectively. The mean operating time of the laparoscopy group (82.9±23.7) min was slightly longer than that of the laparotomy group(67.3±18.3) min, (P0.01) and the operation time was positively related to size of tumors. Estimated blood loss of the laparoscopy group (38.4±25.1) mL was less than that of the laparotomy group(81.1±31.3) mL, (P 0.01). The laparoscopy group had lower postoperative temperature and quicker recovery of bowl movement. The mean days of hospitalization in the laparoscopy group (9.7±2.6) d were shorter than that in the laparotomy group (12.1±2.8) d, (P0.01); Medical costs in the laparoscopy group (6624.8±628.0, Yuan RMB) was higher than that in the laparotomy group(5453.8±953.0), (P0.01). Both postoperative complications and the recurrence rate of the teratoma were similar in the two groups. [Conclusions] Laparoscopic treatment of ovarian teratoma has similar effectiveness and safety to laparotomy and is of less trauma, less blood loss, shorter time of hospitalization and quicker recovery although with slight high medical costs.
Ovarian Teratoma
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Much of the information of a second-look laparotomy can be obtained by a second-look laparoscopy. We describe the strategy and technique of installing laparoscopy ports at the end of the primary laparotomy for visceral ischemia to facilitate a second-look laparoscopy in the ensuing 72 hours. The advantages and limitations are illustrated by three cases. The primary advantage appears to be that when second-look laparoscopy can be accomplished at a minimal cost, much of the inhibition to use it is removed. However, more experience is necessary before the procedure can be used to replace laparotomy.
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The role of second-look laparotomy in management of advanced ovarian cancer is still controversial. One of the arguments against this method is the risk of this wide operation. Replacement of second-look laparotomy by laparoscopy maybe the way to minimize that risk. The aim of this report is the comparison of second-look laparotomy and laparoscopy. The prospectively gathered material consists of 56 women with ovarian cancer, 17 of them were qualified for second-look procedures. Laparoscopy was the first step in this procedure. In 5 patient the residual malignancy in abdominal cavity was found. In 11 there were no evidence of the disease, and in 1 case laparoscopic inspection was impossible. When the laparoscopy was negative or impossible the second-look laparotomy was performed. Only in one case after negative laparoscopy the evidence of malignancy during laparotomy was found. In our opinion: 1) Positive second-look laparoscopy is equivalent to laparotomy and permits to avoid it. 2) The negative second-look laparoscopy with its contemporary technique still requires the subsequent laparotomy.
Abdominal cavity
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