laparoscopy | Acta Medica Marisiensis

Classical Versus Laparoscopic Approach in Retroperitoneal Lesions — Advantages and Limitations

Crăciun C¹, Azamfirei L², Coroș MF1, Crăciun RC³

1 Surgical Clinic 1, County Clinical Hospital, Tîrgu Mureș, Romania
2 ICU Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania

DOI: 10.2478/amma-2013-0042

Background: At present, the laparoscopic intervention in retroperitoneal primitive tumors, abscesses, haematomas and retroperitoneal effusions is still a challenge. The purpose of this paper is to identify the differences between laparoscopic and conventional surgical interventions in diseases of the retroperitoneum.
Material and method: The study follows a retrospective analysis of various retroperitoneal interventions performed on 62 patients between 2010–2012 in the Surgery Clinic 1 of Mures County Hospital. We have chosen from the casuistry the cases with tumoral diseases or non-tumoral and divided the patients into two groups: group I who had undergone classic interventions and group II who had undergone laparoscopic procedures. We studied the clinical medical records, surgical protocols and anatomopathological results.
Results: For 2010 we extracted 23 cases (39,2% classical interventions), for 2011-21 patients (31,4% classic) and for 2012 -18 cases (29,4% classical interventions). According to the type of the disease, 30 classical interventions were performed for tumoral formations and 21 interventions for non-tumoral formations. Laparoscopic tumoral cases included three tumors and a retroperitoneal metastasis,while the non-tumoral were represented by 7 urohaematic effusions as a result of percutaneous nephrolithotomy procedures.
Conclusions: Laparoscopic surgery of retroperitoneal lesions is minimally invasive, the postoperative evolution of patients is favorable, without major complications.. Classical intervention of retroperitoneal lesions is indicated in large haematomas, abscesses, and big invasive tumors with vascular factor which does not allow the use of laparoscopic technique.

Introduction: The aim of this study is the evaluation of the diagnostic and therapeutic strategy in liver hydatid disease.
Methods: We analyzed 97 cases of liver hydatid cyst (63 females/34 males, aged between 5 and 85 years) hospitalized in the Ist Surgical Department of the Emergency County Hospital of Craiova between 2000 and 2012. The diagnosis was established clinically, by laboratory and imaging tests.
Results: The hydatid cysts were unilocular in 60 cases, the majority (68.31%) being located on the right liver, multilocular in 39 cases, located on both lobes of the liver (9.9%); 17 patients had other locations of the cysts as well (spleen 5 cases, peritoneum 12 cases). Fourty-five (46.39%) cases were uncomplicated and the other 52 cases presented one ore more evolutionary complications: biliary – 44 (43.36%), infection – 15 (14.85%), rupture into peritoneum – 12 cases and bilio-bronchial fistula in 1 case. All patients were operated: 90 patients by open surgery and 7 by laparoscopic approach. Albendazole was administered as prophylaxis of postoperative recurrence. In 73 cases (72.27%) the evolution was favorable. We recorded 26 cases (25.74%) of postoperative complications: infectious – 9 cases, external biliary fistula – 12 cases and general complications in 6 cases. The overall postoperative mortality was 2.06%. We did not register any postoperative complication in the laparoscopic group.
Conclusions: Laparoscopic approach is both safe and feasible, with well codified indications. The most important factor to achieve a successful laparoscopic procedure is the adequate selection of patients. Both intraoperative and postoperative data clearly indicated that the minimal invasive approach provided superior results to open access surgery in terms of complications rate, early recovery and hospital stay.