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Background: Patients with early postoperative small bowel obstruction (SBO) are usually managed nonoperatively with nasogastric suction, intravenous fluids, and observation. The majority of early postoperative SBO resolve without an operation., Methods: We performed a retrospective review of patients who had been diagnosed with postlaparoscopic SBO at three Chicago area teaching hospitals., Results: The patients were initially managed nonoperatively for up to 7 days. However, all of them subsequently required an operation. In every case, the postlaparoscopic SBO was caused by the small bowel being incarcerated in a peritoneal defect created either by trocar placement or peritoneal incision for herniorrhaphy., Conclusion: In contradistinction to the approach used for early SBO after laparotomy, prompt operative intervention for postlaparoscopic SBO is recommended.

Background: Surgical stress is known to disturb the immune system so that the overall picture is one of generalized immunosuppression proportional to the degree of stress. It has been suggested that minimally invasive procedures, i.e., laparoscopic cholecystectomy, should be accompanied by decreased surgical stress., Methods: The present study utilized a panel of monoclonal antibodies to identify peripheral blood lymphocyte subpopulations in 11 patients scheduled for elective laparoscopic cholecystectomy. These were obtained immediately preoperatively, one day postoperatively, and one week postoperatively., Results: The results demonstrated a significant (p < 0.05) decrease in T-helper to T-suppressor cell ratios the first day postoperatively compared to the preoperative ratios; the mean decrease was 13% below the preoperative ratios. There was no significant change in the ratios one week postoperatively., Conclusions: Even though laparoscopic cholecystectomy has been documented to have less disability and postoperative pain than open cholecystectomy, alterations in immune function, although attenuated, do persist.

Background: Simultaneous repair of bilateral inguinal hernia remains controversial., Methods: Seventy-two consecutive patients underwent a preperitoneal prosthetic repair of bilateral groin hernia; 25 via laparoscopy. ASA classification, Nyhus type, hospitalization, convalescence time, and cost were examined. Mean follow-up was 36 and 12 months for the conventional and laparoscopic group respectively., Results: Sixty-nine patients were available for long-term follow-up. Average hospital stay, recurrence rate, perioperative urinary retention, transient thigh neuralgia, and return to normal activities were 48 hours, 5%, 9%, 6%, and 22 days as compared to 4 hours, 6%, 20%, 12%, and 9 days for the conventional and laparoscopic group respectively. The cost for laparoscopic repair was $500 greater., Conclusions: The preperitoneal approach to repair of bilateral hernias demonstrates an acceptable recurrence rate with low long-term morbidity. Experience with conventional preperitoneal technique greatly facilitates transition to laparoscopic repair.

Utilizing the described technique, we have been able to obtain adequate cephalad retraction of the acutely inflamed, tense, and thick-walled gallbladder with minimal trauma. This has made it possible to more adequately identify key anatomical landmarks and to more safely perform the dissection in this area. We believe that the benefits of a shorter hospital stay, decreased postoperative pain, and earlier return to normal activity that patients realize when having an elective laparoscopic cholecystectomy for chronic cholecystitis can be made available as well to more patients presenting with acute cholecystitis.