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Intermediate procedures


Cholecystectomy plus exploration of the bile duct.

It consists of the extraction of the gallstones in more advanced cases where the gallstones are already passed through the liver tract and are caught in the main bile duct (choledocholithiasis). It should be taken care of on time because it could leave serious infections in the ducts and in the liver (cholangitis). These infections are irreversible in the liver and it might cause the patient's death. It is possible to do this procedure with three to four small incisions.

Look at video: Cholecystectomy more exploration of the bile ducts

Diverticulectomy.
Sometimes abdominal pain can be present on the left side in young patients. This pain is similar to appendicitis and also causes the patient to have nausea, vomit, fever and/or bleeding when excreting. The square could correspond to Meckel’s diverticulectomy. This pain is resolved effectively by laparoscopy and introducing sharp staplers. The evolution of the patients is sensational. They require little time hospitalized and only three small holes are used in the abdomen for their cure. It is necessary to make a laparoscopic diagnosis, however the diagnosis finds the origin of the problem without laparotomy exploration (opening the abdomen completely).
Look at video:
Meckel’s diverticulectomy

Drainage Hematobilioma Laparoscopy.
When abdominal pain is common, secondary post-surgery (including traditional surgery) could be done for drainage (extraction) of hematic serous collections and purulence of the cavity. In this case the patient is presented with seven days of immediate post-surgery of open cholecystectomy with important infectious state. In the revision, we find a great collection of blood and bile (hematobilioma) that conditions the deteriorated state and septum (infectious) of the patient. In this method, the patient with inadequate convalescence is inappropriate, in that it reduces an important secondary pain on recovery and nullifies the risk of infection of the wound. This conditions the prompt reincorporation of the patient’s normal life.

Look at video: Drainage of abdominal collection one week after open surgery.

Laparoscopic Fundoplication for the hiatal hernia and gastric reflux:
Medical treatment is done in some cases where hiatal hernia and gastro esophagitis reflux hasn’t worked completely and the signs and gastro esophagitis symptoms persist (inflammation of the stomach or esophagus). It is also done to avoid the beginning of a cancer that the chronic reflux caused on the esophagus. This method is the most effective for resolving these pains and is actually considered Gold Standard by hiatal hernia and gastro esophagitis reflux. Many gastroenterologists maintain many years with expensive treatments for gastritis and reflux. This procedure eliminates the necessity of these medications by 95% in all of the cases and it leaves the patients free of symptoms. With some months of post-surgery pursuit, the patient can forget expensive treatments and consultations for life. It just requires four small holes of 0.5mm. It is the most convenient surgery that changes the quality of life.

Look at video: Fundoplication for hiatal hernia and gastric reflux

Placement of catheter of Tencoff laparoscopy
:
Los pacientes que sufren de insuficiencia renal terminal y se encuentran sin posibilidades de recibir hemodialisis por sus costos y alta demanda y/o los pacientes en los que ya no es posible hemodializar, son candidatos a colocación de un cateter que permita el paso de soluciones externas que eliminen los productos metabólicos del organismo. Este procedimiento actualmente se realiza por mínima invasión, esto ofrece muchisimas ventajas al paciente renal, entre ellas menor dolor postquirúrgico, menor riesgo de falla el cateter ya que se coloca bajo visión directa (cosa que no sucede en cirugía abierta), ofrece la posibilidad de colocar tantos cateteres como en cirugía abierta no es posible por estropeo de la pared abdominal y por las adherencias secundarias que cirugía abierta tradicional condiciona. Es un método muy seguro en manos expertas y reduce al minimo la posibilidad de dejar sangrado o lesionar intestino (hechos frecuentes en cirugía abierta ya que es procedimiento a ciegas). Requiere unicamente de dos pequeños orificios de 0.5mm y el paciente puede utilizar el cateter inmediatamente. Se coloca inclusive en pacientes multioperados abiertamente ya que este método encuentra el lugar ideal para alojar nuevamente al catéter.
Look at video: Catheter placement for peritioneal dialysis

Varicocelectomy:
Patients that present secondary dilation of the veins due to draining in the testicles, have a possibility of resolving the problem in a sure and efficient way by laparoscopy. It is a procedure of few minutes and very sure. Mainly the abdominal esthetics is respected. The patient will go out in an ambulatory way. It only requires of one or two holes of 0.5mm.
Look at video: Bilateral Varicocelectomy

Anastomosis of thing or thick intestine:
When a patient has ileostomy caused by dryness of thick intestines, surgery is possible to reconnect it or also known as reanastomosis by laparoscopy with all the advantages already mentioned if the doctor has been trained and with adapted material.
Look at video: Ileocoloanastomosis

Pedro Gutiérrez Contreras MD. Phone: + 212 656 493194
Clinique Al Hamd, No. 15, Boulevard Moulay Ali Cherif Temara - Préfecture de Skhirate-Temara, Rabat-Salé-Kenitra, Morocco.