Evaluating the results of laparoscopic surgery in the treatment of total appendicitis peritonitis at 115 people’s hospital

Journal of military pharmaco-medicine no8-2018

EVALUATING THE RESULTS OF LAPAROSCOPIC SURGERY IN
THE TREATMENT OF TOTAL APPENDICITIS PERITONITIS AT
115 PEOPLE’S HOSPITAL
Nguyen Quang Huy1; Vu Huy Nung2; Van Tan1
SUMMARY
Objectives: To evaluate safety, feasibility and result of laparoscopic surgery in management
of total appendicitis peritonitis. Subjects and methods: A prospective observational study on
82 patients with appendicitis peritonitis who were performed by laparoscopic surgery at
th
th
115 People’s Hospital from 1 January 2011 to 31 December 2016. Results: The rate of farting
time over 72 hours was 52.2%. The mean hospital stay was 5.9 ± 3.5 days. The rate of postoperative
complication was 9.7%, including five cases of paralytic intestine, two cases of wound infection
and one case of post-operative intra-abdominal abscess. The general result of surgery was
excellent (92.8%), good (5.8%), fair (1.4%) and poor (0%). Conclusion: Laparoscopic surgery
for total appendicitis peritonitis was safe, efficacious and feasible and could be widely applied.
* Keywords: Appendicitis peritonitis; Laparoscopic surgery.

INTRODUCTION
In Vietnam, the proportion of acute
appendicitis occupied from 40 to 45%
in emergent operations [1]. Acute
appendicitis complicated exclusively with
peritonitis (ACP) accounts for 10 to 20%.
Laparoscopic surgery is a good choice for
management of this disease. We studied
this topic aiming: To evaluate the results
of laparoscopic surgery for the treatment
of appendicitis peritonitis in terms of the

safety, efficacy and feasibility of the
procedure.
SUBJECTS AND METHODS
1. Subjects.
82 patients (male: 49 cases, female:
33 cases) with the ages from 16 to 95
years old. Mean age was 45.7 ± 21.4. All
patients were diagnosed ACP and treated

by laparoscopic surgery at 115 People’s
Hospital from 1th January 2011 to
31th December 2016.
2. Methods.
Prospective observative and descriptive
clinical study.
* Selective criteria: Patients with
appendicitis peritonitis were diagnosed by
clinical, paraclinical, abdominal endoscopy
and biopsy, were applied by laparoscopic
surgery for the treatment. Adequate
information for the study.
* Exclusive criteria: Peritonitis with the
other causes, lack of information for the
study.
* The technical progress:
+ Indications: Appendicitis peritonitis in
patient over 16 years old. The patient
agreed with the laparoscopic surgery.

1. 115 People’s Hospital

2. Vietnam Military Medical University
Corresponding author: Nguyen Quang Huy ()
Date received: 10/08/2018
Date accepted: 03/10/2018

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Journal of military pharmaco-medicine no8-2018
+ Contraindication: The patient cannot
be applied laparoscopic surgery (serious
disease of cardiovascular or lung…).
- Preparation: The patient lied on the
supine position, general anesthesia. The
surgeon stood on the left of the patient,
the assistant stood beside of the surgeon
on the left.
* Technical steps:
+ Trocar insertion, gaz pump: 3 trocars
(umbilicus, left iliac forsa, hypogastric area).
Abdominal pump CO2 with 12 - 14 mmHg.
+ Check injuries: Check all abdominal
cavity, find appendix.
+ Appendectomy: Using monopolair
electric surgery for appendix mesentery,
ligation of appendage with haemolock.
+ Abdominal suction-irrigation: Natricloride
0.9% solution. Abdominal drainage insertion.
+ Check again all abdominal cavity,
removing appendix, incision suture.

* Process of data: SPSS 22.0, Chisquared test.
- Studying target: Hospital time, farting
time, the time of drainage, complication
rate and general results of the procedure.
RESULTS
1. Characteristics of patients.
82 patients with ACP was operated by
laparoscopic approach, males were more
than females (59.9% compared with 40.2%),
male/female ratio = 1.5.
The mean age was 45.7 ± 21.4 years
old (from 16 to 95).

The proportion of patients with drainage
over 72 hours was the most (72.5%); this
rate under 25 hours was 1.4% and from
25 to 48 hours was 4.3%.
Post-operative flatulence from 49 to
72 hours accounted for 23.2%, over 72 hours
was 52.2%; below 25 hours was 2.9%.
The average length of hospital stay
was 5.9 ± 3.5 days; the shortest time was
1 day and the longest was 30 days.
* Post-operative complications (n = 82):
Post-operative complications were
paralytic intestine 5 patients (6.1%);
wound infection 2 patients (2.4%); intraabdominal abscess 1 patient (1.2%). The
rate of total post-operative complications was
9.7% (8/82 cases). The management of
post-operative complications: Conservative

management were 8/8 cases (100%).
Successful result rate was 100%.
* The early post-operative complications
(n = 82):
The early post-operative complications
were wound infection (2.4%) and intraabdominal abscess (2.4%). The rate of
the early post-operative complications was
4.8% (4/82 cases). The management of
the early post-operative complications:
Conservative management were 4/4 cases
(100%). Successful result rate was 100%.
* Post-operative mortality: The rate of
post-operative mortality was 0%.
* The grade of result of laparoscopic
appendectomy: This grade was based on
the criteria of 115 People’s Hospital.
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Journal of military pharmaco-medicine no8-2018

Chart 1: The grade of result of laparoscopic appendectomy (n = 82).
Excellent results explained 92.8%, good 5.8%, fair 1.4% and bad 0%.
Table 1: The relationship between successful laparoscopic appendectomy and
duration of peritonitis (n = 82).
Laparoscopy
Success

Total

Conversion to open
laparotomy

Medical history

p
2
(χ )

Number

Percentage
(%)

Number

Percentage
(%)

Number

Percentage
(%)

Peritonitis ≤ 12 hours

56

87.5

8

12.5

64

100

Peritonitis > 12 hours

13

72.2

5

27.8

18

100

015

The proportion of successful laparoscopic appendectomy between the groups with
peritonitis ≤ 12 hours or > 12 hours; there was no statistically significant difference (χ2,
p > 0.05).
Table 2: The relationship between successful laparoscopic appendectomy and the
condition of intra-abdomen (n = 82).
Laparoscopy

Condition of intra-abdomen

Success

p
Total

Conversion to
laparotomy

n

%

n

%

n

%)

Mild and moderate distended intestine

64

91.4

6

8.6

70

100

Severe distended intestine

5

41.7

7

58.3

12

100

Little and average pyogenic membrane

49

92.5

4

7.5

53

100

Much pyogenic membrane

20

69.0

9

31.0

29

100

2

(χ

)

0.00

0.01

- The proportion of successful laparoscopy in group with mild and moderate
distended intestine was 91.4%, compared to that of group with severe distended

intestine (41.7%): the higher rate was statistically significantly different (χ2, p < 0.05).
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Journal of military pharmaco-medicine no8-2018
- The proportion of successful laparoscopy in group with little and average pyogenic
membrane was 92.5%, compared to that of group of much pyogenic membrane (69%):
the higher rate was statistically significantly different (χ2, p < 0.05).
Table 3: The relationship between successful laparoscopic appendectomy and the
general clinical condition of appendix (n = 82).
Laparoscopy
General clinical
condition of appendix

Success

Total

Conversion to
laparotomy

p
2

(χ )

n

%

n

%

n

%

Normal position

43

84.3

8

15.7

51

100

Abnormal position

26

83.9

5

16.1

31

100

Gangrenous base

17

77.3

5

22.7

22

100

No gangrenous base

52

86.7

8

13.3

60

100

1.00

0.32

- The proportion of successful laparoscopy in group with normal position of appendix
was 84.3%, compared to that of group with abnormal position of appendix (83.9%):
there was no statistically significant difference (χ2, p > 0.05).
- The proportion of successful laparoscopy in group with gangrenous base of
appendix was 77.3%, which was 86.7% in the group with no gangrenous base; there
was no statistically significant difference (χ2, p > 0.05).
DISCUSSION
The mean time of abdominal drainage
was 3.9 ± 1.7 days in all of the laparoscopy
and was 3.7 ± 1.1 days in open laparotomy.
We took out the abdominal drainage
tube fairly early when patients’ condition
was acceptable (with fluid of abdominal
drainage was clear and no pus, which is
standard of getting out drainage).
Launay-Savary’s advice: Abdominal
drainage should be applied on appendicitis
with diffuse peritonitis. Petrowsky’s
retrospective research indicated that
abdominal drainage after appendectomy
with perforated or ruptured cause more
infections in group with drainage (43 - 85%)

than group without (29 - 54%); about infection
of peritoneum cavity, there were two
researches with results of increasing
infectious rate in patients without abdominal
drainage, one research admitted that this
rate increased in the group with drainage
and one research reported that there
were the same rates in both of groups.
Typically, cecum leak was found in
patients with abdominal drainage with
proportion of 2 - 7% [2].
The mean time of flatus passage was
1.6 ± 0.9 days. When patients had flatus
passage, we advised them to eat. This
indicated that duration of paralytic
intestine in diffuse peritonitis was
relatively longer because of severe
infectious conditions.
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Journal of military pharmaco-medicine no8-2018
The shortest time of hospital stay was
3 days, the longest was 31 days and the
mean time was 6.6 ± 3.6 days. The
reason for long hospital stay was due to
postoperative pain, especially postoperative
abdominal abscess and infectious wound
must be treated for a long time with

antibiotics.

Medical internal treatment: Continuous
gastric emptying, antibiotics, electrolyte
solution, then patients were released from
the hospital on 10th day.

According to Ball’s research: The
mean time of hospital stay was 2.2 days
and the patients could return to work
normally after 9.3 days, the complication
rate was 6%. The advantages of laparoscopy
in complicated appendicitis was shorter
hospital stay and patients could return to
normal activity quickly [3].

Katkhouda found that 4 cases of
postoperative laparoscopic appendectomy
needed reoperation: Of which, there were
3 cases of injuring hypogastric artery due
to the site where the right iliac trocar
inserted and bleeding from appendix artery,
one case of burning ileum due to that
monopolar cauterizing to stop bleeding
caused intestinal leak [5]. Fukami’s research
found that the rate of postoperative
abscess in peritonitis was 5.9% [6].

J Cueto indicated that the mean time
of hospital stay was 3.5 days [4].

We had a case (1.4%) of fluid
accumulation after surgery for residual
abscess after surgery. In this case, the
abscess was small, patient was treated
with antibiotics, no need to puncture the
pus, did not have to resuscitate. This cause
may be in the unclean peritoneum cavity
also left muchpyogenic membrane as well
as do not clean up the fluid washing, and
that the drainage tube, the remaining
residue will be out.
We had 1 case of infectious wound in
trocar site for laparoscopy (1.2%) and
1 case of wound infection with conversion
to laparotomy (1.2%). These two cases
had been treated with patch replacement,
in combination with antibiotics.
In this study, 5 patients had early
bowel paralysis on day 5 after surgery
with such symptoms: Vomiting, unable to
pass stool or gas, abdominal pain.
192

Theoretically, trochanteric infections are
more related to the traction of appendix
through trocar holes and appendix lesions.
In our opinion, this rate is acceptable.

According to Katkhouda’s research,
the proportion of postoperative complication

was 17% such as infectious wound of trocar
inserted site (6.2%), abdominal abscess
(5.3%), these patients were managed by
antibiotics and drainage following by
CT-scanner.
Fukami’s statistic indicated that the
proportion of postoperative complications
were infectious wound (8.9%), postoperative
abdominal abscess (5.9%) and hernia in
trocar site (2%) [6].
Our research found that there was no
mortality. However, in European and American
researches with a great number of
samples, they recorded some rate of
mortality in appendicitis in general and in
diffuse peritonitis appendicitis in particular,
the causes were patients’ other diseases.


Journal of military pharmaco-medicine no8-2018
According to G.Mancini’s research, the
rate of mortality was 2.7 in general while
that rate of postoperative elder patient
was 0.4% because of complication of
myocardial ischemia [7].
CONCLUSION
The studying results of this topic showed
that: The farting time over 72 hours after
laparoscopic surgery for the treatment
of appendicitis peritonitis was 52.2%; the

mean hospital stay was 5.9 ± 3.5 days;
the rate of complication was 9.7%, including
paralytic intestine, wound infection and
peritoneal abscess. The general results:
excellent (92.8%), good (5.8%), fair (1.4%)
and poor (0%).

2. Launay-Savary M.V, Slim K. Analyse
factuelle du drainage abdominal prophylactique,
evidence-based analysis of prophylactic
abdominal drainage. Annales de Chirurgie.
2006, 131, pp.302-305.
3. Ball C.G, Kortbeek J.B, Kirkpatrick A.W
et al. Laparoscopic appendectomy for complicated
appendicitis: An evaluation of postoperative
factors. Surg Endosc. 2004, 18, pp.969-973.
4. Cueto J, D’Allemange B, Vazquez-Frias
J.A et al. Morbidity of laparoscopic surgety for
complicated appendicitis: An international
study. Surg Endosc. 2006, 20, pp.717-720.
5. Katkhouda N, Mason J, Twofigh S.
Laparoscopic versus open appendectomy.
A prospective randomized double-blind study.
Annal of Surgery. 2005, 242 (3), pp.439-450.

The laparoscopic surgery for the treatment
of appendicitis peritonitis was safe, affective
and feasible.

6. Fukami Y, Hasegawa H, Sakamoto E et

al. Value of laparoscopic appendectomy in
perforated appendicitis. World J Surg. 2007,
DOI:10 1007/s00268-006-0065-x.

REFERENCES

7. Mancini G.J, Mancini M.L, Nelson H.S.
Efficacy of laparoscopic appendectomy in
appendicitis with peritonitis. The American
Surgeon. 2005, 71, pp.1-5.

1. Dương Mạnh Hùng. Nghiên cứu ứng
dụng trong phẫu thuật nội soi viêm phúc mạc
ruột thừa. Luận án Tiến sỹ Y học. 2009.

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Journal of military pharmaco-medicine no8-2018

FLEXIBLE CALICO-PYELOSCOPY USING HOLMIUM LASER
LITHOTRIPSY DURING PYELOLITHOTOMY IN TREATMENT
OF KIDNEY STONES: INITIAL EXPERIENCE
Nguyen Duy Thinh1; Dao Quang Minh1; Nguyen Phu Viet2
SUMMARY
Objectives: To report our initial experience with flexible calico-pyeloscopy using holmium
laser lithotripsy during pyelolithotomy in the treatment of renal stones. Subjects and methods:
55 patients/56 kidney stones undergoing open pyelolithotomy combined with endoscopic control
of stone clearance, using laser homium energy to break stones at Thanhnhan Hospital from
March 2012 to October 2017. Patients with many stones in the kidney were only opened renal

pelvis for remove the stones. Then use the flexible tube station 14Fr to control the entire renal
pelvis test sticks left. The small stones were dragged out of the basket Dormia, the larger stones
will be approved by holmium laser. The sonde JJ was placed and withdrawn after 3 weeks.
Preoperative characteristics of renal stones and the results of pyelolithotomy associated flexible
calicopyeloscopy were assessed. Operative time and complications were reviewed. Results:
Endoscopic technique was performed in 47 cases (83.9%). 9 cases (16.1%) failed. The
adsolute cleanlines ratio of gravel in 40/47 cases accounted for 82.2%, in which 7 cases
suffered from remaining stones, which caused bleeding during the gravel. Among 9 cases of
failure, 4 cases of small kidney stones when the grafts bleed multiple tubes do not control the
neck of the kidney due to drainage out, 3 cases when the soft tube into the neck on the test
small neck corner, 2 narrowing the neck of the kidneys. There were no cases where kidney tissue was
removed to remove stones. No blood transfusion in surgery was taken. Average surgery time
was 120 ± 30 minutes, no serious complication after surgery was observed. Conclusion: The
flexible calico-pyeloscopy during pyelolithotomy was feasible and effective to control calculi
clearance in the treatment of complex renal stones with minimal damage of renal parenchyma.
* Keywords: Kidney stones; Flexible endoscopy; Laser holmium.

INTRODUCTION
Although significant progress has been
made in the treatment of multiple kidney
stones, the open pyelolithotomy surgery is
still largely applied in the treatment of
kidney stones. In treatment of multiple
kidney stones, the rate of stone remains

relatively high. In a recent research by
Nguyen Hong Truong (2007), coral surgery
at Vietduc Hospital showed good result at
only 19.8%, average 51.5%, bad 15.8%,
of which the rate of leftover stones in

the surgery was 34.6%. Research by
Tran Van Hinh, Hoang Manh An et al in coral
surgery, the leftover stone rate accounted

1. Thanhnhan Hospital
2. 103 Military Hospital
Corresponding author: Nguyen Duy Thinh ()
Date received: 20/08/2018
Date accepted: 02/10/2018

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Journal of military pharmaco-medicine no8-2018
for 47% [1]. Huynh Van Nghia (2010) applied
three techniques: Turner-Warwich, advanced
Gil-Vernet, renal kidney tissue enlargement
along Brodel in surgery for 100 patients,
its results were as followed: good 69%,
remaining stones 17% [3]. On the other
hand, there is a high risk of renal parenchyma,
even multiple locations for the removal of
stones, renal function damage. How to
overcome these two weaknesses is of
great concern today.
There are many applications of anti-stone
in surgery such as ultrasound, X-ray or
endoscopy in surgery. However, the results
are still limited. The rate of leftover stones
after surgery has decreased but still met

with high rate [1].
Open surgeries for kidney coronary stones
combined with endoscopic hysterectomy
using homium laser are less invasive
methods bringing high efficacy [2].
In Vietnam, this method is relatively new
and has only been applied in some large
hospitals in Vietnam recently [4].
From March 2012 to July 2017,
we conducted the study at Institute of
Relaxation Technology for the application
of soft tube endoscopy and laser energy
to detect and deal with stones in calyx, in
the open multiple kidney stones surgery
for 56 cases. The initial experience of this
application will be shared in this article.
SUBJECTS AND METHODS
1. Subjects.
55 patients/56 kidneys were diagnosed
with multiple kidney stones using renal
endoscopy to detect and treat the remaining
stones with homium laser in surgery from
3 - 2012 to 7 - 2017.

* Requirements:
- Multiple kidney stones.
- Endoscopy combined with using
homium laser.
2. Methods.
Research to perform process, description.

* Tools and methods:
- Soft 10F urography can turn heads in
any directions.
- Light source, screen, camera, wires
light.
- Homium laser.
- Other tools: Dormia goblet, stone plier...
- Continuous watering system (Nacl 0.9%).
RESULTS
1. Characteristics of multiple kidney
stone in the study (n = 56).
Renal pelvis + upper calyx: 0; renal
pelvis + middle calyx: 3 kidney stones (5.4%);
renal pelvis + lower calyx: 2 kidney stones
(3.6%); renal pelvis + middle, lower calyx:
24 kidney stones (42.9%); renal pelvis +
upper, middle calyx: 15 kidney stones (26.8%);
renal pelvis + upper, lower calyx: 3 kidney
stones (5.4%); renal pelvis + upper, middle,
lower: 9 kidney stones (16.1%).
* Level of renal insufficient:
No water stagnant: 45 kidney stones
(80.4%); water stagnant lv I: 4 kidney
stones (7.1%); water stagnant lv II:
6 kidney stones (10.7%); water stagnant
lv III: 1 kidney stones (1.8%)
* Characteristics of the kidney:
Outside of sinuses: 32 cases (57.1%);
reservoir in the sinus: 15 cases (26.8%);
intermediate: tanks: 9 cases (16.1%).

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Journal of military pharmaco-medicine no8-2018
Table 1: Number of stones per patient.
Number
of
kidney

Number
of
stone

Percentage
(%)

3 stones

1

3

1.8%

4 stones

20

80

35.7%

5 stones

23

115

41.1%

≥ 6 stones

12

74

21.5%

Total

56

272

100%

Number of
stones/kidney

2. Results of Calyx - renal pelvis

endoscopy with soft tube.
- Successful endoscopic treatment for
47 cases of stones.
- Soft tube endoscopy failure: 09 cases
(4 cases of torning renal pelvis, 3 cases of
small angle of renal pelvis - lower calyx of
small minor calyx angle, 2 cases of
narrow neck of calyx).
- The rate of stone clearance immediately
after surgery was achieved in 47 cases,
accounting for 82.2% of total cases performed
successful laparoscopy.
Table 2: Treatment of stone in the
group of patients with stone clearance.
Number of
stone

Percentage
(%)

Dormia muxle

34

47

32.9%

Crush with
Holmium laser

53

96

67.1%

143

100%

Total

Stones were found in 16 patients,
accounting for 28.6%; its cause was due
to tornadoes of the neck damage, small
angle of the kidneys, corner, neck, neck
damage.
196

3. Postoperative complications.
Urine monitoring in 24 hours after surgery:
14 patients with dark red urine, 42 patients
with pink urine. These cases were received
medical treatment and hemostatic drugs.
After treatment for 3 - 5 days, the patient
did not need any interventions. No serious
complications were found.
DISCUSSION

The success of the technique:

Method of
Number
removing stones of kidney

* Surgery time: Average operation time
was 140 ± 30 minutes, the fastest was
100 minutes, the longest was 200 minutes.

Extralotomy and multiple kidney stones
were the first choice in treating multiple
kidney stones. However, after long-term use,
many authors have indicated that certain
limitations such as kidney parenchymal
injury are difficult to apply to many tablets
scattered in the kidney. Fabrizio (1998)
used a soft endoscopy through endoscopic
urethral retrograde renal catheterization in
general, achieving a success rate of 89%.
Grasso et al (1999) achieved a 91%
success rate. In 1964, Victor F. Marshall
used soft endoscopy for ureteral stones
and pyelonephritis. Terris M.K then tested
for corneal grafting using a soft-cannula,
a stethoscope, or even a cystoscope to
check, locate and remove some small
stones in the kidney [5]. In 1980, Zingg E.J
et al used rigid endoscopy for corneal renal
excretion and multiple pelvic examinations,

which resulted in more than 60% of multiple
kidney stones, remainly located in the
kidney [6]. In 2004, Unsal A used a "pulsed"
stone scoop that passed through the
pelvic opening to graft the stone and


Journal of military pharmaco-medicine no8-2018
pebbles in the stools after grafting stones
in the pelvis [7]. Traxel. O (2005) used soft
lasers and laser energy to find and dissolve
small stones in the kidney [8]. This rate in
Pham Ngoc Hung et al’s study (2012) was
63.6% [4].
Compared with other methods of
limiting stones in coronary renal excretion
and multiple pelvic exams such as X-rays
or ultrasound in surgery, endoscopic surgery
is more effective than just detecting and
treating the remaining stones, multiple
kidney stones. With a soft 6.5Fr tube, it
can be inserted into all the neck to find
stones. However, this method also has
certain disadvantages. This is a difficult
technique, depending on many factors. If
the technique of opening the kidneys is
not good, picking up multiple kidney
stones causes bleeding in the kidneys,
performing endoscopy in the surgery is so
difficult, even impossible.

Indications for multiple-dose granulomatous
colposcopic catheterization with homium
laser are well suited. For kidney openings
alone, multiple kidney stones and some
tablets in the station can be picked up.
The remaining stones will be removed
or broken through the endoscopy.
Particularly for coral stones and multiple
pellets, the indication of the method of
opening the kidneys alone to remove
stones combined with soft endoscopy
should be strictly specified. Not every
coral is taken through the opening of the
kidneys, but also to extend the opening
into the kidney parenchyma. Therefore,
the opening of the kidney is very wide,

causing bleeding again so the ability to
use the tube is very difficult. Some authors
recommend coral reefs through open kidney
lines alone. We have no experience with
this technique.
In 9 cases failed to perform pyeloscopy,
there were 4 cases of pyelonephritis in
the sinus cavity, because of small size,
we can not bring the soft tube through the
kidney into the kidney, especially the
lower station, 3 cases of angle. The lower
craniofaciens can not enter the coronary
tube, 2 cases of neck obstruction.

Placement of a soft tube through the
kidneys into the middle neck, upper and
lower is a decisive step to the success of
the procedure. For the small neck, we had
calcicectomy. In the process of calcicectomy,
bleeding occurred and we must stop surgery.
Combination in the procedure, we
used the supportive tools such as
pumping in the surgery to collect the
stone as well as use Dormia or pens to
see through the endoscope to extend the
soft tube. A total of 157 stones needed to
be treated with a soft tube. We collected
47 capsules/34 kidneys (26.5%) and the
remaining 110 tablets were used laser.
The use of lithotripsy laser energy in
renaloscopy has many advantages. We
have not seen any cases where the stone
is not cracked when using holmium laser
pebble. Grafts are usually quite smooth
and do not cause damage to the kidney
mucosa. This is a superior advantage of
the laser compared to the electric pulses.
Due to the use of endoscopic surgery,
surgical time is considerably longer.
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Journal of military pharmaco-medicine no8-2018
Our average operative time was 120 ±

30 minutes. The longest was 165 minutes.
Maybe this is the first case, so our experience
and techniques are not good. However,
there was no evidence of complications of
using rinse water during surgery. No changes
in kidney or electrolyte disturbances occurred
during or after surgery.
Excellent results for successful endoscopic
procedures were 71.3%, good results
were 15.3%, no discomfort was 13.4%.
This was a promising result. We think this
is a very "delicate" technique, which requires
the surgeon to be gentle and skillful.
The advantage of this method lies in
the opening of the kidney parenchyma to
grafts of the stones. Therefore, in
addition to limiting stone, postoperative
care is usually mild.
CONCLUSION
Through research we have some
comments as follows:
- The use of a flexible catheter
combined with laser energy holmium
stone is a feasible method that can be
used in combination therapy of multiple
kidney stones by simply opening the
kidney with a success rate of 83.9%. The
rate of stone clearance was 82.2%, no
complications and severe complications
were found.

198

- One case of technical failure is the
one of multiple kidney stones in the sinus,
multiple kidney stones difficult or narrow
neck, large angles.
REFERENCES
1. Tran Van Hinh. Research on some risk
factors and application of high technology in
treating urolithiasis. State Independent
Subject. 2001.
2. Pham Ngoc Hung et al. Soft endoscopic
treatment of renal stones through endoscopic
retrograde infiltration. University of Medicine.
2012, Vol 16, pp.265-268.
3. Huynh Van Nghia. Study on the results
of surgical removal of coral stones at the
108 Central Military Hospital. Doctoral
Dissertation. 2010.
4. Breda A, Ogunyemi O, Lepert J.T,
Schulam P.G. Flexible ureteroscopy and laser
lithotripsy for multiple unilateral intratenal stones.
Eur Urol. 2008, Jun, 13.
5. Terris M.K, Cherukuri S.V, Jadick R.H.
Pyelolithomy, Specialties, Urology, Stone,
Medicine. 2006.
6. Zingg E.J, Futterlieb A. Nephroscopy in
stone surger. Br J Urol. 1980, 52, p.333.
7. Unsal A, Cimentepe E, Saglam R,

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