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A Darzi

Publications and source records attributed to A Darzi.

16 recordsLinked to original sources
PubMed1992

Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients.

Laparoscopic technology is likely to have an increasing impact on surgical procedures that have previously required an open approach. We have prospectively evaluated laparoscopic colectomy in 40 patients requiring elective colonic excision mainly for malignant disease. 33 of 40 patients had a successfully completed laparoscopic colectomy, although there was one postoperative death. Seven operations were unsuccessful and required conversion to conventional open laparotomy. Morbidity was low with no wound infections and only two chest infections in the 32 survivors. Early mobilisation and discharge from hospital (mean 8 days) was a notable feature. Previous abdominal surgery was not an absolute contraindication to laparoscopic colectomy. However, the inability to palpate the colon directly to confirm the site of laparoscopically impalpable lesions leads us to recommend contrast radiology to confirm the location of colonoscopically diagnosed lesions before laparoscopically assisted colectomy. Preliminary pathological assessment of resected tumour specimens revealed a satisfactory tumour clearance. We conclude that laparoscopic colectomy is a feasible operation in most patients and leads to a substantial patient benefit without compromising the chance of a surgical cure of cancer.

Adult↗
PubMed1991

Piezoelectric lithotripsy for gallstones: analysis of results in patients with extended selection.

Extracorporeal shock wave lithotripsy (ESWL) is successful in fragmenting gallstones, but less than 28 per cent of patients with gallstone disease fulfil the conventional criteria for treatment. However, no data exist to substantiate these selection criteria. In this study, the selection criteria were broadened to include patients with radiolucent stones of any size and number, and radio-opaque stones less than 3 cm in diameter. To date; 108 symptomatic patients with gallstones have received treatment. All patients received up to six outpatient sessions of ESWL (6000 shock waves per session) without sedation or analgesia. The dissolution therapy consisted of combined bile salt and terpene administration. The clearance rates were 9 per cent within 2 months, 21 per cent at 2-4 months, 38 per cent at 4-8 months, 60 per cent at 8-12 months, and 78 per cent at 12-18 months. Of patients with a successful outcome only 19 (18 per cent) would have satisfied traditional selection criteria. There have been no significant complications except in one patient who developed mild acute pancreatitis, which settled on conservative treatment, and two patients who developed acute cholecystitis. This study would suggest that the previously accepted selection criteria underestimate the number of patients suitable for gallstone ESWL and dissolution therapy.

Adolescent↗
PubMed1991

Cystic duct obliteration and gallbladder mucosal destruction: a feasible alternative to cholecystectomy.

'Chemical cholecystectomy' has been proposed as an alternative to removal of the gallbladder. This study assessed cystic duct obliteration using bipolar electrocoagulation (with sham cannulation controls) and gallbladder mucosal treatment with tetracycline (or saline controls) in 29 mongrel dogs. Cystic duct obstruction was assessed by tube cholecystography at day 14, and epithelial damage by histology at day 42. Electrocoagulation by duct diathermy effectively occluded the cystic duct in 14 of 19 animals; however, this was associated with mucocele formation unless mucosal treatment with tetracycline was also performed. Immediate instillation of tetracycline after duct electrocoagulation produced only partial epithelial damage. The combination of duct electrocoagulation and delayed tetracycline instillation at 14 days produced complete destruction of all gallbladder epithelium and an effective chemical cholecystectomy.

Animals↗
PubMed1991

Laparoscopic cholecystectomy: a hundred consecutive cases.

Laparoscopic cholecystectomy is a new, minimaly invasive technique for removing the gallbladder which has several advantages over the traditional laparotomy cholecystectomy. We reviewed our initial experience with 100 consecutive patients in whom laparoscopic cholecystectomy was attempted. The indications for operation were biliary colic, chronic cholecystitis, acute gallbladder and gallstone pancreatitis. Laparoscopic cholecystectomy was successfully performed in 87 patients. Anaesthesia time was 144 +/- 52 min. There was no mortality while overall morbidity was 14%. One patient had a retained common bile duct stone. Postoperative hospital stay was 4.1 +/- 2.2 days and the mean time to full activity in a random sample of 25 patients was 13.7 +/- 11.7 days. Laparoscopic cholecystectomy is a safe effective procedure which removes the gallbladder. We suggest that this technique be considered in all patients undergoing cholecystectomy.

Adolescent↗
PubMed1991

Combined ultrasound-guided extracorporeal shockwave lithotripsy and MTBE instillation in the treatment of common bile duct stones.

We report on our initial experience in the treatment of 4 patients with common bile duct stones with extracorporeal shockwave lithotripsy, either alone or in combination with methyl-tert-butyl ether. In four patients, common bile duct stones were successfully fragmented employing a second-generation ultrasound-guided piezoelectric lithotripter (EDAP LT-01). In two of these patients direct application of methyl-tert-butyl ether to the gallstone was utilized to assist in dissolution. There was no mortality or morbidity attributable to either treatment modality. In this first report of this combination of treatments we conclude that ESWL probably has a complementary role to play in the management of patients with common bile duct stones.

Adult↗
PubMed1990

Gallstone clearance: a randomized study of extracorporeal shock wave lithotripsy and chemical dissolution.

Following extracorporeal shock wave lithotripsy it is not known whether gallstone fragments are cleared from the gallbladder without the use of oral dissolution therapy. To assess the efficacy of lithotripsy and dissolution therapy, alone or in combination, 35 patients were randomized to one of three treatment groups: lithotripsy alone, dissolution therapy alone or combined lithotripsy and dissolution therapy. All patients had symptomatic gallstones, functioning gallbladders and comparable stone profiles. Lithotripsy was administered using a piezoelectric lithotripter. Dissolution therapy consisted of combined bile acid and terpene. Clearance was assessed at 6 months using ultrasound and oral cholecystography. Patients with less than 50 per cent stone clearance at the end of 6 months were considered failures. The number of patients with total or partial clearance in the combined group (7/10) was significantly greater than those in the lithotripsy alone group (0/10, P less than 0.002). Gallstone clearance following lithotripsy appears to be dependent upon dissolution therapy.

Adult↗
PubMed1990

Biliary intervention via minicholecystostomy.

Minicholecystostomy was performed in 24 elderly patients, under local anaesthesia. All had symptomatic gallstones removed utilizing endoscopy and fluoroscopy. These procedures were well tolerated, with no significant complications, despite severe coexistent disease. One patient has had recurrent problems due to gallstones and one has died from disseminated malignancy. The remaining 22 are well and symptom-free. This combined surgical and radiological approach is a useful alternative procedure for patients with gallstones who are a poor risk for general anaesthesia.

Aged↗
PubMed1990

Piezoelectric lithotripsy and soft tissue injury. Safety limits in the experimental and clinical setting.

Controversy surrounds the capacity of extracorporeal shock wave lithotripsy to cause soft tissue injury. This study examines the influence of different dosages of shock waves on the gall bladder in both humans and an animal model. Sixty one guinea pigs were divided into groups and subjected to different numbers of shock waves (6,000, 24,000, and 48,000) at different frequencies (2.5, 5.0, 10, 20 shock waves per second) and sacrificed at different intervals. Soft tissue damage after lithotripsy seemed to be related to the number of shock waves administered. In addition, repeated administration of low dose lithotripsy (at weekly intervals for six weeks) did not seem to produce a cumulative injury. Finally, in the animals sacrificed one month after receiving high dose lithotripsy, no soft tissue damage was evident, indicating satisfactory healing. Thirty patients were subjected to either high dose (36,000 shock waves) or low dose (6,000 shock waves) lithotripsy 24 hours before elective cholecystectomy. Both macroscopic and microscopic evidence of soft tissue injury were detected in a significantly higher percentage of patients who received a high dose in a single treatment (p less than 0.05). The group who received repeated low dose lithotripsy showed no evidence of cumulative injury. We conclude that low dose lithotripsy produces minimal soft tissue injury and is safe when repeated up to six times at weekly intervals.

Animals↗