Biomedical subjects

A E Faerden

Publications and source records attributed to A E Faerden.

7 recordsLinked to original sources

PubMed2000

Gut perforation caused by biliary endoprosthesis.

Two cases are reported of perforation of the gut caused by biliary endoprosthesies in the three-year period 1993-1995. The first patient was an 81-year-old man who had perforation of the terminal ileum caused by a straight 10 French/7 cm stent which had been dislodged from the bile duct; he underwent laparotomy but did not recover. The second patient was an 86-year-old man who had perforation of the sigmoid colon caused by a straight 7 French/5 cm stent left in the duodenum during a stent exchange procedure; he was successfully treated laparoscopically. Two cases of gut perforation in a three-year period is a rather high rate of this rare complication of placement of biliary endoprostheses.

Aged↗

PubMed1999

[Laparoscopic splenectomy].

From 1995 to 1998, 14 patients have been treated with laparoscopic splenectomy. Seven patients had immune thrombocytopenic purpura (ITP), six hereditary spherocytosis and one chronic myelomonocytic leukaemia with trombocytopenia. 12 of the patients had normal or nearly normal sized spleen. Median duration of surgery was 156 minutes and the median postoperative hospital stay four days. All operations were completed laparoscopically. Three patients had postoperative fever without any sign of infection, one developed urinary retention and one was readmitted with pneumonia. The patient with chronic myelomonocytic leukaemia died 15 days postoperatively from an intracerebral bleeding. Two patients suffer from relapse of trombocytopenia, one is treated with steroids. Laparoscopic splenectomy can be performed safely in patients with normal sized spleen with all the advantages of minimal access surgery. However, problems related to identification of accessory spleens and splenectomy in patients with splenomegali, should be further evaluated.

Adolescent↗

PubMed1999

Laparoscopic and open operation in patients with perforated peptic ulcer.

OBJECTIVES: To compare the results of laparoscopic and open operations in patients with perforated peptic ulcer. DESIGN: Retrospective analysis. SETTING: Central hospital, Norway. SUBJECTS: 74 patients (36 men, 38 women, median age 69.5 years (18-86)) admitted with perforated peptic ulcers from November 1991-May 1996. INTERVENTIONS: Suture of the ulcer, patching with the greater omentum and lavage, in 49 by open operation and 25 laparoscopically. MAIN OUTCOME MEASURES: Duration of postoperative hospital stay, operating time, number of doses of analgesic, postoperative body temperature, complications, and mortality. RESULTS: There was a significant difference (p = 0.0001) in median operating time: 100 minutes (range 48-160) in the laparoscopic group and 50 minutes (range 20-160) in the open group. The median hospital stay was 8 days in both groups: range 3-23 days in the laparoscopic group and 2-28 days in the open group. There were no significant differences between the two groups with regard to median number of doses of analgesic, median body temperature, complications or mortality. CONCLUSION: Laparoscopic operation for perforated peptic ulcer can be considered as safe as open operation.

Adolescent↗

PubMed1998

[Laparoscopic colorectal surgery. The first experiences from the Central Hospital of Akershus].

Between November 1993 and August 1997, 49 patients (29 women and 20 men) were selected to 51 laparoscopic and laparoscopic-assisted colonic or rectal operations. Five operations were converted to open surgery because of technical problems and adhesions. 46 operations could be performed as planned. The median age was 67 years (20-88 years). A variety of procedures were carried out, including construction of deviating sigmoideostomas without resection (n = 17), segmental resections of colon (n = 15), rectopexi (n = 6), stoma closure (n = 4), abdominoperineal resection (n = 3) and suture of an iatrogenic perforation of the large bowel (n = 1). Eight of the patients with a bowel resection had carcinoma. The median duration of the procedures was 112 minutes (38-293 minutes) and the length of hospitalisation eight days (2-40 days). 13 patients (28%) developed complications. One of these patients died and four were reoperated. These first experiences show that we are able to perform a variety of colorectal surgery laparoscopically. An experienced, well organised operating team with modern laparoscopic equipment is essential to this type of surgery. Prospective, randomised studies have to be done to assess the efficacy of the laparoscopic approach.

Adult↗

PubMed1998

Prediction of common bile duct stones prior to cholecystectomy: a prospective validation of a discriminant analysis function.

BACKGROUND: Selection routines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with symptomatic gallstone disease should give a low frequency of both false-negative ERCP results and residual common bile duct stones (CBDS). OBJECTIVE: To validate a discriminant function (DF) based on retrospectively collected data, for characterization of patients with symptomatic gallstone disease as regards presence of CBDS, and to compare clinical, ultrasonographic, and DF characterization. DESIGN: Prospective registration of CBDS criteria in consecutive patients with symptomatic gallstone disease. SETTING: A department of surgical gastroenterology in a Norwegian central hospital. PATIENTS: One hundred ninety-two patients with gallbladder stones. INTERVENTION: Laparoscopic cholecystectomy or ERCP with or without endoscopic sphincterotomy. MAIN OUTCOME MEASUREMENTS: Sensitivity and specificity of the clinical, ultrasonographic, and DF characterizations, and test of the validity of the DF. RESULTS: Thirty-two patients had CBDS. The clinical criteria of CBDS were present in 152 patients (79.2%): 21.1% of these patients had CBDS and there were no false-negative results (sensitivity, 100%; specificity, 25%). The risk of CBDS in patients with normal bile ducts at ultrasonographic examination was 8 of 124, and in patients with dilated ducts or suspected CBDS, 17 of 47 (sensitivity, 68%; specificity, 80%). The DF was positive in 50 patients (26%): 60% of these had CBDS, and there were 2 false-negative results (sensitivity, 94%; specificity, 88%). A discriminant analysis of the prospectively registered data selected the same set of CBDS criteria, and a new DF did not alter the characterization of any patient. CONCLUSIONS: Clinical characterization had a higher sensitivity for CBDS detection than ultrasonography alone, but a lower specificity. The DF analysis was both more sensitive and specific than ultrasonography, and seemed efficient in selecting symptomatic gallstone patients for ERCP. It was reproducible and simple to use.

Adult↗

PubMed1997

Randomized controlled trial with sequential design of laparoscopic versus conventional appendicectomy.

BACKGROUND: A prospective study including 272 patients with suspected appendicitis was performed. The aims were to evaluate the representativity of the study group and to compare diagnostic and therapeutic laparoscopy with conventional appendicectomy. METHODS: The study was an open, randomized, single-centre trial with sequential design. One hundred and eight patients were randomized between laparoscopy or conventional appendicectomy, of whom 84 had acute appendicitis. Duration of postoperative convalescence was the major endpoint. RESULTS: The study patients were representative of the eligible population regarding age and stage of appendicitis. The risk of unnecessary appendicectomy was significantly (P = 0.03) lower after laparoscopy. The mean difference in duration of postoperative convalescence was 4.7 days in favour of of laparoscopic appendicectomy (P = 0.07), and 26 min in duration of operation in favour of conventional appendicectomy (P < 0.01). No differences were detected in postoperative hospital stay, pain assessment or complications. CONCLUSION: The laparoscopic procedure is at least as good as conventional appendicectomy. Initial laparoscopy reduces the rate of misdiagnosis.

Adolescent↗

PubMed1995

[A national registry for cholecystectomy. Quality assurance with practical consequences?].

Altogether 2,120 patients have been enrolled in the Norwegian Cholecystectomy Registry during the first 18 months after it was established. 1,699 patients (80%) were operated on laparoscopically. In 174 (10.2%) the operation was changed to an open procedure. 421 (20%) were operated on primarily using an open technique. The main quality problems were mortality (1.2%) and injuries of the common bile duct (0.95%) associated with open cholecystectomy. These frequencies are far above the values stated in available literature, and two interpretations are possible: Only the best results tend to be published internationally, and our results may be representative for the national average frequencies of serious complications in other countries too. On the other hand, the present results may disclose inadequate quality insufficiency and a need for improvement. The possible actions seem to be: Firstly, to try harder to avoid open cholecystectomy in seriously ill patients (ASA 3-4). If possible, they should not be operated on at all. When surgery is essential, a laparoscopic technique seems to cause less cardiopulmonary complications. Secondly, an improved dissection technique in open (and laparoscopic) surgery is necessary in order to reduce the frequency of injuries of the common bile duct.

Aged↗