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Biomedical subjects

A Hawasli

Publications and source records attributed to A Hawasli.

At least 19 recordsLinked to original sources
PubMed1999

Laparoscopic live donor nephrectomy at a community hospital.

Recently, laparoscopic harvesting of kidneys from live donors has been reported by major university centers. As a community transplant center, we adopted a multidisciplinary cooperative approach, including a full-time transplant surgeon, a laparoscopic general surgeon, and a urologist with laparoscopic experience, in order to perform our first successful laparoscopic live donor nephrectomy in December 1998. The operative time was 234 minutes, and the warm ischemia time was 2 minutes. No intraoperative or postoperative complications occurred. The length of the renal artery was 2.4 cm, the renal vein was 3.0 cm, and the ureter was 10.0 cm. The donor was discharged home the next day and returned to work within 14 days. The transplanted kidney functioned immediately. The recipient serum creatinine concentration dropped from 9.3 mg/dL preoperatively to 3.4 mg/dL within 24 hours and to 1.3 mg/dL on the third day.

Hospitals, Community↗
PubMed1998

Laparoscopic repair of paraesophageal hiatal hernia.

Twenty-seven patients underwent consecutive elective laparoscopic repair of paraesophageal hiatal hernia between October 1992 and June 1997. There were 24 females and 3 males. The average age was 68 years (range, 46-86) and average weight was 173 pounds (range, 122-243 lb.). Presenting symptoms were: postprandial epigastric pain or pressure in 19 patients, postprandial dyspnea in 7 patients, anemia in 5 patients, postprandial vomiting of food in 5 patients, and 1 patient had postprandial palpitation. Heartburn was present in 9 patients. Five patients had a history of symptoms of intermittent volvulus. History of hiatal hernia was present in 19 patients ranging from 6 months to 38 years in duration. The operative procedure included a laparoscopic reduction of the herniated stomach, excision of the hernia sac, and closure of the diaphragmatic defect with placement of mesh graft. Anterior gastropexy was performed on all patients except two who had a Nissen fundoplication due to severe reflux symptoms. Seven patients had laparoscopic cholecystectomy at the same time and one patient had an excision of a small benign gastric leiomyoma of the fundus. The average operative time was 2:54 hours (range, 1:35-4:05 hrs.). The average hospital stay was 3.8 days (range, 2-8 days). One patient had a postoperative stroke and recovered quickly. Follow-up of 1 to 56 months showed no recurrence of the hernia. Two patients complained of some epigastric pain and six patients had occasional mild reflux that was easily controlled medically. Laparoscopic repair of paraesophageal hernia is a safe procedure with a short hospital stay and recovery time. Using mesh graft decreases the risk of developing an iatrogenic parahiatal hernia. The addition of Nissen fundoplication is not necessary unless the patient has objective findings of reflux.

Aged↗
PubMed1996

Laparoscopic training in residency program.

The use of laparoscopy in general surgery has provided surgeons with a new approach to multiple procedures. New techniques are being developed daily. Laparoscopic training for surgical residents must be incorporated into their curriculum. To decrease the risks of training residents on patients and to decrease operative time, a program of videoscopic "bench" training exercises, to improve eye-hand coordination, was instituted for junior residents. Between July and September 1995, nine surgical residents participated in this proficiency videoscopic study. At the end of the study, there was a statistically significant improvement in the residents performance by an average of 37% (P = 0.0109). This program proved to be both effective and economical. It can be reproduced and easily incorporated into any surgical residency program.

Clinical Competence↗
PubMed1994

The use of absorbable clips in laparoscopic cholecystectomy.

A prospective randomized controlled study was conducted to evaluate the use of absorbable clips in elective laparoscopic cholecystectomy. Fifty consecutive patients, 36 females and 14 males, were randomized into two groups. Group 1 patients had metal clips, and group 2 patients had absorbable clips applied on the cystic duct and cystic artery. These patients were followed for 3 months postoperatively. There was no difference between the two groups with regard to operative time, hospital stay, and postoperative complications. The absorbable clips were as effective as the metal clips in providing hemostasis and securing on the cystic duct stump.

Adolescent↗
PubMed1994

The effect of drains in laparoscopic cholecystectomy.

A prospective controlled randomized study was performed on 100 patients undergoing elective laparoscopic cholecystectomy to evaluate the benefit of routine drainage in simple uncomplicated procedures. The 100 patients were randomized into two groups. Group 1 patients (n = 50) had a drain placed through the epigastric trocar site. The drain was removed before their discharge unless bile or blood was present. Group 2 patients (n = 50) did not have a drain placed. Eleven patients in group 2 (no drain) (22%) were discharged on the same day of surgery (within 8 h), and the remaining 89 patients in both groups were discharged the day after surgery (within 23 h). There were no wound infections or postoperative fever in either group. There were minor but not statistically significant differences between the two groups in postoperative severity and duration of abdominal pain, shoulder pain, and nausea. Furthermore, the two groups were similar in respect to postoperative recovery time and return to work.

Activities of Daily Living↗
PubMed1994

Timing of laparoscopic cholecystectomy in acute cholecystitis.

Laparoscopic cholecystectomy was performed in 467 patients between November 1989 and April 1991. Fifty-four patients (12%) had acute inflammatory changes. These were divided into three different groups: group 1-13 patients who admitted having an attack of right upper quadrant pain within 24-48 h of their scheduled elective laparoscopic cholecystectomy; group 2-23 patients who had a history of acute cholecystitis treated 4-6 weeks before their elective laparoscopic cholecystectomy; group 3-18 patients who were admitted to the hospital and were diagnosed with acute cholecystitis; they had laparoscopic cholecystectomy performed in the same admission. All patients had a successful laparoscopic removal of their gallbladder except 2 in group 3 who had to be converted to an open procedure. Analysis of the operative time, complications, and hospital stay showed that after adequate experience is gained in performing laparoscopic cholecystectomy, acute cholecystitis is not a contraindication. The procedure is faster and safer if performed in the first 24-48 h of the onset of the symptoms. Different technical maneuvers are needed due to the nature of the disease.

Acute Disease↗
PubMed1994

Multifocal musculoskeletal cystic tuberculosis without systemic manifestations.

A case of multifocal cystic tuberculosis is presented, affecting the clavicle and the iliac bones with considerable soft tissue involvement. It was found in a 34-year-old male, an immigrant from Yemen. The extensive cystic nature of both lesions and the lack of systemic manifestations despite multifocal disease are unusual.

Adult↗
PubMed1993

Infected hepatic Echinococcus cyst presenting as recurrent Escherichia coli empyema.

An 81-year-old man, previously a shepherd in Italy, presented with recurrent Escherichia coli empyema over an 8-month period. His empyema was caused by an infected, nonviable hepatic Echinococcus cyst that eroded the diaphragm and led to intermittent spillage and pleural seeding. This case demonstrates that when dealing with Escherichia coli empyema, a subdiaphragmatic source ought to be suspected, and among immigrants from areas with prevalent hydatid disease, infected hepatic Echinococcus cyst might rarely be the cause.

Aged↗
PubMed1993

Laparoscopic cholecystectomy: morbidity and mortality in a community teaching institution.

From November 1989 to December 1990, 474 elective laparoscopic cholecystectomies were performed. This study analyzes the first year's experience with regard to complications, postoperative response in terms of pain and nausea, and time back to activity and work. There were 369 females and 105 males in the group. The average age was 51.5 years. Of these, 394 were discharged within 23 h and 80 required admission postoperatively. Of the group requiring hospitalization, there were 10 (2.1%) major complications, 37 (7.8%) minor complications, 14 (3.0%) aborted laparoscopic cholecystectomies, and 19 (4.0%) others. Major complications occurred early in the surgeon's experience, all but two within the surgeons' first 25 cases. Patients in the short stay group were followed-up with a phone questionnaire. In this group, most patients experienced minimal abdominal pain following surgery, with an average score of 2.4 (SD = 1.38) on a scale of 1 (absent) to 5 (extreme). At home, 48.6% of patients experienced some form of postoperative discomfort. Of these, 38.2% experienced abdominal pain, 18.7% shoulder pain, and 32.7% nausea. The average postoperative time to resume normal daily activity was 7.9 days (SD = 8.2) and to return to work was 11.6 days (SD = 9.9).

Adolescent↗
PubMed1993

Does routine cystic duct cholangiogram during laparoscopic cholecystectomy prevent common bile duct injury?

Between November 1989 and September 1992, the author performed 1,000 laparoscopic cholecystectomies. Three common bile duct injuries occurred (0.3%). Selective cystic duct cholangiograms were performed for diagnosis and management of common bile duct stones. A total of 102 cholangiograms (10%) were done. Only eight of these cholangiograms were done for anatomical verification in the face of severe chronic or acute cholecystitis. Five were cystic duct cholangiograms, resulting in two common bile duct injuries. To avoid the problem of common bile duct injury in cases of obscure anatomy where clarification was needed, a cholecystocholangiogram was done for duct identification in three subsequent cases without event. The third common bile duct injury occurred early in the learning experience without benefit of the cholangiogram.

Cholangiography↗
PubMed1993

Laparoscopic appendectomy for acute appendicitis: is there really any benefit?

Laparoscopic appendectomy is emerging as a popular treatment modality for acute appendicitis. Although claims have been made to potential superiority over traditional appendectomy, comparisons of operative difficulty, hospital stay, hospital costs, complication rates, postoperative pain, and convalescence have not been well studied. Two hundred consecutive patients presenting with signs and symptoms of acute appendicitis underwent appendectomy. Traditional appendectomy was employed in 101 patients, while 99 underwent laparoscopy. Successful laparoscopic appendectomy was possible in 89 patients who were compared with the 101 patients with traditional appendectomy. There were two pregnant patients with appendicitis in each group. The incidence of acute appendicitis was 72 per cent for traditional appendectomy and 74 per cent for laparoscopic appendectomy. Operating time was significantly longer with laparoscopic appendectomy (60.1 vs 45.4 minutes, P = 0.0001). This was reflected in higher (although not significant) hospital costs ($8,683 vs $6,213). Post-op hospital stay was shorter for laparoscopic appendectomy (2.7 vs 3.8 days, P = 0.001). Complication rates were no different between the two groups. Post-op pain, as evaluated by a patient grading scale, was less for laparoscopic appendectomies up to the third post-op week (P = 0.003). The amount of IM pain medication was greater with traditional appendectomy (P = 0.009). Convalescence was significantly shorter with laparoscopic appendectomy as measured by: 1) return to normal household activity (7.8 vs 13.2 days, P = 0.016), 2) returned ability to exercise (19.7 vs 29.0 days, P = 0.009), 3) patient feeling well enough to return to work (14.1 vs 19.2 days, P = 0.032), and 4) actual return to work (15.4 vs 20.5 days, P = 0.038).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

The role of endoscopic retrograde cholangio-pancreaticrogram in laparoscopic cholecystectomy.

Four hundred and fifty-nine patients were studied to evaluate the role of diagnostic and therapeutic endoscopic retrograde cholangio-pancreaticrogram (ERCP) in their management before laparoscopic cholecystectomy (LC) when choledocholithiasis is suspected. Using bilirubin, liver function tests (LFTs) (alkaline phosphatase, SGOT, SGPT) and findings on ultrasound of a dilated common bile duct (CBD), 37 patients (8.1%) were suspected of having concomitant common bile duct stones preoperatively. These patients were subjected to the following diagnostic and therapeutic procedures: 25 ERCPs, 20 laparoscopic cholangiograms, and three extracorporeal shock wave lithotripsies. Preoperative ERCP was done on 19 patients, intraoperative ERCP-sphincterotomy was done on one patient, and postoperative ERCP-sphincterotomy was done on five patients. Fifteen laparoscopic cholangiograms were done as primary tests and five after preoperative ERCP. Sixteen patients (3.5%) had stones in their CBD. Four patients had their laparoscopic cholecystectomy cancelled, and one patient had laparoscopic common duct exploration that was converted to an open procedure. Three groups were identified: group I, patients with a high index of suspicion, included elevated bilirubin with elevation of all three LFTs, or normal bilirubin with elevation of all three LFTs with or without dilated CBD. Seventy-five per cent of this group had CBD stones. Group II, patients with a low index of suspicion, included normal bilirubin and normal CBD by ultrasound with elevation of the alkaline phosphatase alone or elevation of two of the three LFTs. Six per cent of this group had CBD stones. Group III, patients with no index of suspicion, were patients with normal preoperative laboratory test results and CBD. Two patients (0.47%) in this group had elevated LFTs postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiography↗
PubMed1992

Laparoscopic inguinal herniorrhaphy: classification and 1 year experience.

The laparoscopic transabdominal preperitoneal repair of inguinal hernias was utilized in 125 patients in a 12 month period. One hundred and forty three hernias were repaired. These hernias were classified into five different types depending on the site and size of the defect and whether they were primary or recurrent. Cylindrical plugs and screen were used in the first 37 repairs with 2 recurrences and Mushroom Plugs and screen were used in 106 repairs with no recurrences. The two recurrences occurring with the cylindrical plugs were in indirect inguinal hernias with dilated internal rings greater than 2 cm.

Adult↗
PubMed1992

Laparoscopic inguinal herniorrhaphy: the mushroom plug repair.

Laparoscopic inguinal herniorrhaphy was performed on 76 patients with a total of 82 hernias. A modified Schultz repair was done using a mushroom-shaped mesh plug. The flat piece of this plug acts as a stopper to prevent migration of the plug into the inguinal canal or the subcutaneous tissue (in the direct hernia, primary or recurrent). Average operative time was 69 min (range 42-140 min). Short-term follow-up of 1 to 7 months showed no recurrence and good acceptance of the repair by patients.

Adult↗
PubMed1992

To drain or not to drain in laparoscopic cholecystectomy: rationale and technique.

Routine drainage was adopted in laparoscopic cholecystectomy since we started to perform this operation, in November 1989. Its use was triggered by a fear of complications that might require an open operation. Between November 1989 and June 1991, 480 elective procedures were performed. Bile drainage was encountered in five patients and bleeding in three patients. None of the patients with bile drainage developed bile peritonitis or required reoperation; one patient with bleeding required reoperation. Complaint of shoulder pain was minimal (4.8%).

Bile↗