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Biomedical subjects

A Montgomery

Publications and source records attributed to A Montgomery.

At least 19 recordsLinked to original sources
PubMed2007

Laparoscopically assisted or open enterolithotomy for gallstone ileus.

BACKGROUND: Gallstone ileus is associated with high morbidity and mortality rates. Enterolithotomy as a single procedure is recommended to minimize complications. The trauma could potentially be reduced further by using a laparoscopic technique. METHODS: Thirty-two consecutive patients with gallstone ileus operated by a laparoscopic or open approach between 1992 and 2004 were studied retrospectively. Demographic data, preoperative and postoperative hospital stay, duration of operation, complications and deaths were recorded. Median follow-up after surgery was 36 months. RESULTS: Nineteen laparoscopic procedures, with two conversions, and 13 open operations were performed. The median duration of operation was 60 min in the laparoscopic group and 58 min in the open group (P = 0.675). The median hospital stay was 7 and 10 days, respectively (P = 0.383). There were five minor and one major complications in the laparoscopic group, compared with one and four, respectively, in the open group. There were no deaths within 30 days. CONCLUSION: The overall morbidity rate was low after both laparoscopic and open enterolithotomy for gallstone ileus, especially in terms of major complications in the laparoscopic group. Laparoscopically assisted enterolithotomy can be recommended for both diagnosis and treatment.

Adult↗
PubMed2006

Incisional hernia repair in Sweden 2002.

Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures. Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair, 19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed may not be optimal. This study has led to the instigation of a national incisional hernia register.

Adult↗
PubMed2006

Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair.

BACKGROUND: Laparoscopic herniorrhaphy has emerged as a recognized operative method for inguinal hernia repair. This study compared the short-term results of two tension-free methods of repair: totally extraperitoneal (TEP) laparoscopic patch repair and the open Lichtenstein mesh technique. METHODS: A total of 1513 men from 11 hospitals who presented with a primary unilateral inguinal hernia were randomized to one of the two methods. Operating time, short-term complications, reoperations, postoperative pain, consumption of analgesics, sick leave and time to resumption of normal physical activities were recorded. RESULTS: Some 1371 of the 1513 men underwent surgery, 665 in the TEP group and 706 in the Lichtenstein group. The median duration of operation was 55 min for both procedures and 91.0 percent of the patients in both groups were discharged on the day of operation. Patients in the TEP group experienced less postoperative pain (P<0.001), consumed fewer analgesics (P<0.001), had a shorter period of sick leave (7 versus 12 days; P<0.001) and a shorter time to resumption of normal physical activity (20 versus 31 days; P<0.001). CONCLUSION: The TEP technique took no longer to perform, and was associated with less postoperative pain, a shorter period of sick leave and a faster recovery, compared with open Lichtenstein hernia repair.

Adult↗
PubMed2005

Primary access-related complications with laparoscopy: comparison of blind and open techniques.

BACKGROUND: Severe or fatal complications attributable to gas embolus, major vascular injury, or visceral injury are rare but have been reported after blind access to the abdominal cavity in laparoscopy. The open access technique has been introduced with the aim to reduce these injuries. This report evaluates access-related complications with both blind and open access techniques in a teaching hospital using standardized techniques for both methods. METHODS: Two groups of patients at different times from a prospective database were compared. A retrospective analysis of 2,297 patients treated using blind access between 1992 and 1996 were compared with 2,066 patients treated using open step-by-step access between 1999 and 2001 regarding access-related complications. An accreditation program for both techniques was mandatory for the 67 surgeons involved. RESULTS: No case of gas embolus or major vascular injury was seen in either group. Four cases of visceral injuries (0.17%) in the blind access group and one case (0.05%) in the open group were seen (p = 0.337). All the injuries were recognized and repaired intraoperatively with no further postoperative complications. CONCLUSION: Our educational efforts to make both techniques as safe as possible were successful, as evidenced by a minimum of access-related complications. Because no evidence exists to show that the blind access technique is superior in any aspect, the open technique is recommended for access to the abdominal cavity in laparoscopy.

Adolescent↗
PubMed2005

A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis.

OBJECTIVE: To assess the effectiveness of intra-articular triamcinolone injection and physiotherapy singly or combined in the treatment of adhesive capsulitis of the shoulder. METHODS: Eighty patients with adhesive capsulitis of less than 6 months duration were randomized to one of four groups: Group A, injection of triamcinolone 20 mg and eight sessions of standardized physiotherapy; Group B, injection of triamcinolone 20 mg alone; Group C, placebo injection and eight sessions of standardized physiotherapy; or Group D, placebo injection alone. All subjects were given an identical home exercise programme. Outcome measures were assessed at 6 weeks and 16 weeks. The primary outcome measure was Shoulder Disability Questionnaire (SDQ) score. Secondary outcomes were measurement of pain using a visual analogue scale (VAS), global disability using VAS and range of passive external rotation. A two-way analysis of variance was used to explore the effects of corticosteroid injection and physiotherapy. RESULTS: At 6 weeks, the SDQ had improved significantly more in the groups receiving corticosteroid injection (P = 0.004). Physiotherapy improved passive external rotation at 6 weeks (P = 0.02) and corticosteroid injection improved self-assessment of global disability at 6 weeks (P = 0.04). There was no interaction effect between injection and physiotherapy. At 16 weeks, all groups had improved to a similar degree with respect to all outcome measures. CONCLUSION: Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.

Adult↗
PubMed2005

Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis.

BACKGROUND: Laparoscopy is safe for diagnostic and therapeutic purposes in patients with suspected acute appendicitis. This study compared recovery after laparoscopic (LA) and open appendicectomy (OA) for confirmed appendicitis, carried out by experienced surgeons in an educational setting. METHODS: One hundred and sixty-three patients with laparoscopically confirmed appendicitis suitable for LA were randomized prospectively to either LA or OA in a blinded fashion. The primary endpoint was time to full recovery. Secondary endpoints were operating time, complications, hospital stay and functional status. RESULTS: There was no significant difference between LA and OA in time to full recovery (9 and 11 days respectively; P = 0.225). Operating time was 55 min in the LA group and 60 min in the OA group (P = 0.416). The complication rate was 8.6 and 11.0 per cent respectively (P = 0.696), and median hospital stay was 2 days in both groups (P = 0.192). Functional status was significantly better in the LA group 7-10 days after operation (P = 0.045). CONCLUSION: There was no difference in time to full recovery after LA and OA in patients with laparoscopically confirmed appendicitis. A trend towards better physical activity was noted after the laparoscopic procedure.

Adolescent↗
PubMed2005

Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia.

BACKGROUND: The Shouldice technique is the 'gold standard' of open non-mesh hernia repair. The aim of this study was to compare 5-year recurrence rates after Shouldice and laparoscopic transabdominal preperitoneal patch (TAPP) repair for primary inguinal hernia. METHOD: Men with a primary unilateral inguinal hernia were randomized to either Shouldice or TAPP operation. An independent observer scored the surgeons' performance. Follow-up comprised clinical examination after 1 year, a questionnaire after 2 and 3 years, and a clinical examination after 5 years. RESULTS: Between February 1993 and March 1996, 1183 patients were included. Nine hundred and twenty patients were followed for 5 years, 454 in the TAPP group and 466 in the Shouldice group. Recurrences were evenly distributed between groups throughout the follow-up period. The cumulative recurrence rate after 5 years was 6.6 per cent in the TAPP group and 6.7 per cent in the Shouldice group. Postoperative pain was a risk factor for recurrence after Shouldice operation but not after TAPP repair. There was a correlation between a low surgeon's performance score and recurrence. CONCLUSION: The 5-year recurrence rate is acceptable, with no difference between TAPP and Shouldice repair. Poor operative performance resulted in a higher recurrence rate. The TAPP operation represents an excellent alternative for primary inguinal hernia repair.

Adult↗
PubMed2002

Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus shouldice inguinal hernia repair in 1042 patients.

Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n = 518) and the Shouldice technique (n = 524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of cs, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time.

Aged↗
PubMed2001

Using the Colorado birth defects monitoring program to connect families with services for children with special needs.

BACKGROUND AND METHODS: The Community Notification and Referral Program (CNRP), which operates from within the state's birth defects monitoring and prevention program, links children and their families with local public health and early childhood agencies, which then inform families of services and resources in their home communities. In Colorado, many communities have developed systems for identifying, screening, evaluating, and providing services to children with developmental delays or other special needs. CNRP uses the existing infrastructure of services for children with special needs by notifying local community programs of children reported to the birth defects program with birth defects, developmental disabilities, or risks for developmental delay. Children to be referred to local agencies are identified from the birth defects registry on the basis of diagnosis and residence. Minor or lethal conditions are excluded from referral. CNRP provides the child's name, date of birth, address, phone, guardian, diagnoses, date and source of diagnosis, and length of stay to the local agency. A parental consent process is used under some circumstances. RESULTS: CRCSN analyzed data from 1621 children referred to local agencies in 1998. The local agencies contacted 34.1% of the families and referred 46.9%. of those contacted to early intervention, developmental, evaluation, or other services. They determined that 29.5% could definitely or moderately benefit from developmental services. In a telephone survey of families, 65.4% said they had learned about services, resources, or developmental screening about which they had not been aware. CONCLUSION: CRCSN has developed a notification and referral program to link families with services for children with special needs that could serve as a model for other birth defects registries.

Adolescent↗
PubMed2001

Endoscopic repair of bilateral inguinal hernias--short and late outcome.

BACKGROUND: In the last decade there have been dramatic changes in the treatment of inguinal hernia with the introduction of mesh techniques including laparoscopic repair. There is still some controversy regarding the treatment of bilateral inguinal hernia but simultaneous operation has gained popularity. The aim of this study was to evaluate the outcome of laparoscopic simultaneous bilateral hernia with regard to complications, recurrence rate, and late discomfort. METHODS: A retrospective analysis was made of 168 patients operated simultaneously for bilateral inguinal hernia using the laparoscopic technique between October 1993 and December 1998. Complications were registered and a follow-up was performed using a combination of questionnaire and selective clinical examination. RESULTS: Complications were seen in 23 patients (13.8%), the majority minor. Ninety-five percent of the patients were followed for a median of 36 months. The recurrence rate was 2.7%. Twenty-six of the follow-up patients (15.5%) reported some discomfort. CONCLUSIONS: We conclude that simultaneous laparoscopic operation for bilateral inguinal hernia is safe, with complications, recurrence rate and late discomfort are equivalent to those seen after unilateral operation.

Adult↗
PubMed2001

Fixation of infrarenal aortic stent-grafts using laparoscopic banding -- an experimental study in pigs.

PURPOSE: to test whether a laparoscopically-placed external band around the infrarenal aorta could stop vessel dilatation and prevent stent-graft detachment from the aortic wall. METHODS: in 13 growing pigs Gianturco-based stent-grafts were placed in the infrarenal aorta. In eight pigs, an external PTFE band (1 cm width) was placed laparoscopically around the infrarenal aorta. The remaining five pigs served as controls. Angiographic aortic diameters were measured: (1) at the most distal renal artery; (2) 1.5 cm further distally; (3) at the middle of the stent-graft; and (4) below the stent-graft, 1 cm above the aortic bifurcation. RESULTS: at a median follow-up of 16 weeks the pigs in the control group (n =5) and in the banded group ( n =7) increased their weight from 24 kg to 107 kg and 23 to 83 kg, respectively. In the control group, aortic dimensions increased by approximately 40% at all levels. In the banded group, aortic dimensions were unchanged at levels 2 and 3, but increased significantly at levels 1 and 4 (i.e. above and below the stent-graft). In the control group all stent-grafts detached causing a proximal perigraft leakage. No detachment or proximal perigraft leak was observed in the banded group. CONCLUSION: a laparoscopically placed external band around the infrarenal aorta of growing pigs seems to counteract the vessel dilatation and thereby provides a stable fixation of self-expandable stent-grafts.

Animals↗
PubMed2000

Introducing diagnostic laparoscopy for patients with suspected acute appendicitis.

BACKGROUND: The diagnostic accuracy in patients with suspected acute appendicitis varies from 60% to 90% depending on age and gender. The aim of this study was to evaluate the use of diagnostic laparoscopy for diagnostic purposes in patients with suspected acute appendicitis to prevent unnecessary laparotomy and to leave a macroscopically normal appendix in place. METHODS: For this study, 500 consecutive patients with suspected acute appendicitis admitted between January 1994 and October 1996 were included prospectively in a surgical training program set to provide diagnostic laparoscopy on a 24-h-a-day basis. Primary open operation was performed when no laparoscopically trained surgeon was available. Short-term outcome measurements were recorded, and a retrospective long-term follow-up evaluation was performed. RESULTS: We succeeded in performing a diagnostic laparoscopy in 376 patients and a primary open operation in 124 patients. The overall appendicitis rate was 78%. A diagnostic laparoscopy alone was performed in 66 patients (56 of which were fertile women), with a median operating time of 36 min and a complication rate of 0%. The overall complication rate was 8.0%. During a median follow-up period of 19 months one patient returned on a later occasion with appendicitis. At completion of the study, 85% of the surgeons were skilled in diagnostic laparoscopy. CONCLUSIONS: Substantial education effort is needed to introduce diagnostic laparoscopy on a 24-h-a-day basis. Diagnostic laparoscopy has a high rate of accuracy, short operating time, and low associated morbidity, and prevents unnecessary laparotomy. It is possible to leave a macroscopically normal-appearing appendix in place.

Acute Disease↗