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A Voitk

Publications and source records attributed to A Voitk.

12 recordsLinked to original sources
PubMed2001

Blunt hasson trocar injury: long intra-abdominal trocar and lean patient--a dangerous combination.

Injury at the time of trocar placement with the Hasson approach is rare. The cone of the Hasson cannula is wedged into the skin for an air seal, and, using fascial sutures, fastened under tension to flanges of the cannula. The shorter the fascial securing suture, the greater the tension and the more secure the air seal. Flanges for securing the fascial suture were attached to the external cannula in early Hasson cannula models. With these, much of the trocar needs to be intra-abdominal in order to shorten the suture. For lean patients, with very little distance between the anterior and posterior abdominal walls, the force required to fasten the sutures to the flanges may allow an intra-abdominal trocar to damage intervening organs. Later versions of the cannula had the flanges attached to the cone, allowing for short suture without need for intra-abdominal cannula. These models avoid the possibility of such injury. An unusually lean patient underwent laparoscopic cholecystectomy using an older Hasson cannula with flanges for the fascial securing suture attached to the cannula. Postoperative changes in vital signs and hemoglobin led to a diagnosis of intra-abdominal bleeding, and laparotomy revealed a transsected branch of the middle colic artery. Earlier Hasson cannulas, where the flanges are attached to the cannula, should be replaced with those with flanges attached to the cone.

Adult↗
PubMed2001

A simple technique for laparoscopic vertical banded gastroplasty--the JOVO procedure.

A simple technique for laparoscopic vertical banded gastroplasty is described. With the surgeon to the patient's left, four trochars are placed as cephalad as possible. Short gastric vessels are divided and the posterior wall of the stomach mobilized. The ETS-Flex with Articulating Head (Ethicon Endosurgery Inc.) is used to divide the stomach close to a 42-french bougie against the lesser curvature. An additional stapler bite abuts directly against a 28-french bougie to obtain correct stoma size. A ribbon of Prolene mesh is pulled through a tunnel behind the stomach at the apex of the divided gastroplasty and sutured around the distal end of the gastroplasty. To date we have used this method successfully in 5 patients with 1-11 months of follow-up. Although we lack a sufficient number of patients or follow-up for definitive conclusions, we believe this technique will produce good results, as it reproduces exactly that used successfully in open surgery and our early results parallel those following open surgery.

Follow-Up Studies↗
PubMed2001

Impartial long-term review of vertical banded gastroplasty in a low volume community hospital practice.

BACKGROUND: There is some concern whether bariatric surgery can be done well at low volumes or in a community hospital setting. This paper reports an impartial assessment of 25 vertical banded gastroplasties (VBG) over 13 years in a 228-bed non-teaching community hospital. METHODS: Charts were reviewed and patients interviewed by an independent investigator. Complications, weight loss, satisfaction and quality of life were assessed. RESULTS: There were no fatalities, no splenic tears, no stomal stenosis and no symptomatic gastroesophageal reflux. Two reoperations and five incisional hernias were noted. Hypertension was eliminated in 57% and dyspnea in 55%. BMI fell from 44.3 to 34.9 kg/m2 after 6.2 years. BMI decreased more than 10 kg/m2 (10-30) for 15 patients and less than 10 kg/m2 for 10 patients (4-10 for 7, 0 for 1 and a gain for 2). 56% of patients were fully satisfied with the results. Quality of life indicated excellent physical function, physical role and lack of body pain, good general health, social function, emotional role and mental health, but lower vitality. 100% felt better than a year ago. CONCLUSION: Results from a low-volume community hospital general surgical practice are similar to those from specialized series. Obesity is so common, its non-surgical treatment so ineffective and the VBG so well established, that excluding this intervention from community hospitals is untenable.

Adult↗
PubMed2001

Laparoscopic repair of inguinal hernias with higher risk for recurrence: independent assessment of results from 121 repairs.

This study attempts to determine by independent review the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair for hernias with increased risk for recurrence. Indicators used for increased recurrence risk were recurrent hernias or simultaneously repaired bilateral inguinal hernias. Office and hospital records of all such patients who had undergone TAPP repair were reviewed from one surgeon's 242-patient laparoscopic inguinal hernia database from 1992 to 1998. All were called for assessment by an independent surgeon at least 4 months postoperatively (median 34 months). Those unable to come in person were interviewed by telephone. There were 121 hernias: 34 recurrent and 100 bilateral (13 overlap). Recurrence rate was 3 per cent, which was similar for repair of bilateral and recurrent hernias. All recurrences occurred within 3 months of surgery. No unknown recurrence was detected by the independent observer. Laparoscopic TAPP inguinal hernia repair, often claimed as the method of choice for bilateral and recurrent hernia repair, is indeed a safe and effective procedure with a low early recurrent rate in these higher-risk situations.

Databases, Factual↗
PubMed2000

Simple technique for laparoscopic paracolostomy hernia repair.

PURPOSE: The aim of this study was to describe a simple, minimally invasive, and effective technique for repair of paracolostomy hernia. METHODS: Mesh is fastened laparoscopically over the colostomy and hernial defect with wide overlap, without dissecting out the sac or repairing the defect, while ensuring enough room for the colon to prevent obstruction at the level of the mesh. RESULTS: The technique has been used successfully in four patients, with follow-up of 2 to 12 months. Operating time and length of stay were short, and there was no recurrence or prolapse of the colostomy. CONCLUSIONS: This seems to be an effective, simple, and minimally invasive technique for repairing a difficult problem. Although the number of cases is small and the follow-up has been short, the technique mimics that used in massive ventral hernia repair with good results.

Colonic Diseases↗
PubMed2000

Technique and early results of outpatient laparoscopic mesh onlay repair of ventral hernias.

BACKGROUND: This report describes the technique and early results of a simple outpatient laparoscopic ventral hernia repair. METHODS: Data were gathered prospectively for all laparoscopic ventral hernia repairs from January 1996 to December 1997 at a 228-bed hospital. Prolene mesh was stapled to the peritoneal surface of the abdominal wall, leaving sac in situ and mesh uncovered. Patients were seen by the operating surgeon within 2 months, and by an impartial surgeon (J.S.) after 3 to 14 months (average, 7 months; median, 6 months). RESULTS: Repairs involved 44 hernias with orifice sizes 2 to 20 cm in diameter, and an average area of 20 cm(2). Of these 44 hernias, 36 were postoperative and 8 primary. Furthermore, 20% were recurrent hernias. There were four conversions. The outpatient rate was 98%, with one readmission for ileus. The early recurrence rate was 5%. CONCLUSIONS: Laparoscopic mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence rate that can be performed safely on an outpatient basis.

Adult↗
PubMed1999

Factors contributing to laparoscopic failure during the learning curve for laparoscopic Nissen fundoplication in a community hospital.

This study was done to determine the factors contributing to laparoscopic failure (conversion to open surgery or early reoperation) during the learning curve for laparoscopic Nissen fundoplication in a 228-bed nonteaching community hospital. Data were gathered prospectively for the first 100 consecutive patients booked for elective laparoscopic Nissen fundoplication by the four general surgeons at the hospital. All complications were recorded contemporaneously, and particular note was taken of the factors surrounding conversion to open surgery and reoperation within 100 days of surgery. There were no deaths. The conversion rate was 20% and the early reoperation rate 6%. There were two late recurrences. The average operative time was 117 minutes and the average length of stay 1.8 days; 37 operations were performed on outpatients. The laparoscopic failure rate was 26% (18/68) during a surgeon's first 20 operations and 11% (3/28) thereafter (P < 0.09); the corresponding conversion rates were 22% and 4% (P < 0.05). During a surgeon's first 20 operations, the laparoscopic failure rate rose from 21% (12/57) to 55% (6/11) (P < 0.04) if a second surgeon did not assist. After 20 operations, this difference lost its significance. Intrathoracic herniation of the stomach was found preoperatively in 11 (44%) of 25 operations followed by laparoscopic failure and (8%) 6 of 75 without (P < 0.0002). Laparoscopic failure had no correlation with patient age, sex, ASA classification, duration of symptoms, or referring physician's specialty. The individual learning curve for laparoscopic Nissen fundoplication requires about 20 operations to surmount. Factors leading to laparoscopic failure during the learning curve are the surgeon's inexperience, absence of experienced help, and the presence of intrathoracic herniation.

Adult↗
PubMed1999

Hip fracture as a complication of hospitalization.

This work seeks to assess the possible contribution of hospitalization to hip fractures sustained in an acute care hospital and to determine the need for hospital care for these patients at the time of the fracture. Between 1988 and 1997 there was an average of 399 falls and four in-hospital hip fractures per year. For 14 percent, no predisposing factors for falling were noted, 38 percent of the fractures occurred within the first three days and 47 percent during the first week of hospitalization. Original admission did not seem warranted for 10 percent and 48 percent no longer required inpatient care at the time of the fracture. Most fractures occur early during hospitalization; some patients seem to have no predisposing factors for falling and about one-half may not require hospitalization at the time, all implicating hospitalization as a causative factor.

Accidental Falls↗
PubMed1993

Paying the extra.

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