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Biomedical subjects

B A Salky

Publications and source records attributed to B A Salky.

At least 19 recordsLinked to original sources
PubMed2003

Laparoscopic treatment of enteric fistulas.

BACKGROUND: Elective laparoscopically assisted sigmoid colectomy for diverticular disease and ileocolic resection for terminal ileal Crohn's disease are safe and beneficial procedures in many patients. However, few data exist regarding the laparoscopic management of enteric fistulas from diverticular and Crohn's disease. METHODS: We completed a retrospective chart review of patients who underwent laparoscopic treatment of enteric fistulas complicating diverticular and Crohn's disease. RESULTS: During an 8-year period (1994-2002), 72 patients underwent 73 laparoscopically assisted bowel resections for enteric fistulas by one surgeon at the Mount Sinai Medical Center. Ninety percent of patients had Crohn's disease, the average age was 39, and the male/female ratio was 38/34. Patients had a history of prior abdominal surgery in 39.7% of cases. Multiple fistulas were present in 30% of patients and 12.3% underwent multiple resections at the time of operation. Mean operating time was 199 min, and the conversion rate was 4.1%. Average length of stay was 5.2 days. There were no mortalities in the series. Overall morbidity was 11%. CONCLUSIONS: Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.

Adult↗
PubMed2001

Laparoscopic resection of an extraesophageal leiomyoma presenting as an intra-abdominal mass.

Leiomyomas comprise fewer than 1% of esophageal neoplasms. Only 2% of leiomyomas are extraesophageal, and the remainder are intramural or intraluminal. A presumed intra-abdominal mass found at diagnostic laparoscopy was discovered to be an extraesophageal leiomyoma. Esophageal leiomyoma enucleation is most commonly accomplished via a thoracotomy. Increasingly, thoracoscopy has been used. An open transhiatal approach has also been described. Our patient underwent an uncomplicated transhiatal laparoscopic esophageal leiomyoma resection and benefited from the commonly recognized advantages associated with minimally invasive surgery.

Abdominal Neoplasms↗
PubMed1998

The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes.

BACKGROUND: Diagnostic laparoscopy plays a significant role in the evaluation of acute and chronic abdominal pain in the era of therapeutic laparoscopic surgery. METHODS: We referred to our personal series of laparoscopy for both acute and chronic abdominal pain. This is a retrospective review of data accumulated prospectively between 1979 and the present. RESULTS: In our series, 387 consecutive patients underwent laparoscopy because of abdominal pain. In a group of 121 patients with acute abdominal pain, a definitive diagnosis was made in 119 cases (98%). Two patients needed laparotomy to confirm the diagnosis; both had a disease process that did not require laparotomy to treat. A definitive therapeutic laparoscopic procedure was performed in 53 cases 944%). In 45 patients (38%), a diagnosis was made that did not require therapeutic laparoscopy or laparotomy to treat. In the remaining 21 patients (17.5%), exploratory laparotomy was needed to treat the condition. In a chronic abdominal pain group of 265 patients, the etiology was established laparoscopically in 201 cases (76%). A definitive therapeutic laparoscopic procedure was performed in 128 patients (48%). There was a normal laparoscopic examination in 64 patients (24%). There was one false negative laparoscopy that required laparotomy to treat 1 month later. CONCLUSIONS: Laparoscopy is an accurate modality for the diagnosis of both acute and chronic abdominal pain syndromes. These data support the use of laparoscopy as the primary invasive intervention in patients with acute and chronic abdominal pain.

Abdomen, Acute↗
PubMed1998

Durability of laparoscopic repair of paraesophageal hernia.

OBJECTIVES: To define a method of primary repair that would minimize hernia recurrence and to report medium-term follow-up of patients who underwent laparoscopic repair of paraesophageal hernia to verify durability of the repair and to assess the effect of inclusion of an antireflux procedure. SUMMARY BACKGROUND DATA: Primary paraesophageal hernia repair was completed laparoscopically in 55 patients. There were five recurrences within 6 months when the sac was not excised (20%). After institution of a technique of total sac excision in 30 subsequent repairs, no early recurrences were observed. METHODS: Inclusion of an antireflux procedure, incidence of subsequent hernia recurrence, dysphagia, and gastroesophageal reflux symptoms were recorded in clinical follow-up of patients who underwent a laparoscopic procedure. RESULTS: Mean length of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surgery was 68 years. The surgical morbidity rate in elderly patients was no greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medication for a variety of dyspeptic complaints. All but 2 of these 15 had undergone 360 degrees fundoplication at initial repair. Two patients (4%) had late recurrent hernia, each small, demonstrated by esophagram or endoscopy. CONCLUSIONS: Laparoscopic repair in the medium term appeared durable. The incidence of postsurgical reflux symptoms was unrelated to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after floppy 360 degrees wrap was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears indicated in patients regardless of age.

Aged↗
PubMed1998

The difficult cholecystectomy: problems related to concomitant diseases.

The difficult gallbladder is the most common "difficult" laparoscopic surgery performed by general surgeons. It is also "potentially" the one that places the patient at significant risk. This article reports on our first 1,900 laparoscopic cholecystectomies. With this report, it is the desire of the authors to share our experiences and lessons learned from more than 300 difficult gallbladder cases. We surgeons must strive for no bile duct injuries. If certain principles are followed, the surgeon will be able to improve his or her completion rate and decrease (if not eliminate) bile duct injuries. First and foremost is to know when to convert to open. Performance of fluorocholangiography to define anatomy is also very helpful in avoidance of bile duct injury. The laparoscopic surgeon should start with simple cases before "graduating" to more complex cases. Lastly, the ability to suture and knot tie is key in performing advanced procedures. This skill will allow completion of cases that otherwise would have to be converted to traditional surgery.

Cholecystectomy, Laparoscopic↗
PubMed1998

Laparoscopy in AIDS.

Surgical problems in the patient with HIV and AIDS are becoming more commonplace as the incidence of HIV seropositivity increases and patients with AIDS are living longer. Laparoscopic surgery is being applied more frequently in the diagnosis and therapy of these patients' problems as more surgeons become familiar with the techniques. Although no prospectively randomized trials exist, the benefits of the laparoscopic approach clearly have had an impact on the morbidity associated with surgery. The decreased perioperative immune depression may benefit these patients, and risks to the operative teams probably are lessened if basic tenets of laparoscopic surgery are observed.

AIDS-Related Opportunistic Infections↗
PubMed1996

Laparoscopic surgery in Crohn's disease. Indications and results.

BACKGROUND: An effort was made to assess the feasibility, safety, and outcome of laparoscopic procedures performed in patients with Crohn's disease. METHODS: A prospectively maintained laparoscopic database was analyzed regarding operation time, intra- and postoperative complications, conversion to laparotomy, and length of hospitalization.Fifty-one patients (23 males and 28 females) with a mean age of 36 (20-79) years underwent a laparoscopic or laparoscopic-assisted procedure for Crohn's disease. The indications included terminal ileitis in 31 patients, colitis in 11, perianal disease in four, duodenal Crohn's disease in three, and rectovaginal and rectourethral fistula in one patient each. Thirty-two patients underwent an ileocolic resection; total abdominal colectomy with ileorectal anastomosis was performed in six patients with end ileostomy in one, take down of end ileostomy and ileorectal anastomosis in three, duodenal bypass gastrojejunostomy in three, and loop ileostomy in six patients. RESULTS: The mean operating time was 2.4 (0.6-4.5) h and the mean length of hospital stay was 5.1 (3-18) days. Eight complications were noted in seven patients (14%), which included enterotomy in two patients, bleeding in two, stoma obstruction in two, pelvic sepsis in one, and efferent limb obstruction in one. The procedure was converted to laparotomy in seven patients (14%) due to a large inflammatory mass in five and to bleeding in two patients; there was no mortality. CONCLUSION: Laparoscopic surgery is a feasible, versatile, and safe modality in the surgical management of Crohn's disease. Despite the often-malnourished state of these steroid-dependent patients with intraabdominal inflammatory conditions, morbidity, procedural length, and length-of-hospitalization data are all similar to results previously reported for less-challenging laparoscopic colorectal procedures.

Adult↗
PubMed1996

Laparoscopic surgery in the management of inflammatory bowel disease.

BACKGROUND: The role of laparoscopic surgery in the treatment of various upper and lower gastrointestinal disorders is still under investigation. However, a variety of laparoscopic procedures may be applied in the treatment of inflammatory bowel disease (IBD). PATIENTS AND METHODS: We present our initial results of laparoscopic and laparoscopic-assisted management of IBD in 72 consecutive patients (37 women and 35 men; mean age 36 years, range 20 to 79). The indications for surgery included: terminal ileitis in 29 patients, mucosal ulcerative colitis in 23 patients, Crohn's colitis in 11 patients, severe perianal Crohn's disease in 4 patients, duodenal Crohn's disease in 3 patients, Crohn's rectovaginal fistula in 1 patient, and rectourethral fistula in 1 patient. The procedures performed included: total abdominal colectomy (TAC) in 30 patients (22 with total proctocolectomy with ileoanal reservoir, 6 with TAC with ileorectal anastomosis, and 2 with TAC with end ileostomy), ileocolic resection in 30 patients, diverting loop ileostomy in 6 patients, closure of an end ileostomy as an ileorectal anastomosis in 3 patients who already underwent a TAC with end ileostomy, and duodenal bypass gastrojejunostomy in 3 patients. RESULTS: There were 16 complications in 13 (18%) patients: 3 enterotomies, 4 episodes of bleeding, 3 pelvic abscesses, 2 intestinal obstructions, 2 prolonged ileus, 1 anastomotic leak, and 1 efferent loop obstruction after gastrojejunostomy. However, only 3 patients required laparotomy for morbidity, and there was no mortality. In 7 (10%) patients, the laparoscopic procedure was converted to a laparotomy due to a large inflammatory mass with fistula in 4 patients, bleeding in 2 patients, and an enterotomy in 1 patient. The mean operating time was 2.9 hours (range 0.7 to 6) and the mean length of hospital stay was 6.5 days (range 3 to 19). When compared with ileocolic resection, total colectomy was associated with higher morbidity (30% versus 10%, P < 0.05) and longer hospitalization (8.7 days [range 4 to 19] versus 5.2 days [range 3 to 7], respectively; P < 0.05). CONCLUSIONS: According to this initial experience, laparoscopic surgery is a versatile and effective modality in the surgical management of inflammatory bowel disease in selected patients. However, laparoscopic total colectomy is associated with higher morbidity when compared with ileocolic resection.

Adult↗
PubMed1996

Laparoscopic pancreatectomy.

Laparoscopic access to the retroperitoneum is safe and feasible. Pancreatic resection requires complete familiarity with two-handed technique and knowledge of pancreatic anatomy. At present, only benign diseases should be approached laparoscopically, unless institutional review board approval exists for malignant disease.

Feasibility Studies↗
PubMed1989

Use of bedside laparoscopy to identify intestinal ischemia in postoperative cases of aortic reconstruction.

Gangrenous bowel after aortic reconstructive surgery is associated with an exceptionally high mortality rate. Numerous diagnostic modalities have not reduced the incidence of death from infarcted bowel because of their lack of specificity and the associated delays in diagnosis. Recently, we have begun to use bedside laparoscopy to identify suspected gangrenous bowel in critically ill postoperative patients. Herein we describe a case of small-bowel infarction after aortic aneurysm surgery that was identified by the use of a laparoscope, with successful surgical repair and return of bowel function. Postoperative gangrenous bowel, standard diagnostic tests used in this setting, and the use and indications for beside laparoscopy are reviewed.

Acute Disease↗
PubMed1989

Mucosal proctectomy and ileoanal anastomosis.

The classical surgical therapy of ulcerative colitis and familial polyposis has been total proctocolectomy and ileostomy. In order to avoid a cutaneous stoma and to achieve continence without disruption of gastrointestinal continuity, responding to a demand particularly among younger patients, a mucosal proctectomy in association with an ileoanal anastomosis has been devised. The addition of an ileal reservoir proximal to the anastomosis results in fewer bowel movements and a greater degree of continence. In our series of 70 cases, we have analyzed the normal roentgen anatomy of the ileoanal anastomosis and the proximal ileal reservoir and present our findings on plain film and contrast examinations. To assess patients postoperatively, the radiologist should be aware of the basic surgery involved and the normal roentgen anatomy resulting from this procedure.

Adenomatous Polyposis Coli↗
PubMed1987

Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE).

Most abdominal wall incisional hernias can be repaired by primary closure. However, where the defect is large or there is tension on the closure, the use of a prosthetic material is indicated. Expanded polytetrafluoroethylene (PTFE) patches were used to repair incisional hernias in 28 patients between November 1983 and December 1986. Twelve of these patients (43%) had a prior failure of a primary repair. Reherniation occurred in three patients (10.7%). Wound infections developed in two patients (7.1%), both of whom had existing intestinal stomas, one with an intercurrent pelvic abscess. The prosthetic patch was removed in the patient with the abscess, but the infection was resolved in the other without sequelae. Septic complications did not occur after any operations performed in uncontaminated fields. None of the patients exhibited any undue discomfort, wound pain, erythema, or induration. Complications related to adhesions, erosion of the patch material into the viscera, bowel obstruction, or fistula formation did not occur. Based on this clinical experience, the authors believe that the PTFE patch appears to represent an advance in synthetic abdominal wall substitutes.

Adult↗
PubMed1985

Is routine postoperative nasogastric decompression really necessary?

Controversy exists regarding the need for nasogastric tube decompression and the incidence of complications resulting from its use following major intra-abdominal surgery. To determine the value of such tubes, 100 patients were managed after surgery with a nasogastric tube in situ until the passage of flatus per rectum (Group I). In a second group of 100 patients, no nasogastric tube was placed after surgery unless vomiting, gross distention, or overt obstruction occurred (Group II). In Group I, the nasogastric tube remained in place an average of 6 days and five patients required replacement of the tube after its initial removal. In Group II, nasogastric intubation was required at some point after surgery in six patients. No aspiration pneumonia, nasal septum necrosis, anastomotic leak, or wound dehiscence was seen in either group. There were three wound infections in Group I and two in Group II. The most obvious difference was the increased comfort and mobility of the group of patients treated without routine nasogastric decompression (Group II). Routine use of the nasogastric tube adjunct to patient care following gastrointestinal tract surgery may be safely eliminated.

Cholecystectomy↗
PubMed1982

Ruptured hepatic abscess: a rare cause of spontaneous pneumoperitoneum.

A 68-yr-old woman who developed an acute abdomen with clinical and radiological evidence of pneumoperitoneum is is described. At surgery, multiple left lobe hepatic abscesses were identified. Perforation of one abscess was apparent. Bacteriological studies revealed Streptococcus faecalis and gas-producing Klebsiella pneumoniae from the abscess cavities. Spontaneous pneumoperitoneum secondary to a ruptured hepatic abscess has to our knowledge never been reported.

Aged↗
PubMed1981

Experience with the flexible fiberoptic choledochoscope.

Despite significant effort on the part of surgeons, the incidence of retained calculi after common duct exploration still remains unacceptably high. It seems likely that the best way to reduce the incidence of retained calculi would be a more complete exploration of the common duct at the time of the initial operation. We report our experience with a flexible fiber optic endoscope used intraoperatively in 52 patients and postoperatively in one case to visualize the intrahepatic and extrahepatic bile ducts. In addition to visualization of stones, the choledochoscope has a channel through which various instruments can be passed to facilitate stone removal. Flexible choledochoscopy has been performed 53 times in 52 patients between July 1978 and November 1980. In one patient, the choledochoscope was used to explore the bile ducts via the T-tube tract after operation. In 52 patients, the scope was used intraoperatively: a) two patients demonstrated bile duct tumors, b) in 14, stones were not found on exploration. Of these, one had stenosis at the papilla of Vater and one had external compression of the duct by a pancreatic pseudocyst. All of these findings were confirmed by choledochoscopy, c) in 26 patients choledochoscopy confirmed complete surgical removal of all stones, d) in six patients, multiple stones were removed using routine common duct exploration but additional stones were seen with the choledochoscope, e) in three patients no stones were retrieved on routine duct exploration but were seen using the choledochoscope. In groups (d) and (e) the scope facilitated removal of the remaining stones. In eight cases stones were either grasped or crushed using the accessories of the choledochoscope. In one patient calculi were missed both by routine surgical exploration and choledochoscopy. No septic complications were seen in any of these patients.

Endoscopes↗
PubMedDate not supplied

The use of laparoscopy in retroperitoneal pathology.

Laparoscopy is usually not performed for retroperitoneal disease. However, if the retroperitoneal process is palpable or displaces viscera, laparoscopy may allow visualization and directed biopsy. In a personal series of 316 laparoscopies reviewed retrospectively, 19 (6%) were performed primarily for retroperitoneal pathology. All patients had CT scans documenting a retroperitoneal process. A confirmed histologic diagnosis was obtained on directed laparoscopic biopsy in 16 patients, including 9 non-Hodgkin's lymphomas. There was no mortality or morbidity in this series. Laparoscopy is a useful modality in selected patients with retroperitoneal diseases, and its use should be considered when a histologic diagnosis is necessary.

Biopsy↗