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B Ramshaw

Publications and source records attributed to B Ramshaw.

10 recordsLinked to original sources
PubMed2003

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases.

BACKGROUND AND OBJECTIVES: Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multi-institutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique. METHODS: Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions. RESULTS: The mean time from mesh implantation to reoperation was 420 days (range, 2-1 739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91 %) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis. CONCLUSIONS: In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91 % of cases, and no severe cohesive adhesions were found. Comparative analyses of newer materials based on clinical reoperative findings are warranted to assess the safety of intraabdominally placed meshes.

Adult↗
PubMed2002

Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair: initial experience in the United States.

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17-80 years). The average operative time for all cases was 54.3 min (range, 18-157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2-22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages.

Adolescent↗
PubMed2001

Laparoscopic inguinal hernia repair: lessons learned after 1224 consecutive cases.

BACKGROUND: Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence rates are as high as 5-20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear visualization of all preperitoneal fascial planes and anatomic landmarks, as well as the hernia defect(s) and the peritoneal reflection. In the course of our performance of a series of 1,224 laparoscopic inguinal hernia repairs, we have developed a total extraperitoneal approach that yields excellent results with a low initial recurrence rate. Herein we describe our experience. METHODS: After our initial 300 transabdominal preperitoneal (TAPP) hernia repairs, which resulted in six recurrences, two bowel injuries, one bladder injury, and six cutaneous nerve injuries, the total extraperitoneal approach (TEP) was adopted. RESULTS: The first 300 TEP repairs resulted in one recurrence, two bowel injuries, one bladder injury, and two cutaneous nerve injuries. All major complications occurred in patients who had had previous lower abdominal surgery. In the last 624 TEP herniorrhaphies we implemented some modifications to the technique, especially for patients with previous lower abdominal surgery. In this group we recorded one bladder injury, no cutaneous nerve injuries, and one recurrence. CONCLUSIONS: The total extraperitoneal approach for laparoscopic herniorrhaphy allows for a safe and effective repair with low rates of complication and recurrence. A thorough knowledge of the anatomy of the extraperitoneal space and especially the two- and three-dimensional inguinal anatomy of this space contributed greatly to the evolution of our technique.

Adolescent↗
PubMed2000

The use of water-soluble contrast in evaluating clinically equivocal small bowel obstruction.

This study seeks to determine whether a 6-hour abdominal radiograph after oral Gastrografin is a reliable indicator for nonoperative treatment in patients with a clinically equivocal small bowel obstruction. We collected retrospective data from medical records. Patients who received a Gastrografin transit time (GGTT) study between January 1995 and September 1998 were included in the study. Patients who did not appear to be obvious operative candidates, but had signs of intestinal obstruction, underwent a GGTT study. Serial plain abdominal radiographs were taken. If the contrast was in the colon within 6 hours, then the result was negative. A total of 418 GGTT studies were reviewed. Contrast reached the colon within 6 hours in 283 (68%) patients, and 247 (88%) of these patients were managed nonoperatively. The positive predictive value, negative predictive value, sensitivity, and specificity of Gastrografin reaching the colon within 6 hours were 48, 87, 64, and 78, respectively. False negatives included high-grade partial obstructions that ultimately required surgery. Recent operation preceded the GGTT in 128 (31%) cases. Of these 128 patients, only 17 (14%) received an operation. Although the decision to operate or not should never be based on a GGTT study alone, GGTT studies are of significant help in the clinical management of patients suspected to have a small bowel obstruction. GGTT allows for the judicious selection of the appropriate patient for nonoperative management. GGTT studies are cost effective, safe, and clinically useful when attempting to treat patients conservatively.

Contrast Media↗
PubMed1999

Incisional hernia.

Explore the source record for details and available documents.

Hernia, Ventral↗
PubMed1997

Laparoscopy in the evaluation and treatment of patients with AIDS and acute abdominal complaints.

BACKGROUND: The evaluation of AIDS patients with acute abdominal complaints (AAC) is quite difficult, and surgical intervention is associated with a high complication rate. The intent of this study is to evaluate the application of laparoscopy in the diagnosis and treatment of AIDS patients with AAC. METHODS: This is a retrospective analysis of 10 consecutive AIDS patients who presented with AAC. Each had evaluation by a surgical team with subsequent laparoscopic intervention. The charts were reviewed for age, sex, time with AIDS, AIDS comorbidities, evaluation modalities, findings, treatment modalities, and outcome. RESULTS: Laparoscopy resulted in the successful surgical treatment of four patients, diagnosis of medically treatable conditions in four patients, and alteration of the incision site in the remaining two patients. Each patient thus received direct benefit from laparoscopy. Two complications, in the converted patients, and no mortalities were encountered. CONCLUSIONS: Laparoscopy is a safe and effective interventional modality in the diagnosis and treatment of AAC in the AIDS patient.

Abdomen, Acute↗
PubMed1996

Twenty-year follow-up breast screening project.

Routine yearly breast screening with mammograms and physical examination can usually detect very small nonpalpable cancers that have a high survival rate. Routine breast screening with mammography and physical examination of asymptomatic women is the best method of controlling breast cancer at present.

Adult↗
PubMed1980

Experimental brain stem displacement. Its implications in the upward and downward herniation syndromes.

6 dogs were anesthetized and a silver clip attached to a cotton plug as surgically placed in the aqueduct of Sylvius. An immediate postoperative lateral skull film was obtained to demonstrate the position of the clip. The animals developed signs of hydrocephalus within hours after the procedure. 2 weeks after placement of the aqueduct plug, the animals recieved a permanent ventriculostomy. Immediate pre- and postoperative ventriculostomy lateral skull films were taken again to indicate position of the silver clip. Finally, a lateral skull film was taken 2 weeks after ventriculostomy and just prior to sacrifice. Radiological techniques were standardized. In this experimental setting downward brain stem herniation predominated and upward herniation of the brain stem was an infrequent occurrence.

Animals↗
PubMed1979

Cerebrospinal fluid bulk flow study: radioiodinated serum albumin (R131ISA) and technetium-99m-labeled diethylenetriaminepentaacetic acid (DTPA) retention in the ventricles of normal and hydrocephalic dogs.

Eight normal dogs were studied and then made hydrocephalic (kaolin induced) to demonstrate and compare the use of R131ISA and 99mTcDTPA in cerebrospinal fluid (CSF) bulk flow studies. The radioisotopes were simultaneously injected into the CSF space in the cisterna magna of normal dogs and into the lateral ventricles of hydrocephalic dogs after an equal volume of CSF had been removed. The average dose of RISA was 100 muCi, and for TcDTPA it was 7 mCi. A bag of lactated Ringer's solution (500 ml) was used as a control phantom after being injected with the same dose of isotope as used in the animals. Brain scans were obtained with the gamma ray camera at 4 and 24 hours after injection. We used four criteria to evaluate results: clinical state of the animal, CSF ventricular pressures with challenges, percentage of retained isotope in counts per minute, and ventricular size at postmortem examination. The results demonstrate that the amount of isotope retention over 20 hours and the clinical state of the dog are better correlated when RISA is used than when TcDTPA is used. The study indicates that RISA is more reliable than TcDTPA as an indicator of CSF bulk flow in both normal and hydrocephalic dogs.

Animals↗