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Biomedical subjects

Bruce V MacFadyen

Publications and source records attributed to Bruce V MacFadyen.

13 recordsLinked to original sources
PubMed2002

Laparoscopic common bile duct exploration.

In recent years, laparoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique. In this article we discuss the technique and results of laparoscopic common bile duct exploration. Both the laparoscopic transcystic approach and choledochotomy are discussed, together with the results given in the literature. When one considers the costs, morbidity, mortality and the time required before the patient can return to work, it would appear that laparoscopic cholecystectomy with common bile duct exploration is more favorable than open surgery or laparoscopic cholecystectomy with preoperative or postoperative endoscopic sphincterotomy. However, the technique requires advanced laparoscopic skills, including suturing, knot tying, the use of a choledochoscope, guidewire, dilators and balloon stone extractor. Although laparoscopic common bile duct exploration appears to be the most cost-effective method to treat common bile duct stones, it should be emphasized that this procedure is very challenging, and it should be performed by well-trained laparoscopic surgeons with experience in biliary surgery.

Biliary Tract Surgical Procedures↗
PubMed2002

A cause for conversion of laparoscopic splenectomy: splenic candidiasis.

Laparoscopic splenectomy (LS) is now considered the procedure of choice for removal of the spleen in several hematologic and traumatic splenic conditions. Perisplenitis is still considered a relative contraindication. We report a rare case of isolated splenic candidiasis treated by laparoscopic splenectomy. The technical challenges of the laparoscopic approach in cases of perisplenitis are outlined. Because of dense adhesions to the diaphragm, the LS was converted to open splenectomy, and the procedure was completed through a small subcostal incision. This case report suggests the need for and effectiveness of splenectomy in patients whose fungal infection is suspected to be localized to the spleen. Laparoscopic removal of the spleen in these cases is very difficult to accomplish because of the risk for diaphragm injuries and the technical problems encountered.

Adult↗
PubMed2002

Imaging modalities for acute abdominal pain.

The diagnosis of acute abdominal pain remains hinged on the performance of a careful history and physical exam. Five to ten million emergency department visits occur each year for acute abdominal pain, creating a need to achieve improved diagnostic accuracy in an expedient fashion. Technologies such as ultrasound, computed tomography, magnetic resonance imaging, and diagnostic laparoscopy are helping achieve this goal. Of these, computed tomography appears to be the work horse of diagnostic imaging in the setting of acute abdominal pain. In this review, we examine each of these modalities, discussing their strengths and weaknesses. As well, we have reproduced an excellent algorithmic approach published by Martin and Rossi that shows the reader some basic diagnostic strategies for the evaluation of acute abdominal pain.

Abdominal Pain↗