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Biomedical subjects

E H Phillips

Publications and source records attributed to E H Phillips.

9 recordsLinked to original sources
PubMed1992

Laparoscopic choledochoscopy: an effective approach to the common duct.

With increasing acceptance of routine cholangiography during laparoscopic cholecystectomy (for confirmation of anatomy) there has been increased identification of common duct calculi. A technique of laparoscopic transcystic common duct stone extraction is described and early clinical results are presented. Successful stone extraction was accomplished in 39 out of 41 consecutive attempts by one surgical team. Two cases required choledochotomy. There were four complications including hyperamylasemia (2), minor wound infection (1), and incidental pneumothorax (1). Recommendations regarding safety and indications are presented. Initial evaluation suggests laparoscopic transcystic stone extraction is safe and effective.

Adolescent↗
PubMed1992

Laparoscopic-guided biopsy for diagnosis of hepatic candidiasis.

Histopathological evaluation of infected tissue is critical in the diagnosis of hepatic candidiasis since cultures are unreliable. Percutaneous techniques are inaccurate because lesions often are small and multifocal, and open biopsy is not always well-tolerated in acutely ill patients. The authors investigated the feasibility of laparoscopically guided biopsy in patients suspected of having hepatic candidiasis. Preliminary results suggest that laparoscopically guided biopsy is highly accurate and less invasive than open biopsy.

Adult↗
PubMed1992

Laparoscopic colectomy.

Fifty-one laparoscopic colectomies were attempted at two institutions. The clinical results and methods are presented. Seven cases (14%) were converted to facilitated procedures, and four cases (8%) were converted to "open." Cases of cancer, diverticulitis, endometriosis, regional enteritis, villous adenomas, and sessile polyps were operated. Right, transverse, left, low anterior, and abdominoperineal colectomies were performed. Colotomies and wedge resections were also performed. Laparoscopic suturing was required in five cases of incomplete anastomosis by circular stapler (18%). Suturing was required in all right, transverse colectomies and colotomies. Operative time averaged 2.3 hours. Hospitalization averaged 4.6 days. Four patients had complications (8%), and one 95-year-old died of pneumonia (2%). Laparoscopic colectomies can be performed safely, but require two-handed laparoscopic coordination, as well as suturing and knot-tying skills.

Adult↗
PubMed1992

Laparoscopic cholecystectomy in acute cholecystitis.

Between August 1989 and December 1990, twenty-five patients with a preoperative diagnosis of acute cholecystitis underwent laparoscopic cholecystectomy. Twenty-one patients (84%) had abdominal tenderness, 16 (64%) had leukocytosis, and 10 (40%) had fever. Eleven patients (44%) came to the hospital with only one of these previously mentioned clinical signs. Six patients (24%) had two clinical signs. Eight patients (32%) came to the physician with all three findings. The length of surgery correlated directly with the number of presenting clinical signs. The average operating time was 119 minutes. Intraoperative cholangiograms were routinely performed on all patients. Four patients (16%) had common bile duct stones. The average hospitalization was 3.8 days and patients returned to work or routine physical activity between 3 days and 2 weeks (average 8 days) after surgery. There were three wound infections and two cases of hyperamylasemia. One patient developed urinary retention and another had a CO2 embolus. There were no intra-abdominal abscesses and no mortality. Laparoscopic cholecystectomy in acute cholecystitis is technically difficult. The incidence of common bile duct stones is greater than in elective cases, and routine cholangiography is crucial. With sufficient experience and skill, laparoscopic cholecystectomy can be performed safely in patients with acute cholecystitis.

Academic Medical Centers↗
PubMed1990

The importance of intraoperative cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC.

Adolescent↗
PubMedDate not supplied

Laparoscopic splenectomy.

Splenectomy has traditionally been done through a generous laparotomy incision, requiring complete mobilization of the spleen for removal. In selected cases, however, splenectomy may either be facilitated or performed entirely by laparoscopic means. Two patients with Hodgkin's disease in whom splenectomy was facilitated laparoscopically are described; in another patient with idiopathic thrombocytopenic purpura (ITP), the splenectomy was successfully performed through the trocar incisions. In selected cases, laparoscopic splenectomy is feasible, provided the laparoscopist is expert in advanced techniques of intraabdominal endoscopic surgery.

Adult↗
PubMedDate not supplied

Laparoscopic cholecystectomy in the heart transplant candidate with acute cholecystitis.

We report the first successful laparoscopic cholecystectomy for treatment of acute cholecystitis in a heart transplant candidate with end-stage heart disease. Eight successful cases of conventional cholecystectomy in heart transplant candidates have been reported, but convalescence after the conventional procedure is prolonged, and morbidity often interferes with a timely heart transplantation. Laparoscopic cholecystectomy is a less-invasive method for treatment of symptomatic cholelithiasis and cholecystitis and may be better tolerated in this patient population. Although further study is needed, we believe laparoscopic cholecystectomy will have applications in patients with end-stage heart disease.

Cholecystectomy↗