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Biomedical subjects

G A Fielding

Publications and source records attributed to G A Fielding.

At least 19 recordsLinked to original sources
PubMed1999

Laparoscopic gastric banding for morbid obesity. Surgical outcome in 335 cases.

BACKGROUND: Morbid obesity occurs in 2-5% of the population of Europe, Australia, and the United States and is becoming more common. Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients. MATERIALS AND METHODS: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and a full understanding of all possible complications. RESULTS: All patients have needed band adjustments of 1-4 ml over the course of their follow-up. No patient had increased his or her weight during the follow-up, and only three patients have not enjoyed sustained weight loss. CONCLUSIONS: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery is laparoscopic experience.

Adult↗
PubMed1998

Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients.

PURPOSE: The objectives of this study were to refine the technique of laparoscopically assisted anterior resection (LAR) for diverticular disease and to analyze the morbidity and mortality rates, and longer term follow-up of the first 100 consecutive patients. METHODS: Data were collected prospectively, and follow-up was performed by an independent assessor using a standardized questionnaire. RESULTS: The median duration of surgery was 180 minutes, the median time for passage of flatus was 2 days after surgery, and the median length of hospital stay was 4 days. Overall, the morbidity rate was 21%, and the wound infection rate was 5%. There were no deaths. Eight patients underwent open laparotomy. The rate of complications was significantly greater in the latter group of patients (75%) than in those who underwent laparoscopy (16%, p = 0.002). The comparison between the first 20 cases and the last 20 patients revealed a significantly shorter duration of surgery (median 225 min. vs. 150 min.; p < 0.0001) and decreased length of stay (6 days vs. 4 days, p < 0.0001). Apart from a nonsignificant increase in the length of surgery, there were no differences in other study parameters when comparisons were made between those patients who underwent LAR for complicated diverticular disease and those patients who underwent uncomplicated diverticular disease. FOLLOW-UP: Ninety patients were available for follow-up at a median time of 37 months. Ninety-three percent of the patients reported that the surgery had improved their symptoms. No patient required hospitalization, and no one was treated with antibiotics for recurrent symptoms. CONCLUSION: Laparoscopically assisted anterior resection for diverticular disease has acceptable morbidity and mortality rates and a median postoperative hospital stay of only 4 days. Follow-up investigations revealed no recurrence of diverticulitis, and patients reported satisfaction regarding cosmetic and functional results.

Adult↗
PubMed1997

Laparoscopic colectomy.

BACKGROUND: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible. METHODS: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases, operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence of disease. RESULTS: There were 359 cases (206 females, 153 male) average age 58.8 years (18-94), and 149 patients had malignancy. All types of resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22 rectopexies. Operating times fell with experience-the last 20 cases of anterior resection took 150 min (110-240) and of RHC took 130 min (65-210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted 5-7 days (2-33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures (1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days-sepsis, myocardial infarction, aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence was 33 months (15-46 months). CONCLUSIONS: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible role in treating cancer.

Adolescent↗
PubMed1996

Laparoscopic-assisted colorectal surgery. Lessons learned from 240 consecutive patients.

PURPOSE: To audit the development and outcomes of laparoscopic colorectal surgery at the Royal Brisbane Hospital. METHODS: Since July 1991, laparoscopic-assisted colectomy for benign and malignant colorectal disease has been performed on more than 300 patients at the Royal Brisbane Hospital. This paper summarizes the outcome for the first 240 patients who underwent a laparoscopic colorectal procedure. All laparoscopic data were collected prospectively, and for selected studies, data were compared with open surgical controls. RESULTS: Nineteen patients required open conversion (7.9 percent). There was a significant decrease in wound infection rates in patients having a laparoscopic-assisted colectomy (3.6 percent) compared with historical controls (7.9 percent) (P < 0.05; chi-squared). There were five anastomotic leaks, five laparotomies for postoperative adhesive obstruction, and four perioperative deaths. A total of 103 patients had a procedure for colorectal cancer. Of the 79 potentially curative procedures, there have been 5 (6.3 percent) recurrences to date. CONCLUSION: The overall morbidity and mortality in this series seem to be acceptable compared with that of open procedures.

Colonic Diseases↗
PubMed1996

Laparoscopic mesh repair of recurrent inguinal hernia.

BACKGROUND: Pre-peritoneal mesh repair has been a long-standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year. METHODS: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery. RESULTS: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications. CONCLUSIONS: At early follow up, this is a satisfactory technique for recurrent hernias.

Adult↗
PubMed1995

Laparoscopic inguinal hernia repair.

Between March 1991 and May 1994, 444 laparoscopic inguinal hernia repairs were undertaken in 375 patients: 386 transperitoneal and 58 extraperitoneal. During a follow-up period of 20.5 months (range 1-38) there have been three recurrences at 6, 7 and 12 months, all direct and all after transperitoneal repair. A total of 52 patients were treated as a day case (< 6 h), 317 patients spent less than 24 h in hospital and four patients were discharged on the second postoperative day. Operating time for transperitoneal hernia repair was 27 min (range 10-68) and extraperitoneal repair, 29 min (range 11-48). Short-term complications occurred in 18 patients: six haematomas, four seromas, one urinary retention and seven suffered persistent groin pain. Six patients have had neuralgia, three have had mesh removed and three further patients had individual clips removed from within the inguinal canal. There have been two adhesive small bowel obstructions. The first occurred 2 months after laparoscopic surgery and required laparotomy; the second occurred 2 years after surgery and had laparoscopic division of an adhesive band to a pelvic staple. There was one infected lymphocoele treated percutaneously.

Hematoma↗
PubMed1993

The role of ERCP and endoscopic sphincterotomy in the era of laparoscopic cholecystectomy.

The advent of laparoscopic cholecystectomy (LC) has led to some controversy regarding the best method of managing bile duct calculi. This paper reviews the cases of 38 patients who underwent LC and endoscopic retrograde cholangiopancreatography (ERCP), from a series of 600 consecutive laparoscopic cholecystectomies. Twenty-nine patients had ERCP performed pre-operatively because of suspicion of choledocholithiasis. Duct stones were confirmed in eight patients. Recent or current jaundice was the best predictor of bile duct stones. Nine patients had ERCP done postoperatively because of duct stones seen on operative cholangiography. In two patients bile duct cannulation was not possible and a third procedure, open duct exploration, was necessary. Techniques in laparoscopic management of duct stones are improving and the role of ERCP and sphincterotomy should be limited to jaundiced patients or those with proven bile duct stones in whom laparoscopic procedures have been unsuccessful.

Adult↗
PubMed1993

Laparoscopic common bile duct exploration.

Twenty-one patients underwent laparoscopic common bile duct exploration during a 9 month period. Ten had stones flushed after ampullary dilatation. Seven had stones removed with a Dormier basket and one had direct common duct incision with T-tube insertion. Three failed attempted stone flushing and had stones removed by endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. Operating time ranged from 1.5 to 3.5 h. Nineteen patients were discharged by the second postoperative day. This early experience with laparoscopic stone removal is encouraging, reducing the need for pre-operative or postoperative ERCP.

Adult↗
PubMed1992

Laparoscopic cholecystectomy.

A consecutive series of 220 laparoscopic cholecystectomies (June 1990 to May 1991) is presented. These were the author's initial experience of the technique. Procedures were elective (205) and acute (15), including 3 gangrenous cholecystitis and 4 empyema. There were 166 females and 34 males, 12-75 years, weighing 44-115 kg. Forty-eight patients had prior abdominal surgery. Two hundred and eleven patients had successful laparoscopic cholecystectomies, 6 open cholecystectomies and 3 mini-laparotomies to remove split stones. None of the last 120 cases were opened. Operating time ranged from 20 min to 3 h 20 min. There were 4 serious complications: 2 bile leaks from the gall-bladder bed and 2 jejunal injuries (Veres needle and 5 mm trocar). Sixty-one patients were discharged the next day, 29 on day 2, 5 on day 3, 4 on day 4, 1 on day 5, 1 on day 22 and 1 on day 27. At two weeks follow-up all but 2 patients had fully recovered.

Cholangiography↗
PubMed1992

Laparoscopic cholecystectomy for acute cholecystitis.

Sixty-eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty-two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC. One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC. Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be performed.

Acute Disease↗
PubMed1989

Acute pancreatitis and pancreatic fistula formation.

The cause, management and outcome of 23 patients with a pancreatic fistula following acute pancreatitis are reviewed. Nineteen patients developed an external fistula following necrosectomy or drainage of a pancreatic abscess or pseudocyst; four of these patients died. In the 15 survivors spontaneous closure occurred in 11 cases with low output fistulae; operative intervention was needed in the four cases with high output fistulae. Four patients with internal fistulae had not undergone previous surgery; two of them had a pancreaticopleural fistula with associated pancreaticogastric fistulae, while two had pancreatic ascites. All four of these patients required surgical intervention and one died.

Abscess↗
PubMed1989

Management of gallstone pancreatitis.

The clinical course of 143 patients with gallstone pancreatitis is reviewed. Thirty-one patients (22%) had three or more positive prognostic factors on admission and 24 (77%) of these had a complicated course. Thirteen patients died, giving an overall mortality rate of 9%. Patients were divided into three groups on the basis of performance and timing of surgery. In group 1 (n = 56), surgery was undertaken during the first admission with acute pancreatitis; eight of these patients had a complicated course and three died. In group 2 (n = 40), biliary surgery was deferred to a subsequent admission; none of these patients died but 10 experienced further attacks of pancreatitis while awaiting reoperation. Group 3 patients (n = 47) did not undergo surgery; nine patients were diagnosed as having gallstone pancreatitis for the first time at autopsy, five refused operation, seven were lost to follow-up, six were dealt with by endoscopic sphincterotomy, and in 20 cases surgery was not considered appropriate because of general debility or advanced age. Despite the zero mortality rate in group 2, it is advocated that biliary surgery be carried out during the index hospital admission. Endoscopic sphincterotomy can now be considered as an alternative to cholecystectomy and duct clearance in the elderly and unfit, and may be used as a preliminary manoeuvre when severe acute pancreatitis fails to settle promptly on conservative management.

Acute Disease↗
PubMed1988

Two cases of pseudo-aneurysm of the gastroduodenal artery.

Pseudo-aneurysm of the gastroduodenal artery is a rare cause of bleeding-complicated pancreatitis. The use of computerized tomography and angiography lead to early diagnosis. The key to surgical treatment is arterial inflow occlusion prior to opening the aneurysm.

Adult↗
PubMed1988

Homograft skin banking--current practices and future trends.

Homograft skin remains a very successful technique for covering major burns. This paper reviews current techniques of harvesting, microbiological testing, freezing and thawing of the skin, that lead to its optimal use. Recent advances, especially the use of homograft skin in combination with split skin and skin cultures, will add to the effectiveness of homograft skin application.

Burns↗