PubMed Health⌕ Search

Biomedical subjects

G Berci

Publications and source records attributed to G Berci.

At least 19 recordsLinked to original sources
PubMed1992

Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison.

Records of 1200 consecutive open cholecystectomies, performed by a teaching service of a large, urban hospital in the years immediately preceding the laparoscopic era, were reviewed for morbidity and mortality rates. The mortality rate in this series was 1.8%, chiefly in the older age groups. Only two ductal injuries were incurred. A review of published series from 1952 through 1990 revealed a mean mortality rate of 1.53%. These recent observations on the morbidity and mortality after open operation should provide a useful standard of comparison with ongoing similar studies of laparoscopic cholecystectomy.

Adolescent↗
PubMed1992

Biliary ductal anatomy and anomalies. The role of intraoperative cholangiography during laparoscopic cholecystectomy.

Biliary ductal anomalies of surgical importance can occur in 10% of patients. The short cystic duct draining into the common bile or right hepatic duct and the extreme proximity of the common bile duct in case of spiral or posterior entry of the cystic duct--if not recognized in time--can result in ductal injuries. The new mobile, digitized fluoroscopic units provide a vastly improved image within minutes. In case of an inadvertent ductal injury (extravasation, no contrast material visible in the proximal ductal system) the surgeon can immediately repair the injury. Routine intraoperative cholangiography is strongly recommended during laparoscopic cholecystectomies.

Bile Ducts↗
PubMed1991

The role of cholangiography in laparoscopic cholecystectomy.

Cholangiography is not routinely performed in open surgery, but there are reasons why it should be in laparoscopic cholecystectomy. These include finding common duct stones, identifying the cystic-common duct junction, and noting an inadvertent injury. Thirty-six (7.0%) of 516 laparoscopic cholecystectomies were converted to open surgery; 24 before attempting cholangiography and 12 based on roentgenographic findings. In 73 patients (14.1%), cholangiography showed abnormal findings. Common duct injury was identified in one patient and common duct stones were found in 35. Twenty-one patients were treated laparoscopically and eight underwent open choledocholithotomy. In 22 patients, a short cystic duct was seen that might otherwise have been overlooked, and possible injury was avoided. Cholangiography should be attempted routinely, so that in cases with abnormal findings, open cholecystectomy may be considered.

Catheterization↗
PubMed1991

New ideas and improved instrumentation for laparoscopic cholecystectomy.

A new cholangiograsper cannula was developed through which a Fr 4 or 5 ureteric cannula can be advanced into the incised cystic duct and held in a water-tight position. This instrument facilitates intraoperative cholangiography. A plastic trocar stylet eliminates the metal shadow of the trocar during cholangiography. A new "laparocamera" is described where camera and telescope are built together in one unit decreasing the need for additional manipulation during the procedure. A camera holder driven by air helps the operator to keep his/her hands free. The need for a third assistant is avoided by inserting the camera into a (presterilized) holder, the position of which is controlled by press buttons.

Catheterization↗
PubMed1991

A new training device for laparoscopic cholecystectomy.

Laparoscopic cholecystectomy provides a new approach for gallbladder removal with which most general surgeons are not familiar. Requisites for the safe performance of this procedure are good hand-eye coordination, depth perception, and team cooperation. To aid with problems in depth perception and in the opposing movements caused by the lever principle, a training model was designed in which surgeons may execute a variety of exercises to enhance their motor skills and learn to work cooperatively with two other surgeons before operating on an experimental animal.

Cholecystectomy↗
PubMed1991

Elective diagnostic laparoscopy.

Laparoscopy developed as a science at the turn of the century, and many scientists assisted in the evolution of this technique. However, it was many years before the multiple trocar system was developed that allowed internal organs to be moved and biopsies to be obtained. This has led to the development of numerous indications for elective diagnostic laparoscopy. Adequate preparation and attention to instrumentation ensure the safety of this operation. Elective diagnostic laparoscopy is a useful adjunct to many other diagnostic modalities such as, for instance, the assessment of abdominal pain, abdominal masses, fever of unknown origin, and gastrointestinal bleeding. In many other circumstances, such as the assessment of oncology cases, this modality is superior to conventional radiology because biopsy specimens may be obtained. If the procedure is correctly performed, the diagnostic yield is extremely high and the morbidity and mortality are low. The role of this important technique should not be underestimated by today's practicing surgeon.

Adult↗
PubMed1991

Emergency laparoscopy.

Unnecessary abdominal explorations in severely injured patients can be reduced by employing emergent or urgent laparoscopy in blunt abdominal trauma and the obscured, acute abdominal cases. In 150 blunt abdominal trauma cases, a mini-laparoscopy was used in the emergency room or the intensive care unit without major complications. In 56%, the findings were negative. In 19%, the laparoscopic findings were corroborated by surgery. In 25%, a minimal to moderate hemoperitoneum was found and the laparoscopic impression dictated close observation. Unnecessary exploration was avoided except in one case. In the elderly high-risk patient with a poor history, abdominal examination can be noninformative. Laparoscopy can detect acute appendicitis or organ perforation. In the young female, appendicitis can be differentiated from pelvic inflammatory disease. Laparoscopy is more accurate and gives a larger latitude for decision-making than lavage. It can also be useful in the obscured problematic abdominal case.

Abdomen, Acute↗
PubMed1991

Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy?

Intraoperative cholangiography can be helpful in cases in which the anatomy is obscured, unsuspected stones are discovered, or anatomic anomalies of surgical importance are found. There is a difference between open and closed laparoscopic cholecystectomy. It is more difficult to locate the common bile duct during laparoscopic cholecystectomy. During this procedure, the anatomy is distorted due to the extreme traction at the infundibulum. With a short cystic duct, the common bile duct can become "tented" and simulate the appearance of the cystic duct. Ductal injuries may be avoided by knowing where the clips should be placed in relation to the ductal system and by obtaining information about the intact display of the distal and proximal ductal system. The image can be observed immediately by using a modern fluoroscopic system, and permanent documentation can be obtained. We attempted intraoperative cholangiography in 415 cases and were successful in 90%. We strongly recommend the routine use of intraoperative cholangiography.

Catheterization↗
PubMed1991

The Los Angeles experience with laparoscopic cholecystectomy.

Surgeons should be competent in diagnostic laparoscopy before performing laparoscopic cholecystectomy (LC). Well-structured and endorsed courses with experienced faculty are important. Within 12 months, 418 LCs were performed in our hospital. The number of open cholecystectomies decreased to one third of all cholecystectomies performed. Cholangiography was attempted routinely and the duct was successfully cannulated in 90%. Inquiries were made at 6 other hospitals within a 5-mile radius where a total of 220 LCs were performed. The following gray areas need to be addressed: patients with slightly increased liver function tests but no jaundice, and unsuspected stones discovered by cholangiography. New projects are in progress to explore the common bile duct via the cystic duct or directly through the common bile duct with insertion of a T tube. The authors recommend proper training as well as caution and sound judgment before commencing with LC.

Aged↗
PubMed1991

Ancillary instruments for the video microlaryngoscope.

Two years of experience with the video microlaryngoscope has identified the need for ancillary instrumentation to take full advantage of the system's potential. The authors developed the following additions to video microlaryngoscopy: 1) a hinged mirror that may be articulated from its pistol grip handle; 2) a 4-mm 30 degrees or 70 degrees angled telescope for examination of subglottic areas not accessible by mirror examination; and 3) angulated laryngeal instrumentation that permits operation on previously obscured anterior anatomy. The authors also find that the video microlaryngoscope's distal view eliminates interference with visualization caused by the syringe during vocal cord injection.

Humans↗
PubMed1991

Laparoscopic trancystic choledocholithotomy as an adjunct to laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is rapidly becoming the standard operation for symptomatic cholelithiasis. Initially, common duct stones presented a barrier to this treatment modality and are said to be unsuspected in 5-9 per cent of patients. A technique is described that removes common bile duct stones through the cystic duct with a flexible nephroureteroscope, thereby extending the range of laparoscopic cholecystectomy.

Adult↗
PubMed1990

The effect of ursodiol on the efficacy and safety of extracorporeal shock-wave lithotripsy of gallstones. The Dornier National Biliary Lithotripsy Study.

BACKGROUND: In the treatment of gallstones with extracorporeal shock-wave lithotripsy, the bile acid ursodiol is administered to dissolve the gallstone fragments. We designed our study to determine the value of administering this agent. METHODS: At 10 centers, 600 symptomatic patients with three or fewer radiolucent gallstones 5 to 30 mm in diameter, as visualized by oral cholecystography, were randomly assigned to receive ursodiol or placebo for six months, starting one week before lithotripsy. RESULTS: The stones were fragmented in 97 percent of all patients, and the fragments were less than or equal to 5 mm in diameter in 46.8 percent. On the basis of an intention-to-treat analysis of all 600 patients, 21 percent receiving ursodiol and 9 percent receiving placebo (P less than 0.0001) had gallbladders that were free of stones after six months. Among those with completely radiolucent solitary stones less than 20 mm in diameter, 35 percent of the patients receiving ursodiol and 18 percent of those receiving placebo (P less than 0.001) were free of stones after six months. Biliary pain, usually mild, occurred in 73 percent of all patients but in only 13 percent of those who were free of stones after three and six months (P less than 0.01). There were few adverse events. Only diarrhea occurred with a significantly different frequency in the two groups: 32.6 percent were affected in the ursodiol group, as compared with 24.7 percent in the placebo group (P less than 0.04). Severe biliary pain occurred in 1.5 percent of all patients, acute cholecystitis in 1.0 percent, and acute pancreatitis in 1.5 percent; endoscopic sphincterotomy was performed in 0.5 percent, and cholecystectomy in 2.5 percent. CONCLUSIONS: Extracorporeal shock-wave lithotripsy with ursodiol was more effective than lithotripsy alone for the treatment of symptomatic gallstones, and equally safe. Treatment was more effective for solitary than multiple stones, radiolucent than slightly calcified stones, and smaller than larger stones.

Blood Pressure↗