PubMed Health⌕ Search

Biomedical subjects

G L Falk

Publications and source records attributed to G L Falk.

At least 19 recordsLinked to original sources
PubMed2005

Does routine intraoperative cholangiography prevent bile duct transection?

BACKGROUND: The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature. METHODS: Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed. RESULTS: The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection. CONCLUSIONS: In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.

Adult↗
PubMed2004

Symptomatic and radiological follow-up after para-esophageal hernia repair.

The treatment of para-esophageal hernia by the laparoscopic approach has been described by a number of authors. The lower morbidity of the laparoscopic approach compared with the open approach holds some attraction, however, reservations regarding the durability of laparoscopic repair exist. There is a paucity of objective follow-up data in the literature with regard to repair durability and symptomatic outcome. A review was undertaken of 94 patients over a 7 year period undergoing attempted laparoscopic repairs of para-esophageal hernia. Preoperative and operative data was collected and patients underwent postoperative interview and barium meal. Laparoscopic repair was successfully completed in 86 patients. Symptomatic reherniation occurred in 12% (10/86) of patients undergoing laparoscopic repair. These patients underwent open reoperative surgery. There were no symptomatic recurrences in patients undergoing initial open repair. Symptomatic outcome was assessed by interview in 78% (73/94) of patients at a median of 27 months (3-93 months) postoperatively. Ninety-seven percent (71/73) of patients were satisfied with their ultimate symptomatic outcome however, this group included seven patients who had required reoperative surgery for symptomatic recurrence and were therefore laparoscopic failures. In order to determine the asymptomatic recurrence rate patients were requested to undergo a barium meal. A further nine small asymptomatic recurrences were diagnosed in 42 patients having had laparoscopic repair. This represents an asymptomatic radiographic recurrence rate of 21%. Laparoscopic repair in this series was associated with a 12% symptomatic recurrence rate. The majority of patients with symptomatic recurrence underwent open reoperation with good results. Strategies for reducing recurrences should be examined in prospective series.

Adolescent↗
PubMed2002

Laparoscopic excision of a Brunner's gland hamartoma of the duodenum.

Brunner's gland hamartoma (adenoma) was first described in 1876. It is a rare hamartomatous lesion, with only 100 cases reported in the world literature. Treatment has been by endoscopic snaring. Open surgical excision was reserved for cases where snaring had failed. We report a case of a Brunner's gland hamartoma (2.4 cm) that was successfully resected by laparoscopic techniques. Postoperative hospital stay was brief (2 days), and there were no complications. This is the second reported case to be resected laparoscopically.

Brunner Glands↗
PubMed2000

Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication.

Laparoscopic fundoplication has become the standard operation for gastroesophageal reflux disease. In our service, a laparoscopic fundoplication is performed as a 2-cm floppy 360 degrees wrap with division of the short gastric vessels and the fundoplication is sutured using a prolene 2/0 mattress suture (Ethicon, USA) and buttressed laterally with two teflon pledgets (PTFE 1.85 mm; low porosity, Bard, USA). We report a patient with post-operative dysphagia due to an esophagogastric fistula caused by erosion of a teflon pledget. This is the first such case in 734 laparoscopic fundoplications performed between January 1991 and December 1998. Reoperation was required, resulting in a prolonged convalescence. A review of current literature has not revealed any similar cases. Causes for this rare complication are postulated.

Esophageal Fistula↗
PubMed1999

In vitro assessment of back pressure on ventriculoperitoneal shunt valves. Is laparoscopy safe?

BACKGROUND: Whereas there are case reports of laparoscopy in patients with ventriculoperitoneal shunts, there are no studies assessing the potential failure of shunt valves with the increased intra-abdominal pressure of laparoscopy. This study aims to assess this factor. METHODS: An in vitro model was used to assess the potential for retrograde failure of ventriculoperitoneal shunt valves in a commonly used shunt. Nine shunts were subjected to graded increases in back pressure and observed for retrograde valve leak. RESULTS: None of the shunts tested showed any signs of leak associated with the increased back pressure. However, disruption of shunt seals was noted in seven of the nine shunts, occurring at the minimal pressure of 80 mmHg. CONCLUSIONS: There appears to be minimal risk of retrograde failure of the valve system in the ventriculoperitoneal shunt tested. However, tests on different types of ventriculoperitoneal shunts would be needed to confirm these results if laparoscopy is to be considered safe in patients with ventriculoperitoneal shunts in situ.

Equipment Failure↗
PubMed1998

Laparoscopically assisted massive splenectomy. A preliminary report of the technique of early hilar devascularization.

Laparoscopic splenectomy has been safely performed for small spleens, but technical limitations have prevented massive splenectomy. We describe a technique of early hilar devascularization to enable massive splenectomy in three patients over the age of 80 years. Massive splenectomy was performed with minimal blood loss and minor morbidity. Early laparoscopic control of the splenic artery and vein will enable the safe removal of the massive spleen, without major laparotomy. Morbidity of splenectomy may be reduced by laparoscopy.

Aged↗
PubMed1998

Staging of oesophageal carcinoma by endoscopic ultrasound: preliminary experience.

BACKGROUND: Endoscopic ultrasound (EUS) is a relatively recent imaging modality that is capable of visualizing oesophageal tissue layers and para-oesophageal structures. Current pre-operative staging of oesophageal cancer is less than satisfactory, and a modality which may improve pre-operative staging, thus allowing a more rational approach to choice of treatment, may be a welcome addition to current techniques. The purpose of the present study was to evaluate the accuracy of EUS in the staging of oesophageal carcinoma in a consecutive cohort of patients. METHODS: Forty-three patients with oesophageal cancer were prospectively staged with EUS using the radial scanning Olympus EUM-3 echo-endoscope. In the 28 patients who underwent surgery EUS staging was correlated with operative and histological findings to evaluate the EUS accuracy rate of assessing tumour depth (T stage), and the presence of nodal involvement (N stage) using internationally accepted TNM staging criteria. RESULTS: Endoscopic ultrasound accuracy rates for overall T-staging was 61% whereas that of N-staging was 75%. The overall TNM pathological staging was 75% accurate by EUS. CONCLUSIONS: Compared to published literature figures for oesophageal staging by computed tomography scanning (39-54%) these results demonstrate that EUS has a reasonable accuracy rate for staging. Endoscopic ultrasound may prove to be a useful additional modality in the management of oesophageal cancer.

Adenocarcinoma↗
PubMed1998

Lymphoepithelial cyst of the pancreas: serum markers do not help.

We report a case of lymphoepithelial cyst of the pancreas with non-specific elevation of CA 19.9 and CEA. Pre-operative diagnosis by conventional means proved elusive, and only surgical resection and histopathology revealed the diagnosis. The origin and diagnosis are discussed by literature review.

Biomarkers, Tumor↗
PubMed1997

Carcinoma of the esophagus treated with radical chemoradiation 19 years after irradiation for recurrent breast cancer.

Prior irradiation to a site is a relative and often absolute contraindication to further irradiation because the tolerance dose of normal tissues is usually exceeded and therefore the risk of serious long-term side-effects is high. This case report describes radical salvage chemoradiation for an esophageal carcinoma in a patient who had prior high-dose neck and chest wall irradiation for the management of a breast cancer 19 years previously.

Adenocarcinoma↗
PubMed1997

Trainee selection.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed1996

Re-operation for failed anti-reflux surgery.

BACKGROUND: Between 1993 and 1995, 315 anti-reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (80%), a Nissen fundoplication. METHODS: Pre-operative investigations in all patients were manometry, 24h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three (10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re-operation most re-operative surgery was performed transabdominally (94%). Complications occurred in 16%. RESULTS: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome. CONCLUSIONS: Transabdominal re-operative anti-reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.

Adult↗
PubMed1996

Complications of laparoscopic fundoplication: the first 100 patients.

Laparoscopic fundoplication is being performed with increasing frequency. The learning curve for the operation is long, and we herein discuss some of the problems we have experienced with this surgery. We also discuss changes we have made in our technique as the result of our experiences.

Adolescent↗
PubMed1994

The management of perforation of the duodenum following endoscopic sphincterotomy: a proposal for selective therapy.

The successful non-surgical management of retroduodenal perforation following endoscopic sphincterotomy is reported and the literature reviewed. Two patients are described who developed gas in the retroperitoneum following endoscopic sphincterotomy. One patient developed retroperitoneal emphysema and cervical emphysema, while the second patient developed retroperitoneal emphysema and a pneumothorax following endoscopic sphincterotomy. Both patients were treated conservatively and made uneventful recoveries. An algorithm for assessment and treatment is proposed based on the authors' experience and a literature review. Patients with confirmed ongoing duodenal leakage, sepsis or collection should have expeditious surgery.

Cholangiopancreatography, Endoscopic Retrograde↗