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Biomedical subjects

G R Voeller

Publications and source records attributed to G R Voeller.

At least 19 recordsLinked to original sources
PubMed1999

Incisional hernia.

Explore the source record for details and available documents.

Hernia, Ventral↗
PubMed1998

Prospective, multicenter study of laparoscopic ventral hernioplasty. Preliminary results.

BACKGROUND: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE] patch for hernias >/=4 cm2) is being used in a prospective, multicenter, long-term study. METHODS: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted 7-10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients. RESULTS: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120 min. The mean follow-up was 222 days (range 5-731). Postoperative complications were five infections, three cases of prolonged ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively. CONCLUSIONS: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty, the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.

Adult↗
PubMed1995

Totally preperitoneal laparoscopic inguinal herniorrhaphy using balloon distention.

BACKGROUND: After having performed over 200 transabdominal preperitoneal (TAPP) laparoscopic hernia repairs with no recurrences and no neuropathies, we recently changed to a totally preperitoneal repair due to the development of a balloon trocar that easily 'creates' the preperitoneal space. METHODS: The totally preperitoneal operation is similar to our TAPP procedure in that it involves detailed delineation of Cooper's ligament, spermatic cord and transversus abdominis arch with fixation of mesh to Cooper's ligament and arch for an anatomic tension-free hernia repair. RESULTS: Our early experience consists of 60 hernia repairs in 50 patients (46 male, 4 female). There were 32 direct, 26 indirect and two femoral hernias. Eight hernias were recurrent. The operation takes approximately 1 h. There has been no morbidity. As with the TAPP procedure, minimal postoperative discomfort and return to regular activity within 2 to 3 days is the norm. CONCLUSIONS: We believe that the avoidance of the peritoneal incision and the attendant risks of intraabdominal adhesions associated with the TAPP procedure make the totally preperitoneal technique the preferred method of laparoscopic hernia repair.

Female↗
PubMed1994

Laparoscopic femoral hernia repair using a mesh dart.

We report 2 patients with femoral hernias (1 incarcerated) that were encountered during laparoscopic hernia repair for symptomatic direct inguinal hernias. The femoral hernias were readily repaired using the BARD dart that has been described previously for use during open femoral herniorrhaphy. We believe that this is the first report using the dart for laparoscopic femoral herniorrhaphy.

Adult↗
PubMed1993

Preliminary evaluation of laparoscopic herniorrhaphy.

Since November 1990, 50 laparoscopic herniorrhaphies have been done in 47 patients (three patients with bilateral repairs), including 31 indirect and 19 direct inguinal hernias, three of which were recurrent. The 47 patients included 42 men and five women. Small indirect hernias were treated by plugging the hernia orifice with a tightly rolled polypropylene mesh plug. Large indirect, all direct, and combined hernias were treated by creating a peritoneal flap and stapling a polypropylene mesh screen preperitoneally over the defect. The mesh was stapled to Cooper's ligament, iliopubic tract, and transversus abdominous arch. Forty-five patients were discharged on the day of surgery and the other two within 24 h. The average return to full activity has been two days. The only intraoperative complication was an easily controlled trocar site bleeder. Postoperatively one minor trocar site infection occurred. One persistent and one recurrent hernia were among the group, both large indirect hernias done early in our experience (by the plug technique) before stapling instruments were available. The technique of laparoscopic herniorrhaphy is in its infancy and still evolving as our understanding of anatomy and technology improves. Even if long-term follow-up shows an acceptable recurrence rate and less patient disability, surgeons must weigh the wisdom of converting a procedure from local to general anesthesia and an inexpensive procedure into a more expensive procedure.

Female↗
PubMed1991

The effect of a trauma system on the outcome of patients with pancreatic trauma.

Patients suffering pancreatic trauma before and after the creation of a regional trauma center were analyzed. Between 1975 and 1982, before the trauma system was established, 80 patients (10 per year) with pancreatic injury were treated. From 1984 to 1987 (after trauma system implementation), 58 patients (19 per year) with pancreatic injury were treated. There were no significant differences in demographics, mechanisms of injury, types of pancreatic wound, or associated injuries. Sixteen (20%) patients with pancreatic injury during the study period died before the trauma center was established. Of these, 13 (81%) died of hemorrhage. In contrast, five (9%) patients with pancreatic injury who were treated after the trauma center was operational died. Only one death was due to hemorrhage. By relative risk, a patient was 2.67 times more likely to die and 17 times more likely to die of hemorrhage before the presence of the trauma center than after (P less than .03). In this study of a patient population suffering severe intra-abdominal injuries, Organ Injury Outcome Analysis demonstrates that development of a trauma system significantly improves outcome.

Adolescent↗
PubMed1991

Inversion-ligation appendectomy for incidental appendectomy.

Inversion-ligation appendectomy involves the following steps: (1) skeletonizing the appendix from its mesentery; (2) inverting the appendix via a blunt probe into the cecal lumen; (3) ligating the remaining nubbin of tissue; and (4) inverting the nubbin with a purse-string stitch. This procedure allows the surgeon to perform incidental appendectomy while avoiding transection of the appendiceal lumen with its attendant risk of enteric bacterial contamination.

Appendectomy↗
PubMed1991

Laparoscopic posterior truncal vagotomy and anterior seromyotomy: a porcine model.

A training technique for posterior truncal vagotomy and an anterior seromyotomy in the anesthetized pig is described. The first of five procedures was performed open in a conventional method. All succeeding procedures were performed after the establishment of a pneumoperitoneum with CO2 insufflation and the placement of two 10 mm trocars and three 5-mm trocars. A 45 degree camera and monopolar electrocautery were used during the video laparoscopic procedure. After completion of the procedure, the pigs were opened to closely inspect the surgery performed. Though there are some minor anatomic differences between porcine and human anatomy, the pig is an excellent model for gaining technical experience in the performance of a posterior truncal vagotomy and anterior seromyotomy.

Animals↗
PubMed1991

Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries.

During a 5-year period, 482 patients with liver injuries were studied prospectively: 65% resulted from penetrating and 35% from blunt injuries. The injuries were graded by the hepatic injury scale (grades I to VI); transfusion requirements and perihepatic abscesses correlated with increasing scores. Minor surgical techniques were needed in 338 patients and 144 patients required major techniques. Omental packing was used in 60% of the major injuries and yielded 7% mortality and 8% abscess rates. Gauze packs were used for management of 10% of major injuries and yielded 29% mortality and 30% abscess rates. The patients were randomized to no drain, closed suction, or sump drainage and respective perihepatic abscess rates were 6.7%, 3.5%, and 13% (p less than 0.03; suction compared to closed suction). Multivariate analysis demonstrated increasing abdominal trauma indices and transfusion requirements as well as sump drainage to be associated independently with perihepatic infection.

Adolescent↗
PubMed1991

Use of technetium-labeled red blood cell scintigraphy in the detection and management of gastrointestinal hemorrhage.

The effectiveness of technetium 99m-labeled red blood cell scintigraphy in localizing hemorrhage, directing surgical intervention, and screening patients for arteriography was determined in 103 patients. The radionuclide scan result was compared to the bleeding site determined by arteriography, endoscopy, or surgery. Eighty-five patients had a bleeding site identified; 18 patients did not and were excluded. Thirty-one scans were performed in 29 patients for upper gastrointestinal hemorrhage. Five positive scans incorrectly localized an upper gastrointestinal bleeding site, although two scans localized the site, for a scan sensitivity of 8%. Fifty-nine scans were performed in 56 patients with lower gastrointestinal bleeding. Fifteen scans were positive, three incorrectly localizing the hemorrhage. Seventy-four percent of the patients with lower gastrointestinal hemorrhage documented by arteriography, endoscopy, or surgery had negative scans for bleeding. The radionuclide scan sensitivity for lower gastrointestinal bleeding was 23%. Surgery was required in 18 patients for bleeding, 11 of whom had negative scans for bleeding. In seven surgical patients with positive scans, in no instance did the scan direct the surgical intervention. Eighteen patients underwent scintigraphy and arteriography; nearly one half of the patients with negative scans for bleeding had positive localizing arteriograms, although almost one half of the patients with positive scans for bleeding had negative arteriograms. Scintigraphy failed to localize hemorrhage in 85% of the patients. Technetium 99m-labeled red blood cell scintigraphy did not direct surgical intervention, nor did it adequately screen patients for arteriography.

Adult↗
PubMed1991

Preperitoneal herniorrhaphy for the acutely incarcerated groin hernia.

Elective preperitoneal or posterior repair for recurrent groin hernias and primary femoral hernias has been shown to be a technically advantageous approach. In addition to the ease of inguinal floor and femoral canal assessment, scar tissue from prior anterior herniorrhaphy can be avoided. The emergency management of the acutely incarcerated or strangulated hernia of the groin using this approach has not been addressed. During a 30-month period, all patients with a diagnosis of acute incarceration of a groin hernia (n = 28) were surgically managed using either the anterior approach (AA) (n = 14) or the preperitoneal approach (PA) (n = 14). Two patients with strangulated intestine in the AA group required an additional midline incision for bowel evaluation and resection. Intestinal evaluation was easily accomplished through the same incision in four patients in the PA group. The preperitoneal approach also allowed proximal control of incarcerated or strangulated viscera, thus avoiding excessive manipulation of gangrenous or necrotic intestine, potential spillage of infected contents into the peritoneal cavity, and entry of bacteria, toxins, potassium, and the metabolic waste products of anaerobic metabolism into the systemic circulation during hernia reduction. There have been no recurrences in either group, and minor complications, such as wound infection and cellulitis, in the two groups are not statistically different.

Adult↗
PubMed1990

Superiority of closed suction drainage for pancreatic trauma. A randomized, prospective study.

During a 42-month period, 65 patients sustaining pancreatic injuries were treated. They were randomized on alternate days (two separate trauma teams) to receive sump (S) or closed suction (CS) drainage. Twenty-eight patients were randomized to S and 37 to CS; there were six early deaths, which precluded drainage analysis, leaving 24 evaluable S patients and 35 CS patients. Penetrating wounds occurred in 71% and blunt in 29%. No significant differences appeared between the groups with respect to age, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), or grade of pancreatic injury. Twelve patients in each group required resection and drainage for grade III injuries, with the remaining patients receiving external drainage alone. Five of twenty-four S patients versus one of thirty-five CS patients developed intra-abdominal abscesses (p less than 0.04). We conclude that septic complications after pancreatic injury are significantly reduced by CS drainage. Bacterial contamination via sump catheters is a major source for intra-abdominal infections after pancreatic trauma.

Abscess↗
PubMed1990

Carotid artery trauma: management based on mechanism of injury.

Fifty-six patients with carotid injuries were reviewed (35 penetrating and 21 blunt). Shock correlated with a profound neurologic deficit on admission (p less than 0.03) in those with penetrating wounds. Thirty-one percent had primary repair, 25% had interposition grafting, 17% were ligated, and 17% were anticoagulated. Two graft failures resulted in death. Three blunt common carotid injuries followed direct cervical soft-tissue trauma; 18 internal carotid (ICA) dissections followed apparent extreme neck extension or flexion. Seven had bilateral ICA dissections (39%); none of these died. All dissections were diagnosed by angiography prompted by a change in the neurologic examination or an initial neurologic deficit unexplained by CT scan. Seventy-one percent had major associated injuries; 43% intra-abdominal solid viscus, 24% pelvis/long bone fractures, and 24% cervical spine/facial fractures. Dissections were treated with anticoagulation; 60% improved, 23% were unchanged, and 17% deteriorated. It is concluded that interposition grafting should be avoided if possible following penetrating wounds; liberal angiography is warranted with incompatible CT findings following blunt trauma; and anticoagulation is safe and effective therapy for blunt carotid dissections.

Adolescent↗