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H Fallahzadeh

Publications and source records attributed to H Fallahzadeh.

9 recordsLinked to original sources
PubMed1998

Should a laparoscopic appendectomy be done?

For a laparoscopic appendectomy to be part of a surgical armamentarium, it should: 1) decrease hospital stay, 2) lessen narcotic requirement, 3) speed return to normal activity, 4) be cost effective, and 5) have fewer complications. To this end, we reviewed 60 consecutive cases of each appendectomy performed, laparoscopically and by open technique, during the period of 1993-1996. We looked not only at the above criteria, but also at the type of employment. Laparoscopic appendectomy did not decrease hospital stay (2.1 versus 1.4 days), or morphine equivalent narcotic requirement (38.5 mg versus 19.8 mg). However, laparoscopic appendectomy did carry a hospital bill of $3650.00 more than the open technique ($7923 versus $4273). This results not only from chargeable disposable items, but also from an increase in operative time (47 vs. 36 minutes) and room and anesthesia time (88 vs. 63 minutes), because of the increased length of preparation time. In only one category, patients involved in heavy manual activity (17 patients), the return to normal activity decreased by 1 week. There was no difference in complication rate in each category. Based on these findings, laparoscopic appendectomy cannot be recommended in suspected cases of appendicitis.

Adult↗
PubMed1997

Common duct exploration during laparoscopic cholecystectomy.

Management of a common duct stone detected during laparoscopic cholecystectomy remains controversial. Although endoscopic retrograde cholangiopancreatography with sphincterotomy is a procedure preferred by many authors, it has a reported 15 per cent reported morbidity, 1 per cent mortality, 5 per cent failure rate, and 5 per cent incidence of late ampullary stenosis. Cystic duct dilatation with the introduction of a choledoscope and a basket remains an alternative but has a risk of a common duct tear and difficulty in manipulation of instrument should the cystic duct enter the common duct at an angle, and it causes difficulty in extraction of larger stones. In our experience, a choledochotomy with removal of stones during the laparoscopic cholecystectomy is a satisfactory direct approach. We reviewed all of the cholecystectomies performed in the regional hospital since the introduction of the laparoscopic technique. There were 425 cases of laparoscopic cholecystectomies performed with cholangiography, with detection of a stone in 11 patients. In these patients, choledochotomies were performed by making an incision on the anterior surface of the common duct using scissors. The cystic duct should not be divided following cholangiography since provided traction. Following exploration using a Fogarty catheter, a T tube was placed, and a T tube cholangiogram was performed prior to its removal. With this technique, we successfully removed the stones in 10 cases. In one, an impacted stone was removed in the X-Ray Department, 6 weeks postoperative and enables cholecystectomy and bile duct stones to be removed in one session with no increase in morbidity or mortality.

Aged↗
PubMed1995

Leiomyosarcoma of colon: report of two cases.

Leiomyosarcoma of the colon is a rare tumor, with fewer than 45 cases being reported by 1980. Wide resection, 10 cm margin, and adjacent mesentery will decrease chances of locoregional relapse. We recently encountered two leiomyosarcomas in the colon in the past two years. One is a 63-year-old female who was seen with rectal bleeding, pain, and was found to have a large intraluminal leiomyosarcoma in the descending colon. Biopsy revealed leiomyosarcoma, grade III. She underwent a wide subtotal colectomy with ileosigmoid anastomosis, with metastases to three of the nodes in the mesentery, and remains well. The second is a 69-year-old female with general weakness who had previously undergone a hysterectomy and cholecystectomy. On examination she was found to have an abdominal mass. This proved to be a large leiomyosarcoma arising in the proximal portion of the transverse colon. There were no metastatic areas to the liver, chest, or any other areas. She has undergone extended right colectomy and remains well. Because of the rarity of this type of cancer, there is no established protocol concerning its treatment.

Aged↗
PubMed1993

Elective procedure for peptic ulcer: a disappearing operation.

We retrospectively reviewed all the operative procedures performed for benign peptic ulcer disease in a regional hospital during the past 6 years. The indications were hemorrhage, perforation, obstruction, chronicity, and gastrocolic. No operation for chronicity has been performed since 1986. Only in perforation was there a statistical difference between male and female. Two hundred forty-six patients were admitted for bleeding, 108 were given transfusions and 38 required operative intervention for control of bleeding. The average units of blood given to patients with bleeding, who underwent operative intervention and recovered, was 7.2. The 6 deaths in this group were in patients who received 15.7 units of blood. Of these, none survived. Twenty patients with perforated ulcers were successfully treated with gastric resection with vagotomy. One patient with a perforated ulcer had primary suture repair, another had vagotomy and pylorplasty. Both required gastric resection because of obstruction and reperforation, respectively. Gastric resection with truncal vagotomy successfully corrected obstruction in 18 patients and chronicity in 9 patients, without mortality. Death from hemorrhage is directly related to delay in operative intervention. With the availability of effective medication for control of gastric acidity, the need for selective vagotomy or elective operative procedure for ulcers is fast disappearing.

Aged↗
PubMed1979

Hepatic artery ligation.

The use of hepatic artery ligation (HAL) in various clinical situations is illustrated by presenting a series of eight patients. The indications for HAL included ruptured hepatic tumors, spontaneous liver rupture, delayed hemorrhage after liver trauma, hematobilia, hepatic artery aneurysm, and hemorrhage after liver biopsy. Conventional methods of hemostasis had been used in some of these patients, but failed to control hemorrhage. The reasons for the relatively late adoption of hepatic artery ligation in treating liver hemorrhage are discussed and placed in proper prospective. Hepatic artery ligation has been shown to be such an effective method of controlling hemorrhage from the liver that other methods, such as packing and mass suture, which are unsafe and ineffective, should be abandoned. Major resection should be done only when an entire lobe of the liver is reduced to pulp or when exposure and repair of the retrohepatic vena cava are necessary.

Adult↗
PubMed1978

Selective management of post-traumatic obstructing intramural hematoma of the duodenum.

Fourteen patients with post-traumatic obstructing intramural duodenal hematoma were reviewed. Seven patients underwent exploration for associated injuries. Evacuation of the hematoma was performed in two patients. Of 12 patients treated by fasting, nasogastric decompression and parenteral fluid therapy, late obstruction of the duodenum developed in one patient, and operation was required. Criteria are discussed regarding evacuation of intramural hematoma of the duodenum found at celiotomy for associated injuries. In the typical patient with an isolated intramural hematoma in whom no other indications for operation are identified, aggressive nonoperative therapy is the preferred treatment.

Abdominal Injuries↗