Biomedical subjects

J Farhadi

Publications and source records attributed to J Farhadi.

3 recordsLinked to original sources

PubMed1999

Clinical experience of feeding through a needle catheter jejunostomy after major abdominal operations.

OBJECTIVE: To report our incidence of local and systemic complications after needle-catheter jejunostomy. DESIGN: Retrospective analysis. SETTING: University hospital, Switzerland. RESULTS: 100 patients (70 men and 30 women; mean age 65 years, range 42-90) had needle-catheter jejunostomy for postoperative enteral feeding. 26 developed catheter-related and 18 nutrition-related complications. Most of the complications were minor (lumenal obstruction of the catheter or local cellulitis) and only 3 patients needed reoperation, 2 because the catheter broke with extravasation of the nutrition formula into the subcutaneous tissue, and the other because of a small bowel obstruction. There was no small bowel necrosis and no patient died as a direct result of the jejunostomy. Overall, 92 patients were fed enterally according to the protocol, and 8 required removal of the catheter. CONCLUSION: Needle-catheter jejunostomy gives a safe and effective access for postoperative enteral feeding. Minor technical complications are common and can be reduced by a meticulous insertion technique and careful postoperative management. Regular clinical surveillance may reduce the incidence of nutrition-related complications.

Adult↗

PubMed1998

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach.

BACKGROUND: Once paraesophageal hernia has been diagnosed, it should be repaired immediately because of life-threatening complications such as bleeding, ischemia, and perforation when intrathoracic strangulation or volvulus occurs. We describe our surgical strategy for treating this rare type of hiatal hernia with regard to early and late postoperative complications. STUDY DESIGN: This was a retrospective case series from a university hospital. Twelve patients (seven women and five men) with a mean age of 64 years (range, 50-76 years) and a completely intrathoracic stomach underwent laparoscopic paraesophageal hernia repair. Seven patients had a type 2 hernia, and five patients had a type 3 hernia. Additional organoaxial volvulus was present in three patients. All patients underwent reduction of the stomach and the greater omentum, excision of the hernia sac, closure of the hiatal defect, and a floppy Nissen fundoplication. RESULTS: Because of severe adhesions, one patient needed an open stomach reduction (conversion rate, 8%). The mean operating time was 161 minutes (range, 110-200 minutes), blood loss was minimal, and the mean postoperative hospital stay was 6 days (range, 4-7 days). There were no intraoperative complications, but early postoperative complications occurred in three patients (25%; one with dysphagia, 1 reoperation due to organoaxial gastric rotation with gastroduodenal obstruction, and one with deep venous thrombosis). No deaths occurred. Followup in all patients is complete, with a mean followup time of 21 months (range, 3-40 months). The complication rate after long-term followup was 8%, and reflux esophagitis symptoms in one patient were completely relieved by medical therapy. CONCLUSIONS: Laparoscopic paraesophageal hernia repair was feasible and safe with low morbidity and mortality rates in this elderly patient group. To achieve good long-term results, standard surgical treatment should include reduction of the stomach, complete excision of the hernia sac, closure of the hiatal defect, floppy Nissen fundoplication, and anterior gastropexy.

Aged↗

PubMed1998

[Cholelithiasis--laparoscopy or laparotomy?].

Between 10% and 15% of the adult population have gallstones and therefore symptomatic cholelithiasis is the second most common indication for surgery in general practice. It's diagnosis depends on the patients history, clinical findings, laboratory tests and ultrasound. In case of symptomatic gallstones surgery offers the only permanent cure and specific complications due to gallstones such as ileus or fistula are becoming rare. With the introduction of minimal invasive surgery at the end of this century laparoscopic cholecystectomy is now considered to be the standard treatment for symptomatic gallstones. This approach can be offered to > 90% of patients in elective cases and in between 60%-80% of patients having acute cholecystitis with a low morbidity and mortality rate. The main advantages of the laparoscopic approach are the overall increased patients comfort with less postoperative pain, shorter hospital stay, recovery and off work time. Although the rate of common bile duct injury appears to be increased using this minimal invasive approach, this rate is still sufficiently small to justify the use of laparoscopic cholecystectomy for symptomatic disease. Open cholecystecomy remains the treatment of choice for complicated gallstone disease (i.e. cancer, Mirizzi syndrome, severe inflammation) and high risk patients. In case of acute cholecystitis the laparoscopic treatment with all it's advantages may also be offered to many patients. However, in those cases the conversion rate to the open approach may be markedly increased which has not to be considered as a complication of the laparoscopic approach but as a maximization of safety and effectiveness of the treatment.

Adult↗