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J G Stage

Publications and source records attributed to J G Stage.

At least 19 recordsLinked to original sources
PubMed2000

Effect of laparoscopy on bacteremia in acute appendicitis: a randomized controlled study.

Laparoscopic appendectomy is increasingly used in treating acute appendicitis. Several controlled series have demonstrated the clinical benefit of the procedure. However, some basal pathophysiologic changes caused by the laparoscopy still need clarification, i.e., whether laparoscopy can give rise to bacteremia. The purpose of this randomized controlled study in 30 patients undergoing surgery due to suspected acute appendicitis, either by an open classic technique or by a laparoscopic technique, was (by collecting samples for blood culturing pre-, peri-, and postoperatively) to evaluate whether laparoscopy during carbon dioxide pneumoperitoneum could induce bacteremia. Six patients of 12 in the group treated by laparoscopy presented positive blood cultures peri- and postoperatively. No positive blood cultures were demonstrated in the open operated group. The difference was significant (P = 0.0183). The clinical significance of these findings should be clarified in further clinical investigations.

Acute Disease↗
PubMed1998

Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones.

BACKGROUND AND STUDY AIMS: A study was carried out to assess the feasibility of a new rapid technique for percutaneous transhepatic access to the biliary tract with endoscopic lithotripsy (percutaneous transhepatic cholelithotripsy). PATIENTS AND METHODS: 14 patients with biliary stones resistant to endoscopic retrograde cholangiography and extracorporeal shock wave lithotripsy underwent cholelithotripsy, utilizing a new dilation kit with massive teflon dilators covered by "peel-away sheets". RESULTS: Successful lithotripsy was performed in all patients by laser lithotripsy through a choledochoscope or ureteroscope in ten patients and by stone removal by basket in the remaining four patients. The procedure was carried out using local anesthesia in the last 11 patients. Except for two patients with transient cholangitis, no complications occurred. CONCLUSIONS: Difficult bile duct and intrahepatic stones can be treated successfully with a simple percutaneous transhepatic cholelithotripsy procedure including local anesthesia, dilation and stone clearance.

Aged↗
PubMed1997

Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma.

BACKGROUND: Laparoscopic techniques have been evaluated for many operations, but retrospective and prospective studies have failed to show these techniques to be superior to open operations in all patients with colorectal disease. This study compares laparoscopic and open colonic resection in a randomized fashion with special reference to outcome, complications and immunomodulation. METHODS: The clinical course, assessment of convalescence parameters, immunofunction and pathological evaluation of the operative specimen were compared in 34 patients with colonic adenocarcinoma. The patients were randomized to either laparoscopic surgery (group 1, n = 18) or open surgery (group 2, n = 16). As five patients were excluded the number of patients was 15 in group 1 and 14 in group 2. RESULTS: Patients in group 1 were discharged earlier (P < 0.05) and suffered less pain (P < 0.01 at rest, P < 0.05 during coughing and mobilization). Surgery was equally radical in the two groups. Intraoperative bleeding, postoperative reduction in pulmonary function, and level of fatigue were identical in the two groups. The immunodepression was more pronounced in patients in group 1 (P < 0.01). CONCLUSION: Laparoscopic colonic resection is an acceptable and safe alternative to open procedures; the differences between the two techniques are not marked.

Adenocarcinoma↗
PubMed1997

Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series.

BACKGROUND: The risk of bile duct injury in laparoscopic cholecystectomy has been a concern since the procedure became part of the surgical armamentarium. Our study assesses the incidence, types, and treatment for laparoscopic bile duct injury. STUDY DESIGN: Prospective case registration in a national database with participation by all departments of surgery performing laparoscopic cholecystectomy in Denmark since the first operation in January 1991. The case notes for bile duct injury have been reviewed. RESULTS: From 1991 through 1994, 57 of 7,654 patients sustained bile duct injury (0.74 percent; 95 percent confidence interval, 0.55 percent to 0.94 percent), including nine injuries occurring after conversion. The annual incidence did not decrease. Thirty-nine percent of the laparoscopic bile duct injuries were incisions, 39 percent were transections, and 12 percent were clip injuries or strictures. One patient, who sustained transection during open reoperation for bleeding after a converted procedure, died. Bile leaks for reasons other than bile duct injury occurred in 2.1 percent; 71 percent of these were cystic duct leaks. Acute cholecystitis was the indication for laparoscopic cholecystectomy in 968 patients, with 1.3 percent sustaining laparoscopic bile duct injury (95 percent confidence interval, 0.62 percent to 2.08 percent), while the incidence in patients with other indications for laparoscopic cholecystectomy was 0.62 percent (95 percent confidence interval, 0.44 percent to 0.82 percent) (p > 0.05). Preoperative knowledge of bile duct anatomy was available by means of preoperative endoscopic retrograde cholangiopancreatography or intravenous cholangiography in 26 percent of patients undergoing laparoscopic cholecystectomy but this did not reduce the risk of bile duct injury. The frequency of bile duct injury in patients who had intraoperative cholangiography was not significantly different from those who did not. Intraoperative cholangiography was done in 14 cases of injury (diagnostic for injury in 8, misinterpreted in 2, and normal in 4 patients). The case notes described operative difficulties in 11 of 48 cases of laparoscopic bile duct injury, most often because of fibrosis or difficulty delineating the anatomy. CONCLUSIONS: The incidence of bile duct injury in laparoscopic cholecystectomy is higher than previously generally anticipated and did not decrease from 1991 through 1994. Risk factors and possible preventive measures should be evaluated in prospective studies.

Bile Ducts↗
PubMed1996

[Local treatment of tumors of the rectum with transanal endoscopic microsurgical technique].

Nine patients were treated with transanal endoscopic microsurgery for rectal adenomas and three for incurable malignant disease of the rectum. The techniques are presented. One early complication was seen. In the median follow-up period of 6.5 months no recurrences were seen in the adenoma group. In the palliatively resected group of rectal cancers one patient has died and two patients are alive without stomas. It is concluded that the microsurgical technique is a safe treatment modality for some patients with rectal diseases.

Aged↗
PubMed1996

Human gallbladder pressure and volume: validation of a new direct method for measurements of gallbladder pressure in patients with acute cholecystitis.

Increased gallbladder (GB) pressure is probably a part of the pathogenesis of acute cholecystitis, and measurements of GB pressure might therefore be of interest. The aim of this study was to validate a microtip pressure transducer for intraluminal GB pressure measurements. In vitro precision and accuracy was within 0.2 mmHg, (SD) and 0.6 +/- 0.1 mmHg (mean +/- SD), respectively. Pressure rise rate was 24.8 +/- 5.5 mmHg s-1. Zero drift was in the range 0.3 +/- 0.4 to 0.8 +/- 0.9 mmHg (mean +/- SD). GB pressure was investigated in 16 patients with acute cholecystitis treated with percutaneous ultrasonically guided cholecystostomy. Basal intraluminal GB pressure was 8.9 mmHg (2.1-12.2 mmHg; n = 9, open cystic duct) and 1.8 and 5.8 mmHg (n = 2, closed cystic duct). There was no significant difference between two different measurements in the same patients (n = 5). The pressure was significantly influenced by respiration (n = 8) and the pressure seems to be higher in the sitting position than in the supine position (n = 5). Cystic duct opening pressure was 10.4, 11.2 and 16.8 mmHg (n = 3). Pressure-volume responses showed that the GB up to a certain volume could accommodate increases in intraluminal volume with only slight changes in intraluminal pressure (n = 4). Except for the zero drift, this piece of equipment seemed to fulfil the requirements of being able to measure pressure in the GB. In vivo measurements showed a good clinical reproducibility of the method, and also that respiration and patient posture influenced the pressure measurements. Further, a GB pressure-volume relationship was demonstrated, and the possibility of a cystic duct opening pressure was described.

Acute Disease↗
PubMed1995

[Laparoscopic cholecystectomy in Denmark. A prospective registration].

Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.

Adolescent↗
PubMed1995

Cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage.

OBJECTIVE: To investigate gallbladder function by use of cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage. DESIGN: A cholescintigraphy was performed in 40 patients with acute cholecystitis before and after the performance of percutaneous gallbladder drainage. During the post-drainage cholescintigraphies, a cholecystokinin stimulation was performed to investigate gallbladder emptying in 12 selected patients. Gallbladder pressure and volume were measured before drainage in another group of 12 patients with acute cholecystitis. RESULTS: As expected, no gallbladder activity was observed in the cholescintigraphies before drainage, except in a patient with an occluding stone in the common bile duct. Cystic duct patency and gallbladder activity were seen in 80% of patients in cholescintigraphies performed after drainage but before any other treatment. Post-drainage cholescintigraphy revealed a mean gallbladder ejection fraction of 24%, which is significantly lower than the corresponding value in normal individuals and gallstone patients without cholecystitis (n = 12). Gallbladder pressure and volume were markedly increased compared with normal values. CONCLUSION: The relief of increased gallbladder pressure and volume appears to be important for the re-establishment of gallbladder function.

Acute Disease↗
PubMed1994

[Laparoscopic colonic surgery].

Eight patients were treated with laparoscopically assisted surgery for colorectal cancer. The technique, results and complications are presented. Conversion to laparotomy was necessary in two patients. There was one postoperative death, which could not be attributed to the operative procedure. It is concluded that laparoscopically assisted surgery will probably be a suitable treatment for some patients with colorectal diseases.

Adenocarcinoma↗
PubMed1993

[Percutaneous cholecystectomy in acute cholecystitis].

Seventy-two patients with acute cholecystitis were treated with initial ultrasound-guided percutaneous transperitoneal cholecystostomy (PTCS). PTCS could be performed in all 72 patients almost without procedure related complications, and subsequent elective treatment could be done in all, except three patients where acute cholecystectomy was necessary because of accidental catheter dislocation. Seven patients died of their severe underlying illness without relationship to PTCS or cholecystitis. Eight patients with acalculous cholecystitis had no further treatment after removal of the drainage catheter. It is concluded that PTCS is a safe method for acute drainage in patients with acute cholecystitis.

Acute Disease↗
PubMed1993

[Laparoscopic parietal cell vagotomy. Preliminary results].

The results from 11 laparoscopic parietal cell vagotomies are presented. The procedure could be carried out in all patients. The median day of discharge after the procedure was day 1 (range 1-16), median convalescence time 7 (range 4-50) days. One patient required re-operation due to a perforation at the lesser curvature. This complication is ascribed to the learning phase. If a sufficient reduction in gastric acid secretion can be documented in a larger series of patients, laparoscopic parietal cell vagotomy should be considered a serious alternative to conservative treatment.

Adult↗
PubMed1993

Assessment of the biliary tract by antegrade cholecystography after percutaneous cholecystostomy in patients with acute cholecystitis.

The diagnostic value of formal antegrade cholecystography in a consecutive series of 44 patients with scintigraphically confirmed acute cholecystitis, treated by percutaneous transperitoneal cholecystostomy, has been evaluated. A total of six patients did not have antegrade cholecystography (catheter migration in five patients and gangrenous gallbladder perforation in one). Antegrade cholecystography was performed in the remaining 38: 10 patients with persisting cystic duct obstruction and 28 patients with patent cystic ducts. In the persisting cystic duct obstruction group, antegrade cholecystography confirmed the cause of gallbladder outflow obstruction as impacted calculi in either the gallbladder neck or cystic duct in all patients. In the patent cystic duct group, antegrade cholecystography demonstrated the common ducts well in all but two patients, and common duct calculi in eight of nine patients. Three patients had common duct calculi in non-dilated ducts. Antegrade cholecystography is an easy and safe method of clarifying gallbladder pathology in all patients, and can be used to evaluate the common duct for associated common duct calculi in most patients.

Acute Disease↗
PubMed1991

[Minicholecystectomy].

Mini-cholecystomectomy was performed in 24 unselected patients with symptomatic gallbladder stones with pain control by intra- and postoperative epidural analgesia. Twenty three patients were discharged on the second postoperative day, while one patient who required re-laparotomy for haemostasis had recovered completely on the third day postoperatively. Median pain score (VAS) was 0 at rest, during coughing and mobilisation. Pulmonary function was not influenced significantly and postoperative fatigue normalized after 48 hours. These preliminary, uncontrolled observations suggest that mini-cholecystectomy is advantageous compared to conventional cholecystectomy, and may represent an alternative to laparoscopic cholecystectomy.

Adult↗
PubMed1991

[Percutaneous cholecystolithotripsy].

Thirty-two high-risk patients with severe complicating conditions and gall bladder symptoms requiring treatment, including acute cholecystitis in 28 of the patients, were treated with percutaneous cholecystolithotripsy (PTCL). This intervention was carried out under general, regional or local anaesthesia and resulted in fragmentation and removal of the stones in 90% of the patients. Cholecystectomy proved necessary in three patients on account of perforation in two and formation of "steinstrasse" in the cystic duct in one. No other complications of puncture or lithotripsy occurred and the postlithotripsy drainage time was, on the average, ten days. It is concluded that the PTCL technique is a realistic therapeutic offer to high-risk patients with gall bladder stones requiring treatment and in whom laparoscopic cholecystectomy or mini-cholecystectomy are not considered suitable.

Aged↗
PubMed1991

[Endoscopic percutaneous transhepatic cholelithotripsy in the treatment of complicated stones in the deep biliary tracts].

The results of endoscopic percutaneous transhepatic cholelithotripsy in seven patients with stones in the deep biliary passages which could not be treated by endoscopic papillotomy (EST) or extracorporeal shock wave lithotripsy (ESWL) are presented. A new dilator technique combined with mechanical or laser-lithotripsy was employed. All of the patients were relieved of the stones after uncomplicated course. It is concluded that endoscopic percutaneous cholelithotripsy which can be carried out under local anaesthesia, should be offered to patients with stones in the deep biliary passages which are not accessible to conventional treatment with EST or ESWL.

Aged↗
PubMed1991

[Pelvic floor reconstruction with a Prolene net in enterocele].

Nine women, all of whom were multiparae with large symptom-producing enteroceles and all of whom had been submitted to operation by other methods without permanent effect, were submitted to total pelvic floor reconstruction with non-absorbable mesh. No complications of this intervention were observed and the discomfort due to enterocele disappeared in all of the patients during the follow-up period which averaged 11 months (range 1-24 months). The method is recommended in the treatment of large enteroceles where other forms of surgical treatment have failed.

Aged↗