PubMed Health⌕ Search

Biomedical subjects

J H Vansant

Publications and source records attributed to J H Vansant.

At least 19 recordsLinked to original sources
PubMed1994

Laparoscopic-assisted colectomy. Initial experience.

OBJECTIVE: The authors studied the results of laparoscopic colectomies performed by a surgical team on 80 consecutive patients and compared these results with standard open colectomies. METHODS: Eight consecutive laparoscopic-assisted colectomies were performed by Norfolk Surgical Group in a 14-month period and compared to 53 patients who had a conventional open colectomies. Analysis included indications for surgery, types of procedure, complications, incidence and causes for conversion, length of procedure, duration of postoperative ileus, hospital stay, operating room and total hospital charges, and examination of the pathologic specimens. RESULTS: Many different types of colectomies were performed successfully and safely for a variety of surgical indications. The conversion rate was 22.5%, which decreased to 15% in the second half of the series. Complications in patients who underwent laparoscopic operations were not severe in number of type. The length of the operative procedure, operating room charge, and the total hospital charge were greater for patients undergoing laparoscopic-assisted colectomies. Patients who underwent laparoscopic operations had a shorter period of postoperative ileus and less pain, resumed a regular diet sooner, and were discharged from the hospital sooner than patients who underwent open colectomies. There was no significant difference in the pathology specimens obtained by laparoscopic-assisted colectomies compared with conventional open colectomies for length of specimen, surgical margins, and number of lymph nodes retrieved. CONCLUSIONS: This study indicated that laparoscopic techniques can be applied safely and effectively to a broad range of colonic operations. Laparoscopic-assisted colectomies take longer to perform and are more costly, but are associated with less paralytic ileus, less pain, and reduced hospital stay. Laparoscopic colectomies for the treatment of malignancy are achievable technically, but will require careful long-term study.

Adult↗
PubMed1979

The gastroesophageal scintiscan. Comparison of methods to demonstrate gastroesophageal reflux.

The gastroesophageal (GE) scintiscan method of detecting GE reflux was evaluated in a series of 54 patients. Twenty-nine patients had evidence of GE reflux by fluoroscopically monitored barium swallow, esophagogastroscopy, or esophageal biopsy. The pH reflux study showed pathological reflux in four patients. The GE scintiscan demonstrated reflux in only four of these 29 patients. Although the GE scintiscan is a safe, noninvasive technique, in our experience, GE reflux was demonstrated only in those patients in whom reflux was easily verified by barium swallow, esophagoscopy, or esophageal mucosal biopsy. This study indicates that the GE scintiscan, like the pH reflux study, is too insersitive to be of consistent value in the diagnosis of GE reflux.

Barium Sulfate↗
PubMed1979

Zollinger-Ellison syndrome. Spontaneous regression of advanced intra-abdominal metastases with 20 year survival.

A 35-year-old man with the Zollinger-Ellison syndrome who is alive and well 20 years following diagnosis at age 15, is represented. At the initial operation for a bleeding duodenal ulcer a ZE tumor of the pancreas also was excised. After two additional ineffective ulcer operations, total gastrectomy was performed. At that time, retroperitoneal and peripancreatic metastases were noted, and several were removed. Three years later at laparotomy, extensive hepatic metastases were biopsied as well. Spontaneous remission occurred and when re-explored at age 34, after 14 years, no metastases were identifiable in any area. The serum gastrin level has remained elevated, casting doubt upon its value as a criterion for evaluation of tumor recurrence or activity. Other additional interesting aspects are discussed. The importance of elimination of the acid-secreting cells by total gastrectomy is emphasized. The patient remains well.

Abdominal Neoplasms↗
PubMed1979

Smooth muscle tumors of the stomach and small bowel.

Smooth muscle tumors of the stomach and small bowel, although rare, have a favorable prognosis when recognized and treated promptly. This review of 33 patients with leiomyoma, leiomyblastoma, or leiomyosarcoma of the stomach and small intestine reveals that all but two were treated by resection of the tumor, with good results.

Adult↗
PubMed1976

Complications of vagotomy in the treatment of hiatal hernia.

Inclusion of vagotomy and pyloroplasty in the surgical treatment of gastroesophageal reflux associated with hiatal hernia has long been controversial. To evaluate the morbidity of vagotomy in the treatment of reflux esophagitis, a retrospective study of 311 patients treated by the Hill posterior gastropexy technique of hiatal hernia repair was tabulated. Vagotomy with the anti-reflux operation was performed upon 159 patients (51%). Vagotomy was not included for 152 patients (49%). The incidence of postoperative symptoms with or without vagotomy was almost equally divided--41% without vagotomy and 47% with vagotomy. However, the major postoperative symptoms that occurred in both groups were abdominal cramps and bloating which usually disappeared in the early postoperative period and were attributed to the anti-reflux procedure and not to vagotomy. When vagotomy was included with the anti-reflux operation, the incidence and duration of long term, disabling postoperative symptoms were significantly increased. Diarrhea occurred two times more frequently. Nausea and vomiting occurred ten times more frequently and dumping was present only in vagotomized patients. Long term postoperative symptoms, judged on a basis of symptoms lasting longer than three months duration, occurred in 1% of patients without vagotomy and 26% when vagotomy was included. This study revealed that no additional protection against recurrent symptoms of gastroesophageal reflux or radiographic evidence of recurrent hiatal hernia was provided by inclusion of vagotomy. In conclusion, vagotomy is contraindicated in the treatment of gastroesophageal reflux except in the presence of peptic ulcer disease.

Diarrhea↗
PubMed1976

Modification of the Hill technique for repair of hiatal hernia.

The major modification of this technique allows accurate placement of sutures through the median arcuate ligament and eliminates the dissection required to expose the aorta at the origin of the celiac artery. Use of a separate row of sutures to create a sling at the esophagogastric junction maintains the desired intraluminal diameter when the esophagogastric junction is secured to the median arcuate ligament.

Hernia, Diaphragmatic↗