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Biomedical subjects

J J Jakimowicz

Publications and source records attributed to J J Jakimowicz.

At least 19 recordsLinked to original sources
PubMed1996

Laparoscopic introduction of a continuous ambulatory peritoneal dialysis (capd) catheter by a two-puncture technique.

We describe a laparoscopic two-puncture technique for the placement of a continuous ambulatory peritoneal dialysis catheter. With a mean follow-up period of 8 months the short-term results of the first 19 laparoscopic catheter insertions are evaluated and discussed. It appears to be a simple, safe, and viable procedure with a low morbidity and very good results in the short term. The same technique can also be used in catheter salvage in case of outflow obstruction or catheter migration, thus increasing catheter longevity.

Adult↗
PubMed1996

Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis.

OBJECTIVE: The authors performed an initial clinical evaluation of laparoscopic pancreatectomy with splenectomy for chronic pancreatitis. SUMMARY BACKGROUND DATA: Severe intractable pain is the most common indication for resection in chronic pancreatitis. Localized accentuation of the pathology, usually in the head of the organ, is the basis for localized proximal resection, often with preservation of a rim of pancreas and the duodenum, although some favor total pancreatectomy. The reported results for distal pancreatectomy have been variable. Distal resections are limited to those patients in whom the gross pathology is maximal in the left hemipancreas. METHODS: A consecutive series of five patients with intractable pain due to chronic pancreatitis have been treated with laparoscopic 70% distal pancreatectomy and splenectomy using a 5-port technique. RESULTS: The procedure was completed in all with an average operating time of 4.5 hours and a mean intraoperative blood loss of 400 mL. There was one minor pancreatic leak, which resolved spontaneously. The median postoperative hospital stay was 6 days. CONCLUSIONS: Laparoscopic distal pancreatectomy for chronic pancreatitis is feasible, the procedure appears to be safe, and it is accompanied by an accelerated recovery.

Adult↗
PubMed1995

Current state and trends in minimal access surgery in Europe.

The outcome of the two questionnaires designed to determine the current state and trends in minimal access surgery (MAS) conducted amongst members of the European Association of Endoscopic Surgery (EAES) from April to June 1992 and subsequently the same period in 1993 are presented and compared. For the first questionnaire the data were received from 266 surgical departments in Europe and 360 departments in 1993 responded to the second survey. In both instances the same forms were used. The questionnaire was focused on basic aspects of MAS, the motives, the procedures performed, attitudes to training and different aspects of equipment used. This communication presents a comparison of the outcome of the survey as available from 182 departments participating and responding to both the first and second questionnaires. The outcome of both surveys confirms that laparoscopic cholecystectomy became a better alternative to open surgery and is the cornerstone of abdominal MAS. Antireflux procedures, thoracoscopic operations and staging laparoscopy form a solid base for future development and the spread of MAS.

Data Collection↗
PubMed1994

The European Association for Endoscopic Surgery recommendations for training in laparoscopic surgery.

A questionnaire among surgeons in Europe on minimal access surgery (MAS) was carried out. 96% of the responders were of the opinion that the resident or trainee should take training courses before embarking on MAS. 81% recognized a need for basic training and 96.5% for advanced courses. Registrars should be trained in MAS according to 96% of the responders. The recommendations of the European Association of Endoscopic Surgery (E.A.E.S.) for training and privileging in MAS are presented. In one of the centres that fulfills the requirements of the E.A.E.S. there were 602 surgeons from January 1992 to March 1993 who attended teaching courses in laparoscopic surgery. They came from all European countries (except Iceland) and participated in courses in basic and advanced MAS. The courses were rated with high marks and may serve as a model for similar courses elsewhere in Europe. In Europe, standardised and well organised teaching in MAS is currently available, both for surgeons and registrars. Skills laboratories will play an important role in teaching MAS. In the future, training in virtual reality surgical simulations will become central in teaching MAS and with this development, the need for animals for training will be reduced. Preceptorship and proctoring is becoming established. Still, the apprenticeship system remains the cornerstone of surgical training also in MAS.

Curriculum↗
PubMed1994

Technical and clinical aspects of intraoperative ultrasound applicable to laparoscopic ultrasound.

The advent and spread of minimal access surgery (MAS) has underscored the importance of laparoscopic intraoperative ultrasonography (LIOU). The basic requirements of LIOU equipment are discussed and currently available ultrasound transducer probes for LIOU are reviewed. An examination technique with different ultrasound probes is presented and illustrated. Clinical experience gained with LIOU of the biliary tract in 262 patients and in 46 patients undergoing staging laparoscopy is presented. LIOU is a simple, efficient procedure which provides useful information in intraoperative decision-making. It has considerable potential for further development and will play an increasing role in future not only for diagnostics but also to facilitate the safe performance of complex MAS procedures.

Cholecystectomy, Laparoscopic↗
PubMed1993

Review: intraoperative ultrasonography during minimal access surgery.

A total of 176 patients underwent intraoperative ultrasonography in the course of minimal access surgery using dedicated laparoscopic ultrasound probe. In 145 patients ultrasonography was used for screening of the biliary tract during laparoscopic cholecystectomy or laparoscopic cholecystectomy combined with common bile duct exploration. In 31 patients undergoing staging laparoscopy it was used for examination of the liver and staging of gastrointestinal malignancy. The outcome of the preliminary evaluation of this method allows the conclusion that ultrasonography during minimal access surgery has a huge potential to become a simple and reliable diagnostic tool in the future, supporting the surgeon in operative decision-making.

Biliary Tract Diseases↗
PubMed1991

Laparoscopic cholecystectomy: a new trend in the management of gallstone disease.

The results of the first 100 consecutive patients who underwent laparoscopic cholecystectomy in our hospital are described. The procedure was completed in 93 cases, and 7 cases (7%) were converted to open cholecystectomy. Of these conversions six were elective because of extensive adhesions, and one conversion was enforced because of instrument failure. The mortality in the series was 0%, and the morbidity rate was 5%: two wound infections, one haematoma of the wound, one intraabdominal bleeding, and one patient with a retained stone. The median anaesthesia time was 150 min. Recovery after the operation was remarkably fast; the median hospital stay was 4 days, and 80% of the patients had left the hospital on day 5 after admission. Laparoscopic cholecystectomy seems a safe procedure with significant advantages to the patient, such as a short hospital stay, a rapid recovery, and a satisfactory cosmetic result.

Adolescent↗
PubMed1990

Long-term behaviour of modified human umbilical vein grafts; late aneurysmal degeneration established by colour-duplex scanning.

To define long-term results of modified human umbilical vein (MHUV) grafts a retrospective study was undertaken, and in addition the incidence of aneurysmal degeneration was investigated by Colour-Duplex scanning. From July 1979 until December 1986, 227 MHUV grafts were implanted in 181 patients (204 limbs). The operative indication was claudication in 110 limbs and ischaemic rest pain or gangrene in 94 limbs. The distal anastomosis was at the level of the popliteal artery in 167 limbs and at one of the crural arteries in 37 limbs. During the first month mortality was 3%. Primary and secondary patency rates were calculated for different subgroups. At 5 years the cumulative primary and secondary patency rates for femoro-popliteal grafts were 56 and 64% and for femoro-crural bypasses 19 and 21%. In the retrospective part of this analysis non-occlusive graft-failure occurred in 14 limbs (7%). This was due to infection (7 limbs), aneurysm-formation (4 limbs) or progressive footgangrene (3 limbs). Six of these limbs came to an amputation, however, no amputation was related to aneurysmal degeneration. The amputation-rate was significantly higher in the group with femoro-crural reconstructions as compared to the group with femoro-popliteal reconstructions (32 and 13% respectively; P less than 0.001). From these observations it becomes apparent that the use of MHUV-grafts as femoro-crural bypass is rarely justified. Aneurysmal changes as found by colour-Duplex scanning of 63 limbs with patent grafts at the time of this investigation were present in 23 grafts (37%). The mean internal diameter of the aneurysms was 12.6 mm (range 9.1 to 43.0 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

An operative choledochoscopy using the flexible choledochoscope.

In a prospective study, the value of operative choledochoscopy as a completion procedure after standard instrumental exploration of the common bile duct is evaluated. The technique of examination using the flexible scope is described. Operative choledochoscopy was performed upon 320 patients. Retained stones of the biliary tract missed by exploration were detected in 23 patients (7.1 per cent). Stones retained in spite of endoscopic examination were found in five (1.6 per cent) of the patients. The comparison of the personal experience (158 patients) with the experience of other surgeons and registrars performing the biliary tract operations on their own at our institutions (178 patients) allows a conclusion that, if the technique of choledochoscopy is well standardized and correctly learned, no difference in results achieved is to be expect. Operative choledochoscopy is a reliable method of examination supporting valuable diagnostic information, contributing to the operative decision making and reducing efficiently the incidence of retained biliary tract stones.

Aged↗
PubMed1986

A retrospective study of surgical common bile-duct exploration: ten years experience.

The results of surgical common bile duct exploration in 1007 patients were evaluated in a retrospective study. Overall mortality was 2%. Under the age of 70 years mortality was 0.9%. Mortality increased significantly in patients older than 80 years (9.5%), including the patients with acute cholangitis. The most frequently encountered complications were wound infection in 7%, severe pulmonary insufficiency in 4%, and cardiovascular problems in 3%. The results of the present series show that in the current state of pre-, intra- and postoperative care surgical common bile-duct exploration has a low morbidity and mortality rate in patients under 80 years of age.

Age Factors↗
PubMed1983

Postoperative choledochoscopy. A five-year experience.

In a five-year period postoperative choledochoscopy was used in 85 consecutive patients for therapeutic or diagnostic interventions in the biliary tract. Seventy-three patients underwent postoperative choledochoscopy for removal of retained biliary stones; 67 (92%) had successful removal of 94 retained stones; in 11 stones were located in the intrahepatic ducts; in six postoperative choledochoscopy failed; and in 12 postoperative choledochoscopy was performed for diagnostic or other therapeutic reasons. No serious complications were encountered in this series. The advantage of this simple and effective technique over other instrumental or so-called radiologic techniques is discussed. In our opinion, postoperative choledochoscopy is now the method of choice for diagnostic and therapeutic (re)interventions in the biliary tract by patients with a T tube still in situ.

Bile Duct Diseases↗