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Biomedical subjects

J K Champion

Publications and source records attributed to J K Champion.

At least 19 recordsLinked to original sources
PubMed2006

Implantable gastric stimulation to achieve weight loss in patients with a low body mass index: early clinical trial results.

This report describes the authors' early outcomes with implantable gastric stimulation (IGS) used to achieve weight loss in patients with a low body mass index (BMI). After prescreening of potential candidates with a selection algorithm, 24 patients (21 women and 3 men) with a low BMI (30-34.9) underwent IGS implantation at two centers. The patients had a mean age of 43 years (range, 32-60 years), a mean BMI of 33 (range, 30-36), and a mean weight of 92 kg (range, 80-117 kg). At this writing, 6 months postoperatively, there have been no serious adverse events related to the device. The mean percentage of excess weight loss (EWL) was 5.9%, with three patients explanted because of noncompliance. The mean waist circumference decreased 5.8%, which was significant (p = 0.009). A subset of nine patients (37.5%) had an EWL exceeding 10% (mean, 20.1%). A subset of low BMI patients lost a clinically significant amount of weight with IGS within 6 months. Further study is required for better identification of potential candidates for this novel approach.

Adult↗
PubMed2006

Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery.

BACKGROUND: Laparoscopy has become the standard surgical approach to both surgery for gastroesophageal reflux disease and large/paraesophageal hiatal hernia repair with excellent long-term results and high patient satisfaction. However, several studies have shown that laparoscopic hiatal hernia repair is associated with high recurrence rates. Therefore, some authors recommend the use of prosthetic meshes for either laparoscopic large hiatal hernia repair or laparoscopic antireflux surgery. The aim of this article was to review available studies regarding the evolution, different techniques, results, and future perspectives concerning the use of prosthetic materials for closure of the esophageal hiatus. METHODS: A search of electronic databases, including Medline and Embase, was performed to identify available articles regarding prosthetic hiatal closure for large hiatal or paraesophageal hernia repair and/or laparoscopic antireflux surgery. Techniques and results as well as recurrence rates and complications related to the use of prosthetics for hiatal closure were reviewed and compared. Additionally, recent experiences and recommendations of experienced experts in this field were collected. RESULTS: The results of 42 studies were analyzed in this review. Some techniques of mesh hiatal closure were evaluated; however, most authors prefer posterior mesh cruroplasty. The type and shape of hiatal meshes vary from small angular meshes to A-shaped, V-shaped, or complete circular meshes. The most frequently utilized materials are polypropylene, polytetrafluoroethylene, or dual meshes. All studies show a low rate of postoperative hernia recurrence, with no mortality and low morbidity. In particular, comparative studies including two prospective randomized trials comparing simple sutured hiatal closure to prosthetic hiatal closure show a significantly lower rate of postoperative hiatal hernia recurrence and/or intrathoracic wrap migration in patients who underwent prosthetic hiatal closure. CONCLUSIONS: Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates. The type of mesh, particularly the size and shape, is still controversial and is a matter for future research in this field.

Esophagus↗
PubMed2004

Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study.

To gauge the incidence of hepatitis C virus (HCV) infection and associated risk factors among inmates during their imprisonment, the authors recruited adult males in a long-stay Scottish prison into a cohort study between April 1999 and October 2000. On two occasions (at 0 and 6 months), saliva was collected for anonymous HCV antibody testing and risk behavior data were obtained through a self-administered questionnaire. The participation rate was 85% at both initial recruitment (612/719) and follow-up (375/441; 171 men were ineligible for follow-up). For inmates who reported never having injected drugs, ever having injected drugs, having injected drugs during follow-up, and having shared needles/syringes during follow-up, HCV incidences per 100 person-years of incarceration risk were 1, 12, 19, and 27, respectively. Ever having injected drugs (relative risk = 13.0, 95% confidence interval: 1.5, 114.3) and having shared needles/syringes during follow-up (relative risk = 9.0, 95% confidence interval: 1.1, 71.7) were significantly associated with HCV seroconversion. The effectiveness of existing interventions, including the provision of bleach tablets for sterilizing injection equipment, was suboptimal. The development of methadone maintenance programs in prisons and the creation of drug courts to keep offending drug injectors out of prison might help to reduce transmission in this setting.

Adult↗
PubMed2004

Experience with routine intraabdominal cultures during laparoscopic gastric bypass with implications for antibiotic prophylaxis.

BACKGROUND: Techniques for laparoscopic Roux-en-Y gastric bypass that do not use bowel cross-clamping raise a question of increased risk for infectious complications. However, to the authors' knowledge, no studies have recorded routine intraoperative peritoneal cultures. This article reports the authors' experience with routine peritoneal cultures during laparoscopic Roux-en-Y gastric bypass and the role of antibiotic prophylaxis. METHODS: From January 2000 to March 2000, 66 consecutive patients undergoing a laparoscopically divided proximal Roux-en-Y gastric bypass had peritoneal fluid aspirated for routine culture. No mechanical or oral antibiotic bowel preparation was used. All the patients received preoperative intravenous antibiotic prophylaxis with Levoquin 500 mg and Flagyl 500 mg. Peritoneal fluid was aspirated from the left gutter near the site of the enteroenterostomy before irrigation with 1,000 ml of normal saline containing 50,000 U of bacitracin and 1 of kanamycin. RESULTS: The follow-up period averaged 9 months for 100% of patients. For 15 patients (22.7%), the culture results were positive. The 22 organisms cultured involved 15 streptococcus species, 4 anaerobes, 2 staphylococcus species, and 1 enterobacter. None of the patients experienced a clinical infection or required an extension of antibiotics beyond the first 24 h. CONCLUSIONS: This study demonstrated frequent peritoneal contamination during laparoscopic gastric bypass. Prophylactic intravenous antibiotics and antibiotic irrigation may have reduced the risk of clinically significant infections in this small uncontrolled series.

Adult↗
PubMed2004

Linear technique of laparoscopic Roux-en-Y gastric bypass.

The laparoscopic Roux-en-Y gastric bypass (LRYGB) is currently the most common procedure performed for treatment of morbid obesity in the United States. The technique reported in this chapter requires mastering of extra-corporeal and intra-corporeal laparoscopic suturing, but is safe, cost effective, and technically feasible. Use of the straight needle eliminates the challenge of proper needle orientation encountered with a curved needle. The linear technique is used to construct the gastrojejunostomy because it is time saving and relatively simple. An endoscopic ruler and bougie are used to ensure a consistent pouch size and alimentary limb length. This chaper demonstrates the use of preoperative preparation, and a meticulous surgical technique using the linear stapler, to perform a combined total of more than 1800 cases.

Anastomosis, Roux-en-Y↗
PubMed2003

Thoracoscopic Belsey fundoplication with 5-year outcomes.

BACKGROUND: To determine the indications for a minimally invasive thoracic technique in gastroesophageal reflux disease (GERD), we conducted a retrospective review of outcomes with our first 21 thoracoscopic Belsey fundoplications. METHODS: A thoracoscopic Belsey fundoplication was completed in 21 patients (12 males, 9 female; ages, 38-83 years). Preoperative evaluation revealed 13 primary motility disorders, 9 strictures, and 3 epiphrenic diverticuli. Six patients had previous gastric surgery. Sixteen patients underwent 20 ancillary procedures (esophagomyotomy, 14; excision of diverticulum, 2; lung volume reduction, 2; prosthetic diaphragmatic repair, 1; and Thal-Woodward esophagoplasty, 1). RESULTS: Mean follow-up was 75.6 months (range, 67-85 months). There was one operative death (4.8%). Early morbidity included two esophageal leaks (9.8%). Late morbidity included three patients (15.7%) with persistent dysphagia and five patients (26%) with recurrent GERD. CONCLUSION: Thoracoscopic Belsey fundoplication was associated with a high morbidity and recurrence rate in our long-term experience.

Adult↗
PubMed2003

Laparoscopic mesh cruroplasty for large paraesophageal hernias.

BACKGROUND: Previous studies have shown that surgical repair of paraesophageal hernias is associated with a high recurrence rate, especially when a laparoscopic approach is used. Anatomic recurrence due to crura breakdown is a primary etiology, which has led us to employ prosthetic mesh reinforcement of large hiatal defects (> 5 cm) since 1996. We discuss the evolution of this approach and describe our current technique with limited outcomes in 52 consecutive patients during a 5-year period. METHODS: There were 31 males and 21 females, with a mean age of 57 years (range, 32-77 years) with symptomatic reflux and endoscopic or radiologic evidence of a large paraesophageal hernia. Utilizing a laparoscopic approach, the contents of the sac were reduced and the crura approximated with permanent interrupted sutures and a prosthetic mesh was secured over the repair as an on-lay reinforcement buttress. A Nissen (42) or Tilley (9) fundoplication was performed in all but 1 patient, and 18 patients (34%) required a wedge collis gastroplasty. Fifteen patients (28%) had a previous unsuccessful antireflux operation. RESULTS: There was no perioperative morbidity or mortality. Follow-up averaged 25 months (range, 7-60 months). Postoperative gastroscopy or barium swallow have been performed in 27 patients to date, with 11 experiencing foregut symptoms. There has been 1 recurrence (1.9%) and no prosthetic erosion. CONCLUSION: Early results suggest that prosthetic mesh cruroplasty may be effective in reducing recurrence after laparoscopic repair of large paraesophageal hernias, but long-term follow-up is required in all patients to determine the true incidence of anatomic recurrence and prosthetic erosion.

Adult↗
PubMed2002

Role of routine intraoperative endoscopy in laparoscopic bariatric surgery.

BACKGROUND: Laparoscopic bariatric surgery is a challenging procedure with a high risk of technical misadventures that may increase postoperative morbidity. Routine intraoperative endoscopy may reduce postoperative morbidity. This article reviews our 6-year experience. METHODS: From April 1995 to September 2001, we performed 825 laparoscopic bariatric procedures: 743 roux gastric bypasses, 55 vertical banded gastroplasties, 18 laparoscopic adjustable gastric bands, and 9 gastric pacemakers. All the patients underwent flexible endoscopy by the primary surgeon at completion of the operation to assess for technical errors. RESULTS: The 34 intraoperative technical errors (4.1%) identified included 29 suture and staple line leaks, 2 bougie perforations, 2 inadvertent stoma closures secondary to the suture line, and 1 mucosal perforation in a gastric pacemaker. All the errors were successfully repaired laparoscopically at the time of the procedure. Three leaks occurred postoperative (0.36%): 1 in the 34 repaired errors (2.9%) and 2 in the remaining 791 patients (0.25%). CONCLUSIONS: Routine intraoperative endoscopy identified 34 correctable technical errors in a series of 825 laparoscopic bariatric procedures. Of these, 33 (97%) were repaired successfully, which reduced postoperative morbidity.

Adolescent↗
PubMed2000

Laparoscopic esophagomyotomy with posterior partial fundoplication for primary esophageal motility disorders.

BACKGROUND: The outcomes of a laparoscopic esophagomyotomy with posterior partial fundoplication were compared between groups of patients with primary motility disorders. METHODS: In this study, 47 patients (26 women and 21 men, ages 24 to 77 years; mean, 47 years) with significant dysphagia or chest pain who failed conservative treatment underwent a laparoscopic esophagomyotomy and posterior partial fundoplication. Preoperative evaluation revealed four groups of primary motility disorders: achalasia (n = 12), nutcracker esophagus (n = 12), hypertensive lower esophageal sphincter (LES) (n = 16), and diffuse esophageal spasm (n = 7). Statistical analysis was performed by Cramer's V test. RESULTS: Average follow-up period was 30.3 months. There was no mortality or early morbidity. Late morbidity included dysphagia or chest pain over 6 weeks in 10 patients (21%), recurrent gastroesophageal reflux disease (GERD) in 3 patients (6%), and recurrent motility disorder in 2 patients (4%). Overall, 94% of the patients ultimately had complete resolution of dysphagia or chest pain. There was no significant difference in outcomes between groups. CONCLUSION: Early results suggest that laparoscopic esophagomyotomy with posterior partial fundoplication provides safe and effective relief from dysphagia and chest pain in patients with each of the primary motility disorders.

Adult↗
PubMed1999

Comparison of thoracoscopic and laproscopic esophagomyotomy with fundoplication for primary motility disorders.

OBJECTIVES: With the introduction of videoscopic techniques, controversy has arisen whether a thoracoscopic or laproscopic approach is indicated for the surgical management of symptomatic primary motility disorders. The aim of this study was to compare the outcomes of the two techniques performed by one group. METHODS: Between 1995 and 1997, 78 patients (42 female, 36 males: ages 21-86; mean 53 years) underwent a videoscopic esophagomyotomy with fundoplication via a thoracic (12) or abdominal (66) approach for dysphagia or chest pain. Pre-operative evaluation with esophagogastroscopy and manometry revealed a primary motility disorder in 64 and primary motility disorder with stricture in 14. Primary motility disorders exhibited were hypertensive LES (25), nutcracker (26), achalasia (14), and diffuse esophageal spasm (13). Associated fundoplications to prevent reflux included abdominal Toupet partial fundoplicatio (52), abdominal Nissen (14) and thoracic Belsey (12). Significance of variation in outcomes was determined by Mann-Whitney U-test. RESULTS: There was no mortality. Follow-up ranged from 6-40 months (mean = 18). Early morbidity included dyshagia--chest pain greater than 6 weeks in 16 patients. (5 Belsey 41%, 10 Toupet 19%, 1 Nissen 7%) Late morbidity included three recurrent strictures requiring dilatation (Belsey 2/5, Toupet 1/7). Two patients (3.1%) experienced a recurrent motility disorder after abdominal short myotomy--Toupet. Five patients experienced postoperative gastroesophageal reflux after partial fundoplication (two Belsey = 16.6%, three Toupet = 5.7%). Overall 63 patients (81%) were completely relieved of dysphagia--chest pain. CONCLUSIONS: Thoracoscopic esophagomyotomy with Belsey fundoplication was associated with a significantly higher incidence of post-operative dysphagia--chest pain (P = 0.05) and recurrent stricture (P = 0.01 ) than laproscopic esophagomyotomy with partial or total fundoplication, however, there was no significant difference in the incidence of recurrent motility disorders (P = 0.54) or gastroesophageal reflux disease (P = 0.12) between the techniques. Our results support utilization of a laproscopic approach for primary motility disorders.

Adult↗
PubMed1999

Referral patterns between primary care and genitourinary medicine.

Many patients attending genitourinary medicine (GUM) clinics are self referred, but some patients initially present to their general practitioner (GP). The aim of this study was to describe the referral pattern of GPs in the Lothian region of Scotland to the local GUM clinic. A questionnaire was completed by all patients referred by their GP and a case note review supplied further diagnostic and demographic information. Of 1140 (23%) patients, 965 were available for study and were referred by their GP. There was a wide variability in referral rates from different practices and from different partners within a practice. The median referral rate per 100,000 practice population was 22.4/year (range 0-586). A referral letter accompanied the patient in 797/965 (83%) cases. The detection of cases of chlamydia and gonorrhoea in patients in primary care subsequently referred to the GUM clinic was low and poor diagnostic acumen for herpes simplex virus (HSV) was notable. No consistent practice for investigation or treatment prior to referral was found and there was marked failure of the investigations initiated in primary care to achieve diagnosis. Despite this, 24% of patients were already on treatment at the time of their GUM consultation. Few STDs were diagnosed in primary care and subsequently referred to the GUM clinic suggesting either failure to diagnose infections or reluctance to refer on for confirmation, treatment, test of cure and health education.

Adult↗
PubMed1998

Bilateral thoracoscopic stapled volume reduction for bullous vs diffuse emphysema.

BACKGROUND: We compared our results with bullous vs diffuse emphysema by performing a bilateral thoracoscopic stapled volume reduction technique in 15 patients (age 45-80, 10 males, five females). METHODS: Eight patients demonstrated bullous emphysema and seven patients diffuse emphysema. Lung reduction was performed with a bilateral thoracoscopic stapled technique utilizing bovine pericardium in the supine position. RESULTS: Comparison of the bullous versus diffuse groups revealed no significant differences in means for the following variables: length of air leak (7.5 vs 3.3 days); length of stay (8.1 vs 6.5 days); pre-op FEV1, (23% vs 22%); pre-op dyspnea index (3.4 vs 3.6). At 3 months the bullous subset had a highly significant improvement (p < 0.007) in FEV1 (88%) compared with the diffuse subset FEV1 (59%). CONCLUSIONS: These early results suggest that patients with bullous emphysema are at no greater risk and demonstrate a significantly greater improvement in FEV1 than patients with diffuse emphysema.

Adult↗
PubMed1998

Minimally invasive antireflux surgery.

BACKGROUND: Previous reports of minimally invasive antireflux surgery for gastroesophageal reflux disease (GERD) have been small, short-term series utilizing only a laparoscopic approach. We conducted a retrospective review and report our 66-month experience with more than 1,000 laparoscopic and thoracoscopic antireflux procedures. METHODS: Between September 1991 and October 1997, 968 adults underwent 1,003 minimally invasive antireflux procedures on a tailored basis, based on their preoperative evaluation. Procedures performed were laparoscopic Nissen (626), Toupet (348), paraesophageal (33), and thoracoscopic Belsey (22). A total of 23% (233) of patients underwent an ancillary procedure (esophageal myotomy 85, vagotomy 67, pyloromyotomy 13, and cholecystectomy 66). RESULTS: Follow-up averaged 33 months (range 1 to 66), operative mortality was 0.1%. Complications occurred in 2.7% with a 1% long-term dysphagia rate. Demonstrated recurrence rate was 3.8% to date, with an associated 3.4% reporting symptoms of GERD. CONCLUSION: Minimally invasive antireflux procedures provide sustained relief of GERD symptoms with low morbidity and rapid recovery.

Adult↗
PubMed1996

Teaching basic video skills as an aid in laparoscopic suturing.

BACKGROUND: There is a perception among surgeons that performing laparoscopic suturing is unduly difficult. The purpose of this study is to document a program which aides in learning laparoscopic suturing. METHODS: Fourteen volunteer medical students without prior experience were taught laparoscopic suturing. Videoscopic pelvitrainers were utilized for a 2-h training session. Extracorporeal and intracorporeal knot tying was demonstrated utilizing a three-throw square knot. After a 2-h practice session each student's time to complete an extracorporeal and intracorporeal suture was recorded. RESULTS: The average times required for completion were: extracorporeal suture and knot 1 min 54 s; intracorporeal suture and knot 3 min 12 s. CONCLUSIONS: Novice students were able to perform at extra and intracorporeal suturing with 2 h of practice, utilizing a systematic program of teaching basic video skills.

Humans↗
PubMed1996

New application of bipolar coagulation in laparoscopic surgery.

Bipolar electrocautery is associated with a lower risk of tissue injury from an inadvertent energy transfer compared with monopolar diathermy, and bipolar coagulation has been effectively employed in obstetric and gynecologic procedures. The present report describes the successful use of bipolar diathermy during general laparoscopic surgery. Hemostasis and closure of even large vessels was possible with the use of bipolar forceps during laparoscopic cholecystectomy, fundoplication, appendectomy, and highly selective vagotomy procedures. No intraoperative complications resulting from bleeding were apparent in this series of 296 laparoscopic operations, nor were any postoperative complications suggestive of inadvertent tissue damage, such as peritonitis, apparent. Thus, these results suggest that bipolar coagulation can be used safely and without difficulty in laparoscopic surgical procedures.

Electrocoagulation↗
PubMed1995

Access techniques: Veress needle--initial blind trocar insertion versus open laparoscopy with the Hasson trocar.

The two most common techniques used to gain entry into the peritoneal cavity during laparoscopic general surgery are the blind Veress needle/trocar insertion and open trocar placement under direct visualisation. Once entry to the peritoneal cavity has been achieved, gas insufflation is used to establish pneumoperitoneum and enable visualisation of abdominal structures. Many of the complications associated with operative laparoscopy arise from creation of the pneumoperitoneum, such as subcutaneous emphysema and gas embolism, or from injury to internal structures during abdominal entry. Because of the relative infancy of laparoscopic general surgery, much of the information relating to these types of complications are associated with minimally invasive gynaecologic procedures. Compared to gynaecologic laparoscopy, general surgical interventions are typically more complicated, require longer operative times and a greater number of access sites, and are more likely to be performed in older patients. Therefore, complication rates associated with pneumoperitoneum or abdominal entry may actually turn out to be higher for laparoscopic general surgery, making selection of a blind versus open access technique more important. Two direct comparisons of these access approaches in laparoscopic cholecystectomy indicated that an open technique employing a peritoneal cut-down and trocar insertion under direct visualisation was safer than blind insertion of the Veress needle and primary trocar. We also favour the open access technique, believing that the risk for serious visceral or vascular complications is less than that with a blind approach.

Catheterization↗