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Biomedical subjects

J L Ponsky

Publications and source records attributed to J L Ponsky.

At least 55 records · Page 3Linked to original sources
PubMed1997

Comparison of bile duct pressures following sphincterotomy and endobiliary stenting in a canine model.

BACKGROUND: Cystic duct (CD) leaks following laparoscopic cholecystectomy may be diagnosed and managed with ERCP. Treatment options include endoscopic sphincterotomy (ES) and/or endobiliary stenting (Stent). This study was undertaken to determine if ES or Stent is more effective in lowering bile duct pressures by disrupting the pressure gradient created by the sphincter of Oddi and therefore more beneficial in the management of CD. METHODS: Mongrel dogs underwent midline laparotomy and antegrade cannulation of the common bile duct (CBD) with an umbilical artery catheter. Baseline CBD pressures were measured following duodenotomy; 5 Fr and 7 Fr stents measuring 2.5 cm, 4.5 cm, and 7 cm were inserted retrograde into the CBD. CBD pressure was measured after each stent insertion. A 1-cm sphincterotomy was the performed using a double channel papillotome. RESULTS: Insertion of both 5 Fr and 7 Fr stents significantly lowered CBD pressure as compared to sphincterotomy alone, p < 0.05. There was no significant difference in the reduction in CBD pressure following the insertion of either the 5 Fr or 7 Fr stents of varying lengths. Sphincterotomy alone did not significantly decrease CBD pressure as compared to baseline pressure. The insertion of a stent following sphincterotomy also caused a significant decrease in CBD pressure as compared to sphincterotomy alone, p = 0.034. CONCLUSION: Stent placement or ES with Stent placement significantly reduced CBD pressure as compared to ES alone. Stent diameter and length were not significant variables in this study. These results support the use of Stent or ES with Stent rather than ES alone in the management of CD leaks.

Animals↗
PubMed1996

Endoscopic approaches to common bile duct injuries.

Operative injury of the biliary tree is not a new complication of cholecystectomy but has become increasingly more visible during the emergence of the laparoscopic approach. Optimal treatment of such problems depends upon early recognition and strategic planning of a therapeutic approach. ERCP has become increasingly important in identifying bile leaks and their source after cholecystectomy. A high index of suspicion is mandatory in patients complaining of discomfort several days after surgery, and liberal use of CT or ultrasound imaging helps identify bile leaks before peritonitis is severe. Once bile leaks or ductal injury are suspected, ERCP should be performed to confirm the leak, identify its site and cause, and help define a therapeutic plan. In minor leaks, endoscopic diversion by sphincterotomy or stenting provides a rapid solution. In more significant injuries where ductal integrity is intact, endoscopic dilatation and stenting may play a role in closing leaks and resolving strictures while averting surgery. Where injury is severe, ERCP, often combined with transhepatic cholangiography, helps to rapidly assess the extent of injury and plan a strategy for operative repair.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Endoscopic evaluation of the postoperative stomach.

The endoscopic assessment of the postoperative stomach is one of the most challenging areas in endoscopy. This is a function of the plurality of disease entities and anatomic variations with which the endoscopist must be familiar in order to interpret the findings in this setting. At the same time, the diagnostic and therapeutic use of endoscopy in the postoperative environment is magnified because of the opportunity it provides to achieve information and relieve disability in situations of inherently significant morbidity. With the continuing maturation of endoscopic techniques, it is likely that the endoscopist of the future will have an increasingly significant role in the pre- and postoperative assessment and treatment of the patient with foregut pathology.

Evaluation Studies as Topic↗
PubMed1996

Management of common bile duct stones.

Management of common bile duct stones has changed rapidly as new developments in surgical and endoscopic equipment have become available. Prior to advanced laparoscopic surgical techniques and endoscopic sphincterotomy, common bile duct stones required open surgery, choledochotomy, and manual removal. New alternatives in the management of choledocholithiasis must be understood to allow for comprehensive management of common bile duct stones. Endoscopic and surgical techniques can also be combined for excellent results utilizing minimally invasive techniques. The appropriate choice of therapy will depend on the experience and the resources available.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Access routes for enteral nutrition.

Comprehensive management of patients includes a thorough evaluation of nutritional requirements. The risks and the benefits of enteral and parenteral supplementations have been heavily investigated. Recent literature supports use of the gastrointestinal tract, when functioning, as the preferred route for supplemental nutrition. There are multiple access routes available to clinicians to provide enteral nutrition, including feeding tubes, which can be placed transnasally, percutaneously, or surgically. These various techniques have individual indications, contraindications, and complications associated with the procedures. They also have varying levels of invasiveness and overall durability. We discuss the different access routes available for enteral feeding, as well as the process for selecting the most appropriate route.

Enteral Nutrition↗
PubMed1995

Endoscopic retrograde cholangiopancreatography and endobiliary stenting in the treatment of biliary injury resulting from liver trauma.

Two patients with the bile duct injury secondary to blunt liver trauma are presented. Endoscopic retrograde cholangiopancreatography (ERCP) proved to be a useful diagnostic and therapeutic modality in the treatment of these patients. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma.

Adult↗
PubMed1995

Laparoscopic repair of a diaphragmatic laceration.

The role of laparoscopy in the management of trauma patients has yet to be determined. In the stable patient, laparoscopy can be used to verify peritoneal penetration and intra-abdominal organ injuries. This report describes a diaphragmatic laceration in a 17-year-old boy secondary to a single stab wound. This injury of the left hemidiaphragm was identified and repaired using laparoscopic techniques. This case demonstrates the value of laparoscopy as both a diagnostic and a therapeutic tool in the management of trauma patients.

Adolescent↗
PubMed1994

Surgical endoscopy fellowships. What difference do they make?

This study was conducted to evaluate the career impact of a formalized surgical endoscopy fellowship. Sixteen surgeons who have completed this training were surveyed via questionnaire. Twelve individuals were found to be in teaching settings, 10 had academic appointments, and 12 had published in the endoscopic and gastrointestinal literature. Gastrointestinal endoscopy constituted a mean of 28% of these surgeons' practices. Gastrointestinal surgery was the focus of a mean of 51% of their operative experience, and laparoscopic surgery constituted a mean of 40% of their surgical activity. Twelve of these individuals performed ERCP as part of their clinical practice, and 11 performed advanced laparoscopic surgical procedures. Relationships with nonsurgical endoscopic colleagues were considered positive for 5 surgeons, negative for 7, and neutral for 4. Professional relationships with nongastroenterologic physicians were uniformly positive or neutral. We conclude that formal surgical endoscopy fellowships facilitate subsequent academic and educational activity, foster surgical practices oriented toward gastrointestinal disease, and impact relationships with nonsurgical colleagues in a variable fashion.

Career Choice↗
PubMed1994

Intraabdominal mesh prosthesis in a canine model.

Laparoscopic inguinal hernia repair is still at an investigational stage, and varying methods have been described in the literature. These include the transabdominal preperitoneal approach, the intraperitoneal onlay mesh procedure, and the extraperitoneal approach. This study evaluates the differences in macroscopic adhesion formation between transabdominal preperitoneal mesh placement, intraperitoneal onlay mesh procedures, and extraperitoneal mesh placement in a canine model. The determination of microscopic tissue ingrowth and mesh incorporation was not a goal of this study. Operative sites utilizing mesh in a reperitonealized fashion resulted in less adhesion formation than did those sites where mesh was placed in an intraperitoneal manner using the onlay technique. Mesh placed in the extraperitoneal space without entering the peritoneal cavity did not exhibit any adhesion formation. Results favor the reperitonealization of intraabdominal mesh or mesh placement by an extraperitoneal approach.

Animals↗
PubMed1994

Treatment of bile leaks from the cystohepatic ducts after laparoscopic cholecystectomy.

The cystohepatic ducts represent accessory bile ducts of variable size which frequently travel within the gallbladder fossa or in the posterior wall of the gallbladder. These ducts can be injured during laparoscopic cholecystectomy and can result in bile collections if transected. Successful treatment by operative means or radiologically guided percutaneous drainage is possible, but endoscopic management has several advantages. We describe cases managed by endoscopic retrograde cholangiopancreatography (ERCP) with stent placement and discuss the advantages of this method. Also discussed is the anatomy of these accessory bile ducts, additional management options, and techniques for avoiding this injury during open or closed cholecystectomy.

Aged↗
PubMed1993

Giant nonfunctioning islet cell tumor requiring pancreaticoduodenectomy and complete liver revascularization.

Pancreaticoduodenectomy with revascularization of the hepatic artery and portal vein was performed on a 17-year-old girl with giant nonfunctioning islet cell tumor of the pancreas. She had a remote history of neonatal hypoglycemia leading to mental retardation and a right Wilms' tumor resected at 8 months. Serum pancreatic polypeptide levels were elevated. Her postoperative course was complicated by an ischemic perforation of the colon, which did not infect her prosthetic vascular grafts. The relationship between her neonatal hypoglycemia, Wilms' tumor, and subsequent islet cell neoplasm is unclear.

Adenoma, Islet Cell↗
PubMed1993

Laparoscopic therapy of cholelithiasis.

Laparoscopic cholecystectomy has emerged as the treatment of choice for symptomatic cholecystolithiasis. Results will improve and complications rates decrease as surgeons gain experience in the method. New developments will permit a complete laparoscopic approach to cholelithiasis.

Cholecystectomy, Laparoscopic↗