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J L Stoller

Publications and source records attributed to J L Stoller.

At least 19 recordsLinked to original sources
PubMed1990

Ablation of the cystic duct and gallbladder: clinical observations.

The cystic duct and gallbladder were ablated in eight patients with acute gallbladder disease who had been treated with minicholecystostomy instead of cholecystectomy because of multiple risk factors. First, endoluminal transcatheter radio-frequency electrocoagulation of the cystic duct was performed under fluoroscopic control, which resulted in complete occlusion in all eight patients. Next, the mucosa of the isolated gallbladder was sclerosed with 95% ethanol and 3% sodium tetradecyl sulfate in one to four sessions; no analgesics were required. The gallbladder volumes of all patients, estimated by means of ultrasound, were 1.5-22 cm3 (average, less than 10 cm3) after a mean follow-up period of 5 months. One patient died of a cerebrovascular accident 15 months after sclerotherapy. In all surviving patients, the gallbladder fistulas are dry and obliterated. These early clinical data indicate that electrocoagulation permits reliable, safe obliteration of the human cystic duct. The authors believe that sclerotherapy of the isolated gallbladder is feasible without toxic effects but that their treatment needs adjustment to achieve complete ablation of the gallbladder mucosa in a shorter period and in all patients.

Aged↗
PubMed1987

Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients.

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.

Aged↗
PubMed1986

Radiologic dilatation preceding palliative surgical tube placement for esophageal cancer.

A new two-stage technique is reported for tube placement in the palliative treatment of esophageal cancer. The first step consists of radiologic intervention with balloon dilatation of the stricture. The patient is then transferred to the operating room, where the permanent esophageal tube placement is performed. A comparison of technique-related complications in a group of 34 patients with esophageal malignancies who had a permanent tube inserted by either the two-stage technique or by a standard endoscopic operative method show the new technique to have fewer complications and markedly decreased operative time.

Adenocarcinoma↗
PubMed1985

Minicholecystostomy and radiologic stone extraction in high-risk cholelithiasis patients. Preliminary experience.

The treatment of gallstone disease in elderly patients continues to pose problems for surgeons because of a high associated complication rate. We have presented our preliminary experience with a new technique consisting of minicholecystostomy under local anesthetic, followed by radiologic intervention for stone extraction. In this paper, we outline important details of the surgical and radiologic technique and details of our results and complications. This approach has been proved safe and effective in 21 high-risk patients. On the basis of our early results, we suggest that this technique should be given a more extensive trial.

Acute Disease↗
PubMed1984

Palliation after operation and after radiotherapy for cancer of the esophagus.

Because of the negligible cure rate in cancer of the esophagus, treatment is aimed principally at providing good palliation. This paper compares the degrees of palliation achieved after the two main treatments for symptomatic carcinoma of the esophagus. The degree of palliation was measured by a grading system designed to assess only the subjective responses of each patient. The results show that palliation as defined and measured in this study is the same after radiotherapy as after surgical excision. Since the expected survival is the same after radiotherapy as after operation, the expected morbidity and mortality of radiation are lower and radiotherapy may be used where operation is not possible, the authors suggest that radiotherapy is the better primary treatment for symptomatic squamous cancer of the esophagus.

Adenocarcinoma↗
PubMed1984

A new flexible intestinal transposition forcep.

In this report, a new instrument is described which eases the transposition of portions of the intestine or stomach from the abdominal cavity to the neck in esophageal replacement operations. The instrument has two unique features: first, the shaft is flexible in all planes, and second, the gripping end can be adjusted for varying tissue thicknesses. The instrument has been successfully used at the Vancouver General Hospital to transpose colonic segments and the entire stomach from the abdomen to the neck to replace an excised esophagus or to bypass unresectable malignant growths. It is recommended as an improved way to transpose long intestinal segments or the entire stomach to the neck for anastomosis with the cervical portion of the esophagus.

Esophagus↗