Biomedical subjects

J Mamazza

Publications and source records attributed to J Mamazza.

9 recordsLinked to original sources

PubMed1992

[Endoscopic retrograde cholangiopancreatography in the context of cholecystectomy under celioscopy].

This descriptive cohort study documents the results of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) in the perioperative period of laparoscopic cholecystectomy (LC). Of 630 consecutive patients undergoing LC, 83 (13.2%) sustained 96 ERCP, of which 65 were performed preoperatively (67.7%) and 31 postoperatively (32.3%). The common bile duct cannulation rate was 96.9% after the first attempt and 100% after the second in three patients. Common duct stones were found in 40 patients (6.3%) and three other anomalies were demonstrated ES was performed in 42 patients and 100% clearance of the common bile duct was achieved after 45 extraction procedures. Six patients (1%) were found at follow-up with unsuspected common duct stones and were all successfully treated with ES. At present time, the morbidity of ERCP and ES (7.2% and 11.9%) make them worthwhile adjuncts to perative cholangiography for the diagnosis and treatment of common bile duct stones found during the perioperative period of LC.

Adolescent↗

PubMed1992

Laparoscopic splenectomy: operative technique and preliminary report.

A technique of laparoscopic splenectomy was developed on animal models and subsequently applied in two human patients. After creation of a 15 mm Hg pneumoperitoneum, five trocars, two with 12-mm diameters, were introduced into the upper abdomen. The spleen was approached directly by dissection of the gastrosplenic ligament. The short gastric vessels and hilar vessels were individually ligated with metallic clips or a surgical stapler, depending on their size. A plastic bag was then introduced into the abdominal cavity and the spleen slipped inside. An umbilical incision measuring 2 to 3 cm was used for extraction after finger fracture of the spleen. After laboratory experience with seven animals, we used this operation on two patients. The first procedure had to be converted to open surgery because of hemorrhage; the second was successfully performed within 4 h. Knowledge of anatomic variations and meticulous surgical technique are necessary for the successful completion of splenic laparoscopic surgery.

Adolescent↗

PubMed1992

Evaluation of pulmonary function in laparoscopic cholecystectomy.

Historically, values of pulmonary function tests, when taken on the day after open upper abdominal surgery and cholecystectomy, show decreases of 45% to 60% compared with preoperative determinations. In a group of 54 consecutive patients in whom many pulmonary function parameters were studied, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), measured the morning after laparoscopic cholecystectomy, revealed a 22% decrease (3.31/2.59 L) and a 21% decrease (2.68/2.11 L), respectively, on average compared with preoperative values, demonstrating better pulmonary function after laparoscopic cholecystectomy. Furthermore, there was no difference between patients above or below 60 years of age and between smokers and nonsmokers. Improved pulmonary function after laparoscopic cholecystectomy may account for the observed reduced rate of pulmonary complications after laparoscopic cholecystectomy.

Adult↗

PubMed1992

Role of the teaching hospital in the development of a laparoscopic cholecystectomy program.

Laparoscopic cholecystectomy was introduced at McGill University-affiliated hospitals in a planned manner to evaluate the safety and results of this new procedure while training attending and resident surgeons. Laparoscopy was performed with the intent of carrying out cholecystectomy in 500 consecutive patients (70% female, 30% male), whose age averaged 48 years (range from 7 to 93 years). Thirty-seven percent had undergone intra-abdominal surgery previously, and 9.1% had had acute cholecystitis. There were two common-bile-duct injuries and one major small-bowel injury. The procedure had to be converted to open cholecystectomy in 25 (5%) patients. There were no deaths. The mean duration of surgery was 88 minutes. Fifty-five percent of patients were discharged home in 24 hours or less after surgery, and 75% were back to normal activity within 1 week of discharge. Fourteen attending staff and 8 senior residents achieved competence to carry out laparoscopic cholecystectomy independently.

Adolescent↗

PubMed1992

History of laparoscopic surgery.

Since the beginning of the 20th century physicians have promoted laparoscopy as a valuable adjunct to the diagnosis of diseases of the abdominal cavity. Laparoscopy, however, failed to become popular among abdominal surgeons until the advent of laparoscopic cholecystectomy. This single new operative approach to the treatment of gallbladder stones gave rise to such enthusiasm among general surgeons that other innovative laparoscopic procedures are now being promoted in ever-increasing numbers. The general surgeon has again become the leader in the introduction of a new surgical approach. This new technique must be developed with great care, and there must be rigorous criteria for its use, critical analysis of the technique and honest reporting of results.

Cholecystectomy↗

PubMed1992

Laparoscopic surgery--basic armamentarium.

The introduction of laparoscopic techniques into standard intracavitary surgery has received widespread acceptance in North American surgical practice in a very short time. To complete these procedures successfully a basic armamentarium is required by surgeons. The equipment should provide safe conduct of the procedure and maximum flexibility in the types of surgical procedures to be undertaken. The basic laparoscopic equipment needed to facilitate minimal-access-site surgery is reviewed, from the operating table and lighting in the operating room through optics, cameras and television monitors to the instruments and agents needed for the surgical techniques and for securing hemostasis.

Hemostasis, Surgical↗

PubMed1992

Laparoscopic cholecystectomy: strategy and concerns.

After briefly describing the first laparoscopic cholecystectomy performed by Philippe Mouret, the authors review some of the differences in strategy, management and concerns between conventional and laparoscopic cholecystectomy. They address the problems relating to the required skills of triangulation and camera handling, the presence of common-duct stones and concomitant disease, the issues of drainage, hemostasis, access in difficult cases, iatrogenic trauma to the bile ducts and pertinent differences in cardiorespiratory function.

Cholangiography↗

PubMed1992

Laparoscopic cholecystectomy: trans-Canada experience with 2201 cases.

The authors carried out a prospective review of the initial and consecutive experience with laparoscopic cholecystectomy of 58 surgeons from 31 teaching and nonteaching institutions throughout Canada. The perioperative morbidity of 2201 cases is described, with special attention to iatrogenic complications. The data suggest that complications, including bile-duct injury, are not frequent. Pneumonia and wound infection rates appear lower than after open surgery. There were no deaths. Laparoscopic cholecystectomy is replacing open cholecystectomy for the management of symptomatic cholelithiasis.

Adolescent↗

PubMed1991

[Clinical and hemodynamic evaluation of cholecystectomies performed under laparoscopy].

Hundred patients who underwent laparoscopic cholecystectomy and 25 consecutive patients where multiple hemodynamic parameters were measured were included in the study. The mean operative time was 84 minutes and operative cholangiography was selective. No deaths and five major complications were reported. Months after laparoscopic cholecystectomy, two patients needed open surgery for pathology missed at initial exploration. One patient sustained minor trauma to the biliary tree. Despite generally normal vital signs and few cardiac arrhythmias, cardiac output dropped in many patients during laparoscopic cholecystectomy. This was specially marked at the end of peritoneal insufflation when the Fowler position was assumed, emphasizing the need for close anesthetic monitoring, specially during the first half hour of this procedure.

Adolescent↗