Biomedical subjects

J Mamazza

Publications and source records attributed to J Mamazza.

At least 55 records · Page 3Linked to original sources

PubMed1999

Simplified laparoscopic approach to "second-look" laparotomy: a review.

Acute mesenteric vascular accidents are being diagnosed more commonly as a consequence of an aging population and often result in emergency bowel resection for ischemia. Because predicting postoperative intestinal viability remains difficult, second-look laparotomy has been advocated to improve outcomes. Recently, laparoscopy has emerged as an alternative to laparotomy for the diagnosis and treatment of ongoing postoperative ischemia. A review of the literature since 1994 reveals that, to date, 19 procedures have been reported to prevent 13 (68%) unnecessary laparotomies. We describe our laparoscopic second- look technique and review the literature. Second-look laparoscopy has been shown repeatedly to be a safe alternative to laparotomy. It is simple and reduces negative second-look laparotomy in critically ill patients.

Aged↗

PubMed1998

Splenic artery embolization before laparoscopic splenectomy. An update.

BACKGROUND: This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. METHODS: Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20). An anterior surgical approach was used. After 1994 (group II), embolization was not used for these patients (0/26), and a lateral surgical approach was used. Throughout the study period, all patients with spleens longer than 20 cm had embolization (8/8). RESULTS: Five complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely because of embolization. In group II, similar results were obtained because of experience and a better surgical approach (i.e., lateral). CONCLUSIONS: Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).

Angiography↗

PubMed1998

Laparoscopic splenectomy: lessons from the learning curve.

OBJECTIVE: Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. DESIGN: A descriptive study of a prospective database. SETTING: A tertiary care teaching hospital. PATIENTS: Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. INTERVENTIONS: Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. MAIN OUTCOME MEASURES: Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. RESULTS: The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. CONCLUSIONS: Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization).

Adolescent↗

PubMed1998

Surgery for peptic strictures.

Benign peptic stricture of the esophagus is a complex disorder which results from persistent gastroesophageal reflux. Its successful management depends on an accurate preoperative evaluation of the stricture and the patient. Surgical management of peptic strictures can be quite effective in relieving the symptoms and halting the pathologic gastroesophageal reflux that accompanies this disorder. This article reviews the general principles of evaluation and surgical treatment of benign peptic esophageal strictures.

Barrett Esophagus↗

PubMed1998

Operative treatment of malignancy.

The overall prognosis of patients afflicted with cancer of the esophagus is dismal and has not changed greatly over the last few decades. Improvements have largely been due to better perioperative care rather than new surgical techniques. There remain, about the optimal treatment of these patients, and these differences are summarized in this article. The principal elements required to make an appropriate surgical decision also are outlined. Until new markers for early detection and effective systematic therapy emerge, improvement is likely to occur only in subsets of patients referred early and treated in an environment that guarantees low operative mortality.

Esophageal Neoplasms↗

PubMed1995

Laparoscopic splenectomy.

We describe the clinical course of 23 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings, and two (9%) were converted to open surgery. In the remaining 20 patients who successfully underwent laparoscopic splenectomy, no mortality was reported; four postoperative complications (20% morbidity) occurred. Mean operating time was 3 h 35 min (135-300 min). After a mean postoperative stay of 3.9 days (2-9 days), all patients except two were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization, begun with the third patient, helped to reduce operative blood loss and made the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normal-sized (< 11 cm long) or moderately enlarged (11-20 cm long) spleens.

Adolescent↗

PubMed1995

Laparoscopic gastroenterostomy for duodenal obstruction.

BACKGROUND: It is not yet clear where laparoscopic procedures will fit into the armamentarium of the surgeon. Over the past decade, there has been a clear trend toward minimally invasive procedures for palliation of inoperable cancer. Traditionally, when duodenal obstruction occurs secondary to a disease process, gastric bypass through laparotomy is required. PATIENTS AND METHODS: Between November 13, 1992 and September 13, 1994, 10 patients underwent laparoscopic gastroenterostomy for duodenal obstruction. In 9 patients, the procedure was carried out for malignant obstruction; in 1 patient, duodenal obstruction was secondary to chronic scarring from benign peptic ulcer disease. Eight of these patients already had biliary decompression through radiologic or endoscopic means. One patient underwent laparoscopic cholecystenterostomy for biliary obstruction in addition to the laparoscopic gastroenterostomy. RESULTS: Laparoscopic gastroenterostomy was successfully completed in 8 of the 10 patients. In 2, conversion to open surgery was necessary. There was no mortality related to this operative approach. CONCLUSIONS: Laparoscopic gastroenterostomy is a safe procedure for treatment of duodenal obstruction. Good palliation can be expected in patients with obstruction of the duodenum secondary to advanced malignancies.

Aged↗

PubMed1995

Should antibiotic prophylaxis be used routinely in clean surgical procedures: a tentative yes.

BACKGROUND: The incidence of surgical site infection (SSI) after clean surgical procedure has traditionally been regarded as too low for routine antibiotic prophylaxis. But we now know that host factors may increase the risk of SSI to as high as 20%. We assessed the value of prophylactic cefotaxime in patients stratified for risk of SSI in a randomized double-blind trial. METHODS: Patients admitted for clean elective operations were enrolled, stratified for risk by National Nosocomial Infection Survey criteria, and randomized to receive intravenous cefotaxime 2 gm or placebo on call for operation. They were followed for 4 to 6 weeks for SSI diagnosed by Centers for Disease Control and Prevention criteria. RESULTS: Analysis of 775 patients showed that the 378 evaluable patients who received cefotaxime had 70% fewer SSI than those who did not--Mantel-Haenszel risk ratio (MH-RR) 0.31; 95% confidence intervals (CI) 0.11 to 0.83. Benefit was clear in the 616 low risk patients--0.97% versus 3.9% SSI (MH-RR 0.25, CI 0.07 to 0.87, p = 0.018), but only a trend was seen in 136 high risk patients--2.8% versus 6.1% SSI (MH-RR 0.48, CI 0.09 to 2.5). CONCLUSIONS: The results indicate clear benefit for routine antibiotic prophylaxis in clean surgical procedures. High risk patients need more study.

Adult↗

PubMed1993

Ventilatory requirements during laparoscopic cholecystectomy.

The purpose of this clinical study was to determine: (1) the increase in minute ventilation required to maintain preinsufflation arterial carbon dioxide tension (PaCO2) during laparoscopic cholecystectomy, and (2) whether end-tidal PCO2 (PETCO2) can be used as an index of PaCO2 and, therefore, of the adequacy of minute ventilation during the pneumoperitoneum. We measured PaCO2, PETCO2, expired minute volume (Vexp) standardized for body surface area (SA), airway and intra-abdominal pressure (P(aw), Pabd) during general anaesthesia for laparoscopic cholecystectomy just before and 30 min after the creation of a CO2 pneumoperitoneum in 28 healthy (ASA class 1 and 2) consenting adults. They were in the reverse Trendlenburg position (20 degrees) with a 5 degrees lateral tilt. Expired minute volume was increased from 3.75 (SEM +/- 0.12) to 4.19 (0.15) L.min-1 x m-2 to maintain PaCO2 close to control levels: 38.9 (0.8) vs 40.1 (0.6) mmHg 5.19 (0.1) vs 5.35 (0.08) kPa). In most of the patients (23/28), PETCO2 was less than 41 mmHg with a correlation between PaCO2 and PETCO2. In ten of these patients, (Pa-PET)CO2 was greater than the normal range. In 5/28, (Pa-PET)CO2 was negative. The "driving pressure" (P(aw)-Pabd) increased from 8.7 (1.0) to 10.4 (1.1) cm H2O, without any correlation between the increase in P(aw)-Pabd and that in Vexp. The results indicate the need for extra ventilatory requirement during laparoscopy and that PETCO2 is an imperfect index of PaCO2 under these circumstances.

Abdomen↗

PubMed1993

[Splenectomy by celioscopy. Experience of 20 cases].

We describe the clinical course of 20 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings and two (10.5%) were converted to open surgery. The first patient in the series was converted for a hemorrhagic incident and the eight patient, who had a 34 cm spleen, for dissection difficulties. In the remaining 17 patients who successfully underwent laparoscopic splenectomy, no mortality was reported and there were four postoperative complications (23.5%). Mean operating time was 3 h 40 min (135-300 min). After a mean postoperative stay of four days, all patients, except two, were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization was begun with the third patient and was found to significantly reduce operative blood loss and make the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normal-sized or moderately enlarged spleens.

Adolescent↗

PubMed1993

Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization.

We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery--the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most patients were able to resume normal activities < or = 2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r - 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (< 20 cm long) when hematologic indications are present.

Adolescent↗

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↗