When resection of more than 50% of the trachea is necessary, tracheal reconstruction becomes a very difficult problem. We tested a new method of tracheal reconstruction using the left main bronchus. The procedure was performed in 6 adult mongrel dogs. Through a midline sternotomy, a left pneumonectomy is performed, preserving as much of the left main bronchus as possible. The carina is preserved and mobilized, and the left main bronchus is passed under the aortic arch and reversed. The distal end of the bronchus is anastomosed to the proximal end of the resected trachea. The distal end of the resected trachea is closed by stapling. Four animals survived the procedure without apparent functional difficulty and remained healthy until they were killed five to ten months postoperatively. The anastomosis was well healed without stenosis. Anatomical measurements in 10 human cadavers revealed that the length of the left main bronchus to the level of the upper lobe takeoff is approximately 50% that of the trachea. The diameter of the left main bronchus is approximately 75% that of the trachea. We believe that the technique described can extend the limits of tracheal resection in a selected group of patients for whom there is currently no good alternative.

Animals↗

PubMed1982

Reappraisal of the problems of intra-abdominal abscess.

During a ten year period, 69 patients underwent 100 operations for more than 147 intra-abdominal abscesses. The over-all mortality was 24.6 per cent and the redrainage rate, 30.4 per cent. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored two or more different organisms. Mortalities were low in patients less than 20 years of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients more than 40 years of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures, and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intra-abdominal abscess are confirmed.

Abdomen, Acute↗

PubMed1980