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Biomedical subjects

J R Cocks

Publications and source records attributed to J R Cocks.

16 recordsLinked to original sources
PubMed1998

Laparoscopic inguinal hernioplasty: a comparison between transperitoneal and extraperitoneal techniques.

BACKGROUND: This study sequentially compares the results of 148 transperitoneal inguinal hernioplasties in 129 patients with 313 totally extraperitoneal hernioplasties in 254 patients. METHODS: Patients were entered into the study prospectively and reviewed postoperatively at 1 day, 1 week, 5 weeks and 1 year. RESULTS: There was no difference in length of hospital stay, postoperative analgesia requirements or the rate of early or late operative complications. The operating time was shorter and the return to normal activities was earlier for the totally extraperitoneal group. There were no intraperitoneal complications following the totally extraperitoneal operation. CONCLUSIONS: The extraperitoneal technique is favoured over the transperitoneal technique for laparoscopic inguinal hernioplasty.

Adult↗
PubMed1996

Colorectal resection in Victoria:a comparison of hospital based and individual audit.

BACKGROUND: The results of personal audit have not been tested against a hospital-based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained. METHODS: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub-Committee of the Victorian State Committee. One study was public hospital-based and the second was based on voluntary reporting by individual surgeons. RESULTS: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%, anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data. CONCLUSIONS: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital-based audit. The results obtained compare favourably with previously published data.

Aged↗
PubMed1996

Clinical indicators in colorectal surgery.

Two studies conducted in the state of Victoria have tested potential clinical indicators and the suggested thresholds for resection of colorectal carcinoma where an anastomosis has been performed. These studies involving 535 patients were independent of one another: one hospital based and one surgeon based. Threshold figures for these draft indicators have been compared with the study figures and found to be similar. It is suggested that wound infection (elective operation without formation of a stoma), anastomotic leak (clinically recognized) and mortality (elective operations in patients under the age of 80 years) are the most appropriate clinical indicators of colorectal resection for carcinoma.

Cholecystectomy↗
PubMed1993

Developing clinical indicators for cholecystectomy.

This study sets out to develop a set of clinical indicators for the frequently performed procedure, simple cholecystectomy. Four hundred consecutive cases of cholecystectomy were reviewed retrospectively and data were collected regarding the pre-operative condition of the patient as well as any postoperative complications. From this database a set of clinical indicators for simple cholecystectomy are recommended: wound infection rate 4.5%, re-operation or performance of another therapeutic procedure 3.5%, length of stay 7 days, and mortality < 0.025%. These threshold figures are to serve only as a 'flag' to possible problems.

Aged↗
PubMed1992

Perforated peptic ulcer--the changing scene.

There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A 'deliberative' approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surgery.

Adult↗
PubMed1991

Comparison of length of stay after hernia repair in two Victorian hospitals. Standards Sub-committee of the Victorian State Committee of the Royal Australasian College of Surgeons.

The objective of this study was to ascertain factors which determine the length of stay in relation to adult patients admitted for hernia surgery in two different hospitals. It was conducted prospectively on a total of 141 patients, 82 in a central hospital and 59 in a district hospital. There were no significant differences with regard to age, sex, type of hernia, pre-existing disease and postoperative complications. There was a significant difference between the average length of stay in the two hospitals (6.7 days in the central hospital and 3.9 days in the district hospital). There was a longer pre-operative stay in the central hospital through administrative problems, availability of operating time and admission for pre-operative investigations. In the postoperative period there was a significant difference between the day of operation and the time the surgeon stated that the patient could be discharged (i.e. the surgically advised discharge (SAD) date). This period was 4 days at the central hospital, as against 2 days at the district hospital. Once the SAD date was determined, there was no difference between the two hospitals with regard to placement. Consideration should be given to improving admission practices, including patient 'work-up' in the preadmission phase and to shortening the postoperative stay after hernia surgery.

Adolescent↗
PubMed1989

Perforated peptic ulcer: a deliberative approach.

Between 1966 and 1987, 116 patients with 119 episodes of perforation were admitted to Box Hill Hospital into one surgical unit, and 91 patients with 92 episodes were admitted into the other, with patients being admitted in alternate weeks. In the former unit, in order to avoid surgery in those patients whose ulcers had sealed spontaneously, a deliberative approach was followed according to a strict protocol--involving a deliberate time delay in surgical decision-making. In the latter unit, a more conventional approach was adopted, and patients in that unit are used as a retrospective comparison. In the first unit, of 115 episodes which followed the protocol, six were unresuscitable, 15 needed immediate surgery and 94 followed a delayed approach. Of that 94, 12 needed surgery at 4-6 h, and a further eight needed later surgery. Seventy-four (68% of 'operable' patients) did not require corrective surgery at all, for their episode of perforation. The operable mortality rate was lower (6% compared with 13%), the bedstay was shorter, the prolonged bedstay rate was lower, and the morbidity was no worse, than those patients treated more conventionally in the second unit.

Adolescent↗
PubMed1972

Partial gastrectomy for haemorrhage.

An analysis was made of the results of 566 partial gastrectomies for haemorrhage from gastroduodenal ulceration between 1953 and 1962 with regard to mortality, morbidity, and long-term follow up. With rigid criteria for selection of patients for surgery, the overall mortality rate for ulcerative gastroduodenal haemorrhage was 8.6%. The actual operative mortality rate more than doubles if an emergency operation is performed later than four days after the patient's admission with haemorrhage. Postoperative and later bleeding complications occurred in 5% of patients. Regardless of the length of ulcerative history, over 92% of patients have clinically satisfactory long-term results. Six per cent required further operation, after which, they too had clinically satisfactory results.

Adolescent↗