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J Sackier

Publications and source records attributed to J Sackier.

13 recordsLinked to original sources
PubMed1998

Evaluation of mechanism of increased intracranial pressure with insufflation.

BACKGROUND: Previous studies have documented an increase in intracranial pressure with abdominal insufflation, but the mechanism has not been explained. METHODS: Nine 30-35-kg domestic pigs underwent carbon dioxide insufflation at 1.5 l/min. Intracranial pressure (ICP), lumbar spinal pressure (LP), central venous pressure (CVP), inferior vena cava pressure (IVCP), heart rate, systemic arterial blood pressure, pulmonary arterial pressure, cardiac output, heart rate, respiratory rate, temperature, and end-tidal CO2 were continuously measured. Mechanical ventilation was used to maintain a constant pCO2. Measurements were recorded at 0, 5, 10, and 15 mmHg of abdominal pressure with animals in supine, Trendelenburg (T), and reverse Trendelenburg (RT) positions. Prior to recording measurements, the animals were allowed to stabilize for 40 min after each increase in abdominal pressure and for 20 min after each position change. RESULTS: The animals showed a significant increase in ICP (mmHg) with each 5-mmHg increase in abdominal pressure (0 mmHg: 14 +/- 1.7; 5 mmHg: 19.8 +/- 2.3, p < 0.001; 10 mmHg: 24.8 +/- 2.5, p < 0.001; 15 mmHg: 29.8 +/- 4.7, p < 0.01). The ICP at 15 mmHg abdominal pressure increased further in the T position (39 +/- 4, p < 0.01). Insufflating in the RT position did not significantly reduce the increase in ICP. The IVCP (mmHg) increased with increased abdominal pressure (0 mmHg: 11.5 +/- 6.2, 15 mmHg: 22.1 +/- 3.5, p < 0.01). This increase correlated with the increase in ICP and LP (r of mean pressures >/=0.95). There was no significant change in CVP. CONCLUSIONS: This study suggests that care may be needed with laparoscopy in patients at risk for increased ICP due to head injury or a space occupying lesion. The mechanism of increased ICP associated with insufflation is most likely impaired venous drainage of the lumbar venous plexus at increased intraabdominal pressure. Further studies of cerebral spinal fluid movement during insufflation are currently underway to confirm this hypothesis.

Animals↗
PubMed1998

Transthoracic induction of a hiatal hernia in domestic swine.

BACKGROUND: With the common performance of laparoscopic Nissen fundoplication for gastroesophageal reflux disease, there is renewed interest in the pathophysiology and potential histologic consequences of hiatal hernias. However, in vivo model exists that both reliably reproduces the hiatal hernia and is amenable to subsequent laparoscopic repair. METHODS: A transthoracic approach was used to induce a hiatal hernia surgically in female James pig (50-160 kg; n = 5). RESULTS: Hiatal hernias were successfully induced in all pigs and verified with barium swallow, endoscopy, and/or laparoscopy. Laparoscopic reduction and Nissen fundoplication were subsequently completed on each animal on postoperative day 30. One postoperative death occurred on postoperative day 4 after thoracotomy. CONCLUSIONS: We describe the induction of a hiatal hernia via a transthoracic approach in domestic swine. The hiatal hernia is amenable to subsequent laparoscopic repair, enabling surgeons to acquire the technical skills required to correct this defect in the laboratory. To our knowledge, this is the first report of a reproducible model of a transthoracically induced hiatal hernia that allows subsequent laparoscopic repair. We suggest that in addition to refinement of surgical skills, our model may provide new information to researchers regarding the potential indications for antireflux procedures, as well as the natural history and appropriate management of hiatal hernias.

Animals↗
PubMed1996

How does infected bile affect the postoperative course of patients undergoing laparoscopic cholecystectomy?

OBJECTIVES: To assess the rate of infected bile in patients undergoing laparoscopic cholecystectomy (LC) and to study the influence on the postoperative infective complications in this group of patients. METHODS: Bile samples of 247 patients undergoing LC were collected and cultured for aerobic and anaerobic bacteria. All patients were given prophylactic antibiotics. RESULTS: The overall rate of infected bile was 12.8% (56 positive cultures); of these, 54 were aerobic and 2 anaerobic bacteria. Only 2 patients developed infection at the umbilical site, and in both, the bile was sterile. None of the patients with positive bile cultures developed any signs of infection during a mean follow-up period of 26 months. CONCLUSION: The overall rate of septic complications following LC is extremely low, and at least in our study no correlation was found between infected bile and septic complications.

Adolescent↗
PubMed1994

Continuous esophageal pH monitoring during laparoscopic cholecystectomy.

Gastro-esophageal regurgitation (GER) and eventual aspiration is considered a major risk during general anesthesia. High intraperitoneal pressure produced during laparoscopic cholecystectomy (LC) is a possible source of increased GER. We investigated the incidence of GER using continuous esophageal pH monitoring in 14 patients undergoing elective LC. Only two brief episodes of acid reflux (pH < 4) occurred during LC. Apparently the high intraperitoneal pressure during LC carries no increased risk of regurgitation and aspiration.

Adult↗
PubMed1994

Analysis of surgical movements during suturing in laparoscopy.

Laparoscopic suturing is now recognized as a necessary component of minimally invasive surgery. Until recently it has been avoided due to the lack of proper instrumentation and systematic technique. The principles of magnified surgery are discussed as they apply to the laparoscopic field, with emphasis on visual perception, economy of motion, choreography of movements, and "flawless technique". The principles and techniques of needle loading, handling, and driving are presented, as are the series of movements involved in tying an intracorporeal square-slip knot.

Equipment Design↗
PubMed1993

[Laparoscopic cholecystectomy].

80 patients underwent laparoscopic cholecystectomy, of whom 64 were females and 16 males (age range 20-70 years) and 15 had undergone previous abdominal operations. 3 of the 80 operations were converted to open cholecystectomy. In 11, preoperative ERCP was performed, in 2 of whom common bile duct stones were detected. In 7 intraoperative cholangiography was performed. The average hospital stay was 2.2 days. Based on this and other studies, laparoscopic cholecystectomy seems to be the operation of choice for symptomatic cholelithiasis.

Adult↗
PubMed1993

[Endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy].

In 11 of 82 patients undergoing laparoscopic cholecystectomy, preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed. Indications were biliary pancreatitis in 5 and suspected common bile duct (CBD) stones in the other 6 (based on US or liver function tests, or both). The biliary tree was normal in 9 and laparoscopic cholecystectomy was performed. In 8 there was uneventful recovery but in the ninth open surgery was required when the attempted cholecystectomy resulted in uncontrolled cystic artery bleeding. Of the remaining 3 patients, 1 underwent sphincterotomy via ERCP and 3 weeks later, laparoscopic cholecystectomy. In the others, we intended to explore the CBD by laparoscopy, but had to resort to open cholecystectomy due to technical difficulties resulting from unsuspected acute cholecystitis. Based on our short experience, ERCP combined with laparoscopic cholecystectomy seems to be both safe and effective.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1992

Diagnostic laparoscopy in nonmalignant disease.

Laparoscopy is useful in the management of a wide range of benign conditions. In the elective situation, it may be chosen to evaluate hepatobiliary disorders, abdominal masses, or chronic pain, and is an ideal way to sample tissue. Under the emergency setting, it is another tool for the assessment of trauma patients and may be of value in those patients with abdominal pain, mesenteric ischemia, fever of unknown origin, or gastrointestinal hemorrhage. It is important for the surgeon to be familiar with the technique, correctly prepare the patient, and be aware of the risks and limitations of this diagnostic modality.

Abdominal Injuries↗
PubMed1990

The importance of intraoperative cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) using electrocoagulation was successfully performed in 56 out of 58 selected patients. Cholangiography was performed in 53 patients. Six patients had common duct stones; five were unsuspected preoperatively. After the gallbladder was removed, three patients underwent open common duct exploration. In another five cases, anatomical anomalies were discovered. Cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication--common duct injury. Cholangiography should be attempted on all patients undergoing LC.

Adolescent↗
PubMed1990

The intracolonic bypass tube for left colon and rectal trauma. The avoidance of a colostomy.

Traumatic perforations of the left colon and rectum are most frequently managed by procedures that include the formation of a colostomy. Primary repair without colostomy is much less commonly employed. We report nine patients with traumatic perforations of the left colon and rectum treated with the intracolonic bypass tube (ICBT) without concomitant colostomy. In all these patients we believe the standard treatment would have included fecal diversion. Four patients sustained blunt trauma and five sustained penetrating trauma. Healing of the colonic anastomosis occurred in all cases, and the ICBTs were passed per rectum between the tenth and nineteenth days postoperatively. On the basis of this study, we conclude that the ICBT has a role in the treatment of selected injuries of the left colon and rectum as a safe means of avoiding a colostomy.

Adult↗