Biomedical subjects

L R Sands

Publications and source records attributed to L R Sands.

5 recordsLinked to original sources

PubMed2001

Prospective randomized trial of two wound management strategies for dirty abdominal wounds.

OBJECTIVE: To determine the optimal method of wound closure for dirty abdominal wounds. SUMMARY BACKGROUND DATA: The rate of wound infection for dirty abdominal wounds is approximately 40%, but the optimal method of wound closure remains controversial. Three randomized studies comparing delayed primary closure (DPC) with primary closure (PC) have not conclusively shown any advantage of one method over the other in terms of wound infection. METHODS: Fifty-one patients with dirty abdominal wounds related to perforated appendicitis, other perforated viscus, traumatic injuries more than 4 hours old, or intraabdominal abscesses were enrolled. Patients were stratified by cause (appendicitis vs. all other causes) and prospectively randomized to one of two wound management strategies: E/DPC (wound packed with saline-soaked gauze, evaluated 3 days after surgery for closure the next day if appropriate) or PC. In the E/DPC group, wounds that were not pristine when examined on postoperative day 3 were not closed and daily dressing changes were instituted. Wounds were considered infected if purulence discharged from the wound, or possibly infected if signs of inflammation or a serous discharge developed. RESULTS: Two patients were withdrawn because they died less than 72 hours after surgery. The wound infection rate was greater in the PC group than in the E/DPC group. Lengths of hospital stay and hospital charges were similar between the two groups. CONCLUSION: A strategy of DPC for appropriate dirty abdominal wounds 4 days after surgery produced a decreased wound infection rate compared with PC without increasing the length of stay or cost.

Abdominal Abscess↗

PubMed2000

Pelvic actinomycosis presenting as malignant large bowel obstruction: a case report and a review of the literature.

Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made postoperatively because of its unusual clinical presentation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bowel disease, or diverticulitis. Delay in diagnosis leading to inadequate management and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pelvic actinomycosis involving the rectosigmoid and cecum. She required emergency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also reported. Rarely has emergency surgery been described in this condition. Although the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressive surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a woman with prolonged use of an intrauterine device and symptoms of bowel obstruction could help to improve the preoperative diagnosis and management of this rare disease.

Abdomen↗

PubMed1999

Gasless laparoscopic-assisted intestinal stoma creation through a single incision.

Intestinal stoma creation has been performed using both open and laparoscopic surgery. However, each technique still has disadvantages. We created the intestinal stoma through one incision, with the use of the laparoscope in a gasless fashion. This method has not been reported previously. Fourteen adult patients underwent this technique between February 1996 and December 1998. Indications for stoma creation were for various anorectal disease processes, most commonly for purposes of hygiene in patients with spinal cord injury. The average operative time to perform the stoma was 58 (range, 15-78) minutes, with minimal blood loss (<35 ml). Follow-up ranged from 1 to 22 months. Two cases (14 percent) were converted secondary to severe adhesions. All nonconverted patients were able to tolerate a regular diet within two days of surgery. There was only one stoma-related complication. Two patients (14 percent) died of comorbidities during follow-up. In conclusion, the initial experience with gasless laparoscopic-assisted intestinal stoma creation through a single incision is encouraging. Patients requiring ostomy creation as a single intervention may benefit from this approach.

Adult↗

PubMed1999

Staged laparoscopic resection for complicated sigmoid diverticulitis.

Previous studies have utilized different regimens of laparoscopic surgery for treatment of both acute and chronic diverticular diseases. Our aims were to assert that laparoscopic-assisted sigmoid resection and anastomosis for sigmoid diverticulitis after acute attacks is safe and feasible, provided the inflammatory process has subsided. A chart review was undertaken of patients who underwent laparoscopic sigmoid resection after resolution of the acute attack of diverticulitis at hospitals affiliated with the University of Miami. Thirty-eight patients, median age 52 years, were identified. Laceration of the spleen was the only intraoperative complication (one patient). Seven patients (18%) were converted due to severe adhesions. Regular diet was tolerated on the third postoperative day, and the length of hospital stay was 4 days. No major complications or deaths occurred. In conclusion, laparoscopic surgery for sigmoid diverticulitis after resolution of the acute process seems safe and feasible and provides excellent immediate postoperative recovery.

Adult↗

PubMed1996

The role of laparoscopic colectomy and laparotomy with resection in the management of complex polyps of the colon.

Surgical options available to patients with endoscopically unresectable lesions include laparoscopic assisted colonscopy, colonscopic assisted laparoscopy, laparotomy with segmental resection, and laparoscopic colon resection. The choice of modality depends on the nature of the lesion as well as the choice of both the patient and the surgeon. The surgeon should be fluent in all available therapeutic modalities.

Colectomy↗