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Biomedical subjects

M A Memon

Publications and source records attributed to M A Memon.

At least 19 recordsLinked to original sources
PubMed1999

Laparoscopic repair of recurrent hernias.

BACKGROUND: Recurrence after primary conventional inguinal herniorrhaphy occurs in approximately 10% of patients depending on the type of repair and expertise of the surgeon. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The failure rate of these repairs using an open anterior approach may reach as high as 36%. Because of such a high failure rate, a number of investigators have focused on repairing these difficult recurrent hernias laparoscopically using a tension-free approach. Some of the earlier reports suggested a low recurrence rate of 0.5% to 5% when a laparoscopic approach was used to repair these hernias. The purpose of this study was to evaluate the efficacy of laparoscopic treatment for recurrent hernias in our institutions. METHODS: Between February 1991 and February 1995, 96 recurrent hernias were repaired in 85 patients (78 men and 7 women). There were 48 right, 26 left, and 11 bilateral hernias. The mean age of the patients was 59 years (range, 18-86 years); the mean height was 69 in. (range, 54-77 in.); and the mean weight was 176 pounds (range, 109-280 pounds). A total of 68 herniorrhaphies were performed using the transabdominal preperitoneal (TAPP) method: 19 using intraperitoneal on-lay mesh (IPOM) repair and 8 using the total extraperitoneal (TEP) method. The method of repair in one patient was not recorded. The mean operating time was 76 min (range, 47-172 min). Thirteen patients underwent additional procedures. RESULTS: Long-term follow-up was performed by questionnaire, examination, or both in 76 patients (85 hernias). Median follow-up time was 27 months (range, 2-56 months). There were four recurrences (2 in IPOM and 2 in TAPP). Three of these were repaired laparoscopically and one conventionally. There were 20 minor and 14 major complications and no mortality. One conversion occurred in the TAPP group. Mean postoperative stay was 1.4 days (range, 0-4 days). It was felt by 92% of the patients that their symptoms were completely relieved, whereas 4% of the patients continued to exhibit symptoms for which their hernia was repaired, and 3.6% failed to answer. As reported, 86% of the patients preferred their laparoscopic repair; 1% preferred the conventional repair; and 13% failed to reply. Afterward, 77% of the patients returned to normal activity, and 35% returned to vigorous activity within 4 weeks of surgery. Satisfaction with laparoscopic repair was expressed by 92% of the patients, whereas 8% either were dissatisfied or did not answer. In the end, 95% of the patients stated that they would recommend laparoscopic hernia surgery to their family and friends. CONCLUSIONS: These preliminary data show that laparoscopic repair of recurrent inguinal hernia is a safe alternative procedure with acceptable rates of recurrence and complications.

Adult↗
PubMed1999

The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. A prospective analysis.

BACKGROUND: Gallbladder perforation during laparoscopic cholecystectomy (LC) with spillage of bile and gallstones occurs in a substantial number of patients (up to 40%). Most surgeons believe that free intraperitoneal stones are not a justification for conversion to laparotomy even if a large number of stones are left in situ. There are, however, a number of reports demonstrating that, on occasion, these unretrieved gallstones may cause infection or abscess, inflammation, fibrosis, adhesions, cutaneous sinuses, small bowel obstruction, or generalized septicemia. The aim of this study was to determine the outcome of unretrieved gallstones in the peritoneal cavity after gallbladder perforation during LC. METHODS: In a 7-year period between 1989 and 1996, prospective data were maintained on 856 patients who underwent LCs by a single surgeon (R. J.F.). Of the 856 patients, 165 (16%) had gallbladder perforations resulting in lost gallstones in the peritoneal cavity. A concerted attempt was made to remove the lost stones using a variety of extraction devices. Of these 165 patients, 106 (64%) were available for follow-up through mail (76%) and by telephone (24%). The mean age of these patients was 64.9 years (range, 18 to 98 years), and the mean follow-up was 44.8 months (range 4.9 to 92.3 months). RESULTS: Of the 106 patients with unretrieved gallstones, we identified four patients with short-term complications and one patient with a long-term complication. The first patient with a short-term complication had pyrexia for 10 days postoperatively. Diagnostic evaluation, which included computed tomography (CT) scan, failed to reveal any abnormality. The patient was treated conservatively with a course of oral antibiotics. In the second patient, cellulitis developed at a drain site after its removal, which resolved with oral antibiotics. The third patient acquired an umbilical wound abscess, which drained spontaneously, requiring no treatment. A sterile subphrenic collection developed in the fourth patient 1 month postoperatively, which was treated with percutaneous drainage under CT guidance. The only long-term complication was spontaneous erosion of a gallstone from the back of a patient with a questionable history of inflammatory bowel disease 8 months postoperatively. All of the patients made complete recoveries. CONCLUSIONS: In most patients, unretrieved gallstones are of no consequence, but complications occur occasionally. It is therefore advisable to retrieve as many gallstones as possible during LC short of converting to a laparotomy.

Abdominal Abscess↗
PubMed1999

Transversalis fascia: historical aspects and its place in contemporary inguinal herniorrhaphy.

Since the introduction of the term "fascia transversalis" by Sir Ashley Cooper in 1840, this thin layer of tissue has been discovered, denied, and redefined. The transversalis fascia was originally described as a bilaminar membrane. Although most subsequent descriptions do not reflect this analysis, some authors, especially in the surgical literature, believe that a posterior lamina of the transversalis fascia exists. Others believe that the posterior lamina of the transversalis fascia is, in fact, part of the preperitoneal fascia. The usefulness of the transversalis fascia and its derivatives or analogues; e.g., the crura of the deep inguinal ring, have also been extensively discussed. The aim of this paper is to provide a brief survey of the historical literature concerning the transversalis fascia and a discussion of some of the contemporary views on its morphology and significance in current laparoscopic hernia repair.

Anatomy↗
PubMed1999

The effect of the anastomotic size on gastric emptying after hemigastrectomy with Billroth II reconstruction.

OBJECTIVE: To determine if the size of the gastrojejunal anastomosis after Billroth II reconstruction was the rate-limiting factor in gastric emptying in the postoperative period. METHODS: Twelve mongrel dogs were randomized to have either 1.5 cm or 5 cm gastrojejunal anastomoses prior to Billroth II hemigastrectomy. Each dog had three solid and three liquid radiolabelled emptying studies pre- and postoperatively. Data were collected using a gamma camera. For liquid studies, images were obtained at 0 min, 2 min, 4 min, 6 min, 8 min, 10 min, 20 min, 30 min, 40 min, 50 min and 60 min. For solid studies, images were obtained at 0 min, 5 min, 10 min, 20 min, 30 min, 40 min, 50 min, 60 min, 70 min, 80 min, 90 min, 100 min, 110 min and 120 min. Means were compared by analysis of variance using the repeated measures option. RESULTS: Postoperative liquid emptying was significantly faster in the first 10 min with both 1.5 cm and 5 cm anastomoses compared with preoperative scans in the same animals (45% versus 20% and 48% versus 29%, respectively). On the other hand, solid gastric emptying was much slower postoperatively with the 1.5 cm anastomosis compared with preoperative scans (29% versus 65%) as well as compared with postoperative 5 cm anastomosis (29% versus 62%) at the end of 120 min. CONCLUSIONS: Our model suggests that the gastric emptying of solids is affected by the size of the gastrojejunal anastomosis and not by the diameter of the efferent limb of the small intestine following Billroth II reconstruction.

Anastomosis, Surgical↗
PubMed1999

Injection therapy for variceal bleeding.

The role of injection therapies in the management of esophageal and gastric varices are reviewed. Available radiographic, pharmacologic and alternative endoscopic methods are compared and contrasted with sclerotherapy. Recent studies regarding a combination of endoscopic band ligation and low volume sclerotherapy to achieve best eradication of esophageal varices are reviewed.

Acute Disease↗
PubMed1998

Vesicouterine fistula twenty years following brachytherapy for cervical cancer.

This report concerns an extremely rare type of fistula, a vesicouterine fistula, in a 59-year-old female occurring twenty years following brachytherapy for cervical cancer. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely emptying the bladder, nocturia and constant leakage of urine for several months. Cystoscopy revealed a fistulous opening and an exophytic lesion on the posterior bladder wall. Contrast computerized tomography demonstrated a fistulous tract between the posterior bladder wall and the anterior aspect of the uterine cavity. She underwent a hysterectomy, excision of the bladder fistula and interposition of a vascularized rectus muscle graft. Histology of the cervix and bladder only revealed inflammatory changes with no evidence of malignancy. The diagnosis and investigation of this extremely rare condition are discussed, and the management strategies outlined.

Brachytherapy↗
PubMed1998

Hand-assisted laparoscopic surgery (HALS): a useful technique for complex laparoscopic abdominal procedures.

Advanced laparoscopic abdominal surgery is now being performed routinely. However, it can be extremely challenging and time-consuming, and it may be associated with increased intraoperative and postoperative complications, mainly due to the loss of tactile sensation with totally laparoscopic techniques. This article describes a technique of hand-assisted laparoscopic surgery for complex abdominal procedures that allows the surgeon to insert a nondominant hand into the abdominal cavity while preserving the pneumoperitoneum. Use of the hand allows for rapid exploration, methodical dissection, identification of crucial structures, and expeditious performance of a procedure because of the maintenance of the tactile sensation. Our experience with this approach has been favorable.

Abdomen↗
PubMed1998

Assessing risks, costs, and benefits of laparoscopic hernia repair.

Laparoscopic inguinal herniorrhaphy (LIHR) was introduced with the following potential advantages: less postoperative discomfort and pain, reduced recovery time that allows earlier return to full activity, easier repair of a recurrent hernia, the ability to treat bilateral hernias concurrently, the performance of a simultaneous diagnostic laparoscopy, ligation of the hernia sac at the highest possible site, improved cosmesis, and decreased incidence of recurrence. Potential disadvantages include complications, such as bowel, bladder, and vascular injuries; potential adhesive complications at sites where the peritoneum has been breached or prosthetic material has been placed; the apparent need, at least at the present, for a general anesthetic; and the increased cost because of expensive equipment needs. Most surgeons agree that LIHR has a role in the management of patients with a recurrent hernia after a conventional inguinal herniorrhaphy (CIHR), bilateral inguinal hernia, or a need for laparoscopy for another procedure, such as laparoscopic cholecystectomy. The routine use of LIHR for the unilateral, uncomplicated hernia is a more contentious issue.

Anesthesia, General↗
PubMed1998

Extramucosal stenosis of the esophagus.

Extramucosal lesions of the esophagus compose a small but clinically important group of diagnoses presenting as stenosis. Because of their infrequency, they can present a diagnostic dilemma in patients with dysphagia, odynophagia, or radiologic abnormalities on imaging studies. Definitive management is frequently conservative, consisting of reassurance; definitive surgical management, however, may be necessary.

Esophageal Stenosis↗
PubMed1998

Laparoscopic cecectomy for massive appendiceal stump bleeding.

Massive bleeding from an appendiceal stump is extremely rare and typically requires emergency laparotomy and resection. We describe a case of severe gastrointestinal hemorrhage from an inverted appendiceal stump in a 20-year-old man 1 year after appendectomy. This was successfully managed by an urgent totally intracorporeal laparoscopic cecectomy. The patient benefited from the laparoscopic excision and made an uneventful and speedy postoperative recovery. The postoperative discomfort, morbidity, and long hospitalization typically associated with laparotomy were avoided. For appendiceal stump bleeding, totally intracorporeal laparoscopic excision offers a viable alternative to open laparotomy.

Adult↗
PubMed1997

Male breast cancer.

Explore the source record for details and available documents.

Breast Neoplasms, Male↗
PubMed1997

Gastrointestinal carcinoid tumors: current management strategies.

BACKGROUND: Carcinoid or neuroendocrine tumors of the gastrointestinal tract, although characteristically indolent, are also quite heterogeneous both with respect to histologic and endocrine features and with respect to clinical presentation and behavior. PURPOSE: This study was undertaken to review and summarize the current literature on classification controversies, site-specific carcinoid presentation and behavior, and diagnostic and management strategies for primary and advanced carcinoid tumors and the carcinoid syndrome. RESULTS: For carcinoid tumors, oncologic results depend on the location of the primary tumor, extent of locoregional and metastatic disease, functioning status of the tumor, and the feasibility of complete surgical extirpation. Whereas favorable survival rates are typically observed for appendiceal and rectal primaries, less favorable rates are often observed for colonic and ileal tumors. A search for additional tumors is generally advised because multiple carcinoids and second neoplasms are not uncommon. Because of the indolent nature of the tumor and because these therapies have been shown to improve quality and quantity of life, otherwise fit patients with advanced carcinoid disease should be treated with aggressive medical and surgical therapies. Development of a malignant carcinoid syndrome indicates the presence of a functionally active carcinoid tumor and portends a poor prognosis. CONCLUSION: Gastrointestinal carcinoids, although malignant, behave differently from other carcinomas. Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient. A prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.

Biomarkers↗
PubMed1997

Is mechanical bowel preparation really necessary for elective left sided colon and rectal surgery?

The value of mechanical bowel preparation for elective left sided colorectal surgery is debatable. This retrospective study evaluates the incidence of wound infection, wound dehiscence, abdominal/pelvic collections and anastomotic dehiscence between patients who received mechanical bowel preparation [MBP] (n = 61) and those who did not (n = 75). The case notes of 136 consecutive patients undergoing elective left sided colorectal surgery over a three year period in a district general hospital were reviewed. The incidence of infective and anastomotic complications between the two groups was not significantly different. There were two post-operative deaths, both in patients receiving MBP. We therefore conclude that the role of MBP in the era of systemic antibiotics must be questioned. A prospective randomised multicenter trial recruiting an adequate number of patients undergoing elective left sided colorectal procedures would clarify this long standing debate. Note: Presented at the Spring Meeting of the Minnesota Surgical Society in Rochester, Minnesota, USA, May, 1996 and to the American Society of Colon and Rectal Surgeons (ASCRS), Seattle, Washington, June 1996, and published in abstract form in Diseases of the Colon and Rectum (1996) 39:A47.

Adult↗