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Biomedical subjects

M Eisenstat

Publications and source records attributed to M Eisenstat.

5 recordsLinked to original sources
PubMed2000

A case controlled study of laparoscopic incisional hernia repair.

BACKGROUND: Although the feasibility of laparoscopic incisional herniorrhaphy has been demonstrated, its advantages over the open technique are still unproven. METHODS: Fourteen consecutive laparoscopic incisional hernia repairs were compared with 14 matched controls of the open repair done by the same surgeon at the same institution. The controls were selected by a medical record technician not connected with the study. The cases were selected to match diagnoses, ASA status, and body weight as closely as possible. The outcome data for operating time, blood loss, hospitalization, resumption of oral intake, and postoperative complications were analyzed for statistically significant differences. RESULTS: There was no statistical difference between the two groups in the parameters of blood loss, hospital days, or days to oral intake. The laparoscopic operation took 40% longer. Similar complications were seen in both groups. No mortality or early recurrences occurred in either group. CONCLUSION: Laparoscopic incisional hernia repair of at least moderate complexity had no demonstrable advantage over the open repair in the present study.

Aged↗
PubMed1998

Unsuspected choledocholithiasis first diagnosed at laparoscopic cholecystectomy: treatment by trans-cystic duct stenting and elective stent-guided sphincterotomy.

BACKGROUND: Despite advances in laparoscopic surgery, management of unsuspected choledocholithiasis diagnosed at laparoscopic cholecystectomy is controversial. We propose a simple maneuver of laparoscopic trans-cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option. METHODS: We studied retrospectively 16 patients with choledocholithiasis first diagnosed in the course of laparoscopic cholecystectomy, treated with laparoscopic stenting of the papilla via the cystic duct using a short Cotton-Leung stent before completion of cholecystectomy. Elective stent-guided, needle-knife sphincterotomy and stone clearance was performed 2 to 3 weeks postoperatively. RESULTS: Of 16 patients attempted, the procedure failed in one due to an impacted stone that prevented passage of the guidewire. Stenting time was 13 +/- 5 minutes (n = 15). Two stented patients had no stones at endoscopic retrograde cholangiography. Thirteen patients had successful elective stent-guided sphincterotomy with stone clearance without complications. CONCLUSIONS: Laparoscopic biliary stenting combined with stent-guided sphincterotomy is a simple, safe, and cost-effective option for the management of uncomplicated choledocholithiasis.

Adult↗
PubMed1997

One-on-one mentor-resident rotation for improving continuity of care in a surgical training program.

The modern resident team, staffed by multiple attendings, often makes sacrifices on continuity of care due to scheduling conflicts. We investigated a one-on-one mentor-resident rotation where all clinical activities were synchronized to produce near-perfect continuity of care, and we compared the objective and subjective outcome measures to those of control rotations of the same resident during the same year. The results showed that continuity of care close to 100% was possible in such rotations, but work hours were increased by 25%. Also, the number of patients seen was decreased by over 50%. The rotation was well-received by both mentors and residents. Continuity of care per se can be improved by this rotation. However, theoretical disadvantages, mainly narrow training due to exposure to only one mentor and fewer patients, make it unsuitable for extended use.

General Surgery↗
PubMed1997

A case-controlled study of laparoscopic splenectomy.

BACKGROUND: The utility of laparoscopic splenectomy (LS) has not been tested in general surgical practice. This is a case controlled study comparing the clinical results and economics of L.S. and open splenectomy (OS) in a community hospital. METHODS: The outcome of a series of 15 patients undergoing LS were compared to 15 patients undergoing OS matched for diagnosis, splenic weight, age, and main co-morbidites, selected by a person independent of the project. RESULTS: In both series, the indications were immune thrombocytopenic purpura, hemolytic anemias, hairy cell leukemia and, staging for Hodgkin's disease. LS resulted in shorter hospitalization (2.3 vs 8.8 days) with fewer postoperative complications. However, the operation was 1.7 times as long, and the operating room charge 2.9 times as high, so that the total cost of LS ($18,015) was greater than that for OS ($14,524). If the cost of treatment of complications is included, then the total is the same for both at our institutions. CONCLUSION: Except for a few indications not addressed in this study, LS can be used in lieu of OS.

Case-Control Studies↗