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Biomedical subjects

M J O'Reilly

Publications and source records attributed to M J O'Reilly.

At least 19 recordsLinked to original sources
PubMed2000

Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients.

OBJECTIVE: To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device. SUMMARY BACKGROUND DATA: In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases. METHODS: A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. RESULTS: Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%. CONCLUSIONS: The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.

Abdomen↗
PubMed1998

Hand-assisted laparoscopic sigmoidectomy for diverticulitis.

BACKGROUND: Sigmoid colectomy for diverticular disease, a routine procedure when performed using standard open methods, can prove much more challenging using minimum access techniques. Hand-assisted laparoscopic colectomy is a new technique that reportedly has a minimum learning curve, yet retains the benefits of a laparoscopic procedure. The purpose of this study was to perform and then prospectively to evaluate the outcome of this procedure on patients needing elective sigmoidectomy for diverticular disease. METHODS: Hand-assisted laparoscopic sigmoidectomy was performed on all patients undergoing elective sigmoidectomy for diverticular disease between January 18, 1996, and November 21, 1996. RESULTS: The study group consisted of six men and three women. Age averaged 50.8 (range, 39-66) years, weight averaged 183 (range, 150-224) pounds, and operation time averaged 3 hours and 42 minutes (range, 3-5 hours). No cases were converted to open methods. There were two minor postoperative complications (bleeding from the staple line, 1 patient; urinary retention, 1 patient; 22 percent). Resumption of flatus (which was the indication to start the patient on an oral diet) occurred between one and three (average, 1.44) days postoperatively. Patients were discharged from the hospital between one and three (average, 2.1) days postoperatively. Primary surgeon responsibility was distributed among four different surgeons, of which only the lead author previously had performed laparoscopic colectomy at this institution. CONCLUSIONS: Hand-assisted laparoscopic sigmoidectomy is a procedure that has a minimum learning curve, yet retains the benefits of a laparoscopic procedure.

Adult↗
PubMed1998

Sciatic hernia as a cause of chronic pelvic pain in women.

OBJECTIVE: To review experience with 20 women treated for sciatic hernia between 1993 and 1997. METHODS: Patients with chronic pelvic pain and sciatic hernias, identified retrospectively from chart review, were seen during a 46-month period that covered the surgical experience at our institution and included approximately 1100 cases. The median length of follow-up was 13 months (range 3-36). RESULTS: Sciatic hernia was diagnosed in 20 white women with chronic pelvic pain and was treated using laparoscopy. In 14 cases the hernias were right sided, in five they were left sided, and in one they were bilateral. All sciatic hernias contained the ipsilateral ovary alone or with its fallopian tube. All 20 patients reported symptomatic relief at follow-up. CONCLUSION: Sciatic hernia is a cause of chronic pelvic pain and should be considered in the differential diagnosis.

Adult↗
PubMed1997

Laparoscopic management of failed antireflux surgery.

Whether performed open or laparoscopically, antireflux procedures for gastroesophageal reflux disease sometimes fail and may require reoperation for optimal results. Between June 1992 and May 1995 eight patients presented with a failed antireflux procedure. Four patients had previously had a Belsey operation performed through the chest, two had had open Nissen fundoplications, and two had Nissen fundoplications performed via laparoscopy. Preoperative workup included cardiac, hematologic, and pulmonary evaluation as well as Esophagogastroduodenscopy (EGD), esophageal manometry, and 24-h pH studies to document reflux as a cause of recurrent symptoms. Two patients had aspiration symptoms even on medication. All patients had severe esophagitis on biopsy. Six reoperations (75%) were completed laparoscopically. In two patients we converted to open procedures due to an inability to expose the esophageal hiatus secondary to adhesions between the left lobe of the liver and the stomach. Of the six patients completed laparoscopically, one had a Nissen fundoplication and the others had a 200 degrees partial wrap. Two patients developed left pneumothorax, one patient required a single postoperative dilation, and one patient treated with open surgery developed pneumonia. The average hospitalization for laparoscopy was 2.2 days (range, 1-4 days), while those two who underwent open surgery stayed in the hospital 5 and 6 days. All patients were followed from 12 to 42 months and all are currently off medication and free of symptoms. Laparoscopic re-exploration for esophageal reflux disease can be safely performed with excellent results.

Adult↗
PubMed1996

Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases.

Performance of a laparoscopic posterior partial fundoplication (LPPF) for severe gastroesophageal reflux disease may have significant advantages. These include a low incidence of postop dysphagia, maintenance of the ability to belch, excellent antireflux effects, and the ease of performance of the surgery. The purpose of this study was to evaluate this antireflux procedure for these advantages to determine both its safety and effectiveness. Over 200 LPPFs have been performed by the authors in a community setting. One hundred consecutive cases are evaluated for indications, preop, and postop studies (EGD, manometry, 24 h pH), time of operation, hospital stay, complications, and conversions to an open procedure. Our technique of LPPF is presented in detail. All patients maintained the ability to belch. Postop dysphagia resolved totally in 4 patients by 7 days. Four pneumothoraces occurred; 1 patient required bilateral chest tube placement. There were no esophageal, stomach, or splenic injuries. The average hospital stay was 1.6 days. Postop 24 h pH studies revealed resolution of the esophageal reflux. Postop manometric studies show a median increase of 9.2 mm Hg for the LES pressure. No patients have resumed antireflux medication. No short gastric vessels were divided and no esophageal sutures were placed. There were no conversions to a laparotomy. Laparoscopic posterior partial fundoplication is a safe and effective antireflux procedure.

Adolescent↗
PubMed1996

Technique of hand-assisted laparoscopic surgery.

Advanced laparoscopic techniques can be challenging to perform because tactile sensation is limited with available laparoscopic instrumentation. Described is a technique of placing the surgeon's hand into the peritoneal cavity while maintaining pneumoperitoneum. Use of the hand allows for easy exposure, complete exploration, meticulous dissection, and immediate hemostasis. Our experience reveals patients have a short hospital stay and recuperation time.

Colectomy↗
PubMed1993

Laparoscopic Nissen fundoplication: report of first 15 cases.

Performance of a Nissen fundoplication laparoscopically for gastroesophageal reflux disease offers significant advantages such as reduction in hospital stay, postoperative recovery time, and return to work time. Early experience with laparoscopic Nissen fundoplication is presented.

Adult↗
PubMed1991

Laparoscopic cholecystectomy: use and preparation for Operation Desert Shield.

While stationed at Winn army hospital, Fort Stewart, Georgia as backfill surgeons during the initial stages of Operation Desert Shield, we performed eight laparoscopic cholecystectomies (LC) over a 2 1/2 week period. Our patients included four active duty soldiers, three dependents, and one retiree. There were no complications. The average hospital stay was 2 days, and the average time to return to duty was 10 days for LC compared to 5 and 30 days, respectively, with standard cholecystectomy (SC). Performing LC whenever possible can return soldiers back to duty in one-third the time and greatly reduce health care costs by reducing the hospital stay.

Cholecystectomy↗
PubMed1984

Sepsis from sinusitis in nasotracheally intubated patients. A diagnostic dilemma.

The cause of sepsis in the intensive care unit patient can be a perplexing diagnostic problem. We have recently encountered seven patients who had sepsis associated with sinusitis of the paranasal sinuses. They represented 26 percent of all patients who had nasotracheal intubation for 5 days or more. Sinusitis as a complication of nasotracheal intubation has been previously reported, but its frequency has not been appreciated. Three case reports are presented to emphasize the importance of making this diagnosis. Standard x-ray studies will not adequately demonstrate all the paranasal sinuses. We have utilized computerized tomography to study these patients and found it to clearly demonstrate all the paranasal sinuses. We suggest a plan to help prevent sinusitis from nasotracheal intubation. Should this complication occur, however, the nasotracheal tube should be removed and the sinuses surgically drained or treated aggressively with topical agents.

Aged↗
PubMed1983

Effect of reconstructive vascular surgery on red cell deformability--preliminary results.

Using a simple filtration method, red cell deformability was measured in healthy control subjects and in patients with peripheral vascular disease. Impaired red cell deformability was demonstrated in patients with rest pain or gangrene and in patients with intermittent claudication. An improvement in red cell deformability was demonstrated after successful reconstructive vascular surgery in both patient groups. An improvement in red cell deformability was demonstrated in patients undergoing major limb amputation.

Aged↗
PubMed1980

Penetrating injuries of the popliteal vein: a report on 34 cases.

The results of treatment in 34 cases of penetrating injury to the popliteal vein are presented. In 26 cases there was associated damage to the popliteal artery. Satisfactory venous repair by lateral suture was achieved in 11 of 12 limbs. Autogenous vein grafts were used to repair the damaged popliteal vein in 10 limbs. In 4 the saphenous vein was anastomosed directly to the popliteal vein; in 6 cases it was used as a wide-bored panel or compilation graft. Three popliteal veins were ligated. Major postoperative limb oedema and chronic venous insufficiency were not a problem in those cases where the veins were repaired. Fasciotomy was performed in 19 of the 34 cases of venous injury. In 12 of these cases fasciotomy, performed as part of the original operation to repair the vascular injury, led to an excellent clinical result.

Civil Disorders↗
PubMed1979

Haemorrheological response to plasma exchange in Raynaud's syndrome.

Eight patients with Raynaud's syndrome were treated by weekly plasma exchange for four weeks using a Haemonetics Model 30 Blood Processor. The mean whole-blood viscosity at a shear rate of 0.77/s was significantly lower after treatment, and the mean index of red-cell deformability was significantly improved. In four patients studied serially the mean percentage fall in whole-blood viscosity after a single plasma exchange was 49% at 0.77/s but only 14% at 91/s. All patients noticed symptomatic improvement including healing of ischaemic digital ulcers. In six patients the number of digital arterial segments containing detectable blood flow was measured by directional Doppler; in all six the number increased. It is concluded that plasma exchange is an effective means of haemorrheological treatment and may be beneficial in patients with digital ischaemia.

Blood Flow Velocity↗
PubMed1979

Controlled trial of plasma exchange in treatment of Raynaud's syndrome.

Twenty-seven patients with Raynaud's syndrome had their digital vessel patency assessed by Doppler ultrasound after different thermal stresses. Digital vessel patency rates differed significantly after stresses at 15 degrees C and 45 degrees C. In a randomised controlled trial placebo and heparin had no effect either on patients' symptoms or on the patency of their digital vessels. Plasma exchange improved both symptoms and vessel patency rates at 15 degrees C and 21 degrees C. Improvement in seven out of eight of these patients has been maintained for six months. Assessing digital vessel patency by Doppler techniques allow continuous, atraumatic, and safe evaluation of the effects of different methods of treatment on the patency of the digital vessels and has helped to indicate that plasma exchange is a useful adjunct in the management of patients with severe Raynaud's syndrome.

Arteries↗