Biomedical subjects

M Mohan Rao

Publications and source records attributed to M Mohan Rao.

9 recordsLinked to original sources

PubMed2004

A systematic review of laparoscopic live-donor nephrectomy.

BACKGROUND: A systematic review was undertaken to assess the safety and efficacy of laparoscopic live-donor nephrectomy (LLDN) compared with open live-donor nephrectomy (OLDN). METHODS: Literature databases were searched from inception to March 2003 inclusive. Comparative studies of LLDN versus OLDN (randomized and nonrandomized) were included. RESULTS: There were 44 included studies, and the quality of the available evidence was average. There was only one randomized controlled trial and six nonrandomized comparative studies with concurrent controls identified. In terms of safety, for donors, there did not seem to be any distinct difference between the laparoscopic and open approaches. No donor mortality was reported for either procedure, and the complication rates were similar although the types of complications experienced differed between the two procedures. The conversion rate for LLDN to an open procedure ranged from 0% to 13%. In terms of efficacy, LLDN seemed to be a slower operation with longer warm ischemia times than OLDN, but this did not seem to have resulted in increased rates of delayed graft function for recipients. Donor postoperative recovery and convalescence seemed to be superior for LLDN, making it a potentially more attractive operation for living donors. Although in the short-term, graft function and survival did not seem to differ between the two techniques, long-term complication rates and allograft function could not be determined and further long-term follow-up is required. CONCLUSIONS: LLDN seems to be at least as safe and efficacious as OLDN in the short-term. However, it remains a technique in evolution. Further high-quality studies are required to resolve some of the outstanding issues surrounding its use, in particular, long-term follow-up of donor complications and recipient graft function and survival.

Humans↗

PubMed2004

Final report from the ASERNIP-S audit of laparoscopic live-donor nephrectomy.

The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) audit of laparoscopic live-donor nephrectomy commenced in 1999 and concluded in 2003. Six centres in Australia and New Zealand contributed data for 219 donor patients regarding perioperative and postoperative outcome of surgery and short-term follow-up. These data were compared with a recent systematic review of LLDN. The Australasian experience to date compared favourably with worldwide practice, both in terms of efficacy and safety for donors (at least in the short term). The collection of audit data, as this technique was introduced into the Australasian healthcare system, has allowed the local experience with this technique to be pooled and shared, resulting in the development of Australasian practice in line with world's best practice in this area.

Adult↗

PubMed2004

Two-port and single port laparoscopic appendicectomy.

Minimally invasive surgery for appendicectomy generally involves use of 3 or 4 ports. But if the procedure can be safely performed using two or even a single port, it would be beneficial to the patient, since it is less invasive than standard procedure. The present article describes an experience of laparoscopic appendicectomy using only two ports and occasionally a single port and highlights its efficacy and safety.

Appendectomy↗

PubMed2003

Laparoscopic donor nephrectomy: meeting the challenge of consumerism?

BACKGROUND: Despite the increasing adoption of laparoscopic donor nephrectomy, no study has examined donor perceptions following this procedure. In particular, it has been tacitly assumed that a less invasive procedure might in itself provide a more satisfactory donor experience. The present study reviews the experience of donors undergoing laparoscopic nephrectomy, and examines the extent to which contemporary management practice addresses issues relevant to consumerism. METHODS: Forty-two donors participated in a structured telephone interview, and 33 (79%) returned a written questionnaire. RESULTS: Coming through the survey was a strong sense of commitment to donation, and most respondents were satisfied with the experience. The main criticisms related to hotel services, the duration of the preoperative investigations, the perceived quality of nursing care on the general wards, medical communication and the duration of postoperative follow up. The self-reported time to meet recovery goals was extremely broad. CONCLUSIONS: Considering the nature of criticisms offered by the respondents, it is concluded that the expectations of donors as health-care consumers will only be met through modification of existing protocols.

Consumer Behavior↗

PubMed2003

Surgical repair of spontaneous renal allograft rupture: a new procedure.

BACKGROUND: The purpose of the present paper is to introduce a new surgical procedure using the external oblique aponeurosis (EOA) for repair of spontaneous renal allograft rupture. METHODS: Thirty-eight cases with spontaneous renal allograft rupture were encountered in 1000 consecutive kidney transplants between April 1991 and August 2000. Thirty-three cases underwent surgical exploration with two grafts undergoing nephrectomy, while a further 31 were repaired using the new surgical procedure. The external oblique aponeurosis (EOA) from the incision was trimmed into 1 cm x 1 cm square pieces. A 2/0 Dexon suture was placed through each piece of the EOA, then through the parenchyma of the kidney perpendicular to the rupture. Each suture was then placed through another piece of EOA and tied. RESULTS: Two repaired grafts were removed on day 7 and day 10, one due to graft re-rupture and another with ischaemia secondary to irreversible acute rejection. The graft function of 29 cases had recovered completely at 30 days following surgical repair with one graft improving rapidly. Thirteen grafts were diagnosed as undergoing mild to moderate acute rejection, whereas a further 20 cases were considered to have acute tubular necrosis on histopathology. The allograft survival rate at 1 year and 5 years post grafting was 86% and 64%, respectively. No patients died from postoperative complications following repair using this procedure. CONCLUSIONS: Spontaneous renal allograft rupture is a relatively common post-transplant complication secondary to either acute tubular necrosis or acute rejection. This new surgical procedure is proposed as a reliable and practical method of repair following graft rupture. Preservation of graft function and viability following rupture appears achievable both in the medium and long-term.

Humans↗

PubMed2002

Influence of adhesive drapes on intraperitoneal volume and pressure during laparoscopy.

BACKGROUND: The influence of adhesive skin drapes on abdominal wall compliance during laparoscopy has not previously been studied. METHODS: The effect of removing an adhesive abdominal drape on intraperitoneal volume and pressure was studied in 15 patients undergoing a variety of laparoscopic procedures. The internal consistency of this data was evaluated by comparing the observed response to that which was predicted from analysis based on the theory of elasticity. RESULTS: Removal of an adhesive skin drape after induction of a 15-mmHg pneumoperitoneum was associated with changes in intraperitoneal pressure and volume. These changes were statistically significant, highly predictable and clinically relevant. CONCLUSIONS: On the basis of the present observations, we recommend that extensive coverage by adhesive drapes should be avoided for those patients or procedures in which elevated intraperitoneal pressure may be particularly deleterious.

Abdominal Wall↗

PubMed2000

Uncommon Complications of Renal Transplantation.

As a result of advances in surgical technique and immunosuppressive therapy, the incidence and the consequences of post-transplant surgical complications has decreased. However, surgical complications still cause considerable morbidity and test the skills of the surgical team. Several reviews have been published analyzing the incidence of these complications and the management strategies employed to correct them. We report some uncommon or rare complications encountered in our unit after the introduction of low-dose steroids or steroid-free immunosuppressive protocols.

Journal Article↗

PubMed1985

Studies on the mechanism of immunosuppression with adenine.

Studies on the mechanism of immunosuppression shown by adenine comprised two areas: (1) Toxicity studies on hepatic, muscle and renal tissues were undertaken to ascertain if immunosuppression was a result of a non specific toxicity. (2) Studies to determine whether immunosuppression is a function of the inhibitory effect on de novo and salvage pathways of purine nucleotide metabolism. Toxicity studies in mice indicated that adenine caused an acute, reversible renal tubular necrosis and that allopurinol, when combined with adenine, could abrogate both the renal toxicity and immunosuppressive activity of the purine base. This result indicated that the toxic and/or immunosuppressive compound may be a xanthine oxidase catalysed product of adenine. Further studies indicated that it was unlikely that a major part of the immunosuppressive activity of adenine was due to the renal toxicity exerted by this compound. Splenic PRPP levels were found to peak on day 4 after antigen administration (day 0) and this corresponded with the peak in antibody plaque response which occurred at day 4 to 5. Adenine given at an immunosuppressive dose of 25 mumoles/mouse on day 0, 1 resulted in a significant inhibition of splenic PRPP levels on day 2 of the response. This effect on splenic PRPP levels on day 2 was also found with hypoxanthine given at an immune enhancing dose and therefore would indicate that depression of splenic PRPP per se is not responsible for the immunosuppression. Adenosine given at immunosuppressive doses was found not to affect PRPP levels in the spleen and hepatic PRPP levels were unaffected by adenine, adenosine and hypoxanthine. The in vivo effects of adenine on hypoxanthine-guanine phosphoribosyltransferase showed that adenine could inhibit significantly this salvage pathway in spleen and liver and that this inhibition could be overcome with concomitant administration of allopurinol. A metabolite of adenine which could contribute to its immunosuppressive activity may be 2-hydroxyadenine since it is derived from the xanthine oxidase catalysed oxidation of adenine inhibited hypoxanthine-guanine phosphoribosyltransferase gave similar renal toxicity to adenine and was immunosuppressive.

Adenine↗

PubMedDate not supplied

Laparoscopic live donor nephrectomy.

BACKGROUND: The demand for renal transplants is greater than the available kidneys. Live donation is one way of increasing the supply. Laparoscopic removal of the donor kidney appears to reduce morbidity for the donors. Some who are hesitant because of the morbidity associated with open nephrectomy are willing to consider the laparoscopic donor nephrectomy. METHODS: Laparoscopic donor nephrectomy was offered to all but three donors since the commencement of the programme in 1997. Data were collected both prospectively and retrospectively for the first 120 donors. Venous and arterial anatomy was assessed preoperatively by computed tomographic angiography. RESULTS: All but four donor procedures were completed laparoscopically. Three of these were for bleeding that could not be safely controlled laparoscopically and the fourth was a planned conversion to deal with the renal vessels, in the first right nephrectomy. Two kidneys were lost due to arterial thrombosis and two underwent segmental infarction after the loss of one of two or three separately anastomosed vessels. Three recipients had delayed function and two of them required dialysis postoperatively. Other minor complications occurred but were uncommon. CONCLUSIONS: Laparoscopic live donor nephrectomy is safe for the donor and the transplant kidney. It offers the advantage of decreased morbidity for the donor, with a shorter hospital stay, earlier return to normal activity and, for some, early return to work.

Adult↗