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Biomedical subjects

M Murr

Publications and source records attributed to M Murr.

7 recordsLinked to original sources
PubMed2001

Laparoscopic revision of failed antireflux operations.

BACKGROUND: A small number of patients fail fundoplication and require reoperation. Laparoscopic techniques have been applied to reoperative fundoplications. We reviewed our experience with reoperative laparoscopic fundoplication. METHODS: Reoperative laparoscopic fundoplication was undertaken in 28 patients, 19 F and 9 M, of mean age 56 years +/- 12. Previous antireflux procedures included 19 open and 12 laparoscopic antireflux operations. RESULTS: Symptoms were heartburn (90%), dysphagia (35%), and atypical symptoms (30%%). The mean interval from antireflux procedure to revision was 13 months +/- 4.2. The mean DeMeester score was 78+/-32 (normal 14.7). Eighteen patients (64%) had hiatal breakdown, 17 (60%) had wrap failure, 2 (7%) had slipped Nissen, 3 (11%) had paraesophageal hernias, and 1 (3%) had an excessively tight wrap. Twenty-five revisions were completed laparoscopically, while 3 patients required conversion to the open technique. Complications occurred in 9 of 17 (53%) patients failing previous open fundoplications and in 4 of 12 patients (33%) failing previous laparoscopic fundoplications and included 15 gastrotomies and 1 esophagotomy, all repaired laparoscopically, 3 postoperative gastric leaks, and 4 pneumothoraces requiring tube thoracostomy. No deaths occurred. Median length of stay was 5 days (range 2-90 days). At a mean follow-up of 20 months +/- 17, 2 patients (7%) have failed revision of their fundoplications, with the rest of the patients being essentially asymptomatic (93%). CONCLUSIONS: The results achieved with reoperative laparoscopic fundoplication are similar to those of primary laparoscopic fundoplications. Laparoscopic reoperations, particularly of primary open fundoplication, can be technically challenging and fraught with complications.

Adult↗
PubMed2000

Videoscopic Heller myotomy for achalasia--results beyond short-term follow-up.

BACKGROUND: Heller myotomy has long been utilized for patients failing nonoperative management of achalasia. Videoscopy has been advocated to decrease the morbidity of Heller myotomy; however, few reports document outcome beyond 1 year after videoscopic Heller myotomy. PURPOSE: To determine perioperative morbidity, relief of dysphagia, and the incidence of postoperative reflux symptoms following videoscopic Heller myotomy with follow-up to over 4 years. METHODS: Patients with achalasia documented by barium esophogram and esophageal manometry underwent videoscopic Heller myotomy beginning in 1992. Intraoperative peroral endoscopy was utilized to guide the cephalad and caudad extent of myotomy. A barium esophogram was undertaken in the immediate postoperative period to evaluate for subclinical leak and assess esophageal emptying. RESULTS: Seventy-eight patients underwent videoscopic Heller myotomy. The mean age was 51 years +/- 19 (range 14 to 91). Most (62%) patients had undergone pneumatic dilation prior to surgical consultation and 54% had previous botox injections. All patients complained of dysphagia and 40% had symptoms of heartburn prior to myotomy. After myotomy, 91% of patients stated that their swallowing was improved with myotomy. Thirteen patients (18%) experience heartburn more than once per week after myotomy. The average length of stay was 2 +/- 2 days, with 72% of patients spending 2 days or fewer in the hospital. Six (7.7%) major complications occurred: five esophageal perforations and one enterotomy without long-term sequellae. Three procedures (3.8%) were converted to "open" procedures. No deaths occurred. We conclude that videoscopic Heller myotomy is safe and efficacious, with low morbidity and mortality. Videoscopic myotomy provides relief beyond the short term for dysphagia due to achalasia with minimal reflux symptoms. We advocate videoscopic Heller myotomy in the treatment of severe dysphagia due to achalasia not adequately palliated by or amenable to nonoperative management.

Adolescent↗
PubMed1995

Role of the vagal branches to the proximal stomach in mediating gastric distention-induced disruption of canine interdigestive upper gut motility.

Previous experiments from our laboratory have shown that the vagus nerves mediate proximal gastric distention-induced disruption of interdigestive motor patterns in the upper gut of dogs. Our aim was to determine the role of vagal innervation of the proximal stomach in mediating the response to nonnutrient proximal gastric distention. Five dogs underwent proximal gastric vagotomy (PGV) and placement of electrodes and manometry catheters on the antrum and the upper small intestine. Proximal gastric distention for 5 hr was achieved by inflating a thin, compliant bag in the proximal stomach. Four volumes of distention stimulus (0, 1.5, 12.5, and 25 ml/kg) were tested. As with total abdominal vagotomy, intragastric stimulus volumes of 12.5 and 25 ml/kg after PGV no longer inhibited cycling of the migrating motor complex in the stomach, duodenum, proximal jejunum, and distal jejunum. Volumes of 12.5 and 25 ml/kg did, however, on occasion, lead to the absence of phase III activity in the stomach or the duodenum when it would have been expected to precede phase III activity in the jejunum; this effect did not occur in the jejunum. These findings with a nonnutrient stimulus suggest that vagal branches to the proximal stomach might mediate, in part, the postprandial changes in upper gut motility in response to gastric distention by ingestion of a meal.

Animals↗
PubMed1993

Absorption in the isolated bowel segment.

An isolated bowel segment (IBS) is a viable mesenteric segment of intestine. This study was undertaken to investigate the effects of mesenteric vascular and neural supply on intestinal absorption. Ten rats were used for leucine absorption and another 10 for glucose absorption experiments. L-leucine, 12 ml of 15.0 mM/L, or 3.0 mM/L of D-glucose solution were recirculated through the IBS (n = 5) and rat jejunum that underwent sham operation (n = 5) at 2.56 ml/min for 90 min. Absorption was expressed as millimoles of leucine or glucose per gram of mucosal protein. The Student's t test was used for statistical analysis; a p < or = 0.05 was considered significant. The net absorption of L-leucine was 36.20 +/- 3.31 mM/g of mucosal protein in the IBS and 15.52 +/- 1.48 mM/g of mucosal protein in the control group (p < 0.001). The net absorption of D-glucose was 3.82 +/- 0.26 mM/g of mucosal protein in the experimental group and 4.34 +/- 0.31 mM/g of mucosal protein in the control group (p = 0.02). This study concludes that absorption of leucine and glucose in the IBS is preserved after mesenteric division.

Animals↗
PubMed1992

The isolated bowel segment (Iowa model II): motility across the anastomosis with or without mesenteric division.

In previous reports, anastomosis has been shown to disrupt the myoelectric activity of the bowel. However, these studies have failed to delineate the role of the extrinsic nerves. Using an isolated bowel segment (IBS) and an amesenteric bowel segment (ABS), motility was evaluated by myoelectric recording across a bowel anastomosis. Ten rats were divided equally into the experimental group with the IBS and the control group with the ABS. In the IBS group, an 8-cm segment of jejunum was divided, reanastomosed, and coapted to the liver margin (Iowa model II). In the ABS group, an 8-cm segment of jejunum was coapted to the liver margin without disruption of bowel continuity (Iowa model II variant). Two weeks later, bipolar electrodes were implanted in the IBS and ABS, and normal jejunum in both groups. Mesenteric division (MD) was performed 4 weeks later to eliminate extrinsic innervation. Myoelectrical recordings were taken 2 weeks before and after MD. In the control group with IBS, incoordination in the propagation of the migrating motor complex (MMC) and reduction in the frequency of slow waves (FSW) were observed across the anastomosis and were unchanged by MD. In the control group with the ABS, the MMC and FSW were identical to that in the normal jejunum and were unaffected by MD. In both groups postprandial inhibition of the MMC was the same as in the normal jejunum and was unaffected by MD. This study confirms that incoordination in propagation of the MMC and reduction in FSW occur across a bowel anastomosis, and elimination of extrinsic innervation does not affect the autonomy of these changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1986

Effect of enzymatic treatment on calcium absorption by small intestine: a comparative study between rat and rabbit transport mechanisms.

Calcium absorption by the small intestine of rat and rabbit reached steady state after 60 min of incubation with intracellular to extracellular ratio of 2.0. Trypsin and neuraminidase significantly inhibited (P less than 0.05) calcium accumulation in rat small intestine. These enzymes showed no significant effect (P greater than 0.05) on calcium transport across rabbit small intestine. The inhibitory action of trypsin and neuraminidase on calcium accumulation by the rat small intestine does not involve the influx of calcium into the intestinal cells.

Animals↗