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Michael Wayne

Publications and source records attributed to Michael Wayne.

7 recordsLinked to original sources
PubMed2005

Autoimmune pancreatitis: unveiling a hidden entity.

HYPOTHESIS: After alcohol-induced and hereditary disease, idiopathic chronic pancreatitis is the most common cause of calcifying pancreatitis. This designation is used when no associated cause of chronic pancreatitis is found. We present 6 cases of idiopathic pancreatitis in which the postoperative pathological examination results demonstrated lymphoplasmacytic sclerosing pancreatitis or autoimmune pancreatitis. DESIGN: Retrospective case series. The medical records of 6 patients referred and treated for autoimmune pancreatitis were reviewed. The duration of follow-up varies, the longest being 5 years. The disease and a literature review are reported. SETTING: A 200-bed community hospital located in a large city. The patients were referred after being treated elsewhere for recurrent pancreatitis. PATIENTS AND METHODS: Six patients with chronic recurrent pancreatitis were evaluated. They were selected because pathological review indicated that they all had autoimmune pancreatitis. RESULTS: Six cases of lymphoplasmacytic sclerosing pancreatitis are presented and suggest that lymphoplasmacytic sclerosing pancreatitis should be thought of more often in chronic autoimmune pancreatitis. CONCLUSION: Lymphoplasmacytic sclerosing pancreatitis is an increasingly recognized cause of chronic pancreatitis and should be considered in the evaluation of patients with chronic pancreatitis and no discernible cause.

Adult↗
PubMed2005

Hemodynamic changes during laparoscopic gastric bypass procedures.

HYPOTHESIS: Significant detrimental intra-operative hemodynamic and respiratory changes occur in the morbidly obese during laparoscopic gastric bypass. DESIGN: Case series. SETTING: Tertiary care university hospital. PATIENTS: Thirteen patients, 10 women and 3 men, undergoing uncomplicated laparoscopic gastric bypass for morbid obesity. INTERVENTIONS: Using a pulmonary artery catheter and an arterial line, we intraoperatively monitored hemodynamic and respiratory parameters. Parameter values were recorded at set points of the procedure, and the changes were statistically analyzed. RESULTS: Significant hemodynamic and respiratory changes, mostly unfavorable, occur in the morbidly obese when creating the pneumoperitoneum in preparation for laparoscopic gastric bypass. The hemodynamic changes are attenuated when the patient is placed in the reverse Trendelenburg position and almost completely corrected when the abdomen is deflated at the completion of the procedure. The respiratory changes are more persistent. CONCLUSIONS: Laparoscopic gastric bypass surgery for morbid obesity leads to a number of predominantly detrimental, if temporary, respiratory and hemodynamic changes, which are most pronounced at the time of creation of the pneumoperitoneum. In the presence of significant cardiopulmonary comorbidities, the use of invasive intra-operative hemodynamic monitoring of the morbidly obese undergoing laparoscopic gastric bypass appears therefore justified.

Adult↗
PubMed2004

Anatomic variations in right liver living donors.

BACKGROUND: Anatomic knowledge is crucial in right liver living donor transplantation. STUDY DESIGN: We reviewed radiologic and surgical findings in right liver donors. Arterial and portal anatomy was assessed in 96 donors, biliary anatomy in 77, and hepatic venous anatomy in 65. RESULTS: Portal vein (PV): 86.4% had classic anatomy; 6.3% had a trifurcated PV; 7.3% had a right anterior PV taken off the left PV. Hepatic artery (HA): 70.8% had classic anatomy; 12.5% had a left HA arising from the left gastric artery; 13.5% had a right HA arising from the superior mesenteric artery; 2.1% had a double replaced left HA and right HA; and in 1.0% the common HA arose from the superior mesenteric artery. Biliary tree: 55.8% had normal anatomy; 14.3% had a trifurcated biliary anatomy; in 5.2% the right anterior bile duct and in 15.6% the right posterior bile duct opened into the left bile duct; in 2.6% the right anterior and in 6.5% the right posterior ducts opened into the common bile duct. Hepatic veins: S5 and S8 accessory hepatic veins had incidences of 43% and 49%, respectively. The incidence of S6 or S7 short hepatic vein was 38%. CONCLUSIONS: Anatomic variations are common but do not contraindicate donation; surgeons should be prepared to recognize and manage them.

Adult↗
PubMed2004

Laparoscopic splenectomy combined with revision of previous laparoscopic gastric bypass.

Advanced laparoscopic operations can be performed in patients who have previously undergone laparoscopic gastric bypass, because there are fewer adhesions than after open procedures. Also, revisions of previous laparoscopic gastric bypasses can be done laparoscopically for the same reasons. To demonstrate this, we present a patient who had undergone a laparoscopic gastric bypass. The operation was successful initially. After 10 months, she started to regain some of her lost weight. It was also found that she had developed idiopathic thrombocytopenia purpura, which was unresponsive to steroids. She underwent a splenectomy and revision of her gastric bypass, both done laparoscopically. This case demonstrates that these advanced laparoscopic procedures can be performed safely, even after previous surgery.

Adult↗
PubMedDate not supplied

Extremely high body mass index is not a contraindication to laparoscopic gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m2 or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation should not be performed. METHODS: Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP. Average age was 43.6, and average BMI was 56 kg/m2. These patients were divided into those with BMI < 60 and those with BMI > or =60 kg/m2. RESULTS: There were 61 patients with BMI < 60 and 21 patients with BMI > or =60. The groups were similar in age, gender, distribution or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups. The BMI > or =60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI < 60 group developed a gastrojejunal stricture requiring balloon dilatation. CONCLUSION: While patients with a BMI > or =60 are at higher risk for postoperative complications, they are also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course and began shedding excess weight. BMI > or =60 should not be a contraindication for LRYGBP.

Adult↗
PubMedDate not supplied

Use of robotics during laparoscopic gastric bypass for morbid obesity.

To evaluate the theoretical increased precision offered by utilization of the robotic instrument, we attempted to determine whether incorporation of its use into traditional laparoscopic gastric bypass would duplicate or improve the success of the operation without increasing complications. The Roux-en-Y gastric bypass is the most commonly performed procedure for morbid obesity in the United States. We performed 120 gastric bypass procedures with traditional laparoscopy during a 30-month period. We began introducing the da Vinci Robotic Surgical System into our laparoscopic gastric bypass procedure and evaluated its effectiveness.

Adult↗