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Moon-Tong Cheung

Publications and source records attributed to Moon-Tong Cheung.

4 recordsLinked to original sources
PubMed2005

Liver resection for intrahepatic stones.

HYPOTHESIS: Long-term outcome is good for a selected group of patients with hepatolithiasis treated with liver resection. Liver resection should also be offered to patients with complex hepatolithiasis such as bilateral stones or those with strictures. DESIGN: Retrospective study. SETTING: Regional hospital. PATIENTS: A total of 174 patients with hepatolithiasis (201 procedures) treated between January 1, 1989, and September 30, 2003. INTERVENTIONS: Liver resection (52 procedures) or removal of stones primarily by percutaneous choledochoscopy (149 procedures). MAIN OUTCOME MEASURE: Recurrence of cholangitis. RESULTS: Most patients in the liver resection group had stones localized to the left side. The overall success rate in this group was 98.0% (49 of 50 patients, excluding 2 patients found to have cholangiocarcinoma). The chance of biliary sepsis at 5 years after resection was 13.3%. The overall success rate of stone removal primarily by percutaneous choledochoscopy was 70.5%. The bilaterality of stones, the presence of stricture, and the presence of atrophy were found to be significant risk factors for a poor long-term outcome after stone removal alone. The chance of biliary sepsis at 5 years was 26.4% and 43.2% for those without and with stricture, respectively. CONCLUSIONS: The long-term outcome after liver resection for hepatolithiasis was excellent for a selected group of patients. Poor outcomes were recorded for patients whose intrahepatic stones were removed primarily by percutaneous choledochoscopy, especially those with strictures. The indication for liver resection for hepatolithiasis should be extended to patients with strictures and those with bilateral stones. A combination of different treatment modalities is necessary to improve the outcome of these patients.

Adult↗
PubMed2005

Percutaneous drainage and necrosectomy in the management of pancreatic necrosis.

BACKGROUND: The degree of necrosis and presence of infection are the crucial determinants of the outcome in patients with pancreatic necrosis. In patients with sterile necrosis, the necrotic material can persist and subsequently results in sepsis. Some of these patients will ultimately require an operation to remove the necrotic material. Percutaneous necrosectomy has been introduced to remove this residual debris in a minimally invasive way. METHODS: We retrospectively reviewed all patients with pancreatic necrosis who had percutaneous drainage (PCD) performed. Percutaneous pancreatic necrosectomy (PCPN) was done for those patients whose necrotic cavity failed to resolve. RESULTS: Percutaneous drainage was performed in eight patients, four with evidence of infection by the positive culture in the aspirate. In three of them, the necrotic cavity completely resolved after drainage. Percutaneous necrosectomy was performed in another three patients through the tract placed by the radiologist and another one through a sinus tract after an operation. The necrotic cavity in three of them completely resolved after percutaneous necrosectomy. CONCLUSION: Those patients who had 'organized necrosis' after the acute episode of pancreatitis could receive benefit from percutaneous necrosectomy. The persistent symptoms could be alleviated after the removal of the residual necrotic material. It could also be useful after an open surgery to remove any residual devitalized tissue.

Adult↗
PubMed2002

Objective assessment of a surgical trainee.

BACKGROUND: Early assessment of surgical trainees in their training programme is essential. A strong subjective observer's bias occurs when using the mentor assessment form. In-service examinations and qualifying examinations are only valid measurements of the trainee's knowledge of factual material. An objective method to assess a surgical trainee's clinical performance is introduced in the present study. METHODS: We examined the Generalized Linear Mixed Model statistical methodology to obtain standardized performance scores that would identify good and poor performers while taking into account the effects of patients' risk factors. Data regarding the postappendectomy complication occurrence and operation duration were retrospectively collected for each trainee. These variables were analysed by applying logistic regression and proportional hazards regression models respectively. Standardized trainee scores were obtained as by-products that measured the residual effect of surgeons' performances after taking into account the effects of possible risk factors. RESULTS: A total of 37 trainees were involved in 638 appendectomy operations from 1994 to 1997. Age, concurrent medical disease and presence of pus were significant risk factors associated with complication occurrence. Concurrent medical disease, presence of pus, operative findings of gangrenous or ruptured appendix as well as the experience of the surgeon had a significant effect on the operation duration. The present study identifies four trainees that displayed good clinical performance, and one trainee that displayed poor clinical performance of appendectomy. CONCLUSION: Our proposed method makes use of recently developed statistical methodology for predicting the effect of surgeons' performance,taking into account variations in their case-mix and their patients' fitness. This approach may serve as a very powerful tool for early assessment of a trainee's clinical proficiency, and may also have implications for the future assessment of a surgeon's clinical standard.

Appendectomy↗