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Namir Katkhouda

Publications and source records attributed to Namir Katkhouda.

9 recordsLinked to original sources
PubMed2006

Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial.

OBJECTIVE: To compare the efficacy of endoscopic retrograde cholangiopancreatography +/- endoscopic sphincterotomy (ERCP +/- ES) versus traditional conservative management in early gallstone pancreatitis with persistent ampullary obstruction (GSP + AO). SUMMARY BACKGROUND DATA: The effectiveness of early ERCP +/- ES in this setting is controversial. METHODS: Sixty-one consecutive patients with GSP + AO within 48 hours from the onset of symptoms were randomized to receive either conservative treatment and selective ERCP +/- ES after 48 hours (control group, 31 patients) or initial conservative treatment and systematic ERCP +/- ES within 48 hours if obstruction persisted 24 hours or longer (study group, 30 patients). Patient outcome was compared in relation to treatment groups and to duration of obstruction. RESULTS: In the control group, 22 patients disobstructed spontaneously within 48 hours; 3 of the remaining 9 patients underwent ERCP +/- ES and none had impacted stones. In the study group, 16 patients disobstructed spontaneously and 14 underwent ERCP within 48 hours from the onset of symptoms; impacted stones were found and extracted by ES in 79% (11 of 14) of these. PATIENTS: There were no deaths in either group. Patients in the study group showed a shorter period of obstruction (P = 0.016) and a lower rate of immediate complications (P = 0.026) than controls. Patients with obstruction lasting < or =48 hours regardless of the treatment group had fewer immediate complications than those whose obstruction persisted longer (P < 0.001). CONCLUSIONS: This study shows that in patients with GSP + AO limiting the duration of obstruction to not longer than 48 hours by ERCP + ES decreased morbidity.

Adult↗
PubMed2005

Laparoscopic versus open appendectomy: a prospective randomized double-blind study.

SUMMARY BACKGROUND DATA: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. METHODS: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. RESULTS: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). CONCLUSIONS: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.

Adolescent↗
PubMed2004

A new technique for laparoscopic hernia repair using fibrin sealant.

The purpose of this study was to evaluate whether an adequate prosthetic mesh fixation in laparoscopic preperitoneal inguinal hernia repair can be achieved with fibrin sealant (FS) (Tisseel trade mark, Hyland/Immuno Div., Baxter Healthcare Corp., Deerfield, IL, USA), and compare it with stapled fixation. The use of staples for prosthetic mesh fixation in laparoscopic preperitoneal hernia repair is associated with a small but significant number of complications, mainly nerve injury and hematomas. An alternative method of fixation should be as efficient as staples in preventing graft migration. An experimental study was conducted using swine models to compare the efficacy of polypropylene mesh fixation with FS to that achieved with staples and to non-fixed mesh grafts in the preperitoneal groin area. Twenty-five female pigs were used in the study. In each pig, a prosthetic mesh was placed laparoscopically in the groin area bilaterally and fixed with either FS, staples, or left without fixation. The pigs were killed after 12 days. The following outcome measures were evaluated: macroscopic findings including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). The procedures were completed laparoscopically in 49 sites. FS was used to fix 18 grafts; 16 with staples, and 15 were not fixed. No significant difference was noted in graft motion between the FS and staple groups. The non-fixed grafts had a median motion of 5 mm (range: 0 to 10 mm), significantly more than the FS fixed (p<0.01) and stapled grafts (p<0.001). No significant difference was noted in median tensile strength between the FS and staples groups (0.955 Kg vs. 1.03 Kg, respectively) compared with 0.46 Kg in the non-fixed group (p<0.01). FS triggered a significantly stronger fibrous reaction and inflammatory response than those observed in the staples and control groups. An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS, based on our experimental evidence. The FS is equivalent to fixation achieved by staples and superior to no fixation. Soft fixation with FS prevents graft migration and avoids complications associated with use of staples.

Animals↗
PubMed2004

New hemostatic agents in general open and laparoscopic surgery.

F ollowing tissue disruption, whether operative or traumatic, the priorities of any organism are cessation of hemorrhage, prevention of infection, and restoration of tissue integrity and function. Several hemostatic techniques achieve the goal of hemorrhage cessation. One evolving technique is the use of fibrin sealants (FSs) as a surgical tissue adhesive. The different and most common applications of fibrin glue in open and laparoscopic surgery are reviewed.

Animals↗
PubMed2002

Severe trauma is not an excuse for prolonged antibiotic prophylaxis.

HYPOTHESIS: For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures. DESIGN: Prospective nonrandomized study. SETTING: Surgical intensive care unit (SICU) of an academic hospital with a level I trauma center. PATIENTS: A population of 250 trauma patients who required an operation and SICU stay of 3 days or more received antibiotic prophylaxis by 1 antibiotic for 24 hours (SHORT group, n = 133) or 1 or more antibiotics for more than 24 hours (LONG group, n = 117). MAIN OUTCOME MEASURES: Twenty-two outcome variables, including 9 conventional outcomes (eg, sepsis, septic shock, and organ failure) and 13 objective outcomes (days with temperature >38.5 degrees C, days with white blood cell count >14.0 x10(3)/microL, positive cultures, cultures with antibiotic-resistant bacteria, SICU and hospital stay, and death). RESULTS: The LONG group included more patients with orthopedic injuries (60 patients [51%] vs 52 [39%], P =.05) and orthopedic operations (47 patients [40%] vs 30 [23%], P =.003) than did the SHORT group. No other difference was identified in compared characteristics between the 2 groups. There was no difference in any of the examined outcomes except for a higher incidence of resistant infections in the LONG group compared with the SHORT group (59 patients [50%] vs 47 [35%], P =.02). Patients with resistant infections stayed in the hospital longer (mean +/- SD, 33 +/- 18 vs 15 +/- 11 days, P<.001) and had a higher mortality rate (13% vs 1%, P<.001) compared with patients without resistant infections. Prolonged prophylaxis by multiple antibiotics was an independent risk factor of resistant infection (odds ratio, 2.13, 95% confidence interval, 1.22-3.74; P =.008). CONCLUSIONS: The prophylactic administration of more than 1 antibiotic for more than 24 hours following severe trauma does not offer additional protection against sepsis, organ failure, and death, but increases the probability of antibiotic-resistant infections.

Adult↗
PubMed2002

André Toupet: surgeon technician par excellence.

André Toupet is best known for the posterior fundoplication that bears his name, currently used for the treatment of gastroesophageal reflux disease (GERD) or completing Heller's myotomy and subject today to intense discussions. This was not different in 1963, when Toupet proposed his technique at a time when the Nissen fundoplication was emerging as the treatment of choice for GERD. Behind the procedure, we discover a man with great surgical talent and meticulous attention to technical details who opposed criticism with hard work and strong family values.

France↗
PubMed2002

Laparoscopic management of the perforated viscus.

Perforation of a hollow viscus is an emergency which should prompt a rapid and effective treatment. Open surgery has been considered the standard approach, but the use of laparoscopy for diagnostic purposes and treatment in favorable circumstances and locations appears to be a safe alternative with a number of advantages. Indications and contraindications, which depend on the nature of the disease, the duration of the perforation and the location, are discussed in detail.

Abdomen, Acute↗
PubMed2002

Wound management after colon injury: open or closed? A prospective randomized trial.

It is unknown whether leaving the skin wound open to heal by secondary intention is associated with a lower rate of wound infections compared with primary skin-wound closure after operations for colon injuries. From June 1998 to December 2000 at our Level I academic trauma center 48 patients entered into a randomized controlled trial (RCT) and were randomized to have their skin wound primarily closed (CLOSED-RCT) or left open (OPEN-RCT). At the same time patients not included in the RCT were followed prospectively. At the discretion of the surgeon their skin wounds were managed by primary closure (CLOSED-nonRCT) or were left open (OPEN-nonRCT). Univariate and multivariate analysis was done to identify independent risk factors of wound infection, wound dehiscence, and necrotizing soft tissue infection. Wound infection developed in 65 per cent of CLOSED-RCT and 36 per cent of OPEN-RCT patients (P = 0.04) and wound dehiscence in 31 per cent and 14 per cent respectively (P = 0.18). No remarkable differences were noted in any other variable including length of hospital stay. Wound infection developed in 29 per cent of CLOSED-nonRCT and 15 per cent of OPEN-nonRCT patients (P = 0.46). There were three independent risk factors of wound infection: primary wound closure [odds ratio (OR) = 5.5, 95% confidence interval (CI) = 1.8-19.4], colectomy (OR = 3.4, 95% CI = 1.2-10.4), and intraabdominal infection (OR = 5.3, 95% CI = 1.3-24.2). There were two independent risk factors for wound dehiscence and/or necrotizing soft tissue infection: wound infection (OR = 20.9, 95% CI = 4.9-152.3) and intra-abdominal infection (OR = 19.3, 95% CI = 4.0-146.9). Primary closure of the wound almost doubles the rate of wound infection compared with leaving the wound open in operations for colon injuries. Primary wound closure is a risk factor for wound infection and wound infection is a risk factor for wound dehiscence or necrotizing soft tissue infection. Because of the complexity of evaluating the real clinical significance of superficial wound infection larger studies on trauma patients are required.

Adult↗