Biomedical subjects

O N Panton

Publications and source records attributed to O N Panton.

10 recordsLinked to original sources

PubMed1997

Comparison of total versus partial laparoscopic fundoplication in the management of gastroesophageal reflux disease.

BACKGROUND AND METHODS: A comparison of total vs. partial laparoscopic fundoplication was conducted in 89 patients from July 92 to June 96. Parameters examined were operating room (OR) times, conversion rates, and perioperative complications. Patient satisfaction, control of symptoms, and late complications were assessed by follow-up at a mean of 6 and 15.4 months. RESULTS: There were six conversions to open surgery resulting in 48 laparoscopic total (LTF) and 35 laparoscopic partial (25 anterior and 10 Toupet) fundoplications (LPF). The following results were obtained for each respectively: preop Demeester score 44 vs. 39; OR time 2.9 vs. 2.5 hours; length of stay 3.6 vs. 4.1 days; early morbidity 25% vs. 1%. There were no mortalities. At a mean follow-up of 6 months, new-onset dysphagia was present in 8 (17%) vs. 2 (8%), respectively (NS), and both total and partial fundoplications appeared successful in controlling symptoms (98% vs. 97%). At a mean follow-up of 15.4 months, heartburn was resolved or improved in 76% vs. 87% (NS); regurgitation was improved or resolved in 93% vs. 93%; and patient satisfaction with the procedure was present in 93% vs. 97% (NS). Persistent dysphagia was present in 7.3% vs. 10.3% (NS) of patients. Early satiety was present more often in the partial fundoplication group (56% vs. 83% P = .03). CONCLUSIONS: Early follow-up suggests equal efficacy in controlling symptoms and in achieving patient satisfaction. A 6-month follow-up suggested a higher incidence of new dysphagia in the total fundoplication group; however, at 15-month follow-up there was no significant difference.

Female↗

PubMed1996

A four-year experience with laparoscopy in the management of appendicitis.

BACKGROUND: The study was conducted to determine the influences of laparoscopy in the management and outcome of patients with appendicitis. METHODS: A retrospective analysis of 154 consecutive patients who were treated for suspected appendicitis. The pre-operative diagnosis included appendicitis, right lower quadrant pain of unknown etiology, and generalized peritonitis. RESULTS: Laparoscopy was used in 108 patients, including 70 laparoscopic appendectomies (LA) and 31 LAs converted to open appendectomy (OA). Forty-six patients had OA. The average operating time for LA was 74.3 minutes and 48.8 minutes with OA. Postoperative complications for LA (7%) included 1 trochar wound hemorrhage, 2 wound infections, and 2 intra-abdominal sepsis; and for OA (9%) were 1 post-operative intra-abdominal hemorrhage, 4 wound infections, 1 wound dehiscence, and 1 intra-abdominal sepsis. Post-operative stay for LA averaged 2.5 days and for OA averaged 4.5 days (P = .0049). LA patients had a considerably faster return to work and/or normal activity than OA patients (P = .00065). CONCLUSIONS: Laparoscopy influenced the management of 29% of patients presenting with suspected appendicitis. LA resulted in shorter hospitalization and a more rapid return to work and/or normal activity than OA.

Adolescent↗

PubMed1995

Laparoscopic cholecystectomy: a continuing plea for routine cholangiography.

The purpose of this clinical study was to demonstrate the usefulness of routine intraoperative cholangiography (IOC) and the safety of laparoscopic cholecystectomies (LC) in a community hospital. There were no ductal injuries and perioperative complications were extremely low. Patients (n = 236) with symptomatic gallstone disease, acalculus cholecystitis, or gallbladder polyps underwent LC from March 1991 to June 1993. During this period two patients were not considered appropriate candidates for this procedure. There were 172 women and 64 men ranging in age from 15 to 84 years. Four had preoperative endoscopic retrograde cholangiopancreatographies (ERCPs) for suspected choledocholithiasis. Elective LC was performed on 194 patients and emergency LC on 42 patients. The average operating time for elective LCs was 89 min and 97 min for emergency LCs. Thirty-six percent of patients had previous abdominal or pelvic surgery. IOC was attempted in 99% of patients and successful in 89%. Five percent had choledocholithiasis. Laparoscopic duct exploration was performed on four patients. Six patients had postoperative ERCP with stone extraction. Three percent of elective patients had additional surgery. One patient had LC during pregnancy (17 weeks), with a normal recovery and successful outcome of the pregnancy. Six elective and four emergency patients were converted to open cholecystectomy, a conversion rate of 4%. There were no ductal or vascular injuries, intraoperative haemorrhages or deaths. There were one small bowel laceration (0.4%). Postoperative complications included seven wound infections (3%), four bile leaks (2%), three trocar site haemorrhages (1%), one intraabdominal haemorrhage (0.4%), one suspected halothane hepatitis (0.4%), one drug-induced cholestatic jaundice (0.4%), and one subcutaneous emphysema (0.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Laparoscopic hernia repair.

Seventy-nine patients (106 repairs) with inguinal hernias underwent laparoscopic transabdominal preperitoneal hernia repair. The patients included 73 males and 6 females, ranging in age from 19 to 86 years. Twenty-five percent had undergone previous abdominal surgery, and 19% had recurrent hernias. Preoperative diagnosis was 40 right inguinal hernias (RIH), 33 left inguinal hernias (LIH), and 6 bilateral hernias. Intraoperatively, 30 RIH, 22 LIH (1 patient also had a left incisional hernia), 26 bilateral hernias, and 2 femoral hernias were diagnosed and repaired. Twenty patients (25%) had contralateral hernias diagnosed intraoperatively. Average operating time for unilateral repairs was 76 minutes and for bilateral repairs was 110 minutes. Forty-three percent of patients underwent day-care surgery, and 35% were discharged on the first postoperative day. Postoperative complications included 6 cases of transient neuralgias (7%), 3 cord/scrotal hematomas (4%), 1 trocar site hematoma (1%), and 1 case of chronic pain (1%). Follow-up ranged from 1 to 12 months with no recurrences. This study demonstrates the importance of laparoscopy in identifying undiagnosed contralateral hernias, that bilateral hernias can be repaired with no additional morbidity, and that there are high rates of success and safety in laparoscopic hernia repairs in a community hospital.

Adult↗

PubMed1988

Splenic pregnancy--case report.

Primary splenic pregnancy is the rarest form of extrauterine pregnancy. Only six cases have previously been documented, none of which occurred in North America. A case of this rare entity is presented in which a pregnancy was found to arise from the spleen, requiring splenectomy. In addition to the classic signs of a fulminant ruptured ectopic pregnancy, a history of upper abdominal pain was the only distinguishing feature.

Adult↗

PubMed1985

Gastrointestinal tuberculosis. The great mimic still at large.

Gastrointestinal tuberculosis has declined markedly in frequency since the introduction of antituberculous therapy. As a result, the diagnosis is often delayed in North American patients. Segmental colonic disease, especially in the absence of pulmonary tuberculosis, is often difficult to differentiate from Crohn's disease or a neoplasm. We describe a case of colonic tuberculosis mimicking carcinoma of the hepatic flexure of the colon.

Barium Sulfate↗

PubMed1985

Mechanical preparation of the large bowel for elective surgery. Comparison of whole-gut lavage with the conventional enema and purgative technique.

In this prospective, randomized study, 121 elective colorectal surgery patients had whole-gut lavage (n = 67) or enemas and purgatives (n = 54). Patient characteristics were well matched. Intravenous metronidazole and tobramycin were administered preoperatively initially in 53 patients, with the remaining 68 patients receiving the drugs perioperatively. Bowel preparation was satisfactory (minimal or no contents remaining) in 92.8 percent of patients with whole-gut lavage and 92.6 percent with enemas and purgatives (p = 0.72). Nasogastric tube insertion was poorly tolerated by 39 percent of the patients receiving whole-gut lavage, and enema tube insertion by 23 percent with enemas and purgatives. Fluid infusion tolerance was similar with both techniques. Abdominal wound sepsis occurred in 22 patients (18.8 percent), being unrelated to mechanical preparation or antimicrobial prophylaxis (p = 0.19). Colostomy closure was associated with a 42.8 percent sepsis rate. Excluding this group, wound sepsis with the remaining procedures was 13 percent (statistically significant, p = 0.03). Other complications included intraabdominal abscesses (3.3 percent), anastomotic leaks (2.5 percent), eviscerations (1.6 percent), and an operative mortality of 1.6 percent. We have concluded that whole-gut lavage and enemas and purgatives are equally efficacious mechanically with similar associated wound sepsis rates.

Adolescent↗

PubMed1985

The incidence of wound infection after stapled or sutured bowel anastomosis and stapled or sutured skin closure in humans and guinea pigs.

In a study of antimicrobial prophylaxis in colorectal surgery, a higher incidence of wound sepsis was noted in patients who underwent stapled rather than sutured anastomoses and skin closures. There were six wound infections in 69 patients (8.7%) who underwent nonstapled anastomoses compared with seven in 28 (25%) in whom GIA or EEA staplers were used (p = 0.003). Excluding the EEA-stapled cases, the infection rate was 29% (p = 0.022). In patients who underwent sutured anastomoses, there were no wound infections in 21 whose skin was closed with sutures compared with five in 38 patients (13%) with stapled skin closure (p = 0.082). In an experimental guinea pig model dual incisions were infected with Bacteroides fragilis and Escherichia coli. One incision was then closed with staples, the other with sutures. There was a statistically significant (p = 0.016) advantage to the use of staplers. The possible significance of these results is discussed.

Animals↗

PubMed1984

Hartmann resection for perforated sigmoid diverticulitis. A retrospective study of the Vancouver General Hospital experience.

The results of management of perforated sigmoid diverticulitis were studied retrospectively at Vancouver General Hospital over a 15-year period. The Hartmann resection (or a modification) was the surgical procedure used. A classic Hartmann resection was performed in 63 of 78 patients, i.e., following removal of the distal segment, the rectal stump was closed. A modified Hartmann resection was performed in 15 patients (19.2 per cent), where a distal mucous fistula was created to facilitate subsequent colostomy closure. Hemorrhage was a common problem during the procedure (37.2 per cent) and other organ injury was uncommon. The wound infection rate was 24.4 per cent. Nine per cent of patients required a second operation for treating postoperative complications. Two of the patients died; the mortality was 2.6 per cent. Recommendations include the creation of a distal mucous fistula when possible. Minimal resection of the distal segment may often permit this and will allow easier closure of the colostomy.

Adult↗

PubMed1983

Adenocarcinoma of the vermiform appendix: retrospective study and literature review.

Adenocarcinoma of the vermiform appendix is a rare clinical entity, fewer than 200 cases having been reported. The authors carried out a retrospective review over a 25-year period and found five patients admitted to the Vancouver General Hospital with primary appendiceal adenocarcinoma. Four other patients, initially reported as having appendiceal adenocarcinoma, were found after critical microscopic review to have had either benign disease or mucinous carcinoid. Primary epithelial neoplasms of the appendix demonstrate a wide variety of histologic types and because of the different clinical behaviour, an accurate diagnosis must be made. For the benign tumours, appendectomy alone will suffice but for adenocarcinoma of the appendix, right hemicolectomy is recommended.

Adenocarcinoma↗