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Oded Zmora

Publications and source records attributed to Oded Zmora.

25 records · Page 2Linked to original sources
PubMed2003

Laparoscopy for Crohn disease.

The laparoscopic approach to Crohn disease offers the multiple potential benefits of faster recovery, better cosmesis, and a lower incidence of adhesion-related complications and incisional hernias. Most of these advantages are unproven, but a review of the current literature reveals that advantages have been suggested in almost all series that have compared laparoscopy to laparotomy. Some features of Crohn disease, such as fistula, abscess, and phlegmon, may pose a surgical challenge; however, laparoscopic resection is often feasible, with morbidity rates comparable to or lower than those associated with laparotomy. Experience both in advanced laparoscopic techniques and surgery for Crohn disease, coupled with sound surgical judgment and a reasonably low threshold to convert to laparotomy before intraoperative complications occur, are essential for the successful and safe employment of these procedures.

Crohn Disease↗
PubMed2003

Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons.

The utility of antibiotic and mechanical preparation for colorectal surgery is controversial, and numerous different regimens are used. The aim of this study was to detect trends in preparation for surgery among American colon and rectal surgeons. Members of the American Society of Colon and Rectal Surgeons practicing in the United States were surveyed with a postal questionnaire regarding their routine preparations for colon and rectal surgery. Five hundred fifteen (40%) of the 1295 questionnaires sent were returned. Eighty-one per cent of the respondents had completed an accredited colorectal training program, and the average experience in practice was 13.7 (+/- 8.7) years. Half of the surgeons felt that prophylactic oral antibiotic is essential, 41 per cent felt it was doubtful, and 10 per cent considered oral prophylaxis unnecessary. Despite these statements 75 per cent of the surgeons routinely utilized oral antibiotics (96% of them used a combination of two drugs), 11 per cent used them selectively, and only 13 per cent omitted oral prophylaxis from their practice. Similarly although the usefulness of intravenous antibiotics was questioned by 11 per cent of the surgeons 98 per cent routinely used them. The average number of postoperative doses was two (+/- 1.9). Although 10 per cent of the surgeons questioned the importance of mechanical preparation more than 99 per cent routinely used it. Forty-seven per cent of the surgeons used sodium phosphate, 32 per cent used polyethylene glycol, and 14 per cent alternated between these two options. We conclude that although the use of oral antibiotic prophylaxis for colorectal surgery is controversial among surgeons it is still routinely practiced by 75 per cent. Intravenous antibiotic prophylaxis and mechanical cleansing, however, are still a dogma and almost invariably used. There is a trend toward the use of a shorter course of postoperative intravenous antibiotics and the use of sodium phosphate for mechanical cleansing.

Administration, Oral↗
PubMed2003

Focused, minimally invasive radio-guided parathyroidectomy: a feasible and safe option for elderly patients with primary hyperparathyroidism.

BACKGROUND: Primary hyperparathyroidism in elderly patients is usually associated with additional co-morbidity that increases operative risk, and thus many geriatric patients are denied the benefit of surgery for a single parathyroid adenoma. OBJECTIVES: To evaluate the safety and efficacy of accurate single photon emission computed tomography sestamibi scintigraphy, enabling precise localization of a single adenoma, in the geriatric population. METHODS: Twenty-two patients aged 70 years and over with biochemically proven PHPT and with a single parathyroid adenoma identified by localization studies (sestamibi SPECT scan and ultrasonography) underwent 23 operations over 29 months (out of a total of 140 patients operated upon during the same period). Immediate preoperative sestamibi scintigraphy and marking of focal adenoma uptake followed by intraoperative hand-held gamma probe were used for the removal of the parathyroid adenoma by unilateral minimal access surgery. Associated major co-morbid conditions and pre- and postoperative calcium, phosphorus and parathormone levels were recorded. Indications for surgery were listed and operative and postoperative complications were noted. The patients were followed for a mean period of 17.7 months using the same parameters. RESULTS: The 22 patients with PHPT had a mean age of 76.3 +/- 5.9 years (range 70-88 years) and a female to male ratio of 13:9. Associated co-morbidity included ischemic heart disease (n = 15), hypertension (n = 22), non-insulin-dependent diabetes mellitus (n = 9), chronic obstructive pulmonary disease (n = 3), and previous neck surgery (n = 3). Mean preoperative serum calcium, phosphorous and PTH were 11.7 +/- 1.3 mg/dl, 2.5 +/- 0.5 mg/dl and 160.9 +/- 75.4 pg/ml respectively. In 20 of the 22 patients, surgery was successful in curing PHPT (91%). One patient had persistent hypercalcemia due to a missed adenoma, and repeat operation (by focused minimal accesss surgery) was successfully performed 2 weeks later. There were no complications and no morbidity postoperatively. Mean postoperative serum calcium, phosphorous and PTH were 9.6 +/- 1.2 mg/dl, 3.0 +/- 0.5 mg/dl and 35.2 +/- 24 pg/ml respectively. In all patients, serum calcium levels remained normal (9.7 +/- 1.3 mg/ml) after long-term follow-up (mean 17.7 +/- 9.6 months). CONCLUSIONS: Minimally invasive, radio-guided focused parathyroidectomy for a single adenoma is a safe and effective method to cure hyperparathyroidism in the elderly. Success of surgery is directly related to the surgeon's experience and to the precise localization marking provided by sestamibi scintigraphic SPECT localization and concurrent sonographic findings.

Adenoma↗
PubMed2002

Endorectal advancement flap: are there predictors of failure?

PURPOSE: The management of complex perianal fistulas with endorectal advancement flap is aimed at avoiding the risk of sphincter injury associated with traditional surgical methods. Long-term follow-up is required to assess the recurrence and continence outcomes of this procedure. The aim of this study was to review our experience with endorectal advancement flap in the treatment of complex perianal fistulas and to define the predictors of successful healing. METHODS: A retrospective chart review of all patients who underwent endorectal advancement flap for complex perianal fistulas between 1988 and 2000 was performed. Follow-up was established by telephone interview. RESULTS: One hundred six consecutive endorectal advancement flap procedures were performed on 94 patients (94.4 percent). There were 56 females (59.6 percent). Mean age was 41.6 (range, 18-76) years. Cryptoglandular disease was the most common cause of fistula (n = 41, 43.6 percent), followed by Crohn's disease (n = 28, 29.8 percent). At a mean follow-up of 40.3 (range, 1-149) months, the procedure was successful in 56 (59.6 percent) of 94 patients. Twelve patients underwent repeat surgery with the same technique because of initial failure, 8 of whom eventually healed. Crohn's disease was associated with a significantly higher recurrence rate (57.1 percent) when compared with fistulas in patients without Crohn's disease (33.3 percent, P< 0.04). Prior attempts at repair of the fistula were not associated with less favorable outcome of the procedure (P = 0.5). Recurrence was not associated with the type of fistula, origin, preoperative steroid use, postoperative bowel confinement, use of postoperative antibiotics, or creation of a diverting stoma. The median time to recurrence was 8 (range, 1-156) weeks; there was no postoperative mortality. Two patients had postoperative bleeding, one requiring resuture of the flap on the first postoperative day. Recurrences were observed in 15.7 percent of the patients 3 or more years after the repair. In 8 patients (9 percent), continence deteriorated after the endorectal advancement flap, a more common finding in patients who had undergone previous surgical repairs (P < 0.02). CONCLUSION: The success rate of endorectal advancement flap for complex perianal fistulas is modest. Failure is mainly correlated with the presence of Crohn's disease.

Adolescent↗
PubMedDate not supplied

Late regeneration of infarcted small bowel mucosa: a case report.

Ischemic injury of the small bowel may recover after revascularization, provided that full-thickness infarction did not occur. Animal studies showed that if the mucosal crypts remain viable, rapid mucosal restitution occurs hours after injury. The treatment of transmucosal infarction that does not extend to full wall thickness, however, was not investigated thoroughly. The patient presented had a mesenteric event leading to resection of about half of his small bowel. The unresected segment had severe ischemic injury, which seemed to cause transmucosal, but not transmural, infarction. Imaging of the remaining small bowel revealed a seromuscular layer denuded of mucosa. The ischemic damage was too deep to allow rapid regeneration, and the patient had short-bowel syndrome. A year later, during operation for stricture complications, new mucosa covered parts of the small-bowel surface, encouraging the surgeon to elect a conservative approach. Sixteen months after the injury, normal mucosa covered the entire small bowel, and enteral feeding resumed successfully. This report shows that infarcted small-bowel mucosa may regenerate even months after injury.

Adaptation, Physiological↗
PubMedDate not supplied

A technique for laparoscopic-assisted colectomy using two ports.

OBJECTIVES: Laparoscopic colon and rectal surgery requires advanced laparoscopic skills. The aim of this study was to describe a novel technique for laparoscopic-assisted colectomy using only 2 ports and to review our initial experience with this technique for patients with benign colonic pathologies. METHODS: A retrospective chart review of all patients who had laparoscopic-assisted colon surgery using this technique was performed. The technique is described. RESULTS: For right colectomy, a 10-mm trocar for the camera was placed just below the umbilicus and a 5-mm working port just above the umbilicus. The colon was mobilized using one instrument and gravity assistance. The incisions were then connected, and the mobilized colon was pulled through this incision. For left-sided colectomy, the 5-mm working port was placed at the left suprapubic hairline, which was then extended for removal of the specimen. Sixty patients with benign colonic pathologies had laparoscopic-assisted colon surgery using only 2 ports. Conversion to open surgery was required in 4 cases. The average length of the skin incision was 3.82 cm, and the mean length of hospital stay was 4.18 days. Postoperative complications occurred in 11 patients (18%) and included anastomotic leak in 1 patient and wound infection in 2. CONCLUSIONS: Laparoscopic-assisted segmental colectomy using 2 ports is easy and feasible, with minimal skin incisions and fast recovery. Our initial experience suggests that it may be easier for the experienced colorectal surgeon to acquire the skills needed to perform this technique.

Aged↗