PubMed Health⌕ Search

Biomedical subjects

P J Borgstein

Publications and source records attributed to P J Borgstein.

5 recordsLinked to original sources
PubMed1995

Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery.

The management of common bile duct (CBD) stones in patients subjected to laparoscopic cholecystectomy is still a subject of debate. A prospective study was performed of all 699 patients with symptomatic gallstones at risk of CBD stones between mid-1987 and 1994. Based on clinical, biochemical and ultrasonographic criteria, 119 patients underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) with or without endoscopic sphincterotomy. Results showed a high positive predictive value (over 85 per cent) for the presence of CBD stones in patients with acute cholangitis, persistent obstructive jaundice or in the acute phase of gallstone pancreatitis. In the other groups (increased liver enzyme levels, a wide CBD and after resolution of jaundice or pancreatitis) the positive predictive value was less than 25 per cent. The complication rate of ERCP with sphincterotomy was 14 per cent with a mortality rate of 2 per cent. These results argue for more selective use of preoperative ERCP only for patients with acute cholangitis, persistent jaundice or acute gallstone pancreatitis. Other patients at risk of harbouring CBD stones should undergo intraoperative laparoscopic cholangiography and, if stones are found, laparoscopic exploration of the bile duct or postoperative ERCP.

Adult↗
PubMed1993

Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy.

Despite the advances made since the introduction of ultrasonography, computed tomography and magnetic resonance imaging, a wide discrepancy may occur between preoperative and peroperative staging of gastrointestinal malignancy with liver and peritoneal metastases. Diagnostic laparoscopy performed immediately before a planned laparotomy can provide valuable information for the accurate assessment and appropriate management of some forms of gastrointestinal malignancy, especially that of the liver and pancreas. For evaluation of small liver and retroperitoneal malignancies, intraoperative ultrasonography performed by laparotomy is of proven value. It is now technically possible to perform ultrasonography through a laparoscopic cannula using high-resolution ultrasonographic transducers. This combination of laparoscopy and ultrasonography was studied in 25 patients with established liver lesions, carcinoma of the gallbladder or pancreatic cancer. Additional information leading to a change in surgical approach was obtained in 20 patients. Laparoscopic ultrasonography, although still in a preliminary phase of development, is a simple and reliable technique that will contribute to more accurate staging of intra-abdominal malignancy.

Adult↗
PubMed1993

Laparoscopic rectopexy.

Laparoscopic rectopexy has been performed in four female patients with rectal prolapse. Four or five trocars were used in each case, with the same introduction places as for laparoscopic anterior resection. After dissecting the rectum free, a polypropylene mesh was introduced and fixed to the promontorium with an endoscopic stapler device, and then sutured to the rectum leaving a fourth of the anterior rectal wall free. The average operating time was three hours and the hospital stay six days. No constipation has been observed postoperatively in the patients with preoperative normal bowel habit. The introduction of laparoscopic rectopexy opens the possibility of performing different fixation techniques for various functional problems in the pelvis, offering a significant decrease in morbidity.

Aged↗