Does gum chewing ameliorate postoperative ileus? Results of a prospective randomized, placebo-controlled trial.
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Chewing Gum↗
Biomedical subjects
Paul H Niloff
Publications and source records attributed to Paul H Niloff.
Clinical experience using the computerized digital stapling system in open gastric bypass surgery for morbid obesity.
BACKGROUND: Roux-en-Y gastric bypass is currently the preferred method of surgical treatment for morbid obesity. Complications associated with this technique include anastomotic leaks and anastomotic strictures. Our technique employs a computerized digital stapling system (SurgASSIST). This stapling system has been utilized in affecting both the end-to-end gastrojejunostomy and end-to-side enteroenterostomy anastomoses. METHODS: SurgASSIST is a computerized stapling system consisting of a power console and a 2.13-meter flexshaft. Using a remote control, various stapling cartridges can be opened and closed, and the tip of the flexshaft can be steered in four directions prior to firing. Because the firing mechanism and force are generated away from the surgical field, torque applied to the anastomotic site is minimized. The system is designed to approximate tissue to the correct staple height, based on tissue thickness, which precludes excessive compression of the tissues. RESULTS: We have employed the SurgASSIST computerized digital stapling system in a series of 403 cases with 558 applications. We have experienced no anastomotic leaks. There were 7 strictures (1.7%) requiring balloon dilatation. There were no strictures requiring surgical intervention. CONCLUSION: Our extensive clinical experience using the SurgASSIST computerized digital stapling system has shown it to be a safe and effective method for performing stapled anastomoses.
Anastomosis, Roux-en-Y↗
Prophylactic cholecystectomy with open gastric bypass operation.
BACKGROUND: There has been controversy regarding prophylactic cholecystectomy with Roux-en Y gastric bypass. The results reported in open cases showed no significant increase in morbidity by the addition of cholecystectomy. A series of open cases were reviewed to evaluate the propriety of prophylactic cholecystectomy. METHOD: The records of 141 patients undergoing cholecystectomy during open gastric bypass were reviewed, documenting age, ultrasound findings and pathology. RESULTS: Of the 141 cases analyzed, the incidence of gall-bladder pathology was 80%. 24 (17%) of the 141 patients were noted to have gallstones on preoperative ultrasound examination, and 3 (2%) showed polyps. 9 patients (6%) had gallstones at surgery with normal ultrasound. Cholesterolosis was present in 52 cases (37%) and chronic cholecystitis in 25 cases (18%). CONCLUSION: In view of the high incidence of gall-bladder disease (80%) already present in morbidity obese patients undergoing gastric bypass and the lack of significant morbidity in open surgery with prophylactic cholecystectomy, the addition of prophylactic cholecystectomy appears appropriate.
Adolescent↗