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Biomedical subjects

R Ger

Publications and source records attributed to R Ger.

At least 55 records · Page 3Linked to original sources
PubMed1985

Temporary colostomy--an outmoded procedure? A report on the intracolonic bypass.

The intracolonic bypass is a procedure preventing the gastrointestinal secretions and fecal contents from coming into contact with an anastomotic closure site without interrupting the intraluminal continuity of fecal flow from proximal to distal colon. Experimental and clinical data have indicated that the intracolonic bypass can protect such an anastomosis, in the presence of maximal colonic loadings, dehiscences, and fecal peritonitis. This single stage procedure obviates the necessity for construction and subsequent closure of a temporary colostomy in situations where it is currently indicated; the morbidity, mortality, psychologic problems, and economic costs associated with these multiple procedures are avoided. Sufficient experience now has been gained to recommend the intracolonic bypass as a viable alternate to temporary colostomy.

Adult↗
PubMed1985

Management of esophageal dehiscences by an intraluminal bypass tube. An experimental study.

The high incidence of leaks from esophageal anastomoses and the significant morbidity resulting from spontaneous or iatrogenic perforations have prompted an experimental study involving the protection of esophageal anastomoses, dehiscences, and perforation by use of an intraluminal bypass graft. To accomplish this, a specially prepared soft tube is inserted that conducts the salivary and esophageal secretions and ingested food to the stomach, thus preventing any contact with the anastomotic site. Even in the face of surgically created gross esophageal anastomotic dehiscences and perforations, there has been a complete absence of leakage as evidenced by barium studies and by gross and microscopic examination of anastomoses and dehiscences. The technique of inserting the intraluminal bypass graft and its efficacy in protecting the esophageal anastomoses with gross dehiscences has been presented.

Animals↗
PubMed1985

Unusual extraperitoneal presentations of diverticulitis.

Extraperitoneal presentations of complicated diverticular disease are unusual. The initial clinical presentations of these extraperitoneal manifestations have been described in the perineum, scrotum, buttock, hip, joints, thigh, lower extremities, mediastinum, and neck. These presentations render the diagnosis difficult and may lead to the delay of the proper therapy. The purpose of this report is to call attention to these unusual extraperitoneal presentations of complicated diverticular disease to describe the routes of spread and to present a case in point. Reviewing the literature, we have concluded that these unusual presentations occur more commonly in women and the elderly, that a delayed diagnosis significantly increases the mortality rate, and that the most common site of an extraperitoneal presentation is in the area of the hip.

Abscess↗
PubMed1985

Treatment of bleeding esophageal varices by portoazygos disconnection and esophageal transection with the button of Boerema and EEA stapler: ten years' experience.

We present 64 patients with bleeding esophageal varices who have been treated with portoazygos disconnection, devascularization of the esophagogastric junction, and esophageal transection with the button of Boerema (32 patients) and EEA stapler (32 patients). The patients were treated between 1973 and 1983. Their ages ranged from 50 to 70 years. Based on Child's classification, 26 (37.5%) of the patients fell into class A, 35 (54.6%) in class B, and five (7.8%) in class C. These patients were also divided into three subgroups: group I--21 patients (32.8%) underwent emergency operations; group II--40 patients (62.5%) underwent semiemergency operations; and group III--three patients (4.7%) underwent elective operations. The perioperative mortality rate was 10.8%. With the Fischer exact test, we found the combined death rate of Child's classes A and B to be significantly lower than that for class C patients. The duration of follow-up ranged from 6 months to 9 years (average 32.9 months) in the 80% of the patients that we were able to follow. There was a 6.5% incidence of recurrent gastrointestinal bleeding and a 28% incidence of late encephalopathy. The incidence of transitory dysphagia was 40% when the button of Boerema was used as compared with 9% when the EEA stapler was used. The surgical approach presented herein is an attractive alternative to portosystemic decompression for patients in whom hepatic dysfunction is complicated by uncontrolled variceal hemorrhage.

Aged↗
PubMed1984

Prevention and treatment of intestinal dehiscence by an intraluminal bypass graft.

The most important cause of morbidity and mortality in the surgery of the colon, rectum and oesophagus is dehiscence. An experimental study to investigate a method of protecting intestinal anastomoses/dehiscences by an intraluminal bypass graft was carried out. This was accomplished by the implantation of a soft tube (graft) in the proximal intestine above the proposed anastomosis/dehiscence, which conducts the salivary, gastrointestinal secretion, food and faecal stream past the anastomosis/dehiscence into the distal intestine; these contents are thereby prevented from coming in contact with the anastomosis/dehiscence. Intestinal continuity is then completed. The graft is expelled spontaneously after a varying time. In the face of gross anastomotic dehiscences, faecal peritonitis and mediastinitis, primary healing without leakage occurs. A clinical study has been instituted.

Animals↗
PubMed1984

Intracolonic bypass by an intraluminal tube. An experimental study.

The most important cause of morbidity and mortality in colonic resection remains anastomotic leakage and, to this end, temporary stomas, with their own incidence of mortality or morbidity, are often created. Problems associated with both anastomosis and stoma can be prevented with the use of an internal bypass tube. This tube is implanted in the proximal colon above the proposed anastomotic site, then passed distally to the rectal ampulla, following which, the proximal and distal colonic segments are anastomosed. The fecal stream and gastrointestinal secretions are there by prevented from coming in contact with the anastomotic site. The tube is expelled spontaneously after a varying time. The anastomoses in the experimental animals were subjected to maximal stress. Additionally, large dehiscences and induced fecal peritonitis were purposefully created in some animals. Results demonstrated that the intracolonic bypass tube prevents leakage even from gross dehiscences and that these dehiscences progress to complete healing. The experimental study leading to its clinical adaptation is presented.

Animals↗
PubMed1984

A preliminary report on the intracolonic bypass as an alternative to a temporary colostomy.

Anastomotic leakage remains the most important cause of morbidity and mortality in colonic operations, and the considerable complication rate accompanying the construction and closure of colostomy to prevent this has prompted an experimental study designed to protect the colonic anastomosis and dehiscence by an intraluminal bypass graft. To accomplish this, a specially prepared soft tube conducts the fecal flow and gastrointestinal secretions from the proximal part of the colon to the distal part of the colon or rectum, preventing any contact with the anastomotic site. Even in the face of surgically created gross colonic anastomotic dehiscences, these dehiscences have progressed to complete healing. The graft is expelled spontaneously after a varying time. A clinical study was therefore instituted. In ten patients in whom temporary colostomies would have been performed with or without a resection at the time, a one stage primary resection and anastomosis with the insertion of an intracolonic bypass graft was carried out. Preliminary clinical results indicate that one procedure could obviate the necessity for construction and subsequent closure of a temporary colostomy avoiding the morbidity and mortality and the considerable economic implications associated with these procedures. Clinical results have paralleled the experimental one. Since this article was accepted for publication, another 25 patients have undergone an intracolonic bypass procedure. Results have paralleled the previous ones except for one patient with fecal impaction at the fifth postoperative week. The separated tube formed part of the impacted fecal mass.

Animals↗
PubMed1984

Intracolonic by-pass: a new technique to prevent anastomotic complications in colon and rectal surgery.

A new technique, the "intracolonic bypass" designed to prevent anastomotic complications after colonic and rectal resections is reported. It consists of a latex tube fixed to the intestinal wall above the anastomosis, which prevents the fecal stream from reaching the anastomotic site. The tube is retained until complete healing of the anastomosis and then excreted spontaneously through the anus. This new and simple technique avoids the disadvantages of a temporary diverting ileostomy or colostomy.

Colitis↗
PubMed1984

Newer concepts in the surgical management of lesions of the foot in the patient with diabetes.

Ulcerative lesions of the foot are commonly due to ischemia, neuropathy or a combination of these factors. When these lesions fail to respond to conservative measures, they are usually treated by ablative or destructive procedures which often result in the loss of a portion of the foot or deformities, or both. These procedures or deformities may, themselves, lead to further problems as the weight is transferred to other areas not designed for this purpose. Reconstructive procedures may prevent these problems, as well as conserve the foot. Lesions of the heel, middle of the foot and forefoot were managed by excision and closure of the defects by the transposition of muscle or muscles into the area with or without subsequent skin grafts. A total of 31 patients were treated; in 22, muscles were transposed with primary healing of the lesion in 15, delayed healing in three, necrosis of the muscle in two and delayed healing of the incision in two. Ablative operations were required in nine patients, when 15 procedures were carried out, including below-knee amputations in two. In five patients, the peroneal tendons were explored behind the fibular malleoulus, and in two, unsuspected necrosis of a tendon was found. It is concluded that reconstructive rather than destructive surgical treatment be considered in ulcerative lesions of the foot. Spread of infection from foot to leg along the tendon sheaths should be suspected when supperative foot lesions persist despite apparently adequate treatment; small incisions over the suspected tendons may confirm this suspicion and allow timely surgical treatment which will prevent extensive surgical treatment on the leg, including amputation.

Adult↗
PubMed1984

The management of recurrent inguinal hernias by muscle transposition--a preliminary communication.

Recurrent inguinal hernias occur almost exclusively in adult men. The rarity of both direct and recurrent hernias in women is due, among other factors, to the muscularity of an inguinal canal that has not been partially replaced by fibrous tissue to allow the passage of a large spermatic cord. Throughout the body, contractile dynamic muscular tissue resists strains and stresses better than do fascia and ligaments. With regard to the abdominal wall, herniation through this muscular corset is a rare event and herniations nearly always occur through areas in which fibrous tissue has replaced muscle. When the tissues of a recurrent hernia or the type of hernia preclude a satisfactory repair, transposition of a thigh muscle, preferably the gracilis, will provide a dynamic repair that is superior to the introduction of foreign material with all its disadvantages or to the other approaches when local conditions are unsatisfactory. Clinical experience with seven procedures in six patients is presented as a preliminary report.

Aged↗
PubMed1983

Pseudo-obstruction of the colon following cesarean section. A review.

Pseudo-obstruction of the colon is characterized by an adynamic unobstructed colon which rapidly progresses to marked dilatation of the cecum and transverse colon. Disagreements exist regarding the etiology or pathogenesis of this syndrome; it has been associated with metabolic, traumatic, postoperative, and idiopathic causes. In reviewing the literature we have concluded that in pseudo-obstruction of the colon after cesarean section, the mean age of occurrence is 35 years. The symptoms occur in the first 72 hours after operation. Straight x-ray examination of the abdomen is the most useful diagnostic measure. All cecal perforations occurred by the fifth postoperative day. For this reason, we recommend early diagnosis and prompt surgical intervention before that time. In cases when the cecal distention is 12 cm or more, decompression is urgent.

Adult↗
PubMed1983

Muscle transposition in lesions of the ischemic leg.

Ulcerative lesions of the ischemic leg that cannot be revascularized present serious problems. Under carefully defined conditions, a muscle transposition procedure, with or without skin grafting, may be successful. The indications and contraindications, risks, and technical considerations have been presented. Nine patients formed the basis of this study: there was complete healing in six, partial healing in two, and complete treatment failure in one. It has been concluded that this operative approach should be considered in patients with an ulcerated ischemic leg, especially when amputation is being considered.

Aged↗
PubMed1983

The prevention and repair of large abdominal-wall defects by muscle transposition: a preliminary communication.

Abdominal-wall defects, whether occurring as perioperative or postoperative phenomena, have been variously managed. Where the defect cannot be repaired by the use of the patient's own tissues, synthetic material is commonly utilized. Where both the preceding are unsuccessful, closure by means of muscles transferred from the thigh should be considered. Muscles have distinct advantages over fascial grafts or synthetic materials: they are dynamic structures that are effective in controlling herniae, may relieve symptoms in the case of symptomatic scoliosis resulting from the muscle loss, and may improve bowel action by improving expulsive abdominal efforts. Preliminary experience with for patients is presented, together with details of the operative technique. Since this report was submitted, a fifth patient suffering from a congenital "prune belly" syndrome has been treated.

Abdominal Muscles↗
PubMed1983

Muscle transposition in the management of perforating ulcers of the forefoot.

Perforating ulcers of the foot that fail to respond to conservative medical or surgical treatment are usually treated by ablative surgery. This treatment may include removal of one or more metatarsophalangeal joints, which transfers weight-bearing to an area not designed for this purpose. Ablative surgery often leads to forefoot deformities that require additional surgical treatment. Reconstructive, rather than destructive, surgery is recommended to preserve normal foot function. The plantar surface can be preserved by a muscle transposition procedure followed, if necessary, by the application of a skin graft, which is superior to healing by scar tissue.

Adult↗
PubMed1982

The mechanism of T tube dislocation and its prevention.

Dislodgement of the T tube from the common bile duct is an uncommon but potentially serious or even lethal complication. Partial dislodgment with one limb of the T tube lying outside the duct is more common than complete dislocation into the peritoneal cavity. The mechanism for this accident is not always clear; often the patient is blamed for apparently pulling on the tube, even though it is securely sutured to the skin. An alternative hypothesis is presented-namely, that a postoperative adynamic ileus can displace the tube by stretching one of the points of fixation. This has been proved by distending an experimental animal's abdomen by inducing a pneumoperitoneum or by distending the gastrointestinal tract by air insufflation. Dislodgment of the T tube is rendered more likely when the tube is brought through the abdominal wall without slack, as opposed to use of a gentle intra-abdominal loop. The former technique being encouraged by persons engaged in the removal of retained calculi through the T tube track. Further suggestions are made that might reduce the incidence of partial or complete T tube dislodgment.

Abdominal Muscles↗