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R H Rutledge

Publications and source records attributed to R H Rutledge.

At least 19 recordsLinked to original sources
PubMed1993

The Cooper ligament repair.

Although a Cooper ligament repair is a more extensive operation than most hernia repairs, it can be done safely with minimal morbidity and a very low recurrence rate. A generous relaxing incision and careful technique around the femoral vessels are required. Many surgeons would choose a Cooper ligament repair for direct, large indirect, and femoral hernias only. I have used it for all groin hernias in adults, primary or recurrent, regardless of the presenting defect. I believe it is the best hernia repair done today.

Hernia, Femoral↗
PubMed1992

Primary appendiceal malignancies: rare but important.

The four main types of appendiceal neoplasms are carcinoid tumors (CT), mucinous cystadenocarcinomas, colonic adenocarcinomas (CAC), and adenocarcinoid tumors. They have different clinical features and require different therapy. They are rarely diagnosed before or during surgery and frequently require a secondary operation for proper treatment. A series of 14 patients treated between 1979 and 1989 at Harris Methodist Fort Worth Hospital are described. There are six important points of management. (1) A frozen section should be done whenever the appendiceal findings are atypical. Then a diagnosis of malignancy can be made during surgery and appropriate surgery can be done primarily. (2) All patients with appendiceal neoplasms should be followed because a second malignancy will develop in 15% to 20% of them. (3) Appendectomy is recommended for patients whose CT are less than or equal to 1.0 cm in diameter and for most patients whose tumors are between 1.0 and 2.0 cm in diameter. Right hemicolectomy is preferred for those patients whose CT are 2.0 cm or more in diameter or between 1.0 and 2.0 cm with heavy lymphatic and mesenteric invasion. (4) Mucinous cystadenocarcinomas are slowly progressive and are best treated by means of right hemicolectomy with aggressive debulking added if pseudomyxoma peritonei is present. (5) CAC require a right hemicolectomy and have the same prognosis as have other colon adenocarcinomas. (6) Adenocarcinoid tumors have a dual cell origin, a predilection for developing ovarian metastases, and a malignant potential between CT and CAC. They are best treated by means of right hemicolectomy with concomitant oophorectomy in postmenopausal women.

Adenocarcinoma↗
PubMed1988

Cooper's ligament repair: a 25-year experience with a single technique for all groin hernias in adults.

In the belief that recurrences will be lower if all defects are repaired at the original operation, I performed a Cooper's ligament repair on all groin hernias in adult patients between 1959 and 1984, regardless of the hernia type. This series includes 1142 repairs in 942 patients. Follow-up has been 97%, with 80% of the patients being personally examined by the author. Excluding late deaths, 906 repairs in 747 patients have been followed up for an average of 9 years. There have been 18 recurrences, for a recurrence rate of 2% of live repairs. This breaks down to 1.9% for 779 primary hernias and 2.4% for 127 recurrent hernias. In primary hernias only the recurrence rates are 3.5% for 289 direct hernias, 1.1% for 459 indirect hernias, and 0% for 31 femoral hernias. Seventeen of the 18 recurrences have been indirect along the cord in a subgroup of 147 repairs done with a subcutaneously transplanted cord and followed for an average of 17.4 years (recurrence rate, 11.6%). This method was discarded in 1972. There has been only one recurrence in 572 repairs with the cord left in the natural position and followed for an average of 7.1 years (recurrence rate, 0.2%). This shows the value of not superimposing the internal and external rings (90% confidence limits that the recurrence rate is less than 0.7%). There has been no recurrence in 154 repairs in female patients or 33 repairs with orchiectomy followed for 8.1 and 8.8 years, respectively. A Cooper's ligament repair gives a strong posterior wall and repairs all the defects that can occur in the groin. It can be done safely on all adult groin hernia patients, with a recurrence rate lower than those reported for selective methods of repair.

Adolescent↗
PubMed1983

Methods of repair of noncircumferential bile duct defects.

Although noncircumferential bile duct defects are uncommon, they are important because they require careful repair to avoid subsequent biliary stricture. I have encountered three of these defects in more than 1000 biliary operations. The method of repair chosen for a particular case depends on the pathologic defect, the potency of the ampulla, and the tissues available for use. If the ampulla must be bypassed, a Roux-en-Y jejunal reconstruction is applicable for most biliary defects. An anastomosis between the bile duct and duodenum may be suitable to repair low biliary defects. Occasionally, the gallbladder can be used as a conduit between the bile duct defect and the duodenum or jejunum. If the ampulla need not be bypassed, a Heineke-Mikulicz repair is suitable only for very short defects. A patch technique is a better choice for larger defects. Patches can be made of autogenous vein, gallbladder, knitted Teflon, or a serosal onlay patch of duodenum or jejunum. A vein patch is especially appealing because it will easily cover any extrahepatic defect. A different method was chosen in each of three cases. Side-to-side Roux-en-Y hepaticojejunostomy was used to repair a large cholecystocholedochal fistula with associated pancreatitis. Heineke-Mikulicz repair was employed for a short hepatic duct stricture. Saphenous vein patch was used to repair a long bile duct defect during a left hepatectomy for hepatocellular carcinoma. This patient presumably represents the second successful reported vein patch repair and the only one with subsequent studies showing the fate of the vein patch. The vein patch apparently acts as a temporary scaffold allowing the outgrowth of biliary epithelium from the remaining bile duct wall. Careful initial repair of these noncircumferential bile duct defects is essential to avoid a subsequent biliary stricture with its disastrous consequences.

Bile Ducts↗
PubMed1976

Sphincteroplasty and choledochoduodenostomy for benign biliary obstructions.

Both sphincteroplasty and choledochoduodenostomy are valuable for choledocholithiasis, stenosis of the terminal bile duct, and occasional cases of pancreatitis. Selection of patients, technical details, and advantages and limitations of both operative procedures are presented. In a personal series of 600 benign biliary operations 73 patients had a sphincteroplasty or choledochoduodenostomy. Sixty of these had a sphincteroplasty without operative mortality, serious complication, or recurrence of biliary problems although 5 still have pain. A positive morphine-prostigmine test was a prime indication for surgery in these 5 patients. The evocative tests are now negative. Thirteen patients had a choledochonduodenostomy without mortality or significant complication. Twelve are symptom free but one has a "sump syndrome." Sphincteroplasty has been preferred because it gives dependent drainage, direct inspection of the ampullary area, and facilitates removal of impacted stones and debris. It is not always applicable and choledochoduodenostomy has been chosen in elderly poor risk patients or in those with pancreatic inflammation or periampullary duodenal diverticula. Both operations have specific advantages and limitations such that the surgeon should not use one to the exclusion of the other.

Aged↗