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Biomedical subjects

S Larach

Publications and source records attributed to S Larach.

4 recordsLinked to original sources
PubMed2006

Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure?

BACKGROUND: Adhesions can result in serious clinical complications and make ileostomy closure, which is relatively simple procedure into a complicated and prolonged one. The use of sodium hyaluronate and carboxymethyl cellulose membrane (Seprafilm) was proven to significantly reduce the postoperative adhesions at the site of application. The aim of this study was to assess the incidence and severity of adhesions around a loop ileostomy and to analyze the length of time and morbidity for mobilization at the time of ileostomy closure with and without the use of Seprafilm. METHODS: Twenty-nine surgeons from 15 institutions participated in this multicenter prospective randomized study. 191 patients with loop ileostomy construction were randomly assigned to either receive Seprafilm under the midline incision and around the stoma (Group I), only under the midline incision (Group II), or not to receive Seprafilm (Group III). At ileostomy closure, adhesions were quantified and graded; operative morbidity was also measured. RESULTS: All 3 groups were comparable relative to gender, mean age and number of patients with prior operations (26, 25 and 19, respectively). Group II patients were significantly more likely to have pre-existing adhesions than Group III patients (30.6% vs. 14.1%, p = 0.025). At stoma mobilization, significantly more patients in Group III than in Group I had adhesions around the stoma (95.2% vs. 82.3%, p = 0.021). Mean operative times were 27, 25, and 28 minutes, respectively (p = 0.38), with significant differences among sites. There was no significant difference in the number of patients needing myotomy or enterotomy (29, 27 and 24 patients, respectively), nor in the number of postoperative complications (7, 9 and 7 patients, respectively). CONCLUSIONS: When consistently applied, Seprafilm significantly decreased adhesion formation around the stoma but not operative times without any increase in the need for myotomy or enterotomy. These findings were not seen in the overall study population possibly due to the large number of surgeons using a variety of application techniques.

Adjuvants, Immunologic↗
PubMed1996

Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group.

UNLABELLED: This study was undertaken to determine the early experience of the embers of the COST Study Group with colorectal cancer treated by laparoscopic approaches. METHOD: A retrospective review was performed of all patients with colorectal cancer treated with laparoscopy by the COST Study Group before August 1994. Tumor site, stage, differentiation, procedure completion, presence of recurrence (local, distant, trocar site), and cause of death were analyzed. RESULTS: A total of 372 patients with adenocarcinoma of the colon and rectum were treated by laparoscopic approach between October 1991 and August 1994 (170 men and 192 women): right colectomy, 170; sigmoid colectomy, 55; low anterior resection, 56; abdominoperineal resection, 44; left colectomy, 22; colostomy, 8; total colectomy, 6; transverse colectomy, 7; exploration, 2. Conversion to an open procedure was required in 15.6 percent of cases. Operative mortality was 2 percent. Tumor characteristics were as follows: TNM state: I, 40 percent; II, 25 percent; III, 18 percent; IV, 17 percent; Differentiation: well-moderate, 88 percent; poor, 12 percent; carcinomatosis, 5 percent. Local (3.6 percent) and distant implantation occurred in four patients (1.1 percent). Only one of these patients died a cancer-related death (Stage III at 36 months). Cancer-related death rates increased with increasing stage of tumor: I, -4 percent; II, 17 percent; III, 31 percent; IV, 70 percent. CONCLUSION: A laparoscopic approach to colorectal cancer results in early outcome after treatment that is comparable with conventional therapy for colorectal cancer. A randomized trial is needed to compare long-term outcomes of open and laparoscopic approaches with colorectal cancer.

Adenocarcinoma↗
PubMed1994

Intraoperative use of Toradol facilitates outpatient hemorrhoidectomy.

UNLABELLED: Pain after hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control their pain postoperatively. PURPOSE: In an effort to decrease posthemorrhoidectomy pain by applying newer methods of analgesia, a prospective trial was conducted to investigate the postoperative analgesic effect of Toradol (ketorolac tromethamine; Syntex Labs, Palo Alto, CA) injected into the sphincter muscle at the time of hemorrhoidectomy and taken orally during a five-day postoperative period in a group of 24 patients (Toradol group). Results were compared with two other groups of matching patients: one group (narcotics, n = 18) treated with standard postoperative narcotic intramuscular/oral analgesics after overnight hospital stay, and a group (SQMP, n = 21) previously treated by one of us with outpatient, subcutaneous infusion of morphine sulfate (Roxane Laboratories, Columbus, OH) via a home infusion pump. METHOD: The length of hospitalization, severity of postoperative pain and complications, costs, and side effects were analyzed by patient questionnaire at the time of the first postoperative visit and hospital and clinic records were reviewed. Differences between groups were analyzed using Student's t-test with P < 0.05 being significant. RESULTS: Subjective pain response and hospitalization cost were significantly less in the SQMP group; however, this was at the expense of increased postoperative complications (urinary retention) and side effects (day until first bowel movement, nausea) although without a decrease in satisfaction rating. The Toradol group had pain control equivalent to that of the narcotics group, a higher satisfaction rating, and suffered no increase in complications relative to either group. Significantly, there was no urinary retention in the Toradol group. CONCLUSION: Postoperative pain after hemorrhoidectomy can be safely controlled as an outpatient using newer methods of pain control. These include both constant-infusion pain pump or supplemental use of the nonsteroidal analgesic ketorolac, both of which allow early release of the patient the day of surgery by diminishing postoperative pain. An important advantage of local injection of ketorolac is the elimination of urinary retention in our study group, probably by blunting the pain reflex response facilitated by prostaglandins, thus allowing safe same-day discharge.

Ambulatory Surgical Procedures↗