Biomedical subjects
Publications and source records attributed to Steven D Schwaitzberg.
Several variations in intrahepatic and extrahepatic accessory biliary ducts have been reported in the past. An accessory extrahepatic biliary duct connecting the lateral segment of the left lobe to the medial segment of the left lobe is described. A review of the literature reveals that this anomaly has rarely been reported in the past. Knowledge of such anomalies is critical in the prevention of iatrogenic injuries during surgery.
BACKGROUND: Esophagogastric devascularization is an alternative treatment for bleeding gastroesophageal varices. The aim of this experimental study was to develop an approach for laparoscopic devascularization of the lower esophagus and upper stomach. MATERIALS AND METHODS: We used six swine pigs weighing 25 to 25 kg. With the use of five trocars, the steps of the procedure are as follows: (1). dissection of the gastroesophageal junction and mobilization of the esophagus; (2). encircling the abdominal esophagus with umbilical tape; (3). devascularization of the fundus and upper two thirds of the greater curvature of the stomach; and (4). identification and ligation of the left gastric vessels and devascularization of the lesser curvature of the stomach. RESULTS: The mean operative time was 100 minutes (80-120 minutes), and the mean blood loss was 60 mL (40-80 mL). All procedures were completed laparoscopically. CONCLUSION: Laparoscopic devascularization of the lower esophagus and upper stomach is a technically feasible procedure.
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Diagnostic laparoscopy is a powerful tool in the surgeon's armamentarium when used appropriately. There is a low complication rate and high diagnostic sensitivity. In addition to conventional operating room procedures, this technique can be applied in a variety of other settings, often without general anesthesia. Many patients can be spared invasive nontherapeutic laparotomies particularly in the area of trauma and cancer diagnosis. The surgeon must become a superior visual anatomist in order to be able to take maximum advantage of this technique.