PubMed Health⌕ Search

Biomedical subjects

T B Hugh

Publications and source records attributed to T B Hugh.

At least 19 recordsLinked to original sources
PubMed1992

Laparoscopic cholecystectomy. A prospective study of outcome in 100 unselected patients.

OBJECTIVE: To describe the outcome of laparoscopic (percutaneous) cholecystectomy in the management of gallbladder stones. PATIENTS AND METHODS: One hundred unselected consecutive patients referred for cholecystectomy, or admitted as emergencies with complicated gallbladder disease. Ten patients had acute cholecystitis, three had empyema, three had gallstone pancreatitis, and 11 had a history of recent jaundice. Common bile duct stones were dealt with by endoscopic sphincterotomy. OUTCOME MEASURES: Intraoperative and postoperative complications, 30-day mortality rate, duration of hospital stay, and length of postoperative disability. RESULTS: Three patients were excluded and underwent open cholecystectomy. Laparoscopic cholecystectomy was attempted in the remaining 97, and successfully completed in 87; 10 were converted to open cholecystectomy. There were no significant intraoperative complications. Two patients had a postoperative haemorrhage and one had a transient bile leak; none required reoperation. There was one death from myocardial infarction 12 days after operation. Minor complications occurred in 12 patients. Mean operating time was 88 minutes. The average length of hospital stay was 72 hours, and most patients returned to normal activities after seven days. CONCLUSIONS: Laparoscopic cholecystectomy offers an outcome comparable to standard cholecystectomy and is applicable to 90% of patients requiring removal of the gallbladder. Laparoscopic cholecystectomy has significant advantages over open cholecystectomy in terms of reduced postoperative pain and disability.

Adolescent↗
PubMed1992

Laparoscopic anatomy of the cystic artery.

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is important. We reviewed the anatomy of the cystic artery and its variations as seen through the video laparoscope. A "normal" cystic artery was found in only 72% of patients. The most important laparoscopically noted variations were doubling of the cystic artery (22%) and an artery that ran inferior to the cystic duct (6%). Small branches of the cystic artery, which we suggest be named Calot's arteries, supply the cystic duct and may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. A scissor dissection technique was found most useful for identifying the arterial anatomy. Careful identification of arterial anomalies should help to reduce the incidence of bile duct injuries during laparoscopic cholecystectomy.

Arteries↗
PubMed1991

Empyema of the gallbladder treated by laparoscopic cholecystectomy.

PATIENT: A 52-year-old woman with an eight-year history of gallstones who had twice declined to have a cholecystectomy. CLINICAL FEATURES: The patient presented as an emergency with severe abdominal pain, hectic fevers and rigors. Results of examination showed an enlarged, tender and easily palpable gallbladder. A diagnosis of empyema of the gallbladder was made. INTERVENTIONS: Intravenous administration of antibiotics was started immediately and a laparoscopic cholecystectomy was performed 36 hours after admission. OUTCOME: Postoperative recovery was uncomplicated. The patient was discharged after 72 hours and returned to normal activities within one week. CONCLUSION: Laparoscopic cholecystectomy seems a useful technique to treat gallbladder disease in emergency as well as elective situations.

Cholecystectomy↗
PubMed1991

Endoscopic management of gallstone pancreatitis.

The use of minimally invasive techniques of removing gallstones, and the gall-bladder, is an attractive option for patients who may be severely ill with pancreatitis. We describe here a patient with gallstone pancreatitis who was managed completely by endoscopic techniques consisting of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy.

Adult↗
PubMed1991

Physics and function of operating room suction.

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1988

Combined gastrointestinal and abdominal aortic aneurysm operations.

Experience with gastrointestinal surgical conditions in 154 consecutive aneurysm operations at St Vincent's Hospital, Sydney, over 5 years (1982-86) is reported. Seventeen patients (11%) had coincidental gallstones, and six patients had other gastrointestinal conditions. Postoperative gastrointestinal complications occurred in eight patients. The overall in-hospital mortality rate was 7.8%. Four of the 12 deaths were associated with gastrointestinal problems, but these complications first developed after aneurysm surgery in three patients and could not have been avoided by a concurrent operation. The management of gastrointestinal pathology in association with the treatment of abdominal aneurysm is reviewed. The coincidence of these disorders is not sufficiently frequent to allow valid comment on the probability of successful outcomes, but the risks posed by surgically untreated gastrointestinal conditions are low, so that secondary gastrointestinal procedures should be avoided in most aneurysm operations.

Aorta, Abdominal↗