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T Buanes

Publications and source records attributed to T Buanes.

At least 37 records · Page 2Linked to original sources
PubMed1997

Outpatient laparoscopic cholecystectomy.

INTRODUCTION: The results of laparoscopic cholecystectomy performed as an outpatient procedure were evaluated in a prospective study. METHODS: Initially, only well motivated and healthy patients were offered outpatient laparoscopic cholecystectomy. After 50 procedures, all patients referred to the hospital, except those with American Society of Anesthesiologists (ASA) grade IV and those living alone, were included. Some 200 procedures were studied. RESULTS: Twelve patients (6 per cent) were admitted, and 188 (94 per cent) were discharged 4-8 h after operation. Fifteen patients (8 per cent) who had early discharge were readmitted, nine with complications; in six no complications were documented. The frequency of minor complications was 2 per cent and of major complications 5 per cent. Some 173 patients who had successful outpatient laparoscopic cholecystectomy completed a questionnaire: 164 (95 per cent) characterized their experience as excellent, five (3 per cent) as good, two (1 per cent) as intermediate and two (1 per cent) as unacceptable. DISCUSSION: This high achievement of day-case treatment, even in patients with ASA grade III, is explained by a new anaesthetic regimen together with good surgical technique and close follow-up.

Adolescent↗
PubMed1997

Simultaneous hemodynamic and echocardiographic changes during abdominal gas insufflation.

The purpose of this study was to investigate cardiovascular changes during CO2 pneumoperitoneum. We performed simultaneous hemodynamic recordings and transesophageal echocardiographic measurements of possible alterations in cardiac dimensions. Seven patients scheduled for elective laparoscopic cholecystectomy were investigated. With an intraabdominal pressure of 15 mm Hg, mean arterial pressure increased from 75 to 93 mm Hg (p < 0.05). Despite the increase in pulmonary capillary wedge pressure (PCWP) from 10 (9.5-12) to 17 (16-19.9) mm Hg (p < 0.05), left ventricular end-diastolic area index (EDAI) did not change significantly. The cardiac index remained unchanged. Thus abdominal gas insufflation substantially alters the PCWP/EDAI relation. During pneumoperitoneum, left ventricular filling pressure, estimated by PCWP, cannot be used as an indicator of left ventricular dilation.

Adult↗
PubMed1996

[Liver injuries].

We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.

Adolescent↗
PubMed1996

Complications in laparoscopic and open cholecystectomy: a prospective comparative trial.

Laparoscopic cholecystectomy (n = 250) was compared with the open procedure (n = 250) in a prospective comparative study focusing on complications. Severity grade was classified according to the Toronto system. The frequency of severity grade 1 complications was equal after open and laparoscopic cholecystectomy (5.6%), but major complications (grade 2 and higher) were significantly more frequent in the open group (10.4 versus 3.6%). The only postoperative death occurred after open cholecystectomy. The conventional advantages of laparoscopic cholecystectomy were also verified: The need for postoperative analgesics was significantly reduced from 7 (range, 4-16) standard opiate doses in the open group to 3 (range, 0-7) in the laparoscopic group. Hospital stay was reduced from 6 (range, 4-31) days after open surgery to 2 (range, 1-7) days after laparoscopic surgery and sick leave from 28 (range, 18-48) to 10 (range, 2-21) days, respectively. The overall complication rate was significantly higher in the open group (16 versus 9%, p < 0.01). In our hands, laparoscopic cholecystectomy carries a lower risk of serious complications than the open procedure.

Adolescent↗
PubMed1995

[A national registry for cholecystectomy. Quality assurance with practical consequences?].

Altogether 2,120 patients have been enrolled in the Norwegian Cholecystectomy Registry during the first 18 months after it was established. 1,699 patients (80%) were operated on laparoscopically. In 174 (10.2%) the operation was changed to an open procedure. 421 (20%) were operated on primarily using an open technique. The main quality problems were mortality (1.2%) and injuries of the common bile duct (0.95%) associated with open cholecystectomy. These frequencies are far above the values stated in available literature, and two interpretations are possible: Only the best results tend to be published internationally, and our results may be representative for the national average frequencies of serious complications in other countries too. On the other hand, the present results may disclose inadequate quality insufficiency and a need for improvement. The possible actions seem to be: Firstly, to try harder to avoid open cholecystectomy in seriously ill patients (ASA 3-4). If possible, they should not be operated on at all. When surgery is essential, a laparoscopic technique seems to cause less cardiopulmonary complications. Secondly, an improved dissection technique in open (and laparoscopic) surgery is necessary in order to reduce the frequency of injuries of the common bile duct.

Aged↗
PubMed1995

[Laparoscopic cholecystectomy as ambulatory surgery. Safety requirements, benefit potential and patient satisfaction].

Ambulatory laparoscopic cholecystectomy was attempted using a new anaesthetic regimen in 50 patients. 46 patients were discharged 3-5 hours after operation, four were admitted to and remained in hospital for 1-5 days, one for psychosocial reasons, one because of emesis and two because of extended surgery. 45 of 46 ambulatory patients were generally satisfied after having experienced ambulatory cholecystectomy. Postoperative pain and nausea were moderate. Only 24% needed parenteral opioids postoperatively, and only 30% needed anti-emetic treatment. One woman suffered unacceptable pain and discomfort during the first two days at home, and would not prefer to have ambulatory treatment (questionnaire). Four patients were readmitted. Two had a forgotten stone in the common bile duct and underwent ERCP to extract the stone, without further complications. The third had a clip occluding the common bile duct. She was reoperated on in order to remove the clip and insert a T-tube in the common bile duct. Finally one woman was readmitted because of abdominal pain and vomiting, of which we never found the cause. She recovered spontaneously. Even though serious complications associated with biliary surgery were unavoidable in this ambulatory series, we have documented that patients can be operated on safely in this way. Most patients were very content, and experienced much less postoperative discomfort than they had expected.

Adolescent↗
PubMed1994

[Surgical treatment of gastrointestinal malignant melanoma].

Malignant melanoma is the most common metastatic lesion of the intestine, found at autopsy in approximately 60% of patients who die from melanoma. Common symptoms include bleeding, perforation and ileus/subileus. Patients with such symptoms should be operated on immediately, if they are not too reduced because of advanced disease. Long-term survival (five years) has been achieved in 34 of 179 (19%) of stage IVA melanoma patients after a radical operation procedure. Surgical removal of gastrointestinal metastases provides effective palliation in 80-95% of patients, who undergo laparotomy. We describe two patients with gastrointestinal metastases from malignant melanoma. A 33 year-old man had a large melanoma metastasis removed (non-radically) from the small intestine. He recovered rapidly, and experienced good palliative effect for three months, but died from a recurrence of the disease six months after operation. The other patient had a melanoma metastasis in the right lobe of the liver, which was treated by right hemihepatectomy. There has been no recurrence ten months after operation. We recommend surgical removal of abdominal melanoma metastasis if the surgery can be performed without unacceptable risk.

Adult↗
PubMed1994

Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals.

OBJECTIVE: To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990. DESIGN: Postal collection of prospectively collected data. SETTING: Practices of 26 surgeons in 7 district and university hospitals. SUBJECTS: 527 patients who underwent laparoscopic cholecystectomy. INTERVENTIONS: 133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37. MAIN OUTCOME MEASURES: Morbidity, number converted to open operation, and number who required reoperation. RESULTS: There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury. CONCLUSION: The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.

Bile Ducts↗
PubMed1993

[Prospective comparative studies as tools for quality assurance. Important when laparoscopic techniques are introduced].

During the first two years of laparoscopic surgery altogether 200 cholecystectomy and 40 appendectomy patients were included in prospective, comparative studies. The stay in hospital averaged two days after laparoscopic versus seven days after open cholecystectomy. Days away from work postoperatively averaged nine days after laparoscopic, versus 28 days after open cholecystectomy. After appendectomy, the stay in hospital was reduced from three to one day and absence from work from 14 days in the open surgery group to seven days in the laparoscopic group. Clear advantages have thus been documented in the groups with mini-invasive treatment, since only 5% experienced postoperative complications after laparoscopic treatment, as against 11% after open cholecystectomy (p < 0.02).

Appendectomy↗
PubMed1993

[Laparoscopic surgery in Norway. Operational statistics from surgical departments after 1990].

In October 1992 all Norwegian hospitals were asked whether or not they currently performed laparoscopic cholecystectomy. 36 hospitals performed laparoscopic surgery, 15 did not and 20 hospitals did not reply. During 1990 six hospitals began to use the laparoscopic technique. The number had increased to 21 hospitals in 1991. Altogether 497 cholecystectomies were performed laparoscopically i 1991, comprising 36% of all cholecystectomies in the 51 responding hospitals. In October 1992 the number of hospitals performing laparoscopic cholecystectomy had increased to 36, and the mini-invasive technique was used in 920 cases, i.e. in 68% of the total number of cholecystectomies. Only approximately 7.5% of all appendectomies were performed laparoscopically in 1992 as well as in 1991. Until 1992, cholecystectomy was the only operation where the mini-invasive technique is widely used in Norway.

Appendectomy↗
PubMed1993

[Cost-benefit calculations in laparoscopic surgery. Substantial total benefits, but extra expenses for hospitals are required--reversed effect].

Based on data from our prospective comparative study, we calculated health care costs associated with cholecystectomy (n = 200) and appendectomy (n = 40) patients undergoing open and laparoscopic procedures respectively. Average costs associated with cholecystectomy were reduced from NOK 36,750 to NOK 14,050 (62% decrease) when the laparoscopic technique replaced the conventional open method. A similar comparative study focused on appendectomy was performed with 20 patients in each group, and the costs were reduced by altogether 56%. The potential for decrease in health care costs seems to be substantial, even though requiring investments in equipment and education. Mini-invasive surgery not only improves the quality of surgical treatment, but also increases the efficacy of health care investments.

Appendectomy↗
PubMed1993

[Splenic neoplasms].

Carcinomas of the spleen are rare, whether primary or secondary. Two patients are described, one with a primary angiosarcoma. In this patient the first symptom was abdominal pain, caused by spontaneous rupture of the spleen. The other case was a woman with carcinoma of the breast which metastasized to the spleen. Both underwent splenectomy and adjuvant oncological treatment. Angiosarcomas constitute less than 1% of all sarcomas. Only about 60 cases of angiosarcomas in the spleen have been reported in the world literature. Spontaneous rupture of the spleen occurred in 30% of these cases. The prognosis for both untreated and treated splenic angiosarcomas is poor. Virtually all malignant tumours have been shown to metastasize to the spleen, most frequently from primary tumours localised to the breast, lung or ovary. Neoplasm should be considered for patients with splenomegaly having no apparent cause.

Adult↗
PubMed1993

Atrial natriuretic factor (ANF) does not affect ion transport in human intestine but does in porcine intestine.

The aim of this study was to test whether atrial natriuretic factor (ANF) exerts any effect on human intestinal ion transport, and the porcine intestine was used as a positive control of ANF's effects. Tissues from human proximal (n = 6) and distal (n = 6) colons, and from distal ileum (n = 6) were mounted in Ussing chambers, and short circuit current (Isc) was measured subsequent to serosal application of ANF (10(-6) M), 8-Br-cyclic guanosine monophosphate (8-Br-cGMP) (10(-4) M), and theophylline (10(-2) M). ANF did not affect Isc whereas 8-Br-cGMP increased Isc by 28 (8-53), 16 (3-36), and 16 (5-41) microA cm-2 in the distal colon (DC), proximal colon (PC) and distal ileum (DI), respectively. Likewise, transepithelial potential difference (PD) became more negative by 5.0 (0.6-8.9), 2.5 (0.4-4.0) and 0.9 (0.3-2.3) mV in DC, PC, and DI, respectively, subsequent to addition of 8-Br-cGMP. Isc and PD were further increased by theophylline. Additional radio-isotope flux studies in human colon revealed that ANF did not affect electroneutral sodium and chloride transport either. For comparison, ANF (10(-6) M) was administered to large intestinal tissues from young pigs in which ANF induced a significant increase in Isc which was comparable to the 8-Br-cGMP response in humans. The porcine Isc response was partly inhibited by chloride-free solution on the serosal side, by serosal application of bumetanide (10(-4) M) and BaCl2 (10(-3) M), and mucosal application of the chloride-channel blocker diphenylamine-2-carboxylate (DPC) (10(-3) M). Mucosal amiloride (10(-5) M) pre-treatment reduced baseline Isc but did not affect the porcine intestinal Isc response to ANF. In vitro radio-autography demonstrated specific binding sites for ANF in porcine distal colon, whereas no apparent labelling was observed in human distal colon. These findings suggest that the lack of effect of ANF on sodium and chloride transport in human distal ileum and colon is probably due to lack of ANF receptors. In the porcine intestine, however, the Isc response induced by ANF seems to involve stimulation of electrogenic chloride secretion, whereas electrogenic sodium absorption seems unaffected.

Adolescent↗
PubMed1993

Thoracoscopic pleurodesis.

Thoracoscopic pleurodesis for pneumothorax was performed on 23 patients (16 men, 7 women), including seven with chronic obstructive pulmonary disease, over a 12-month period. Single-lumen intubation with spontaneous ventilation were used making intrapleural insufflation unnecessary. Postoperatively the patients required chest drainage for 1-28 (mean 3) days and remained in hospital for 3-33 (mean 6) days. The 14 gainfully employed patients had 11-40 (mean 20) days' sick leave. Hydrothorax requiring pleurocentesis developed in one patient after thoracoscopy. Pneumothorax recurred in another immediately after removal of the chest drain, but resolved definitively after 2 more days of drainage. A patient with obstructive lung disease required ventilator management for a week after the operation, but otherwise no serious complications were observed.

Adolescent↗
PubMed1993

Introduction of laparoscopic techniques in gastrointestinal surgery: experience at a Norwegian university hospital as revealed by prospective comparative studies.

Prospective studies compared (a) laparoscopic and open cholecystectomy and (b) laparoscopic and open appendectomy. A second purpose of this study was to assess the value of laparoscopic staging of pancreatic and liver tumors. A total of 141 cholecystectomy cases were studied, comprising a laparoscopic group (n = 50), an open prospective control group (n = 50), and historical controls (n = 41). The need for postoperative analgesics was significantly reduced with the laparoscopic procedure compared with open cholecystectomy. Hospital stay was 1 (1-5) day after laparoscopic cholecystectomy versus 6 (5-28) days after open cholecystectomy. Time away from work was 9 (4-21) versus 28 (21-60) days. These differences were statistically significant (p < 0.001). Complication rates were 8% in both prospective groups. A similar comparative study of laparoscopic appendectomy versus the open technique was undertaken, with 10 patients in each prospective group. Again, hospital stay and time away from work proved shorter for laparoscopic procedures. Finally, 15 staging procedures for pancreatic and liver cancers were performed. One patient with unresectable liver metastases was spared explorative laparotomy.

Appendectomy↗