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Biomedical subjects

T C Dehn

Publications and source records attributed to T C Dehn.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic antireflux surgery in the treatment of the acid-sensitive oesophagus.

BACKGROUND: Approximately 10 per cent of patients referred for 24-h oesophageal pH tests with symptoms suggestive of gastro-oesophageal reflux disease will have a normal endoscopic examination and normal distal oesophageal acid exposure times, but a clear temporal correlation between their symptoms and episodes of acid reflux. These patients have an 'acid-sensitive oesophagus', which forms part of the spectrum of reflux-related conditions. Their response to antireflux surgery has not been reported previously. This study represents a prospective cohort analysis of a clearly defined group of patients with acid-sensitive oesophagus who have undergone laparoscopic antireflux surgery. METHODS: Nineteen patients (nine male and ten female; median age 32 years) underwent laparoscopic antireflux surgery for acid-sensitive oesophagus. All had had an incomplete response to medical therapy. RESULTS: Eighteen of 19 patients were graded Visick I or II at 6 months after operation; all 16 patients followed for 1 year were graded Visick I or II. There were significant falls in DeMeester symptom score (4.0 versus 0.5; P < 0.001), symptom events (20 versus none; P < 0.001), number of reflux episodes (17 versus two; P < 0.001) and overall acid exposure times (1.2 versus 0.3 per cent; P < 0.001) after operation. CONCLUSION: Laparoscopic antireflux surgery is a valid and effective treatment for patients with an acid-sensitive oesophagus. Presented in poster form to the British Society of Gastroenterology, Birmingham, March 2000 and the American Gastroenterological Association, San Diego, May 2000

Adolescent↗
PubMed2001

Patient self-assessment of test-day symptoms in 24-h pH-metry for suspected gastroesophageal reflux disease.

BACKGROUND: Marked daily fluctuations may occur in the pattern and degree of gastroesophageal reflux (GOR) and in patients' symptoms. The aim of this study was to observe how patients' self-assessment of their symptoms on the day of a 24-h pH test correlates with the likely outcome of the test and the potential value in repeating it. METHODS: 367 patients with symptoms suggestive of GOR underwent 24-h pH tests. Fifty-eight patients had repeat studies. Patients assessed the severity of their test-day symptoms as 'better than typical', 'typical' or 'worse than typical'. RESULTS: A 'typical' or 'worse than typical' day was more likely to produce an abnormal test result (P < 0.0001). A normal first test on a 'better than typical' day was more likely to be followed by an abnormal second test than a normal first test on a 'typical' or 'worse than typical' day (55% versus 22%; P = 0.025). The symptom index score, the total acid exposure time on the first test and the presence of oesophagitis were not associated with an abnormal second test (P not significant). CONCLUSIONS: Patients' self-assessment of the severity of their test-day symptoms should be included in the interpretation of 24-h pH tests for suspected GOR. Patients with a normal pH test on a 'better than typical day warrant a repeat test.

Endoscopy, Gastrointestinal↗
PubMed2001

Twenty-four-hour pH monitoring is required to confirm acid reflux suppression in patients with Barrett's oesophagus undergoing anti-reflux surgery.

OBJECTIVE: To assess whether relief of gastro-oesophageal reflux symptoms in patients with Barrett's oesophagus who undergo laparoscopic anti-reflux surgery is a reliable indicator of acid suppression. DESIGN: Prospective cohort study. SETTING: Surgical department of a large district general hospital. PARTICIPANTS: Twenty-two patients with Barrett's oesophagus and symptomatic gastro-oesophageal reflux who underwent laparoscopic anti-reflux surgery. INTERVENTIONS: Laparoscopic anti-reflux surgery. MAIN OUTCOME MEASURES: Postoperative symptom scores and 24-h pH test results. RESULTS: Twenty-one out of 22 patients had no or minimal residual symptoms postoperatively (Visick I or II). DeMeester symptom scores improved from a median of 5 preoperatively to 0 postoperatively (P < 0.001, Mann-Whitney rank sum test). Eighteen out of 22 patients had postoperative pH studies: three had persisting abnormal acid exposure times postoperatively, but all three were asymptomatic. CONCLUSIONS: In patients with Barrett's oesophagus, relief of reflux symptoms following laparoscopic anti-reflux surgery is unreliable as an indicator of acid reflux suppression.

Adult↗
PubMed2001

Ratio of invaded to removed lymph nodes as a prognostic factor in adenocarcinoma of the distal esophagus and esophagogastric junction.

This study examined the influence of nodal harvest and the proportion of positive nodes on survival in 59 patients with adenocarcinoma of the distal esophagus and esophagogastric junction undergoing esophagectomy with curative intent. A total of 754 lymph nodes were harvested (median 13, range 0-28). Two hundred and twenty-eight positive nodes were found on histology (median 4, range 1-23) in 43 (79%) patients with a higher incidence from T3/T4 than T1/T2 lesions (P < 0.003). Overall 1- and 3-year survival rates were 73% and 47% respectively. Node positivity increased with increased total nodal harvest, but was not influenced by the site of tumors or surgical approaches. There was no survival benefit for patients with <20% over >20% nodal positivity (P=0.31). Only negative lateral resection margin emerged as a significant factor in both univariate (P < 0.01) and multivariate analysis (P < 0.05). We conclude that the degree of nodal positivity in adenocarcinoma is less important than resection margin status as a prognostic factor.

Adenocarcinoma↗
PubMed2001

Laparoscopic management of pseudoachalasia, esophageal diverticulum, and benign esophageal stromal tumor.

A case report is presented of a 59-year-old woman who was suspected of having a paraesophageal hernia, but at operation was found to have an epiphrenic diverticulum of the esophagus, a benign stromal tumor of the esophagus, and pseudoachalasia. The stromal tumor was resected laparoscopically together with a laparoscopic Heller's myotomy and partial posterior fundoplication.

Diverticulum, Esophageal↗
PubMed1997

A traumatic deterioration in general surgeons access to emergency theatre.

An audit has been carried out of general surgical emergency theatre usage before and after the allocation of some of the emergency theatre time for trauma lists. The median delay between decision to operate and operation starting rose from 1 hour 15 minutes to 2 hours 30 minutes. There was a fall in the number of operations carried out during the day (p < 0.001) and a corresponding increase in the number of procedures performed after midnight (p < 0.005). Emergency theatre usage provides advantages to patient and surgeon alike. However, by its nature it will not be fully occupied all of the time. There is always likely to be a temptation to use some of the "free time' for non-emergency cases. This results in the advantages of the emergency theatre being lost.

Abscess↗
PubMed1996

Use of covered expandable metal stents in the treatment of oesophageal carcinoma and tracheo-oesophageal fistula.

Palliation for malignant dysphagia has relied on oesophageal dilatation, insertion of rigid prostheses and laser treatment. All three methods have substantial risk of perforation. Displacement of the tube is also well described. Seventeen expandable polyethylene-covered metal stents were inserted in 15 patients with oesophageal carcinoma; there were 11 men and four women, of median age 70 years. Thirteen stents were inserted for dysphagia and four for tracheo-oesophageal fistula (TOF). Stents were inserted endoscopically under fluorosopic control. Seven patients died from their disease a median of 5 (range 1-11) months after stent insertion. Median follow-up in the remainder is 6 (range 1-11) months. Median dysphagia scores before and after insertion were 3 (range 2-4) and 1 (range 1-2) respectively. Stent insertion provided cure of symptoms in patients with TOF. Median hospital stay following insertion was 2 (range 1-20) nights. There were no deaths and no perforations associated with the procedure. Two patients complained of retrosternal chest pain for 2 days after stent insertion. One patient presented with dysphagia related to later stent migration. There has been no deterioration in symptoms of dysphagia in the remainder. Expandable oesophageal stents offer a safe alternative to traditional methods of palliative treatment for oesophageal carcinoma. In the long term they may provide a cost-effective alternative to standard treatments.

Aged↗
PubMed1996

Port-site metastases in patients undergoing laparoscopy for gastrointestinal malignancy.

Laparoscopic colonic resection and laparoscopy for the assessment of malignant disease have been advocated. Metastatic deposits at port sites are recognized but the incidence of these is poorly defined. Forty-six patients, of median age 65 (range 19-90) years, with gastrointestinal malignancy underwent laparoscopy. Eighteen patients died a median of 4 (range 1-28) months after laparoscopy, four following colonic resection and 14 with gastro-oesophageal malignancy; ten had undergone resection. Median follow-up of the 28 survivors is 8 (range 2-39) months. Five of the 46 patients developed port-site recurrence giving an early incidence of port-site recurrence in this cohort of patients of 11 per cent. Five of 20 patients with tumour involving serosal surfaces developed port-site recurrence compared with none of 26 without serosal involvement (P = 0.022, Fisher's exact test). Port-site recurrence may be related to serosal involvement with tumour.

Adult↗
PubMed1996

A prospective audit of cholecystectomy in a single health district.

Laparoscopic cholecystectomy is becoming the treatment of choice for patients presenting with gallstones. A prospective audit of all patients undergoing cholecystectomy in a single health district over a six-month period was carried out. The aim was to define those patients not having laparoscopic cholecystectomy and determine the morbidity and mortality associated with open and laparoscopic procedures. Cholecystectomy was performed on 173 patients; 149 operations were attempted laparoscopically, of which 134 were successful, giving a conversion rate of 10%. Elective open cholecystectomy was performed on 24 patients. Twenty of these patients were under the care of a consultant who only performs open cholecystectomy and the others were not offered a laparoscopic procedure because of previous abdominal operations. The median time taken for open cholecystectomy was significantly shorter (P < 0.05) than for laparoscopic cholecystectomy or for converted procedures. Laparoscopic cholecystectomy resulted in bile duct injury in one patient (0.7%). This study shows that the majority of patients with gallstones are being offered laparoscopic cholecystectomy, although some patients will undergo open cholecystectomy. The latter include patients under the care of surgeons not performing laparoscopic cholecystectomy, those presenting as an emergency where laparotomy is performed and those where laparoscopy is contra-indicated. The findings of this study are probably representative of other health districts where a similar mix of surgical practice exists.

Adult↗
PubMed1995

Lateral subcutaneous sphincterotomy for treatment of anal fissure in children.

Twenty-three children, aged between 8 and 168 months, underwent lateral subcutaneous sphincterotomy. All fissures healed by 8 weeks after operation. Two children had recurrent proctalgia and defaecating difficulties after surgery despite a healed fissure. Requirement for stool softener was reduced or abolished in 17 children. The parent-child satisfaction score after operation was more than 70 per cent in 19 of 23 cases. Lateral subcutaneous sphincterotomy is an effective procedure in children.

Adolescent↗
PubMed1995

Theatre delay for general surgical emergencies: a prospective audit.

A prospective audit of emergency theatre use for general surgery has been undertaken. Two month periods were studied before and after the introduction of a fully staffed 24-hour emergency theatre. Data were collected using a proforma documenting the time of the decision to operate, the actual time of the operation and the reason for and duration of any delay. After the introduction of the facility the proportion of procedures performed after midnight fell from 29 cases (21.3 per cent) to 7 (6.3 per cent) (p < 0.05). Emergency operating between 0900-1700 hrs increased from 40 cases (29.4 per cent) to 71 (61.3 per cent) (p < 0.05). There was no significant difference in the causes of delay between the two groups, the commonest being queuing for theatre. However, the length of the delay was significantly reduced. That for an appendicectomy was reduced from a median of 4 hrs 40 mins (range 30 mins-18 hrs 45 mins) to 1 hr 29 mins (0-6 hrs 30 mins) (p < 0.01) and for drainage of abscess from 5 hrs 56 mins (15 mins-20 hrs 30 mins) to 1 hr 51 mins (0-4 hrs 30 mins) (p < 0.01). There was no significant difference in the seniority of the surgeon making the decision to operate. In the first part of the audit we identified problems with regard to delay which were addressed by the introduction of the emergency theatre. The audit cycle has been successfully closed improving the care of general surgical emergencies requiring urgent or emergency operations.

Emergencies↗