Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication.
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Fundoplication↗
Biomedical subjects
T Gys
Publications and source records attributed to T Gys.
A safe and simple method for routine open access in laparoscopic procedures.
BACKGROUND: Access to the peritoneal cavity in laparoscopic procedures is generally achieved by means of a pneumoperitoneum, following introduction of a Veress needle. Because this procedure must be done blindly, it is not without visceral or vascular hazards. Therefore, we sought an alternative technique that might obviate these complications. METHODS: In a series of 803 patients, a modified Hasson technique was used to obtain a pneumoperitoneum without risking the complications associated with the introduction of a Veress needle. RESULTS: The modified Hasson technique proved to be feasible in all cases. No visceral or vascular complications resulted, but 10 patients had a transient serous discharge. Follow-up ranged between 5 and 52 months. CONCLUSION: The modified Hasson technique should always be used in laparoscopic procedures.
Humans↗
Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery.
Twenty patients undergoing elective colorectal surgery were studied during and after operation by means of tissue oximetry measuring the subcutaneous partial pressure of oxygen (PscO2) and by gastric intramural pH measurement. Mean(s.d.) PscO2 recorded 24 h after surgery was significantly lower than the peroperative value: 14(10) versus 24(14) mmHg, P less than 0.02. The postoperative PscO2 was also significantly lower than that measured in a control group of ten healthy volunteers: 14(10) versus 34(18) mmHg, P less than 0.001. The peroperative PscO2 of the patients who developed a postoperative complication was significantly lower than that of those who had an uneventful postoperative clinical outcome: 16(9) versus 32(14) mmHg, P less than 0.02. The peroperative PscO2 of the patient group with complications was also significantly lower than that of the control group: 16(9) versus 34(18) mmHg, P less than 0.02. The peroperative PscO2 of the group of patients without complications was almost identical to that of the control group. During operation only one patient developed gastric intramural acidosis. Perioperative oxygen debt and the response of subcutaneous tissue oxygen tension to oxygen breathing seemed to correlate better with clinical outcome than gastric wall pH values and the conventional parameters of tissue perfusion.
Adult↗
Assessment of the perfusion in peripheral tissue beds by subcutaneous oximetry and gastric intramucosal pH-metry in elective colorectal surgery.
Gastric intramucosal pH (pHi) and subcutaneous oxygen tension (PscO2) were compared with traditional perfusion parameters in patients undergoing elective colorectal surgery and were related to clinical outcome. Ten patients were studied per- and postoperatively and tissue oximetry studies were also performed in a group of 10 healthy volunteers. The response of PSCO2 to oxygen breathing proved to be the most sensitive predictor of clinical outcome. Of the 10 patients 8 failed to respond to an O2 challenge, while all 10 volunteers in the control group did so. Out of those 8 patients 6 presented with mainly infectious complications while only 3 had an inadequate perioperative urine output and none presented with signs of arterial or of gastric intramural acidosis. The present study suggests a possible relationship between clinical outcome and oxymetric signs of tissue hypoperfusion after O2 challenge in surgical patients, even in the presence of an adequate urine output and a normal gastric wall pH.
Adult↗
Prognostic value of gastric intramural pH in surgical intensive care patients.
Gastric intramural pH (pHi), which has been shown to reflect the adequacy of oxygenation in peripheral tissue beds, was measured in acutely ill surgical patients in order to evaluate its value as a prognostic factor and its relation to the sepsis score. Fifty-nine surgical patients were studied on ICU admission. The stomach wall pH was calculated from the PCO2 in gastric juice and arterial bicarbonate concentration using the Henderson-Hasselbalch equation. A fall in tissue pH less than 7.32 was taken as an indication of inadequate tissue oxygenation. Patients with sepsis scores greater than 10 were considered septic. Hospital and short-term (within 72 h of admission) mortality rates were determined. A significantly higher short-term mortality rate was observed in patients having a pHi less than 7.32 (37% vs. 0%, p less than .005). Most (90%) of the septic patients had a pHi less than 7.32. The short-term mortality rate was the highest (50%) in the septic group. In this group also, a linear correlation was found between pHi and the sepsis score (r = -.43, p less than .01). Gastric pHi, however, offered no prediction for the long-term outcome.
Adult↗
Initial staging of malignant melanoma by positron emission tomography and sentinel node biopsy.
UNLABELLED: By a retrospective study and literature review we aimed to evaluate the accuracy of Sentinel Node Biopsy (SNB) and F-18-fluorodeoxyglucose positron emission tomography (PET) for early detection of lymph node metastases. MATERIAL AND METHODS: Every patient presenting with a malignant melanoma without clinical lymph node involvement and a Breslow index over 1 mm or a recurrence was subjected to a preoperative PET scan and a sentinel node biopsy. Over a period of 10 months, 5 patients were included. They were submitted to conventional staging techniques, PET and SNB. RESULTS: In none of the patients the PET scan showed signs of lymph node involvement or distant metastases. However, two patients, both with a Breslow index of 1.4, had micrometastases in the sentinel node. CONCLUSION: Already in this small group of patients, PET scanning missed two metastases (40%). This is confirmed by several recent publications, stating that the resolution of positron emission tomography is about 5 mm and thus insufficient to detect micrometastases. Several larger series showed a sensitivity of PET to detect lymph node involvement of 15-50%. Therefore we conclude that PET is of limited use in these patients without palpable lymph nodes. Sentinel node biopsy however proves to be a useful tool and should be considered in the initial staging of malignant melanoma without palpable lymph node or distant metastases.
Female↗
Autoimmune pancreatitis with evolution to cholangitis: a case report.
We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic resonance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholangitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancreatitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. Also, our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment.
Adrenal Cortex Hormones↗
The value of short-term peripheral parenteral nutrition after colorectal surgery: a comparative study with conventional postoperative intravenous fluid.
The potential beneficial effect of postoperative peripheral parenteral nutrition (PPN) was assessed in ten patients undergoing colorectal surgery and compared with the conventional use of intravenous fluids in ten controls. Clinical and biological parameters were checked. A significant improvement in the nitrogen-balance, which was not positive during the first postoperative days was observed. All other daily measured parameters (lipid metabolism, electrolytes, glucose levels and plasma pH) remained within normal ranges. In our opinion, short-term postoperative PPN may lessen protein losses and is indicated in those patients who may have a prolonged paralytic ileus without risking complications of central venous access. However, peripheral solutions may cause phlebitis and PPN is by no means an alternative to central TPN.
Aged↗
A prospective comparative clinical study between monofilament absorbable and non-absorbable sutures for abdominal wall closure.
One hundred and sixty-seven patients undergoing laparotomy were randomly allocated to a continuous layered closure technique with absorbable monofilament polyglyconate (PG) (Maxon*) or non-absorbable polyamide (PA) (Ethilon*). Laparotomy wounds were closely observed during the postoperative hospital course and all patients were reviewed at one month, six months and one year. Any wound complications were noted. Two patients in the PA group (3.0%) presented with burst abdomen and one (1.9%) in the PG group (ns). The incidence of incisional hernia was not statistically different between the two groups (4/64, 6.0% in PA group and 4/65, 6.2% in PG group). The postoperative wound infection rate was 21.0% in the Pa group and 15.4% in the PG group (ns). The present study clearly shows a major increase in incidence of wound failure in patients with infected abdominal wounds in both groups (28.6% vs 3.8% in PA group p less than 0.025; 20% vs 5.5% in Pg group p less than 0.05). This clinical trial confirms the important roles of wound infection and respiratory failure in the occurrence of wound failure; the choice of an absorbable or a non-absorbable suture material seems to play a minor role only.
Abdominal Muscles↗
Problems in the surgical treatment of motility disorders occurring after gastric surgery.
Delayed or accelerated gastric emptying and excessive reflux of upper intestinal contents into the stomach are the main disorders of motility occurring after gastric surgery. Most of these syndromes may be treated by conservative measures. When surgical therapy is needed attention must be paid to the possible specific side effects of remedial treatment. Interposition of a reversed jejunal loop in the treatment of dumping after Billroth I gastrectomy may be responsible for the development of an anastomotic ulcer. Roux-en-Y biliary diversion for the surgical treatment of postoperative reflux alkaline gastritis may result in a Roux-en-Y syndrome characterized by severe, delayed gastric emptying. Whenever possible, the pyloric sphincter should be preserved in gastric surgery as the elimination of the pylorus is the main cause of postoperative motility disorders.
Duodenogastric Reflux↗
[Hyperselective vagotomy in the surgical treatment of duodenal ulcers].
The results of hyperselective vagotomy for duodenal ulcer in 181 patients were evaluated 0.5-8.5 years after operation. The overall recurrence rate was 12.7%. The functional results were excellent in 151 patients (83.4%).
Adolescent↗