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Biomedical subjects

T Ravintharan

Publications and source records attributed to T Ravintharan.

8 recordsLinked to original sources
PubMed1998

Laparoscopic drainage of liver abscesses.

BACKGROUND: The mainstay of the management of liver abscesses has been intravenous antibiotics and radiologically guided percutaneous drainage. However, not all abscesses are treated successfully in this way, and some require surgical drainage. Laparoscopic drainage of liver abscesses may be an alternative to open surgical drainage. METHODS: Twenty consecutive patients with liver abscesses treated by laparoscopic drainage in combination with intravenous antibiotics were studied prospectively. Fifteen had had failed percutaneous drainage previously. RESULTS: There were 13 right lobe and seven left lobe abscesses ranging from 6 to 25 cm in diameter. Mean operating time was 38 min. Seventeen patients were drained successfully. Three patients developed recurrent symptoms of which two resolved with conservative measures, but one required a second laparoscopic procedure. There were no intraoperative or other postoperative complications in the 20 patients. Follow-up ranged from 5 to 12 months. CONCLUSIONS: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.

Aged↗
PubMed1996

Laparoscopic bladder-neck suspension for urinary stress incontinence in women: our first twenty patients.

BACKGROUND: Laparoscopic bladder-neck suspension for women with urinary stress incontinence avoids the problems associated with a large abdominal incision. This study reviews the short-term outcome of this minimally invasive operation. METHODS: Between September 1993 and February 1995, 20 female patients with type II urinary stress incontinence underwent laparoscopic bladder-neck suspension at our institution (mean age, 46.6 years; mean weight, 59.5 kg; mean duration of symptoms, 3.75 years; mean follow-up, 7 months). The extraperitoneal space was created with a preperitoneal distention balloon system; dissection of the bladder and bladder neck was done via 3 working ports. In 16 patients, the paraurethral vagina on either side of the bladder neck was hitched up to the iliopectineal ligament by 2-0 sutures. In the remaining 4 patients, the bladder-neck suspension was performed using hernia mesh and staples. Four patients had intraperitoneal suspension. RESULTS: The operative time ranged from 75 to 205 minutes, with a mean of 111.5 minutes. The period of urethral catheterization ranged from 2 to 7 days, with a mean of 3.1 days. The hospitalization stay ranged from 5 to 15 days, with a mean of 6.35 days. Thirteen patients (65%) had complete resolution of symptoms, 5 patients (25%) reported significant improvement, and 2 patients (10%) did not benefit from the operation. CONCLUSION: Long-term follow-up is necessary to determine the efficacy of this laparoscopic technique. The success rate for any incontinence procedure is usually inversely proportional to the duration of follow-up.

Adult↗
PubMed1996

Emergency laparoscopic procedures.

Emergency laparoscopic procedures (ELPs) have been performed since the 1960s. It never caught on due to limitations inherent in the actual procedure. Technological innovations notably in camera, electronic insufflators and light systems were key to the rebirth of laparoscopy in the late 1980s. This was mostly confined to elective indications where its benefits were most obvious. With increasing experience, the benefits of minimally access surgery (MAS) are being applied to emergency indications such as evaluation of peritonitis and abdominal pain, appendectomy, repair of perforated ulcers and other acute conditions. ELP offers good training for surgeons but requires a trained laparoscopist to perform more complicated procedures. As there is not much time for thorough patient evaluation, patient selection and resuscitation are key to safe ELP. It should be done the same way as in open surgery; the difference is in the access. Visibility and technical difficulties are more likely and where further progress is limited or patient's condition changes, then early conversion is wise. Conversion rate in ELP is higher and the tolerance level for this should be much lower than in elective circumstances. However, the benefits of ELPs can be seen in decreased wound and other complications, and earlier mobilisation. Hospitalisation is not very much shorter in most instances as managing the disease process itself requires this. With time, more emergency procedures will be done laparoscopically for demand and knowledge will increase as patients and surgeons become familiar with MAS.

Abdomen, Acute↗
PubMed1995

Laparoscopic varicocelectomy: technique and results.

OBJECTIVE: To determine the safety and efficacy of laparoscopic varicocelectomy in the treatment of symptomatic varicocele. PATIENTS AND METHODS: Indications for surgery were subfertility in 98 patients and pain in nine. All varicoceles were confirmed on Doppler ultrasound. Seventy-two per cent of the patients had left-sided varicoceles and bilateral varicoceles were seen in 27%. A three-puncture technique was used with carbon dioxide insufflation. The spermatic vessels were individually identified and clips were used to ligate the veins. The spermatic artery was preserved in all cases. The operation was performed on a day surgery basis with an average operative time of 61.4 min (56.6 min for unilateral and 75.8 min for bilateral varicocelectomy). RESULTS: Morbidity was low, with pneumoscrotum in two patients and wound infection in two others. Sixty-one patients for whom pre- and post-operative seminal analyses were available showed improvement in sperm count and motility, with a concomitant fall in the percentage of abnormal sperm forms. CONCLUSION: Laparoscopic varicocelectomy is safe and effective, causing minimal discomfort and allowing patients an early return to activity.

Adult↗
PubMed1995

Nodular skin tuberculosis with lymphatic spread--a case report.

An unusual case of tuberculosis paronychia with skin infection of the big toe was recently seen in a patient returning from Kalimantan. This was complicated by inguinal lymphadenitis and tuberculosis abscess formation. The diagnosis was made on culture of the pus from the abscess and upon biopsy and histological examination of the skin lesion from the toe. The patient responded to surgical treatment and chemotherapy with ethambutol, rifampicin and isoniazid.

Adult↗
PubMed1994

Gastric ulceration with acute bleeding from tuberculosis of the stomach--a case report.

Tuberculosis of the stomach is a rarity. Its diagnosis is difficult as it is often unsuspected or unrecognised. This is a case report of an elderly man who presented with active upper gastrointestinal tract bleeding. The diagnosis was made postoperatively following gastrectomy for bleeding gastric ulcers. The histological specimens showed caseating epithelioid granulomas with Langerhan's giant cells centrally. The authors reviewed the recent literature on tuberculosis of the stomach, and suggest ways to identify the patients at risk.

Aged↗
PubMed1991

Ureterorenoscopy: factors influencing success.

The first 100 patients with ureteric calculi to undergo planned ureteroscopy and lithotripsy were retrospectively studied to evaluate the factors which influenced the success of the procedure. All 75 males and 25 females who underwent this procedure had surgical indications to treat the stones. The factors influencing a successful outcome were studied over four different time frames. It was found that the procedure was more successful in females, and lower ureteric stones. The stone size did not affect the outcome as expected. The learning curve was very evident as increased experience produced higher success rates for ureteric access and lithotripsy, less morbidity, shorter operating time and lower open surgery rates. The introduction of the miniscope and laser lithotripsy was however the most significant factor in ensuring a successful outcome.

Adult↗