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Biomedical subjects

V J Bagnato

Publications and source records attributed to V J Bagnato.

13 recordsLinked to original sources
PubMed1993

Laparoscopic choledochoscopy and choledocholithotomy.

Laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the treatment of choice for patients with cholelithiasis. Complications of cholelithiasis are likewise being treated laparoscopically. Choledocholithiasis represents a major challenge for the laparoscopic surgeon. This report is of the early experience with laparoscopy as the primary treatment of common bile duct stones. Two methods are described: (a) transcystic duct choledochoscopy and (b) laparoscopic choledochotomy. Twenty-two patients were encountered with choledocholithiasis (4.8% of total cholecystectomies). Successful laparoscopic choledocholithotomy was performed in 18 cases (82%). Techniques and options are discussed.

Common Bile Duct↗
PubMed1992

Surgical thoracoscopy: a preliminary report.

Laparoscopic surgery has demonstrated advantages of less pain, early recovery, and cosmesis. Applying laparoscopic surgical techniques to thoracic procedures may allow for similar advantages. New instrumentation provides for greater versatility in treating thoracic conditions. Described herein is the use of thoracoscopy for a variety of thoracic procedures.

Adolescent↗
PubMed1992

Treatment of recurrent spontaneous pneumothorax.

Thoracoscopy is a natural extension of laparoscopic techniques that have proved to be useful in the treatment of biliary tract disease and other general surgery problems. Similar to the experience with laparoscopic surgery, thoracoscopy also provides for early recovery and return of normal activity. The treatment of spontaneous pneumothorax under thoracoscopic guidance represents a major advance in thoracic surgery. Recently developed endoscopic stapler devices allow for both the excision and closure of ruptured blebs in a fashion identical to the traditional approach with open thoracotomy. Presented in this report are 17 consecutive cases of pneumothorax that were treated using a thoracoscopic approach. No postoperative complications were encountered and no recurrences have been identified. The surgical methods and techniques are outlined.

Adolescent↗
PubMed1992

Laparoscopic Nissen fundoplication.

Laparoscopic Nissen fundoplication represents a minimally invasive surgical approach to symptomatic gastroesophageal reflux and may offer patients an attractive alternative to indefinite medical therapy. Fourteen patients with persistent gastroesophageal reflux and two with severe achalasia underwent a laparoscopically guided 360-degree or Nissen fundoplication. Both individuals with achalasia also had an extended distal esophagomyotomy. Two patients required conversion to open laparotomy because of difficulties in defining the anatomy of the posterior esophagus. All 16 patients reported complete relief of their symptoms. The average length of hospital stay was four days. These early results of laparoscopic Nissen fundoplication are encouraging and hopefully will stimulate further experience in this area.

Gastric Fundus↗
PubMed1992

Modern operative thoracoscopy.

Laparoscopic surgery has demonstrated advantages of less pain, early recovery, and cosmesis. Applying laparoscopic surgical techniques to thoracic procedures may allow for similar advantages. New instrumentation provides for greater versatility in treating thoracic conditions. Described herein is the use of thoracoscopy for a variety of thoracic procedures.

Biopsy↗
PubMed1992

Thoracoscopic treatment of spontaneous pneumothorax without pleurodesis: a preliminary report.

Laparoscopy has shown to be associated with less morbidity than laparotomy. General surgeons are realizing that procedures so far performed through traditional incisions can be equally performed effectively by laparoscopy. Likewise it is apparent that some thoracic procedures are amenable to thoracoscopic approach. With the development of new instrumentation thoracoscopy is effective for the treatment of spontaneous pneumothorax. Pleurodesis seems to increase the morbidity associated with the thoracoscopic procedure and may reduce its effectiveness. Results of 17 consecutive cases of spontaneous pneumothorax treated thoracoscopically without pleurodesis are herein presented. No significant complications were encountered and no recurrences have been identified so far. Pleurodesis was omitted chiefly because it increases the morbidity of thoracoscopy.

Adolescent↗
PubMed1991

Justification for routine cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has been accepted by surgeons in the United States with unprecedented rapidity. Since introduction it has become, in many areas, the standard of care for treating patients with cholelithiasis. However, as with all new surgical procedures, complications are being recognized. Bile duct injuries are a complication of laparoscopic cholecystectomy, perhaps with greater incidence than with traditional cholecystectomy. Routine cholangiography may minimize the incidence of common bile duct injury. We review our experience with laparoscopic cholangiography and suggest methods to avoid common bile duct injury.

Catheterization↗
PubMed1987

Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage.

Mediastinitis is an infrequent but life-threatening complication after cardiac operations. We reviewed our experience in treating eight select patients in whom this complication developed. Diffuse mediastinitis was verified at operation, and all patients were treated with the same surgical procedure by the same surgeon. The technique consisted of sternal bone débridement, mediastinal fat and connective tissue excision, pericardiectomy, and transfer of the greater omentum into the mediastinum on a vascular pedicle for obliteration of dead space. The sternum and sternal fascia were closed completely and the skin was closed loosely in each case. Postoperative drainage was not provided and postoperative irrigation was not performed. The mortality rate was 12.5% and the hospital stay averaged 27 days, comparable to other series in which irrigation has been used. We conclude from this review that the approach of omental transfer provides an alternative to prolonged irrigation and drainage of the mediastinum in the surgical management of these critically ill patients. This is neither a radical nor a disfiguring procedure, but is simple and easily done by the cardiac surgeon. Early ambulation, because of a lack of cumbersome irrigation and drainage apparatus, results in improved pulmonary function. Dead space is obliterated with tissue that has demonstrable ability to resist infection. Also, loose closure of the skin allows for primary healing with a good cosmetic result.

Drainage↗
PubMed1986

Vacuum-assisted perfusion of the dog hindlimb.

A method for rapidly changing perfusion pressure to the relatively intact dog hindlimb using vacuum assistance is proposed and demonstrated. The hindlimb of an anesthetized dog is inserted into a rigid sealed enclosure for application of a partial vacuum. The circulation of the hindlimb remains entirely intact except for a single large noncollapsible catheter placed in the femoral vein and connected to a servo-pump. The servo-pump maintains the venous pressure equal to the enclosure pressure even when this pressure is in the partial vacuum state. The automatically adjusted pumping rate of this pump also provides a continuous measure of the blood flow in the limb as it returns the blood via a jugular catheter. In nine dogs the systemic arterial pressure was maintained constant, and the enclosure pressure and venous pressure were set to subatmospheric levels, thus changing the perfusion pressure to any desired value up to 220 mmHg. The procedure had minimal impact on the central circulation, suggesting that the technique may be useful in studying hemodynamics of the hindlimb or other organs at high perfusion pressure, which has always been difficult to achieve experimentally. In the nine dogs, blood flow responses were observed at both elevated and reduced perfusion pressure. The changes in measured blood flow induced by the changes in perfusion pressure were variable but were generally directly proportional to perfusion pressure in the steady state.

Animals↗