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W T Siu

Publications and source records attributed to W T Siu.

29 records · Page 2Linked to original sources
PubMed1998

Laparoscopic gastropexy for chronic gastric volvulus.

Gastric volvulus is an infrequently encountered clinical entity characterized by abnormal rotation of the stomach around an axis made by its two fixed portions, the cardia and pylorus. Surgical treatment by anterior gastropexy is usually indicated for chronic gastric volvulus to prevent complications and treat the underlying pathology. We report a patient with chronic gastric volvulus who was treated with laparoscopic anterior and diaphragmatic gastropexy. Laparoscopy not only identifies underlying predisposing conditions but also allows effective fixation for gastric volvulus. Laparoscopic approach minimizes the access trauma and is superior for benign upper gastrointestinal lesions.

Adult↗
PubMed1998

In vitro bovine ciliary body/epithelium in a small continuously perfused Ussing type chamber.

Our goal is to assess the viability of an in vitro preparation of bovine ciliary body/epithelium (CBE) in a small volume Ussing-type chamber. A new small volume Ussing-type chamber with continuous perfusion was developed for bovine CBE. The trans-CBE electrical parameters were monitored and the electrical responses of the CBE to ouabain (1 and 0.01 mM) were recorded. The trans-CBE fluxes of [14C]-L-ascorbate and [3H]-L-glucose were also studied. The bovine CBE preparation was stable inside the chamber in terms of its potential difference (PD), short circuit current (SCC) and trans-CBE resistance. They were -0.51+/-0.05 mV (aqueous side negative), -5.43+/-0.04 microAcm-2 and 94+/-2 Q.cm2 (mean s.e.m., n=35), respectively. The preparation hyperpolarised when 0.01 mM ouabain was administered to the aqueous side, depolarised when ouabain was applied to the stromal side. [3H]-L-glucose diffusion was about 74 nEq h(-1)cm(-2) in either direction (n=12). Taking the area magnification factor of the CBE into consideration, the diffusional L-glucose flux across the bovine CBE was comparable to other tight epithelia. A significant net ascorbate flux (0.26+/-0.05 nEq h(-1)cm(-2), n=4, p<0.01) was found in the stroma to aqueous direction. We have developed a viable in vitro bovine CBE preparation which was (1) electrically stable, (2) responsive to ouabain, (3) tight to L-glucose diffusion, and (4) capable of actively secreting ascorbate. A net trans-CBE chloride transport (0.81+/-0.30 microEq h(-1)cm(-2), n=12, p=0.01) from stromal to aqueous side was found in the present in vitro model under short-circuited conditions.

Animals↗
PubMed1997

Laparoscopic resection of bleeding gastric polyps.

Gastric polyps account for a small proportion of gastric neoplasms. Many of them presented with acute or chronic bleeding. Endoscopic polypectomy is the preferred treatment modality. However, endoscopic polypectomy is often incomplete and impossible for large polyps. Large and intramural polyps require laparotomy and excision. From June to October 1995, four patients with bleeding gastric polyps received laparoscopic resection in our unit. All were women, aged 40-78, with polyps 2-6 cm in diameter. One patient underwent emergency surgery for active bleeding. The others received elective operations. Operating time ranged from 90 to 120 min. There was no perioperative morbidity or mortality. Full diet was resumed by the 4th postoperative day. The average postoperative hospital stay was 5. 3 days (4-7). Laparoscopic resection of gastric polyp is a preferable treatment option when endoscopic treatment fails.

Aged↗
PubMed1997

Single stitch laparoscopic omental patch repair of perforated peptic ulcer.

The standard treatment for perforated peptic ulcers in most institutions is omental patch repair and lavage. A laparoscopic approach is attractive because of the simplicity of the procedure. Most of the previously described laparoscopic methods required multiple working ports and multiple stitches. We employed three operating ports and applied a single stitch to close small peptic ulcer perforations. Prospective evaluations of the initial 33 cases of laparoscopic patch repair have confirmed its safety. There were five conversions, two for large perforations (> 10 mm), two for perforated gastric ulcers and the remaining one was converted because of bleeding. One patient early in the series with a 10-mm perforation suffered from radiological leakage after repair, which required secondary intervention. The mean operating time was 50 min. Patients, on average, require one dose of intramuscular pethidine (1 mg/kg body weight) for pain relief. The mean hospital stay was 6 days and 97% of them returned to their daily activities within 10 days of the operation. There was no mortality.

Adult↗
PubMed1997

Laparoscopic management of ruptured pyogenic liver abscess.

Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically. The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples. A thorough peritoneal lavage could be also performed. The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.

Aged↗
PubMed1996

Gasless laparoscopic excision of bleeding gastric polyp.

A case of bleeding gastric polyp in an elderly woman with compromised respiratory function was treated successfully as an emergency by the gasless laparoscopic technique after endoscopic means failed to control the bleeding. The application of laparoscopic mechanical stapling devices allows rapid gastrotomy and resection, with simultaneous hemostasis that is beneficial in acute bleeding condition. The use of gasless laparoscopy also allows continuous suction to be applied for identification of the bleeding pathology and it also reduces the risk of pneumoperitoneum in patients with poor cardiorespiratory reserve. The operative approach and technique are fully discussed.

Aged↗
PubMedDate not supplied

Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones.

BACKGROUND/AIMS: To demonstrate the safety and feasibility of primary closure of the common bile duct (CBD) after laparoscopic choledochotomy in patients with CBD stones. Traditionally, the CBD is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication and the patients have to carry it for several weeks before removal. In the laparoscopic era, surgery is performed with minimally invasive techniques in order to reduce the trauma inflicted on patients, hasten their recovery and hence reduce the hospital stay. T-tube insertion seems to negate these benefits and we believe that primary closure can be as safe as closure with T-tube drainage. METHODOLOGY: This is a retrospective analysis of patients who underwent primary closure of the CBD after successful laparoscopic choledochotomy for ductal stones between January 2000 and December 2003. A concurrent control group of patients who underwent T-tube drainage was used for comparison. RESULTS: Of the 64 patients that underwent laparoscopic exploration of the CBD, 24 (37%) underwent transcystic duct approach and 40 (63%) underwent choledochotomy. There were three open conversions (5%). Stone clearance was achieved in all patients with successful laparoscopic choledochotomy (100%). Of the 38 successful laparoscopic choledochotomies, 12 had primary closure of the CBD and 26 had closure with T-tube drainage. There was no mortality in both groups. One patient in the primary closure group suffered from paralytic ileus and small subhepatic collection which was treated conservatively. The median operative time (90 vs. 120 minutes, p=0.002) and postoperative stay (5 vs. 8.5 days, p=0.003) were shorter in the primary closure group when compared with the T-tube group. CONCLUSIONS: Primary closure of the CBD is feasible and as safe as T-tube insertion after laparoscopic choledochotomy for stone disease.

Adult↗
PubMedDate not supplied

Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction.

BACKGROUND/AIMS: Only a minority of patients with tumor at the pancreaticoduodenal junction is suitable for resection, palliation is however often required relieving the obstructive jaundice and gastric outflow obstruction (GOO). This study evaluates endo-laparoscopic approach as a palliative treatment of obstructive jaundice and malignant gastric outflow obstruction. METHODOLOGY: A retrospective review of a prospectively maintained database. During the period from 1992-2002, patients with diagnosis of unresectable tumor at the pancreaticoduodenal junction were evaluated. If the tumor was confirmed to be unresectable, patients would be offered either open double bypass or laparoscopic gastrojejunostomy (LGJ) +/- endoscopic or percutaneous transhepatic stenting for any obstructive jaundice, the choice of approach would depend on whether the endoscopic access was still maintained. RESULTS: Out of 942 patients with tumors around the pancreaticoduodenal junction during the study period from 1992-2002, there were 34 patients (13 male & 21 female) with median age 69 years (range, 48-87) selected for LGJ. Of these 34 patients, 3 of them underwent endoscopic biliary stenting whereas 16 jaundice patients were palliated by transhepatic biliary drainage. When the results were compared to the 35 open double bypass (roux-en-Y choledochojejunostomy and gastrojejunostomy) during the same study period, the median operation time was significantly shorter (80 vs. 135 minutes; P=0.0001) and median intraoperative bleeding was significantly less in the endo-laparoscopic group (0 vs. 100mL; P=0.0001). Two patients in the endo-laparoscopic group were converted to open because of tumor infiltration of the small bowel mesentery causing difficulty in construction of gastrojejunostomy. Although the overall complication rate (13 vs. 17; P=0.387) and incidence of delayed gastric emptying (7 vs. 7, P=0.952) were similar in both groups, the incidence of wound infection was remarkably less common in the endo-laparoscopic group (0 vs. 6, P=0.012). The 15 postoperative complications (13 patients) in the endo-laparoscopic group (38.2%) included prolonged gastric stasis (7), biliary sepsis (2), chest infection (2), myocardial ischemia (2), gastrointestinal bleeding (1) and extensive ischemic stroke (1). Median time to resume diet was statistically shorter in endo-laparoscopic group (5 vs. 7 days, P=0.009) however the hospital stay was similar in both groups (11.5 vs. 14 days, P=0.238). The hospital mortality rate was again comparable between the two groups (6 vs. 5, P=0.703). The short median survival in the endolaparoscopic group (3 vs. 7 months; P=0.0001) might just be a reflection of selection bias. CONCLUSIONS: With the advent of laparoscopic and endoscopic surgery, palliation of both gastric outflow obstruction and obstructive jaundice can also be accomplished using the endo-laparoscopic approach. In comparing to the open double bypass, operation time, intraoperative blood loss and incidence of wound infection are significantly less and patients can have early resumption of diet. However, the results can be improved further with a better patient selection and perioperative optimization.

Aged↗
PubMedDate not supplied

Non-operative management of endoscopic iatrogenic haemobilia: case report and review of literature.

Haemobilia denotes an abnormal communication between a vessel of the splanchnic circulation and the biliary system. Patients typically presents with the triad of abdominal pain, upper gastrointestinal haemorrhage, and jaundice. Common causes for haemobilia are iatrogenic causes secondary to hepatobiliary system instrumentation and trauma. Management of patients with haemodynamic significant haemobilia is aimed at stopping bleeding, maintaining continuous flow of biliary system, and cure of the underlying aetiology. Iatrogenic haemobilia after ERCP polyethylene biliary endoprosthesis placement is extremely uncommon. Herein we present a case of iatrogenic haemobilia triggered by biliary endoprosthesis placement and was successfully managed by non-operative treatment. The management algorithm for a rational approach to haemobilia is discussed.

Angiography↗
PubMedDate not supplied

Laparoscopic management of acute torsion of the omentum in adults.

BACKGROUND: Acute torsion of the greater omentum is a rare cause of acute abdomen in adults. We report our experience on the clinical presentation, diagnosis, treatment, and outcome of this condition. METHOD: This is a retrospective review of 9 patients who had a clinicopathologic diagnosis of acute torsion of the greater omentum and were treated at the Department of Surgery, Pamela Youde Nethersole Eastern Hospital from January 1994 to March 2004. Eight patients were male and 1 was female with a median age of 43 years (range, 24 to 65). Median body mass index was 24 kg/m(2) (range, 22 to 24). All presented with acute abdominal pain with a median temperature of 36.8 degrees C (range, 36.5 to 37.2) and a median white cell count of 9.5 x 10(9)/L (range, 7.4 to 15.1 x 10(9)). Preoperative ultrasound was done in 5 patients. RESULTS: All diagnoses were made during surgery. Resection of the infarcted omentum was performed for all patients (5 laparoscopic resections and 4 open resections). No postoperative complications occurred. The overall median time from admission to operation was 23 hours (range, 2 to 98). The overall median operating time and postoperative stay were 70 minutes (range, 38 to 105) and 3 days (range, 1 to 6), respectively. The median oral and parenteral analgesic requirement for postoperative pain control was less and the median hospital stay was shorter in patients who underwent laparoscopic resection. CONCLUSION: Acute torsion of the greater omentum is an uncommon cause of acute abdomen in adults, and preoperative diagnosis is usually difficult. Laparoscopy seems a safe and minimally invasive technique for both diagnosis and treatment of this rare disease entity.

Acute Disease↗