Biomedical subjects

Yvan J Silva

Publications and source records attributed to Yvan J Silva.

7 recordsLinked to original sources

PubMed2006

Do support groups play a role in weight loss after laparoscopic adjustable gastric banding?

BACKGROUND: Surgical intervention represents the only treatment with long-term efficacy for morbid obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive operation that is increasing in popularity. We hypothesized that attending support groups is beneficial to achieve optimal weight loss after LAGB. METHODS: 38 patients who underwent LAGB between Dec 2002 and Aug 2003 were studied retrospectively. Patients were divided into 2 groups; A included 28 patients who did not attend the support groups (surgery without support groups), and B included 10 patients who attended the support groups (surgery with support groups). Weight loss between the 2 groups was compared over a 1-year period. RESULTS: Patients who attended support groups achieved more weight loss (mean decrease in BMI = 9.7 +/- 1.9) than patients who did not attend support groups (mean decrease in BMI = 8.1 +/- 2.1), P = 0.0437 (unpaired t-test). CONCLUSION: Support groups appear to be an important adjunct for patients who undergo LAGB, to achieve and maintain improved weight loss.

Adult↗

PubMed2004

Effects of surgical gloves on postoperative peritoneal adhesions and cytokine expression in a rat model.

BACKGROUND: Postoperative intraperitoneal adhesions are a major cause of morbidity. We studied the effects of synthetic and latex gloves, and their powders, on postoperative adhesions and cytokine expression in a rat model. METHODS: Rats underwent laparotomy and cecal abrasion. Rats were grouped based on the glove type used: synthetic powder-free (SPF), synthetic powdered (SP), latex powder-free (LPF), and latex powdered (LP). Serum cytokine (tumor necrosis factor [TNF], interleukin-1 [IL-1], and IL-6) levels were measured. Animals were killed and peritoneal adhesions were graded. RESULTS: The SPF group had no adhesions. Adhesions were increased similarly in the SP and LPF groups, and further increased in the LP group. Postoperative serum cytokine levels showed a similar pattern of increases. CONCLUSIONS: The presence of latex or powder on surgical gloves promoted increased adhesions. Serum cytokine levels correlated with the degree of adhesion formation. Strategies to use latex-free, powder-free gloves and/or limit cytokine expression may decrease peritoneal adhesions in the clinical setting.

Analysis of Variance↗

PubMed2002

Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease.

PURPOSE: The feasibility of laparoscopic colectomy for colon surgery has now been well established. Most of the studies on laparoscopic colectomies include all types of colonic pathologies without discrimination. Our goal was to compare laparoscopic sigmoid colectomy open sigmoid colectomy for simple sigmoid diverticular disease, to assess whether it can be done safely and whether the proposed advantages could be realized. METHODS: We evaluated the differences in outcomes of 66 laparoscopic sigmoid colectomy patients and 88 open sigmoid colectomy patients. We report a five-year outcomes analysis of 154 patients undergoing sigmoid colectomy for diverticular disease. We compared age, gender, history of prior abdominal surgery, estimated blood loss, operative time, total conversions with reason for conversion, time until a liquid diet was started, postoperative complications, hospital length of stay, operation costs, and total hospital charges incurred for both laparoscopic sigmoid colectomy and open sigmoid colectomy. RESULTS: Mean age and gender were similar in the two groups. However, the mean estimated blood loss (143 ml 314 ml), time until a liquid diet was started (2.9 4.9 days), and hospital length of stay (4.8 8.8 days) were all significantly less in laparoscopic sigmoid colectomy patients. The mean operative time for laparoscopic sigmoid colectomy was 212 minutes as compared with 143 minutes for open sigmoid colectomy ( < 0.05). Conversion rate of laparoscopic sigmoid colectomy to open procedure was 19.7 percent. All laparoscopic sigmoid colectomy patients received a lighted ureteral stent preoperatively, which was removed at the end of surgery. Relevant complications for laparoscopic sigmoid colectomy open sigmoid colectomy were as follows: anastomotic leak in 1 3 (1.5 3.4 percent) patients, hematuria in 64 6 (97 6.8 percent) patients, with an average duration for 2.93 3 days, urinary tract infection in 5 4 (7.6 4.5 percent) patients, and ureteral injury in 1 2 (1.5 2.2 percent) patients. Although the mean operating room charges were greater in the laparoscopic sigmoid colectomy patients ($9,566 $7,306) the mean hospital charges ($13,953 $14,863) were less. CONCLUSIONS: We recommend laparoscopic sigmoid colectomy as the modality of treatment for diverticular disease. Laparoscopic sigmoid colectomy seems to be a reliable, safe and efficacious treatment modality with better outcomes for diverticular disease of the sigmoid colon. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.

Colectomy↗

PubMed2002

Abdominal wall endometriomas.

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our institution was done. The mean age of the patients was 28.4 years. Twelve of these reported cases were secondary to previous surgery. One patient presented primarily with an abdominal wall mass without previous surgical history. The most common presentation was an abdominal wall mass associated with pain during the menstrual cycle. Endometrioma was considered as a differential diagnosis in seven patients. All patients underwent surgery. Along with the literature review on endometrioma, the importance of considering it in the differential diagnosis for patients of child-bearing age is discussed.

Abdominal Muscles↗

PubMedDate not supplied

The implications of lighted ureteral stenting in laparoscopic colectomy.

OBJECTIVE: The placement of indwelling ureteral catheters during colorectal surgery has been recommended for prevention of ureteral injuries. With the advent of laparoscopic colectomy (LCo), the role of preoperative placement of lighted ureteral stents (LUS) has also become commonplace. We sought to evaluate the value of lighted ureteral stent placement in laparoscopic colectomy. METHODS: Sixty-six patients underwent LCo with LUS inserted preoperatively. Stents were removed in the immediate postoperative period. Two surgeons performed all the colectomies; 32 patients were males and 34 were females. Fifty patients underwent sigmoid colectomy, 4 had abdominoperineal resection, 4 had right colectomy, and 1 each had transverse or subtotal colectomy. Eighteen patients had a diagnosis of cancer, 34 had diverticular disease, and 14 had neoplastic polyps. Forty patients had bilateral and 26 had unilateral stent placement. A review of the incidence of ureteral injuries, hematuria, and anuria as the cause of acute renal failure was accomplished, comparing the unilateral and bilateral stented groups. RESULTS: One (1.5%) patient suffered a left ureteral laceration during sigmoid colectomy. This was managed successfully with stent reinsertion. Sixty-five (98.4%) patients had gross hematuria lasting 2.93 days (1 to 6 days). The cost of bilateral stent placement was $1,504.32. A statistically significant difference occurred in the duration of hematuria (days) between patients who had unilateral (2.5 +/- 0.82) and bilateral stent placement (3.37 +/- 1.05), (P < 0.001). Four patients suffered from anuria, 2 required renal support needing hemodialysis for 3 to 6 days, 3 (75%) had bilateral stents, and 1 (25%) had a unilateral stent. CONCLUSIONS: We recommend the placement of lighted ureteral stents as a valuable adjunct to laparoscopic colectomy to safeguard ureteral integrity. Transient hematuria is common but requires no intervention. Reflux anuria occurs infrequently and is reversible.

Colectomy↗

PubMedDate not supplied

The laparoscopic challenge of cholecystitis.

OBJECTIVE: To evaluate the efficacy of laparoscopic cholecystectomy (LC) in acute and chronic cholecystitis and compare it with the open procedure. METHODS: This is a 5-year retrospective analysis performed at our hospital. Surgical treatment of gallbladder disease was performed in 1003 patients. Acute cholecystitis was present in 120 (11.9%) patients, and chronic cholecystitis was present in 830 (88.1%). Acute patients underwent surgery within 72 hours of symptom onset. The patients selected for LC or open cholecystectomy (OC) depended on the severity of disease, comorbid factors, and surgeon's preference. We reviewed age, sex, operating time, length of stay, perioperative complications, conversion rates, and cost. RESULTS: Patients chosen to undergo LC for acute cholecystitis tended to be younger females. Patients treated with LC for acute or chronic cholecystitis on average had a shorter operating time and length of hospital stay when compared with patients treated with OC (P < 0.005 by ANOVA with Bonferroni). Conversion rates (CR) for all LC decreased considerably from the first to the fifth year: 9% in 1995 (10/103), 9% 1996 (22/232), 4% in 1997 (8/188), 2% in 1998 (5/226) and 2% in 1999 (5/193). CONCLUSIONS: LC appears to be a reliable and cost-effective procedure for acute and chronic cholecystitis; however, the surgical approach should be chosen with caution because of the potential spectrum of technical difficulties. CR is also improving as surgeons' experience broadens.

Acute Disease↗

PubMedDate not supplied

Laparoscopic sigmoid colectomy for chronic diverticular disease.

BACKGROUND: The feasibility of laparoscopic sigmoid colectomy for diverticular disease has now been well established. We report herein our experience with laparoscopic sigmoid colectomy in 100 patients who underwent laparoscopic colectomy for chronic diverticular disease. METHODS: A retrospective review was performed of a 7-year period from January 1995 to June 2002. Chronic diverticular disease was treated with laparoscopic sigmoid colectomy in 100 patients. The setting was a community hospital. All cases were performed by 1 of 2 colorectal surgeons. All laparoscopic sigmoid colectomy patients received lighted ureteral stents placed preoperatively that were removed at the end of surgery. RESULTS: Mean age was 61.6 years. The male to female ratio was 38:62. The mean estimated blood loss was 138 mL, liquid diet was tolerated for 2.4 days, and hospital length of stay was 4.6 days. The mean operative time for laparoscopic sigmoid colectomy was 196 minutes. Relative complications for laparoscopic sigmoid colectomy are as follows: anastomotic leak in 2 (3.0%) patients, hematuria in 95 (95%) with an average duration for 3.1 days, urinary tract infection in 6 (6%), and ureteral injury in 1 (1%). The mean operating room charges in the laparoscopic sigmoid colectomy patients was dollars 9,643. CONCLUSION: We recommend laparoscopic sigmoid colectomy as the modality of treatment for chronic diverticular disease. Laparoscopic sigmoid colectomy appears to be a reliable, safe, and efficacious treatment modality for chronic diverticular disease. The operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience.

Adult↗