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At least 37 records · Page 2Linked to original sources
PubMed1999

How large should a skin trephine be for an end stoma?

BACKGROUND: Although much has been written about techniques for making a good stoma, little has been described regarding how to excise a trephine that will perfectly fit a given end stoma. METHODS: A reproducible technique for making a stomal trephine to a precise fit for each stoma is described. RESULTS: More than 20 stomas have been made with good results. CONCLUSION: The skin trephine should have a diameter approximately two-thirds of the width of the crushed bowel end.

Colostomy↗
PubMed1998

Hepatic parenchymal perfusion abnormalities after pancreaticobiliary surgery. Evaluation with dynamic helical CT.

PURPOSE: To evaluate perfusion abnormalities of the liver after pancreaticobiliary surgery. MATERIAL AND METHODS: We retrospectively evaluated 128 patients with pancreaticobiliary malignant tumors who had been examined both before and after surgery by means of helical CT of the liver. An infusion of 3 ml/s of 60% nonionic contrast material was followed by helical CT of the liver in a sequential arterial phase, portal venous phase, and equilibrium phase. RESULTS: Of 128 patients, we followed 97. In 21 patients (22%) we found 47 lesions with perfusion abnormalities that were detected 1-33 months (mean 6.6 months) after the operation. All patients were asymptomatic. The shape of each perfusion abnormality was characterized as geographic (n = 23, 47%), wedge-shaped (n = 21, 45%), or round (n = 3, 8%). The abnormalities were seen in the arterial phase in 46 lesions (98%), in the portal venous phase in 18 lesions (38%), and in the equilibrium phase in 1 lesion (0.2%). In all lesions, the size either decreased spontaneously, or it remained unchanged for more than one year. CONCLUSION: Perfusion abnormalities of the liver may occur in patients who undergo pancreaticobiliary surgery. This findings should not be confused with hypervascular metastases.

Aged↗
PubMed1998

Bibliography.

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Cardiac Surgical Procedures↗
PubMed2005

Early experience with laparoscopic inguinal hernia repair in a district general National Health Services hospital.

The introduction of laparoscopic hernia repair into the National Health Services (NHS) gave us an opportunity to study the feasibility and practicality of carrying out this modern hernia repair technique in a district general NHS hospital. The laparoscopic tension-free transabdominal preperitoneal (TAPP) method of hernia repair, as we do it, is cost-effective and efficacious. Most patients can be treated as day cases. We discovered incidental hernias in 18.8% of patients, which were treated simultaneously. A low recurrence rate (0.17%) with low morbidity makes it an attractive method for routine treatment of groin hernias in the NHS.

Adolescent↗
PubMed2005

Delayed massive hemorrhage after pancreatic and biliary surgery: embolization or surgery?

OBJECTIVE: To analyze the management of delayed massive hemorrhage (DMH) after major pancreatic and biliary surgery. SUMMARY BACKGROUND DATA: Despite a decreased mortality rate for pancreatic and biliary surgery, DMH is still an important cause of postoperative mortality. The aim of the present study was to analyze the management of DMH after pancreatic and biliary surgery, and specifically to assess the role of embolization and surgical intervention. METHODS: The study group (SG) consisted of 1010 patients from 1994 to 2002 who underwent pancreatic or biliary surgery (cholecystectomy excluded). Patients from a previous study (1983-1993, n = 686) were used as a historical control group (HCG). RESULTS: The incidence of DMH (SG 2.3% vs. HCG 3.2%) declined somewhat but did not differ significantly between both periods. The number of patients with a septic complication (SG 74% vs. HCG 50%) and a sentinel bleed (SG 78% vs. HCG 100%) before the onset of DMH did not differ significantly. Embolization (SG 2 of 2 patients vs. HCG 0 of 2 patients) was not used frequently. Successful outcome after surgical intervention (SG 14 of 16 patients vs. HCG 8 of 14 patients) and the surgical procedures performed to obtain hemostasis were comparable and overall mortality (SG 22% vs. HCG 29%) was comparable. CONCLUSIONS: The incidence of DMH declined somewhat from 3.2% to 2.3% over the past years. Most patients present with septic complications and a sentinel bleed before onset of DMH. Despite general acceptance of embolization in our unit, it was used infrequently in patients with DMH. Aggressive surgical intervention was the treatment of choice in patients with DMH after pancreatic or biliary surgery.

Adult↗
PubMed2002

Hepatic trauma.

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Bile Ducts↗
PubMed2000

Early results of inguinal hernia repair by the 'mesh plug' technique--first 200 cases.

INTRODUCTION: Inguinal hernia repair is the most common surgical procedure performed in the UK. Evidence from several earlier studies suggests that primary inguinal hernia repair has a high recurrence rate of 10-15%. The Royal College of Surgeons of England guidelines suggested the use of layered suture (Shouldice) or prosthetic (Lichtenstein) repair. Per-fix plugs have been used in the US for more than a decade with excellent results. This study was a series of 200 consecutive cases. The aim was to evaluate the mesh plug technique in the repair of all types of inguinal hernias and its results in one consultant practice within a district general hospital. PATIENTS AND METHODS: In a 15-month period between 1997 and 1998, all patients with inguinal hernias presenting to the general surgical clinic of one consultant were recruited to the study. All had mesh plug repair under local (n = 40), regional (n = 50) or general (n = 110) anaesthesia either by the consultant, associate specialist or specialist registrar (following initial training), using the same standard technique. The majority 80% (n = 160) were done as day cases. The results were evaluated by questionnaire and personal outpatient review initially at 3 weeks, then at 1 year (9-13 months). RESULTS: 200 consecutive patients with inguinal hernias underwent mesh plug repair; mean age was 54 years (95% CI, 46-61). The majority of patients had primary (n = 180) and others had recurrent (n = 20) hernia. All types of hernia (Gilbert's I-VII) were included. Median follow-up was 1 year (9-15 months). Groin pain, which was the leading symptom at presentation, was relieved in 96% of the patients; 79% returned to previous jobs within 4 weeks (95% CI, 0.71-0.87). All retired patients resumed normal life activities within 2 days. Postoperative pain was minimal; 28 patients did not require any postoperative analgesia. There were very few minor (n = 6) and no major complications. During the follow-up, one recurrence occurred. CONCLUSIONS: Mesh plug repair is associated with minimal postoperative pain, quick recovery and return to work. It is an ideal technique for day-case surgery. Although longer follow-up will be required to assess true recurrence rate, so far the recurrence rate at 0.5% is acceptable, particularly in the light of other published series.

Adult↗