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At least 631 records · Page 35Linked to original sources
PubMed1997

Simultaneous bilateral breast reconstruction with the transverse rectus abdominus musculocutaneous free flap.

OBJECTIVE: The purpose of the study was to assess the results and morbidity associated with simultaneous bilateral TRAM free flap breast reconstruction and describe refinements in its surgical technique. SUMMARY BACKGROUND DATA: Bilateral prophylactic total mastectomies might be an agreeable option for those patients at highest risk for breast cancer if autogenous tissue breast reconstruction could be performed with reasonable technical ease and acceptable morbidity. However, some surgeons harbor reservations regarding the extensiveness of the surgery, the associated morbidity, and the aesthetic quality of the resulting outcome. METHODS: A multicenter retrospective review of clinical experience with 120 consecutive patients who underwent 240 simultaneous bilateral TRAM free flap breast reconstructions was developed. RESULTS: The average operating time, including the time required for the breast ablative portion of the procedures, was 8.6 hours. The average length of hospitalization was 7.6 days. However, for the last 40 patients, these figures were reduced to 7.1 hours and 6.1 days, respectively. Nonautologous blood transfusions were needed in 33 cases (28%), but only 1 was required in the last 40 patients. Thromboses developed in six of 240 flaps (2.5%): 4 were arterial and 2 were venous. Re-exploration allowed us to restore circulation in five flaps, whereas one flap was unsalvageable and was replaced successfully with an alternate flap. An uncomplicated deep vein thromboses developed in one patient with a history of recurrent deep vein thromboses that had no adverse effect on her outcome. Minor complications developed in 18 patients (15%) (e.g., hematoma, partial wound necrosis, wound infection, or prolonged postoperative ileus) that did not affect the long-term outcome. Fourteen patients (11.6%) had abdominal wall weakness or hernias. Follow-up time averaged 37.2 months (range, 14-62 months). On last follow-up, patients' self-reported overall satisfaction with the procedure was 56% excellent, 40% good, and 4% fair. CONCLUSIONS: Simultaneous bilateral free flap reconstruction is technically feasible with a high rate of success and an acceptable morbidity. When performed by experienced surgeons, bilateral prophylactic total mastectomies combined with simultaneous bilateral TRAM free flap reconstruction may provide an adequate surgical option with aesthetically acceptable results for patients at high risk for breast cancer.

Blood Loss, Surgical↗
PubMed1998

Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse.

OBJECTIVE: Our purpose was to compare anatomic and functional results of 2 procedures performed at vaginal hysterectomy for vaginal vault suspension in patients with advanced uterovaginal prolapse. STUDY DESIGN: A retrospective case-control study was designed comparing 62 patients who underwent sacrospinous ligament fixation and 62 members of a matched control group who underwent modified McCall culdoplasty during vaginal hysterectomy and reconstructive pelvic surgery. The 62 pairs were matched for grade of uterine prolapse, age, parity, dystocia, menopause, body mass index, previous prolapse surgery, heavy work, constipation, and chronic cough. RESULTS: Operative time and blood loss were significantly greater (P < .001) in the group with sacrospinous suspension. With a follow-up from 4 to 9 years, 17 (27%) patients receiving sacrospinous suspension had prolapse recurrence at any vaginal site compared with 9 (15%) patients receiving modified McCall culdoplasty (P = .14). Recurrent vault prolapse was recorded in 5 (8%) and 3 (5%) subjects, respectively (P = .72). Thirteen (21%) and 4 (6%) patients, respectively, had recurrent cystocele (matched odds ratio 4.1, 95% confidence interval 1.3 to 14.2, P = .04). No significative difference was observed in postoperative sexual function. CONCLUSION: Sacrospinous ligament fixation is not recommended as a prophylactic measure at vaginal hysterectomy in patients with uterovaginal prolapse.

Adult↗
PubMed2002

Surgical techniques used during caesarean section operations: results of a national survey of practice in the UK.

OBJECTIVE: To determine what surgical techniques are used by obstetricians in the UK for elective and emergency caesarean section operations. STUDY DESIGN: A postal questionnaire to all members and fellows of the Royal College of Obstetricians and Gynaecologists (RCOG) resident in the UK, requesting information about the use of surgical techniques and antibiotic and anticoagulant prophylaxis for elective and emergency caesarean sections. RESULTS: The response rate was 78.7%. A range of techniques was used for all procedures in caesarean section operations. Only a few techniques were used by more than 80% of obstetricians, including double layer closure of the uterus, use of prophylactic antibiotics and Pfannenstiel abdominal entry (for elective caesarean sections). There were few large differences in practice between elective and emergency caesarean sections. In emergency operations, more obstetricians use the Joel-Cohen method of abdominal entry (32.7 versus 16%) and more usually use prophylactic antibiotics and heparin (93.2 versus 85.4% and 45.8 versus 32.9%, respectively). CONCLUSIONS: There was wide variation in the surgical techniques used by obstetricians for caesarean section operations. There is an urgent need for future research to evaluate many aspects of caesarean section operations on substantive short- and long-term outcomes.

Anti-Bacterial Agents↗
PubMed2001

Outcome of primary and secondary ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis.

PURPOSE: The aim of this study was to present Swedish experiences of the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis from the introduction in 1984. The study also compared the surgical and functional outcome of different anal continence preserving procedures: ileal pouch-anal anastomosis as primary surgery, ileal pouch-anal anastomosis as secondary surgery after colectomy and ileorectal anastomosis, and ileorectal anastomosis alone. METHODS: The material comprises all 120 patients with familial adenomatous polyposis reported to the Swedish Polyposis Registry who had undergone prophylactic colorectal surgery, including those operated on because of colorectal cancer from 1984 until the end of 1996. Anal continence preserving surgery was performed on 102 patients: 20 had ileal pouch-anal anastomosis as primary surgery at a median age of 24.5 years, 39 had ileal pouch-anal anastomosis as secondary surgery at a median age of 34 years, and 43 had ileorectal anastomosis alone, at a median age of 26 years, because 6 of the initially ileorectal anastomosis-operated patients were converted to ileal pouch-anal anastomosis as secondary surgery. Surgical outcome was assessed on the basis of hospital records. A questionnaire was used to evaluate the functional outcome. Fisher's exact probability test was used for statistical analysis. RESULTS: Complications occurred in 51 percent of the patients after ileal pouch-anal anastomosis: 40 percent after ileal pouch-anal anastomosis as primary surgery and 56 percent after ileal pouch-anal anastomosis as secondary surgery. When the previous ileorectal anastomosis was taken into account 67 percent of the patients suffered complications which was significantly more compared with ileal pouch-anal anastomosis as primary surgery. After ileorectal anastomosis, 26 percent had complications which was significantly less compared with all other procedures but ileal pouch-anal anastomosis as primary surgery. No cancer occurred after ileal pouch-anal anastomosis, either in the ileal pouch or in retained rectal mucosa, but two of the patients who had an ileorectal anastomosis developed rectal cancer. One pouch excision was performed compared with ten rectal excisions. Functional outcome did not differ between ileal pouch-anal anastomosis as primary surgery and ileal pouch-anal anastomosis as secondary surgery. However, ileorectal anastomosis-operated patients had significantly better bowel function with regard to nighttime stool frequency, continence and perianal soreness. CONCLUSION: These findings indicate that major advantages of ileal pouch-anal anastomosis are the low excision rate and, so far, no cancer in the ileal pouch. Moreover, the surgical outcome of ileal pouch-anal anastomosis as primary surgery is not significantly different from that of ileorectal anastomosis. However, the good surgical and functional outcome of ileorectal anastomosis, despite the long-range prognosis including rectal cancer and excision risks, has to be taken into consideration when selecting patients with familial adenomatous polyposis for primary surgery.

Adenomatous Polyposis Coli↗
PubMed1997

Leonard I. Malis and prophylactic antibiotics.

Leonard I. Malis introduced important changes in the antimicrobial regimen for neurosurgical procedures at The Mount Sinai Hospital. Among Dr. Malis' innovations, intraoperative administration of a single dose each of vancomycin and gentamicin or tobramicin and constant irrigation of the surgical site with a bactericidal antibiotic (streptomycin) led to the elimination of primary wound infections during a 20-year period. In a study to locate potential sources of microbial contamination in his operating room, this combination of parenteral antibiotics was justified, because 36% of patients were at risk for exposure to methicillin-resistant Staphylococcus aureus and Gram-negative bacteria. Streptomycin as a topical agent was found to be highly efficacious in preventing intraoperative growth of potential pathogens cultured from the surgical wound and the operating room environment.

Antibiotic Prophylaxis↗
PubMed2006

[Loss of vision after non-ophthalmic surgery: systematic review of the literature on incidence, pathogenesis, treatment and prevention].

BACKGROUND AND GOAL: Postoperative loss of vision is a rare, but devastating complication after non-ocular surgery. It can occur partially or completely and may involve one or both eyes. Since its etiology has not yet been solved, the purpose of this review was to extract potential causes from the case collections reported to propose prophylactic measures. METHODS: A literature search was performed using the "Pubmed" database of the US National Library of Medicine. MeSH terms and combinations used were: blindness, postoperative complications, ischemic optic neuropathy, not ophthalmological surgical procedures, not neurosurgical procedures. Additionally, the results of the interim analysis of the postoperative visual loss (POVL) registry of the ASA were considered. RESULTS: The incidence of permanent loss of vision after non-ophthalmologic surgery is reported to be 0.0008%. However, it is elevated up to 0.11% after cardiac and 0.08% after spine surgery. Risk factors seem to be perioperative anemia, arterial hypotension and prone position, but also pre-existing diseases such as arteriosclerosis. Thus hemodynamic stabilization or correction of anemia may be successful in therapy. CONCLUSION: Patients with pre-existing arteriosclerotic disease scheduled for spine or cardiac surgery, but also for bilateral neck dissection should be informed preoperatively about the rare possibility of POVL. Postoperatively any visual changes should be immediately referred to an ophthalmologist and treated accordingly.

Atherosclerosis↗
PubMed2002

Aortic complications after bicuspid aortic valve replacement: long-term results.

BACKGROUND: Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR). PATIENTS AND METHODS: One hundred consecutive patients were allocated into two groups according to the presence of BAV (group A, 50 patients) or TAV (group B, 50 patients). Mean age was 51 +/- 12 years in group A, and 50 +/- years 12 in group B. No patients had hypertension or Marfan's syndrome. Until July 2001, mean follow-up was 234 +/- 47 months in group A and 241 +/- 43 months in group B. RESULTS: Five patients (10%, CL 5.7 to 13.9) in group A suffered late acute aortic dissection. Acute aortic dissection (5 vs 0, p = 0.0001) and sudden death (7 vs 0, p = 0.0001) occurred more frequently in patients with BAV. All survivors were assessed by echocardiogram. The mean diameter of the ascending aorta was 48.4 mm in group A and 36.8 mm in group B. Three patients in group A were operated on because of ascending aorta aneurysm more than 6 cm in diameter. CONCLUSIONS: As a result of our experience, we recommend a policy of prophylactic replacement of even a seemingly normal and definitely a mildly enlarged ascending aorta in cases of BAV at the moment of AVR, and consideration of a similar approach for any other cardiac surgical procedure in patients with BAV.

Acute Disease↗
PubMed1993

Quantitative changes in platelet counts following major urological pelvic surgery.

Postperative quantitative changes in platelet counts have been reported following various extensive surgical procedures. It is generally accepted that reactive thrombocytosis at levels less than 1,000,000/mm3 is a benign condition and is not associated with increased risk of postoperative thrombohemorrhagic complications. The role of prophylactic treatment with platelet inhibitors in these situations is controversial. We assessed retrospectively the timing and the extent of postoperative thrombocytosis in 85 consecutive patients following major urological pelvic surgery and evaluated its possible clinical significance to hemorrhagic and thromboembolic complications, in view of the coincidence of multiple potential risk factors for thromboembolism in these patients. 73 (85.9%) patients demonstrated marked postoperative changes of platelet counts. In 12 patients (14.1%) we found only minor fluctuations in platelet counts throughout the postoperative period. Two distinct groups of 26 and 47 patients respectively could be identified among these 73 patients, who differed in the rate and extent of changes in platelet counts. Those fluctuations were characterized by an early decrease in platelet levels (mean percentage change of 40 and 60% in groups I and II respectively). This was followed by a gradual increase leading to delayed thrombocytosis (mean percentage change of 225 and 305% in groups I and II respectively). Thromboembolic complications were diagnosed in 5 patients. The occurrence of thromboembolism preceded any significant increase in platelet counts in all 5 patients. There was no correlation between the timing of thromboembolic complications and timing and extent of the change in platelet count. We conclude that reactive thrombocytosis following major urological pelvic surgery is a frequent innocuous finding and is not associated with hemorrhagic or thromboembolic complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

[Prophylactic contralateral orchiopexy in patients with testicular torsion].

The aim of the study was to examine the recommendations for prophylactic contralateral orchiopexy in patients presenting with unilateral testicular torsion in Denmark. A questionnaire was mailed to the 61 surgical departments treating acute urological patients. Prophylactic contralateral orchiopexy was performed in 60 of the 61 departments. Twenty-eight departments routinely performed a combined ipsilateral and contralateral operation. In 20 departments the contralateral procedure was performed immediately in the case of a vital ipsilateral testis, but delayed a median of five (3-12) weeks in the case of a necrotic testis. In seven departments the contralateral orchiopexy was routinely performed a median of 10 (2-12) weeks after the ipsilateral operation, and in the remaining five departments the time of the contralateral procedure was determined by the surgeon. In conclusion prophylactic contralateral orchiopexy was widely used in patients with unilateral testicular torsion, but the timing of the procedure varied.

Denmark↗
PubMed1991

Preoperative preventive antimicrobial therapy.

Prophylactic antibiotics play a significant role in the management of the modern surgical patient. Guidelines for their use have been presented. Marked variations in nosocomial pathogens and their resistance patterns exist among institutions and surgical procedures are frequently far from routine owing to a variety of perioperative circumstances. A willingness to monitor and alter protocols based on local observations and newly published data remains imperative.

Anti-Bacterial Agents↗
PubMed1982

[Domperidone after ether anaesthesia. Prevention of postoperative hyperemesis (author's transl)].

In catastrophe situations ether is an important alternative to the usual anaesthetics being easy to manage and economical. We wanted to study the effects of the new antiemetic Domperidone on vomiting after either anesthesia. Two groups of patients were anaesthetized for general surgical procedures by means of the EMO (Epstein-Macintosh-Oxford) Vaporizer. Half an hour before the end of the operation one group received 0.2 mg/kg domperidone while the randomized control group received no prophylactic antiemetic medication. The domperidone group showed better, statistically significant, results (p less than 0.05). Domperidone proved to have a good prophylactic antiemetic effect which does not cause side effects or circulatory alterations. In preparation for catastrophe situations ether anesthesia under improved conditions was again included in the regular training programme.

Adult↗
PubMed1994

The nature of complications following liver biopsy in transplant patients with Roux-en-Y choledochojejunostomy.

Liver biopsy is an important diagnostic tool in the management of patients following orthotopic liver transplant. We evaluated complications following percutaneous liver biopsy in a group of liver transplant patients who had Roux-en-Y choledochojejunostomies fashioned as part of their biliary reconstruction during liver transplantation. Complications were divided into two major groups: septic complications (including fever, symptomatic bacteremia, cholangitis, infected hematoma and hypotension related to sepsis) and bleeding (defined as hypotension requiring volume expansion greater than 500 cm3 or blood transfusion, hemothorax, intrahepatic or peritoneal hemorrhage and hemobilia occurring within 1 wk of liver biopsy). One hundred ninety-two biopsies were performed in 46 patients with choledochojejunostomies, and 118 biopsies were carried out in an age- and sex-matched control group of patients with choledochocholedochostomy biliary anastomosis. There were no septic complications in the choledochojejunostomy patients and one (0.32%) septic complication in the choledochocholedochostomy patients (NS). Eight bleeding complications occurred (2.6%) in eight patients (8.3%). Five (2.6%) occurred in five (10.8%) of the choledochojejunostomy patients, vs. three (2.5%) in three (6.5%) choledochocholedochostomy patients (NS). None of the bleeding complications required surgical intervention or was fatal. We conclude that liver biopsy in posttransplant patients with Roux-en-Y choledochojejunostomies is a safe procedure and that the incidences of complications were similar in our two groups. The negligible incidence of septic complications in the choledochojejunostomy patients does not appear to warrant the administration of prophylactic antibiotics, as has been previously suggested.

Adult↗