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At least 163 records · Page 9Linked to original sources
PubMed2001

Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease.

BACKGROUND: Laparoscopic-assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population. METHODS: All adolescents undergoing ileocolic resection for Crohn disease during a 3-year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic-assisted approach with those having open resection. RESULTS: Eleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic-assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic-assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic-assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6; P < 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic-assisted group with postoperative fever and a wound infection. CONCLUSIONS: Laparoscopic-assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.

Adolescent↗
PubMed2000

The normal CT appearances of the second carina and bronchial stump after left upper lobectomy.

We retrospectively evaluated the computed tomography (CT) appearance of the bronchial stump and second carina (left upper lobe spur) after left upper lobectomy. There were 69 CT examinations in 38 patients; all were free of recurrent or metastatic disease. The spur was graded as a) sharp (wedge-shaped tip configuration with <90 degrees angulation), b) lobulated (bulbous tip with <90 degrees angulation), or c) widened (>90 degrees angulation regardless of tip configuration). The bronchial stump was evaluated for the presence or absence of soft tissue in proximity to the surgical staples. The spur had a sharp appearance in 33 of 38 patients (87%) and was lobulated in 5 of 38 (13%). No patient had soft tissue at the bronchial stump. Serial examinations showed no change in the appearance of either structure. The spur remains sharp after left upper lobectomy in most patients; lobulation occurs in 13%. No changes occur over time. Interval change, widening of the spur, or soft tissue at the bronchial stump may suggest abnormality. Knowledge of normal and potentially abnormal appearances is essential to proper CT interpretation, particularly in the setting of postoperative surveillance for recurrent or metastatic disease.

Aged↗
PubMed2005

One-stage resection without colonic lavage in emergency surgery of the left colon.

OBJECTIVE: Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. PATIENTS AND METHODS: All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. RESULT: The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. CONCLUSION: The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.

Anastomosis, Surgical↗
PubMedDate not supplied

Hepatic lobe torsion as a cause of colic in a horse.

A 14-year-old Arabian gelding was examined for colic. An exploratory celiotomy was subsequently performed and the left lobe of the liver was found to be twisted. The lobe was resected using a TA-90 surgical stapling instrument. Histologic examination of the resected liver indicated portal vein and sinusoid dilation and congestion with blood. There were focal areas of necrosis and bacterial cocci and rods throughout the section. The histologic findings were consistent with hepatic lobe torsion. After surgery, the horse was treated with broad spectrum antibiotics, anti-inflammatory drugs, heparin, and intravenous fluids. The horse recovered without complications, although serum liver enzymes remained elevated for more than 1 week after surgery. Seven months after surgery the horse showed no adverse affects from the disease.

Animals↗
PubMed1997

An experimental in vivo method for analysis of local deformation on tibia, with simultaneous measures of ground reaction forces, lower extremity muscle activity and joint motion.

This paper presents the pilot procedures of a new in vivo experimental method for measures of local bone deformation on tibia. The tibia transducer consists of a strain gauge mounted on a surgical staple, and was designed to measure local bone deformation. Pilot measurements were undertaken during two standardized conditions of forefoot and heel landing in seven healthy volunteers. Implantation of two tibia force transducers on tibia were performed under local anaesthesia. The local peak tibia deformation occurred at 20-42 ms (median) after ground contact, and was up to eight times higher during stance phase loading compared with standing still on one leg. Ground reaction forces, muscle activation patterns and kinematics were registered simultaneously, and were used to validate that the observed local deformation on tibia occurred under controlled and clinically relevant conditions. The new method may be used for investigating local deformation within various bone structures of the lower extremity. There are further methodological issues to address before major clinical interpretations may be concluded. In order to verify that the strain gauge transducer system was valid, a controlled displacement of the staple shanks was performed with a micrometer, and showed a linear relationship between applied deformation and strain gauge response (r = 0.97-0.99). In addition, a linear relationship was found between externally applied static forces and strain gauge response in a four-point bending cadaver system (r = 0.96-0.98).

Adult↗
PubMed1999

Cardiocutaneous fistula.

Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis.

Aged↗
PubMed2004

Fluorescein-enhanced autofluorescence thoracoscopy in primary spontaneous pneumothorax.

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax, and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.

Administration, Inhalation↗
PubMed1986

Influence of cisplatin on wound healing--an experimental model.

Recent clinical studies have shown that adjuvant chemotherapy may improve response rates to treatment for advanced head and neck carcinomas. Given preoperatively, some chemotherapeutic agents adversely affect wound healing. The specific purpose of this study was to evaluate the influence of cisplatin on wound healing when it is given preoperatively. Forty-four Swiss outbred mice were divided into control and treatment groups. One week before surgery, the treatment group received cisplatin (2 mg/kg body weight) by subcutaneous injections on 2 consecutive days. Each control animal was given an equal volume of normal saline. A 1.5 cm transverse incision was made in each animal, and wounds were closed with surgical staples. The mean wound-breaking strength was determined for a minimum of 5 treatment and 5 control mice on postoperative days 6, 10, 13, and 16. Serum creatinine, blood cell counts, and changes in weight were also monitored. Results showed wound strength on postoperative day 10 to be significantly reduced in mice treated with cisplatin (P less than 0.05). There was no significant difference for wound strength on any other days and all other variables were similar between both groups. In conclusion, cisplatin has an adverse effect on wound healing, the peak of which probably occurs during the proliferative stage of wound healing. Further studies are needed to determine the optimal time for surgery after preoperative chemotherapy. All new chemotherapeutic agents, particularly those being considered in a preoperative regimen, should be tested in this manner.

Analysis of Variance↗
PubMed2006

New device for the introduction of a circular stapler in laparoscopic gastric bypass surgery.

BACKGROUND: In laparoscopic Roux-en-Y gastric bypass (LRYGBP) surgery, the anastomosis between the gastric pouch and the jejunum can be performed using a circular stapler, as described in the original publication by Wittgrove in 1994. The introduction of the circular stapler through the thick abdominal wall in morbidly obese patients can be challenging. To overcome the difficulties of this task, a new device was developed and its use is presented. METHOD: The new device has the shape of a trocar tip which can be mounted on the circular stapler, giving it the properties of a trocar. Therefore, easier introduction into the abdominal cavity is feasible. The use of the device was assessed analyzing the data of a prospective database, comparing patient groups operated without the device (n=301) and patients operated with the device (n=100). RESULTS: The groups were comparable in age, sex, BMI and number of previous abdominal operations. The wound infection rate at the site of stapler introduction decreased from 6.6% to 1% (P=0.035). The overall operating time, hospital stay and complication rate were unchanged. CONCLUSION: The new device proved to be useful in daily practice and enabled an easier stapler introduction with fewer wound infections.

Adult↗
PubMed1997

Vertical banded gastroplasty-gastric bypass in Mexican patients with severe obesity: 1 year experience.

BACKGROUND: Different surgical alternatives for the treatment of severe obesity have been described. The two most common surgical procedures are the Vertical Banded Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (GBP). METHODS: This work describes the results seen during the first 12 months after a surgical technique named Vertical Banded Gastroplasty-Gastric Bypass on 221 Mexican patients with severe obesity operated on between March 1993 and August 1996. RESULTS: 73.3% of the patients were female with an average age of 33.4 years with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2 kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The initial body mass index (BMI) was 44.9 kg/m2 (SD = 9.1). The average of excess weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7 kg/m2 (SD = 5.9). An interesting finding was that the greater the initial overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001). CONCLUSIONS: The procedure was fairly easy to perform. The results were excellent in terms of weight loss and postoperative complications. It is an early experience and the long-term results are still inconclusive; regular check-ups should indicate the procedure's long-term effectiveness.

Adult↗
PubMed1999

Complications of adjuvant radiotherapy for rectal cancer.

The incidence of rectal cancer in the US is 45,000 per ann um. The 5-year survival is between 40 and 70%. This has not improved over the last 50 years despite improvements in techniques, the aid of new technology (surgical stapling devices in particular) and safer anesthesia.

Journal Article↗
PubMed2005

[Analysis of the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids in the treatment of hemorrhoids].

OBJECTIVE: To explore the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids (PPH) in the treatment of hemorrhoids. METHODS: Four hundred and one hemorrhoid patients were treated with circular stapler. II hemorrhoids, 45 cases; III-IV hemorrhoids, 356 cases. The position of stoma located 1 cm up dentate line, 219 cases; 1-2 cm up dentate line, 87 cases; 2-3 cm up dentate line, 60 cases; 3-4 cm up dentate line, 25 cases; > 4 cm up dentate line, 10 cases. The patients were followed from one week to two years postoperatively. RESULTS: Postoperative effects and procidentia rates have significant association with the position of stoma. If the distance between position of stoma and dentate line is < or = 2 cm, the postoperative procidentia rate was 1.1%, lower than that of the distance > or = 4 cm. CONCLUSIONS: The complication and procidentia rate of PPH is associated with the stoma position. The stoma position should be no more than 2 cm to dentate line.

Female↗
PubMed1989

[Obstructive left colonic cancer. Retrospective analysis of the therapeutic attitude in a series of 40 recent cases].

In a series of 40 cancers involving the descending and sigmoid colon and producing true acute obstruction, the following were performed: 16 colostomies of first intention (including 11 palliative); 14 resections with colostomy (Hartmann type); 9 resection-anastomoses (including 3 protected); 1 attempt at laser treatment for non consent to surgery. Only 22 patients were theoretically suitable for anastomosis (18 contraindications due to invasive cancer or peritonitis); this was in fact carried out in 9 cases. Thus, if single stage surgery represents the ideal, it cannot be systematically applied; on the other hand, tumor resection can often be performed. It would seem that the use of per-operative colonic lavage can increase the percentage of single stage surgery, though there will always be a place for Hartmann or Bouilly-Volkmann type procedures, future reestablishment of continuity being facilitated by the use of surgical staples (EEA type).

Acute Disease↗
PubMed1987

Fictitious calculi and human calculi with foreign nuclei.

The correlative approach employing polarized light microscopy, x-ray powder diffraction, scanning electron microscopy, transmission electron microscopy, selected area electron diffraction and energy dispersive x-ray microanalysis proves to be very useful in identifying fictitious calculi and genuine human calculi with foreign body nuclei. The common artifacts as reported in the literature and observed also by us were minerals, vegetable and plant seeds, cereals, sand grains and sea shell fragments. Two interesting cases involving foreign body nuclei have been reported: one urinary calculus containing a piece of plastic-coated titanium foil in the center; one nasal calculus with a nut as a nucleus. Another common cause for foreign body nucleation is iatrogenic: intrauterine devices, catheters, suture materials and even surgical staples have been reported in the literature to be potent nidi for calculus formation. These cases remind us of the important fact that our body fluids are supersaturated with respect to calcium phosphates and occasionally to other compounds. Hydroxyapatite crystals are readily nucleated by foreign bodies. Whitlockite is involved if the fluid Mg/Ca ratio is in a suitable range, brushite if the fluid is acidic and struvite if there is urea-splitting infection. In urine and other fluids, calcium oxalate and uric acid crystals contribute to the calculus growth.

Calculi↗
PubMedDate not supplied

[Total gastrectomy: a comparison between manual and mechanical sutures].

The authors report their experience of the use of mechanical staplers in total gastrectomy. The advantages of their use can above all be seen in anastomosis, in particular in high-risk areas like esophago-jejunal anastomosis, in which there is a lower incidence of dehiscence and mortality than when manual suturing techniques are used.

Adenocarcinoma↗
PubMed1996

Is routine drainage of pelvic anastomosis necessary?

The routine use of drains for pelvic anastomosis is controversial. This study was undertaken to determine whether drainage alters leak rate, aids in diagnosing a leak, and/or prevents the need for laparotomy when a leak occurs. Records of 156 consecutive patients who underwent elective resection and pelvic anastomosis for cancer from 1986 to 1994 were retrospectively reviewed. The patients were stratified into two parent groups, I and II. One hundred and eleven Group I patients who routinely had Jackson-Pratt 10-mm drains inserted were subdivided into subgroup I-A (n = 24) with proximal intraoperative diversion and subgroup I-B (n = 87), without diversion. Forty-five Group II patients routinely did not have drains inserted. They were also subdivided, into II-A (n = 3) and II-B (n = 42), i.e., with and without simultaneous diversion, respectively. The overall leak rate was 5.1 per cent (8/156). Subgroups I-A and II-A had leak rates of 8.33 per cent (2/24) and 0 per cent (0/3), respectively. The leak rates were 4.6 per cent (4/87) in subgroup I-B and 4.8 per cent (2/42) in subgroup II-B, with no significant difference (P > 0.05). Also, no significant difference was noted when the overall leak rate for diverted cases was compared with nondiverted ones. Of the four leaks in I-B, three occurred after the drains were removed; two of these required laparotomy, drainage, and diversion. The fourth occurred with the drain in place, but failed to demonstrate feces or pus in the drainage fluid or prevent the need for laparotomy. The presence of a drain did not affect the leak rate (P > 0.10). Drain contents did not aid in diagnosing anastomotic dehiscence. Routine prophylactic use of Jackson-Pratt drains seems unjustified because leaks either occurred after the drains were removed or failed to prevent the need for laparotomy.

Adult↗
PubMed1994

[Complications in esophagojejunal anastomosis].

In the period between January 1, 1982 until December 31 1993, in the Center for Esophageal Surgery, Institute for Digestive Disease - 1 st Surgical clinic in Belgrade, 345 esophago-jejuno anastomosis (EJA) were performed. In 326 pt's EJA, with the Roux-en-Y reconstruction with the segment of the small intestine, was performed after a total gastrectomy due to a malignant disease of stomach or cardia and in 7 due to an extensive corrosive changes of the stomach. In 12 pt's a resection of the distal esophagus due to an undilatable stricture and the reconstruction with the short segment of the small intestine (Merendino) was performed. In all 345 pt's a terminolaternal EJA was performed. In 149 pt's EJA was done mechanically by staplers (e.g., the EEA instrument) and in 196 an interrupted two layer suture was performed. In 326 pt's (operated due to a malignant disease) complications occurred in 29 of them (8.89%) while in the group of patients with benignant disease only in 2 pt's or 10.52%. A dehiscention of EJA occurred only in the group of pt's with malignant disease. Comparing the way of performing EJA a higher percentage of anastomotic leaks was found in the group of hand sewn anastomosis (18/8.16%) while in the group with a stapler performed anastomosis anastomotic leak was found only in 7 pt's (4.69%). In two pt's where a stapler anastomosis was performed there was a hemorrhage from the anastomosis during the operation, and in 8 pt's or 5.36% an unsuccessful anastomosis using a stapler was performed. Overall mortality was 6.66% or 23 pt's. Due to anastomotic leak 13 pt's died (3.76%). In 5 pt's 4 to 14 months after the operation a stenosis of anastomosis developed on EJA that severely compromised EJA and needed further medical treatment. None of the pt's was reoperated.

Anastomosis, Surgical↗