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Results for “Laparotomy”

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At least 19 recordsLinked to original sources

PubMed1978

Staging laparotomy in Hodgkin's disease: a critical appraisal of its value.

Although staging laparotomy changes the stage of one third of patients with Hodgkin's disease, this change in stage does not establish that routine staging laparotomy is of clinical value. The value of laparotomy depends on the results of clinical decisions which are based on the information provided by laparotomy. Increased accuracy in staging may improve clinical results by eliminating undertreatment, with an increased risk of relapse, or overtreatment with an increased risk of morbidity--including second malignancies. In some clinical settings information provided by laparotomy may be clinically irrelevant. Since clinical studies have not established the optimal therapy for every stage of Hodgkin's disease, rigid guidelines for performing staging laporotomies cannot be established. However, staging laparotomy should be done only after consideration of how the information provided by laparotomy will affect clinical decisions. Recent evidence that the extent of abdominal nodal involvement has major prognostic implications may play a role in this decision-making process.

Abdominal Neoplasms↗

PubMedDate not supplied

Repeat laparotomy as a preclinical diagnostic and therapeutic method for treating ovarian carcinoma.

One hundred forty-two cases of epithelial ovarian carcinoma were treated from 1972 to 1976 in the Department of Obstetrics and Gynaecology, University Central Hospital, Turku, Finland. Repeat laparotomy was performed on 37 of the patients about six months after total extirpative surgery (group I). In addition, a second laparotomy was performed on 14 patients after partial surgery or exploratory laparotomy (group II). All patients were given external radiation therapy combined with cytostatic treatment prior to the repeat laparotomies. A preclinical carcinoma was detected in six of the 37 patients in group I. Two of them are asymptomatic after five years of follow-up. In group II, total surgery after initial partial or exploratory laparotomy succeeded in half of the cases. Serous and endometroid carcinomas appeared to respond best to conservative therapy preceding repeat laparotomy.

Female↗

PubMed1977

[Laparotomy in the therapy of Hodgkin's disease].

We have performed laparotomy and splenectomy for seventy patients with Hodgkin's disease. Among 43 stages I or II before exploration, primary laparotomy revealed ignored abdominal localizations in 16 cases (37,2%). Involvement of the spleen occurred in 13 of these 16 patients, lonely (5 cases), associated with positive nodes (4 cases) or associated with positive nodes and liver involvement (4 cases). Among 4 stages III before exploration, no regression was found. Among 9 patients with presumed stages I or II above the diaphragm and previously treated by radiotherapy, delayed laparotomy revealed abdominal relapse in 6 cases. At last, among 14 patients with obvious stages II or IV and previously treated by combination chemotherapy, laparotomy, caused by persistent evolutive signs, showed residual localizations under the diaphragm in 8 cases. According to these results, we preconise immediate laparotomy in almost all presumed stages I or II above the diaphragm. About third of these subjects have their staging advanced to stage III or IV and, according to us must be treated by combination chemotherapy while the remaining cases justify of radiotherapy. In obvious stages III and IV delayed laparotomy may be useful in some circumstances, after chemotherapy.

Cobalt Radioisotopes↗

PubMed1977

[Primary and secondary exploratory laparotomy and splenectomy in Hodgkin's disease (author's transl)].

Exploratory laparotomy with splenectomy was performed on 275 patients with hisologically confirmed Hodgkin's disease. In 188 patients the laparotomy was a primary one to determine more precisely the state of the disease. A secondary laparotomy was performed in 87 patients 1-12 years after diagnosis and radiotherapy. In 17.5% of patients the state had to be revised after laparotomy with splenectomy. In 38 the disease had further progressed, while in ten it had slighty regressed. In four cases clinical stage I proved to be stage III. Even prognostically more favourable forms may have progressed at first diagnosis. There was no correlation between B-symptoms and histological type, but there was between B-symptoms and spread of the disease. Calculated spleen weight provided no clue as to spleen involvement. There was no clear relationship between spleen involvement and histological subclassification. Risk-effect analysis indicate that laparotomy with splenectomy was useful because it makes optimal treatment possible.

Adult↗

PubMed1977

Laparotomy for staging of Hodgkin's and non-hodgkin's lymphoma.

To justify the performance of an invasive technique as an aid to determining diagnosis and therapy in any condition, one must correlate the benefits derived with the adverse effects of performing that procedure. The review of the records of the patient indicates that clinical staging remains a moderately inaccurate means of assessing the extent of the disease in patients with Hodgkin's and non-Hodgkin's lymphoma. Lymphangiogram remains an aid to the surgeon in the localization of suspicious nodes. It is of greater accuracy in the patient with Hodgkin's lymphoma as compared with those with non-Hodgkin's lymphoma. Conversely, laparotomy for staging was not of as great a value in the patients in the non-Hodgkin's group as in those in the Hodgkin's group, and the incidence of complications was higher in the non-Hodgkin's group; especially in the patients with advanced disease. Laparotomy for staging is of significant benefit in the Hodgkin's lymphoma group, and the complication rate is not prohibitive. Laparotomy for staging in the non-Hodgkin's lymphoma group, on the other hand, is of less value than it is in the Hodgkin's group and is associated with a substantially higher complication rate in the face of advanced disease. In non-Hodgkin's lymphoma, individual decisions regarding laparotomy must be used, and the routine use of laparotomy may not be warranted.

Female↗

PubMed1979

Laparotomy in the emergency department.

Reports of advancements in emergency department operative resuscitative skills have included craniotomy, thoracotomy, cardiorrhaphy and even cardiopulmonary bypass. The efficacy and advisability of laparotomy in the emergency department remain in question. Between July, 1972, and July, 1977, adhering to an established protocol, resuscitative laparotomy was performed on 51 patients in the emergency department. All 51 patients underwent emergency thoracotomy also. Twenty-four patients were victims of gunshot wounds, 24 had sustained blunt trauma, and three had abdominal stab wounds. Injuries to the liver, major vessels, and spleen were most common. Control of hemorrhage by clamps, packs or pressure was the primary objective of laparotomy. Control of exsanguinating hemorrhage with precise application of vascular clamps was possible in all but 15 patients. Because of extensive multiple injuries and inability to achieve cardiovascular stability, only 11 patients reached the operating room, and none survived to leave the hospital. Although technically possible, laparotomy in the emergency center did not alter the fatal outcome of moribund patients in this series.

Abdominal Injuries↗

PubMed1975

Laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin's disease.

The relative merits of laparoscopy with liver and spleen biopsy and staging laparotomy were studied in 91 unselected patients with Hodgkin's disease. Laparoscopy with liver and spleen biopsy were combined with needle biopsy of the bone marrow and laparotomy was combined with open bone marrow biopsy. In 65 untreated patients six out of seven with liver or marrow disease, or both, were shown to have extranodal lymphomas in these sites by laparoscopy plus needle marrow biopsy. Among 26 patients who had been treated this finding occurred in six out of 10 patients. Spleen biopsies during laparoscopy detected infiltration by lymphoma in 14 out of 37 (38%) patients with diseases spleens. Morbidity was higher after laparotomy than after laparoscopy. Laparoscopy produced abdominal bleeding secondary to splenic biopsy in two patients. All patients with Hodgkin's disease should be subjected to laparoscopy plus needle marrow biopsy before undergoing laparotomy.

Adolescent↗

PubMed1978

Propulsion and mixing of small bowel contents after laparotomy in rat.

Radioactive test substances were infused slowly into the duodenum of conscious rats via a permanent catheter starting 2, 12 and 24 h after a standardized laparotomy. Two differently labelled but otherwise identical test substances were used. The first test substance (125I-PVP) was infused for 4 h, the second (131I-PVP) for the remaining 1 h of the 5-hour infusion period. Immediately after the infusion the animals were killed, and the radioactivity emanating from each isotope was recorded from the excised bowel specimen. The bowel length passed by the border zone and the degree of overlap between the labels in this zone were taken as measures of propulsion and mixing, respectively. Propulsion and mixing were uninfluenced by laparotomy as measured 2--17, 12--17 and 24--29 h after laparotomy. The present findings indicate that laparotomy is not followed by a disturbance in the capability of the small bowel to transport and mix chyme, at least when no high demands with respect to chyme volume are required.

Animals↗

PubMed1975

Percutaneous liver biopsy, peritoneoscopy and laparotomy: an assessment of relative merits in the lymphomata.

The relative merits of percutaneous liver biopsy, peritoneoscopy directed liver biopsy and wedge liver biopsy during laparotomy were examined in a series of 100 consecutive untreated patients with non-Hodgkin's lymphoma. Sixteen of 77 patients had positive findings on percutaneous liver biopsy specimens, with the best yield in patients with nodular (21%) and diffuse (33%) poorly differentiated lymphocytic lymphoma. Forty-nine of the 61 patients having negative percutaneous biopsies were subjected to peritoneoscopy and 9 additional positive biopsies were obtained. Thirty-two of the 40 patients having negative percutaneous and peritoneoscopy findings underwent laparotomy and wedge biopsy of the liver, and 8 specimens (25%) were positive for liver involvement; all but one of these were in patients with nodular or diffuse poorly differentiated lymphocytic lymphoma. This study indicates that over two-thirds of untreated patients with non-Hodgkin's lymphoma can be shown to have Stage IV disease without undergoing laparotomy, and that in the remaining patients, laparotomy proved of consistent value only in patients with poorly differentiated lymphocytic lymphoma.

Biopsy↗

PubMed1977

[Exploratory laparotomies in geriatric-gynaecological patients (author's transl)].

In 17 gynaecological departments of West-Berlin hospitals, 2940 laparotomies were done between 1960 and 1969 in women of at least 60 years of age, of which 331 (10,9%) were exploratory. Of these the postoperative mortality was 39,2% (130 cases). The fatal cases could be divided into 120 women suffering from inoperable malignant tumors, 7 from sigmoid diverticulitis and 3 from chromical gynaecological inflammatory tumors. The frequency of such critical exploratory laparotomies could be lowered partly by intensifying cancer routine check-up by specialists by more complex diagnostic measures before the operations and by fewer adhesiotomies in cases of chronical inflammatory complaints. Most important, however, seems to be the well indicated application of laparoscopy under conditions that allow consecutive laparotomy if necessary. It is thought that to an experienced surgeon the diagnostic value of laparoscopy is almost equal to that of laparotomy. It therefore can be considered a true alternative.

Age Factors↗

PubMed1977

[Early diagnostic laparotomy in patients with multiple injuries (apropos of 125 cases)].

Hundred twenty five patients with multiple areas of injury requiring surgical repair outside of the abdomen too were subjected to laparotomy. In patients with multiple areas of trauma the abdomen is almost always suspect. The proliferation of diagnostic tools to detect intraperitoneal damage have, in some ways, helped phisicians decide as to laparotomy. However, when multiple injuries are present, particularly of the central nervous system, classical findings of peritoneal damage are difficult to elicit. A diagnostic laparotomy does not add significantly to the overall morbidity or mortality, for that we think is still a place for diagnostic laparotomy in patients with multiple trauma.

Abdominal Injuries↗

PubMed1978

Practical approach to laparotomy for staging in the management of lymphomas.

This study was designed to delineate the role of laparotomy for staging in the management of lymphomas and to determine the accuracy of nonsurgical staging procedures. Fifty-four untreated patients with diagnoses of Hodgkin's disease or non-Hodgkin's lymphoma had extensive physical, laboratory, roentgenologic, scintigraphic, nonsurgical and surgical staging evaluation. Forty-five out of 54 patients had clinical Stage I and II disease; clinical Stage IV patients were excluded. One out of eight enlarged spleens, 12 out of 46 normal spleens, none of four enlarged livers and four out of 50 normal livers were positive at laparotomy. None of the preoperative needle biopsies of the liver and iliac crest was positive for lymphoma. The pathologic stage was advanced in six out of 25 of clinical Stage I, six out of 20 Stage II and two out of nine of Stage III. 67Ga scanning and lymphography were accurate in 16 out of 30 and 24 out of 45 patients, respectively. There was no mortality, but morbidity was limited to atelectasis, thrombophlebitis and subphrenic abscess in three patients, respectively. Only when treatment regimen is stage-dependent and only if nonsurgical staging procedures have reliably failed to rule out disseminated disease, then laparotomy for staging indicated in localized lymphomas. Laparotomy for staging should not be done when the treatment plan is not altered by staging data or when there is a medical contraindication or when evidence of disseminated disease has been reliably and consistently obtained by nonsurgical methods as needle biopsies of the liver and bone, lymphography, scintigraphic studies and laparoscopy.

Female↗

PubMed1978

Staging laparotomy for Hodgkin's disease in children.

Resort to laparotomy for the staging of Hodgkin's disease has been controversial because of its questionable advantage over nonsurgical staging methods. The recent concern over splenectomy and subsequent overwhelming infection has added to this debate. The author reviews experience with Hodgkin's disease in 34 patients whose ages ranged from 6 to 18 years. Seventeen patients underwent staging laparotomy after their disease had been staged by standard nonoperative methods; the duration of follow-up was from 2 to 7 years. In 7 of these 17 patients the stage of their disease was changed as a result of the laparotomy findings. Complications have been late septicemia resulting in death in one patient and subacute bowel obstruction not requiring reoperation in two patients. In the author's opinion staging laparotomy in children with Hodgkin's disease is a valuable means of deciding on their subsequent therapy.

Adolescent↗

PubMed1977

Staging laparotomy for Hodgkin's disease in children. Evaluation of the technique.

The evaluation of a technique of laparotomy for the staging of Hodgkin's disease in childhood, including 52 operative procedures, is reviewed. A standard protocol, including splenectomy, multiple hepatic and bone marrow biopsies, and the routine sampling of at least six designated lymph node groups, was employed. It was demonstrated that the surgeon is unable to identify Hodgkin's disease by gross inspection and that the biopsy of node groups previously not included in routine laparotomy studies, ie, mesenteric and porta hepatis nodes is essential to staging in childhood. Stage was altered from stages I and II to stages III and IV in 35% of the patients. The incidence of abdominal recurrence following a negative laparotomy was 7%, and the incidence of post-splenectomy hyperacute infection was 4.5%. This study included minimal use of the lymphangiogram (33%), which accounted for the relatively larger group of patients in clinical stages I and II.

Biopsy↗

PubMed1977

New assessment of the prognostic significance of histopathology in Hodgkin's disease for laparotomy-negative stage I and stage II patients.

This paper describes preliminary radiotherapy results in 90 patients with Stage I and II Hodgkin's disease who were evaluated by laparotomy, including splenectomy, and liver and bone marrow biopsies. As a result of selection by laparotomy, the estimated five-year survival rate for these patients was 96%. No statistically significant differences were detected in the disease-free survival for patients with mixed cellularity, nodular sclerosis, and lymphocytic predominance disease. Since only one patient with lymphocytic depletion was in this series, no statement can be made regarding this rare histopathology. Patterns of new disease differed for Stage I and II patients. The major difference was that patients with nodular sclerosing Stage II presentations involving the mediastinum were at considerable risk of developing subsequent disease in the pulmonary parenchyma or the pleura. This finding, together with the demonstration that a histologic diagnosis of mixed cellularity did not carry an inferior prognosis, indicates the need for reassessment of the appropriateness of applying treatment programs based on results of lymphangiographically staged patients to Stage I and II patients evaluated by laparotomy.

Adolescent↗

PubMed1977

Are pelvic irradiation and routine staging laparotomy necessary in clinically staged IA and IIA Hodgkin's disease?

Thirty-nine patients with clinically staged IA and IIA Hodgkin's disease were treated with mantle plus paraaortic/splenic irradiation between 1968 and 1975. All patients had supradiaphragmatic presentations, and none had staging laparotomies. With a follow-up time of 1 to 9 years, mean 4.3 years, the overall relapse-free survival is 92% (100% for stage IA and 89% for stage IIA). The absolute relapse-free 5-year survival is 91% There were no pelvic recurrences. These data show that routine staging laparotomy and pelvic irradiation are not indicated for clinically staged IA and IIA Hodgkin's disease with supradiaphragmatic presentation. The criteria for staging laparotomy in early-stage Hodgkin's disease are discussed.

Adolescent↗

PubMed1978

Morbidity of staging laparotomy in Hodgkin's disease.

The morbidity of exploratory laparotomy and splenectomy in Hodgkin's disease was determined at three institutions--a university hospital, a major university affiliated hospital and a large community hospital. Of the 90 patients who underwent exploratory laparotomy, 33 (37%) sustained a major or minor complication within two weeks of surgery. Seventeen patients (19%) sustained a minor complication and 16 patients (18%) a major complication. There was no mortality. A higher complication rate occurred in patients more than 28 years of age (p = 0.01), and in patients with advanced clinical stage when age was controlled (p = 0.05). We suggest that prior to performing an exploratory laparotomy in a given patient, the necessity of the procedure be weighed against its potential hazards.

Adult↗

PubMed1979

Evaluation and complications of 107 staging laparotomies for Hodgkin's disease.

From 1971--1975, 107 staging laparotomies for Hodgkin's disease were performed at the University of Wisconsin Hospitals. Forty-one per cent of patients with abnormal abdominal lymphangiograms preoperatively had abdominal nodes which were negative for Hodgkin's. Thirteen per cent of patients with negative preoperative lymphangiograms had positive nodes at staging laparotomy. Twenty-nine per cent were upstaged by laparotomy, i.e. assigned to a less favorable stage (II A to III A), and 11.2% were downstaged. There were no surgical mortalities. Minor surgical complications occurred in 14.9%, and major ones in 3.7%. We conclude that surgical staging for Hodgkin's disease is valuable in making an accurate diagnosis and, hence, in determining the most effective treatment.

Adolescent↗