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Biomedical subjects

A Ayalon

Publications and source records attributed to A Ayalon.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic transabdominal suspension sutures.

A limited number of access ports used in laparoscopic surgery may impair the ability of the surgeon to achieve adequate retraction and exposure, or to stabilize "moving targets" while operating on nonfixed organs. Solutions such as adding more ports or using a hand-assisted technique have the disadvantages of being more invasive, possibly creating a cumbersome situation of multiple instruments in a limited working space. We describe a useful technique for retraction and stabilization with the use of temporary sutures that pass through the abdominal wall. Although not new, this technique is not widely known or used, and laparoscopic surgeons may find it useful for a variety of applications.

Abdominal Muscles↗
PubMed2001

Closure of laparoscopic trocar site wounds with cyanoacrylate tissue glue: a simple technical solution.

Cyanoacrylate-based tissue glue has been widely used for many years around the world, and was recently approved for use in the United States, mainly for skin cuts and lacerations. Other applications were described, in different surgical situations. Although ideal for small, clean incisions, its use in laparoscopic surgery is currently limited. Over a year period, 100 patients with more 250 trocar site wounds had their wounds glued using histoacryl. Infection rate was extremely low (one case), and partial dehiscence of the wound happened in two patients, where wound edge approximation was not optimal. Cosmetic results were excellent and patient satisfaction was high, as no sutures had to be removed. Glue application is easy and quick, with no risk of needle sticks, and it is a viable option for laparoscopic wound closure.

Cyanoacrylates↗
PubMed2001

[Laparoscopic adrenalectomy for pheochromocytoma].

Laparoscopic adrenalectomy has recently been shown to be a safe and effective strategy of treating a variety of benign adrenal tumors. The ability to reduce hypertensive crisis during surgery for pheochromocytoma by adequate preoperative alpha- and beta-blockade and early intraoperative venous ligation have reached a level sufficient to permit a safe laparoscopic approach. During the period January 1995 to December 1999, laparoscopic adrenalectomy was attempted in twelve patients with unilateral pheochromocytoma and in 2 patients with multiple endocrine neoplasia type II. All procedures were completed laparoscopically. The mean operative time was 90 minutes (45-120). Blood transfusion was not required and there were no postoperative complications. The median hospital stay was 3 days.

Adrenal Gland Neoplasms↗
PubMed2000

Laparoscopic interval appendectomy for periappendicular abscess.

BACKGROUND: Laparoscopic appendectomy was first described in the early 1980s and is currently widely used for the treatment of acute appendicitis. The application of laparoscopic techniques to interval appendectomy and the value of this procedure as compared to open elective interval appendectomy remains uncertain. Therefore, we set out to assess the usefulness of interval laparoscopic appendectomy following periappendicular abscess. METHODS: This study analyzes the data for 10 patients who underwent interval laparoscopic appendectomy 8-10 weeks following documented periappendicular abscess in the period between January 1996 and June 1998. RESULTS: Laparoscopic appendectomy was completed successfully in all 10 patients. Nine patients were discharged 1 day after the operation; one patient was discharged on the evening of the operative day. There were no complications and no wound infections. CONCLUSION: We conclude that the laparoscopic approach is the preferable treatment for interval appendectomy. It is associated with minimal or no morbidity and a very short hospital stay.

Abdominal Abscess↗
PubMed2000

Laparoscopic approach to small-bowel obstruction.

BACKGROUND: Small-bowel obstruction poses both a diagnostic and a therapeutic challenge. The laparoscopic approach may assist in determining the cause of the obstruction and in many cases to treat the obstructing lesion. METHODS: For the last 2 years, we have been approaching patients with small-bowel obstruction laparoscopically. RESULTS: We have found this technique to be successful as the definitive treatment in more than half of the cases. CONCLUSION: The laparoscopic approach should be the modality of choice for most, if not all, cases of small-bowel obstruction in which there is an indication for exploration.

Adult↗
PubMed2000

Laparoscopic resection of huge omental cyst.

Mesenteric cysts are uncommon, and their pathological type includes pseudocyst, mesothelial cyst, lymphangioma, and omental cyst. We describe a case of a giant omental cyst treated successfully by a minimally invasive approach.

Adult↗
PubMed1999

[Preliminary report of experience with laparoscopic splenectomy in adults and children].

Laparoscopic splenectomy is effective and technically feasible for treating various hematological diseases such as idiopathic thrombocytopenic purpura (ITP), congenital spherocytosis, hemolytic anemia, and Hodgkin's lymphoma. An anterior approach to the vascular pedicle is usually described. However, in this approach to the splenic hilum, the dissection of the splenic artery is frequently difficult. The laparoscopic posterolateral approach involves dissection of the posterolateral attachments to the diaphragm, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. We used it in 9 adults and 4 children: 11 patients had ITP, 1 spherocytosis and 1 Hodgkin's lymphoma. This procedure was completed in 13 patients, but in 2 it had to be converted to open surgery. Mean operating time was 3 hours and mean postoperative stay 3 days. Blood transfusion was not required and there were no postoperative complications. Laparoscopic splenectomy is safe in both adults and children, and the posterolateral approach provides excellent visualization and allows control of the branches of the splenic vein and artery in the splenic hilum.

Adult↗
PubMed1998

[Laparoscopic approach to perforated duodenal ulcer].

As laparoscopy becomes more prevalent, it is being used for a growing variety of abdominal operations, both electively and as emergency treatment. We describe our preliminary experience in laparoscopic repair of perforated duodenal ulcer. 2 women and 2 men, aged 40-78 were operated over a period of 4 months and in all laparoscopic suture and omentopexy were performed with meticulous abdominal lavage. Despite somewhat longer operative time but a similar period of hospitalization, the easier post-operative course and fewer wound complications justify this technique. The effectiveness of medical treatment of peptic disease, and especially the anti-Helicobacter pylori regimen, supports the view that closure of the perforation is usually enough, and vagotomy is not needed.

Adult↗
PubMed1998

[Abdominal compartment syndrome].

Abdominal compartment syndrome refers to a complex of negative effects of intra-abdominal hypertension. Its most common cause is complicated abdominal trauma. The syndrome includes mainly hemodynamic and respiratory manifestations but may involve other systems as well. It may present as a life-threatening emergency in the multi-trauma patient. Awareness of the syndrome may enable the surgeon to take preventive measures or to diagnose it earlier and to treat it effectively. We describe a 21-year old man who developed this syndrome after multiple gunshot wounds, with severe liver injury. After 2 operations the typical manifestations of the syndrome were diagnosed. He was re-operated to release intra-abdominal hypertension and then slowly recovered.

Abdominal Injuries↗
PubMed1998

Posterolateral approach. An alternative strategy in laparoscopic splenectomy.

Laparoscopic splenectomy (LS) is effective and technically feasible for treating various hematological diseases, especially idiopathic thrombocytopenic purpura (ITP). An anterior approach to the vascular pedicle is usually described. However, in this approach to the splenic hilum, the dissection of the splenic artery is often difficult. A total of 13 patients with ITP underwent elective laparoscopic splenectomy. We utilized a laparoscopic posterolateral approach involving dissection of the suspensory ligaments at the lower pole, then dissection and division of the posterolateral attachments, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. This procedure was completed in 11 of our 13 patients and converted to open surgery in the other two patients. Mean operative time was 3 h; mean postoperative stay was 3 days. No blood transfusion was required, and no complications were noted in the postoperative period. The posterolateral approach provides better visualization and control of branches of the splenic vein and artery in the splenic hilum. It also permits visualization and control of surgical hemorrhage through the operating ports.

Adolescent↗
PubMed1997

[Surgical approach to benign cecal ulcer].

Benign cecal ulcer is a rare lesion, usually diagnosed during operation for suspected acute appendicitis or peritonitis of unknown origin. In the past, right hemicolectomy was recommended as the treatment of choice because of the difficulty in differentiating malignant lesions from benign cecal ulcers. However, in recent reports a more conservative approach has been suggested, consisting of selective colectomy followed by frozen section biopsy. This approach is aimed at preventing unnecessary excision of the colon and conserving the ileocecal valve. We present a 47-year-old woman operated for right lower quadrant peritonitis, believed to be due to acute appendicitis. On exploration, a biopsy-proven benign cecal ulcer was found and resected.

Cecal Diseases↗
PubMed1996

[Laparoscopic cholecystectomy during pregnancy].

The decision whether to perform cholecystectomy during pregnancy, and in what manner, is complex. A 26-year-old pregnant woman was admitted because of persistent biliary colic, which did not respond to conservative treatment. Laparoscopic cholecystectomy was done, with a normal course and without negative effects on the pregnancy. Contraindications to laparoscopic cholecystectomy are becoming fewer as technique improves and experience accumulates. This case report is added to the other few reported, which reinforce the view that pregnancy should no longer be considered a contraindication to laparoscopic cholecystectomy.

Adult↗
PubMed1995

Correct preoperative localization: does it permit a change in operative strategy for primary hyperparathyroidism?

BACKGROUND: A meticulous bilateral neck exploration by an experienced endocrine surgeon offers a high cure rate with low morbidity for patients with primary hyperparathyroidism. The advent of localizing studies raises the possibility of unilateral neck exploration. The cost-effectiveness of preoperative localizing studies and unilateral neck exploration in primary hyperparathyroidism are controversial issues. This study was designed to determine the risks of missing a contralateral pathologic parathyroid gland in patients with preoperative localization that was confirmed at neck exploration. METHODS: Preoperative studies (ultrasonography, nuclear radioactive imaging scan, or both) were performed in 79 patients with primary hyperparathyroidism. In 58 patients a definite localization of an enlarged parathyroid gland was confirmed at operation. All patients underwent a meticulous bilateral neck exploration. RESULTS: Unilateral neck exploration was feasible only in 73.4% of the patients, according to our localizing modalities, and an additional enlarged parathyroid gland on the contralateral side, not detected before operation, was revealed in five patients (8.6%). False-positive rates were 1.7% for ultrasonography and 13% for scan. CONCLUSIONS: These results indicate an unacceptably high surgical failure rate for unilateral neck exploration guided by preoperative localizing studies compared with a bilateral neck exploration by an experienced endocrine surgeon, questioning the cost-effectiveness of preoperative localizing studies.

Adenoma↗
PubMed1995

Lost gallstones found in a hernial sac.

Spillage of bile and gallstones is not a rare event during laparoscopic cholecystectomy. The natural history of spilled and retained stones is not well defined. We report of such lost stones that were found several months later in a hernia sac.

Cholecystectomy, Laparoscopic↗
PubMed1994

[Intestinal obstruction due to phytobezoar in a Meckel's diverticulum].

Meckel's diverticulum is the most prevalent anomaly of the gastrointestinal tract, found in about 2% of the general population. Most are asymptomatic; but most frequent complications are intestinal obstruction, diverticulitis and lower gastrointestinal bleeding. A 33-year-old man was operated on for mechanical small bowel obstruction caused by a large Meckel's diverticulum filled with a phytobezoar. This mechanism of obstruction is rare. When the history of a patient without previous intestinal operations, as in this case, raises the possibility of phytobezoar, the probability of congenital anomaly is high.

Adult↗