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Biomedical subjects

A Cuschieri

Publications and source records attributed to A Cuschieri.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Multicenter prospective evaluation of laparoscopic antireflux surgery. Preliminary report.

BACKGROUND: A prospective study of 116 patients undergoing laparoscopic antireflux surgery was undertaken in four centers in the United Kingdom and the United States. METHODS: Patients with a hiatal hernia (n = 80) underwent total Rosetti-Hell fundoplication, whereas those without a hiatal defect (n = 36) were treated by a partial fundoplication (Toupet). The follow-up period ranged from 3 to 24 months; median was 13 months. RESULTS: The median duration of the operations was 2.5 h. Intraoperative complications were encountered in 16 patients (14.0%) and conversion to laparotomy was necessary for esophageal perforation in one. The postoperative recovery of gastrointestinal function was rapid and the median hospital stay from the time of the operation to discharge was 2 days, range 1-10. A good symptomatic result (> 70% reduction of preoperative symptom score) was observed in 106 patients (91%). There were no postoperative deaths but 15 patients (13.0%) developed complications in the immediate postoperative period. At 3 months, complete endoscopic healing of the esophagitis was observed in 65/92 patients (71%) and improvement by at least one grade was seen in 19 patients (21%). Twenty-four-hour pH monitoring, which was abnormal preoperatively in 93% of patients, was normal after surgery in 95%. There were 10 symptomatic failures (persistent reflux symptoms) and 14 patients (12%) developed adverse symptoms related to the procedure (gas-bloat 8, dysphagia 9, gastroparesis 1, explosive diarrhoea 1). Readmission to hospital within 3 months was necessary in 9 patients. CONCLUSIONS: Laparoscopic antireflux surgery can be performed with a low morbidity. In the short term, 83% of patients were rendered symptom free. These results are similar to those reported after the equivalent open operations.

Adult↗
PubMedDate not supplied

Abdominal wall lift. Low-pressure pneumoperitoneum laparoscopic surgery.

A method of abdominal wall lift has been developed and evaluated clinically in this unit during the past 18 months. It permits the conduct of laparoscopic procedures at an intraabdominal pressure of 6-8 mm Hg. The technique was introduced for laparoscopic surgery in patients with preexisting cardiac disease and chronic bronchitis. The procedure, by lifting both the abdominal wall and the falciform ligament together, also elevates the central portion of the liver (segments 3-5), thereby improving the surgical exposure. For this reason it is now also used in fit patients with ptotic livers or hypertrophied quadrate lobes undergoing laparoscopic cholecystectomy and common bile duct exploration, and to facilitate left subhepatic exposure in patients during laparoscopic antireflux surgery and vagotomy.

Abdominal Muscles↗
PubMedDate not supplied

Endoscopic ultrasonic dissection for thoracoscopic and laparoscopic surgery.

A specifically designed handpiece has been developed for ultrasonic dissection of tissues and organs during minimal-access surgery. The experimental prototype has been evaluated in major endoscopic operations on the esophagus, colon, and rectum (n = 19). The benefits documented by this initial experience include increased dissection efficiency of extensive fibroareolar attachments, safe exposure of major vascular pedicles (especially those located in mesocolic fat), greatly reduced risk of major hemorrhage, and decreased operating time.

Colectomy↗
PubMedDate not supplied

Laparoscopic antireflux surgery and repair of hiatal hernia.

Laparoscopic mobilization of the esophagus and esophagogastric (O-G) junction enables the safe and effective performance of endoscopic antireflux surgery for intractable reflux esophagitis. The two antireflux procedures that we have evaluated in clinical practice at this institution are the ligamentum teres cardiopexy (n = 9) and partial posterior fundoplication (n = 5). More recently, laparoscopic repair of large symptomatic hiatal hernia (sliding, paraesophageal, and mixed) has also been introduced (n = 4). The procedure entails reduction of the hernia, mobilization of the O-G junction with crural repair by a continuous suture technique employing a special preformed jamming loop knot, followed by total fundoplication, which is fixed proximal to the anterior margin of the diaphragmatic hiatus and distal to the O-G junction. The early results (maximum follow-up 18 months) of this experience have been favorable, with minimal morbidity, early hospital discharge, and effective control of reflux symptoms without adverse sequelae. Laparoscopic antireflux surgery is an alternative to long-term medication in patients with intractable esophagitis, and laparoscopic repair of large hiatal hernias offers significant advantage over the conventional open surgical approach in terms of rapid convalescence.

Gastroesophageal Reflux↗
PubMedDate not supplied

Dynamics of bile flow through the human choledochal sphincter following exploration of the common bile duct.

The opening pressure and flow rates through the sphincter of Oddi using the patient's own bile to prime the system were measured daily in 17 patients after cholecystectomy and exploration of the common bile duct. The sequential changes in these parameters were correlated with preoperative serum bilirubin, bile bacteriology, biliary lipid composition, and bile viscosity. The opening pressure fell from an initial value of 17.2 +/- 1.9 to 9.1 +/- 0.9 cm bile (p less than 0.01) on the seventh postoperative day, indicating a self-limiting hold-up following stone extraction. The low opening pressure after the fifth to sixth day is well below the maximal hepatic secretory pressure and suggests that the bile flow into the duodenum may be continuous after cholecystectomy. The flow rate through the sphincter measured at a fixed pressure head of 30 cm of bile increased from 23.9 +/- 3.9 to 40.0 +/- 6.1 ml during the same period (p less than 0.01). Presumably, the latter represents the maximal flow rate of bile through the sphincter of Oddi under physiological conditions. These changes in flow could not be explained by alterations in the bile viscosity during the study period. The increase in flow rate was significant only in the nonjaundiced group and correlated positively with the phospholipid concentration in the bile. There were no significant differences in opening pressure, flow rates, and biliary lipid concentrations between patients with sterile bile and those with positive bile cultures.

Adolescent↗
PubMedDate not supplied

The spectrum of laparoscopic surgery.

Laparoscopic procedures have begun to replace many conventional operations because of the avoidance of major surgery and the rapid recovery of the patient. The majority of these traditional operations will be performed laparoscopically in the future. For example, patients who suffer from achalasia will be able to undergo laparoscopic cardiomyotomy and patients with non-cardiac chest pain of esophageal origin will be able to undergo thoracoscopic myotomy. Likewise, a viable alternative to long-term medication with H2 blockers or omeprazole will be laparoscopic posterior vagotomy and anterior lesser curve seromyotomy. As methods are developed to deal with the extraction of large specimens, many ablative procedures will be undertaken by the laparoscopic route. Extraction techniques must not compromise the need for histopathological examination of the resected specimen in cancer resections. The ultimate spectrum of laparoscopic surgery will be determined by the progress in remote handling technology, overcoming the manipulative restrictions inherent in the current instrumentation. Research evaluating the efficacy of new methods will be essential.

Acute Disease↗
PubMedDate not supplied

The rotary gallstone lithotrite to aid gallbladder extraction in laparoscopic cholecystectomy.

During laparoscopic cholecystectomy, a large stone burden may cause difficulty when extracting the gallbladder through the abdominal wall. Currently, the alternatives available to the surgeon include increasing the incision, removing stones singly, or utilizing complex fragmentation techniques like the pulsed dye laser. We have employed an electromechanical rotary gallstone lithotrite (RGL) to fragment stones to an aspiratable size. Initially, cholesterol spheres were pulverized in a latex balloon to demonstrate the efficacy of the device. Then, human gallstones were placed in the balloon and reduced to fragments less than or equal to 1 mm from initial sizes of 4-24 mm. Human stones were then inserted in ex vivo porcine gallbladders in a controlled experiment and treated with the device. Ten out of 12 tests were completed within 30 s; one test required 49 s and one 105 s to achieve complete fragmentation. Blinded histological evaluation demonstrated that tissue abrasion caused by use of the device would not interfere with the diagnosis of unsuspected malignancy. Clinical trials have now commenced under the auspices of the hospital ethical committee.

Animals↗
PubMedDate not supplied

Tetralogy of Fallot in a patient with Killian-Pallister syndrome.

Killian-Pallister syndrome is a rare dysmorphic condition characterized by specific clinical manifestations and tetrasomy 12p. Although the association of this condition with congenital heart disease has been previously documented, no cases have been reported in association with Fallot's tetralogy. We report one such case.

Abnormalities, Multiple↗
PubMedDate not supplied

Potential hazards of excluded bowel and use of parenteral nutrition: a case report.

This case demonstrates that excluded gut may be a reservoir for bacterial translocation and recurrent sepsis. Translocation may contribute to cholestatic hepatitis, and restoration of bowel continuity is fundamental to reversing these pathologic changes. It also emphasizes that parenteral nutrition even when used as interim supportive treatment is not without serious hazard.

Bacteremia↗