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Biomedical subjects

B V MacFadyen

Publications and source records attributed to B V MacFadyen.

At least 19 recordsLinked to original sources
PubMed2006

Endoluminal and transluminal surgery: current status and future possibilities.

The field of minimally invasive surgery has seen tremendous growth since the first laparoscopic cholecystectomy was performed in 1987. The key question is not how successful these techniques are currently, but rather where may they lead in the future? New technologies promise to usher in an era of even less invasive procedures. The terms being coined in the literature include "incisionless," "endoluminal," "transluminal," and "natural orifice" transluminal endoscopic surgery. These techniques certainly have the potential to become the next wave of minimally invasive procedures. A recent editorial in Surgical Endoscopy by Macfadyen and Cuschieri highlighted the ongoing developments in endoscopic surgery and stressed the critical importance of surgeons being involved in future applications and permutations of these techniques [1]. There are early signs of such involvement. The work of numerous investigators in the field was presented recently at the 2005 Digestive Disease Week. The American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), in collaboration with the American College of Surgeons, recently organized a postgraduate course in endoluminal therapy at the spring 2005 meeting held in Hollywood, Florida. The course is being offered again at the 2006 SAGES annual meeting. Similar courses are being offered at other regional and national meetings. This review attempts to highlight some of the available and evolving endoluminal therapies reviewed at that forum, including techniques for the management of gastroesophageal reflux disease, endoscopic mucosal resection, endoluminal bariatric surgery, transanal endoscopic microsurgery, and transgastric endoscopic surgery, as well as new technologies and possible future directions in luminal access surgery.

Bariatric Surgery↗
PubMed2006

Intraoperative cholangiography: past, present, and future.

The extrahepatic biliary tree was first visualized in 1918 when Reich injected bismuth and petrolatum and defined a biliary fistula, thus opening the field for further studies of the biliary tree. Mirizzi recorded the first series of intraoperative cholangiography in 1932 using static films. Later, the mobile C-arm image intensifier using a TV monitor was reported in a series by Berci and colleagues in 1978. They emphasized the importance of using routine cholangiography in all laparoscopic cholecystectomies. This procedure can be performed through the cystic duct or through the gallbladder with excellent visualization of the anatomy of the extrahepatic biliary tree, including the potential of finding bile duct stones, stricture, and tumor, as well as defining the function and anatomy of Oddi's sphincter. Numerous benefits of this technique can be observed, including early definition of a bile duct leak or injury. X-ray resolution will continue to improve as well as three-dimensional imaging, and intraoperative magnetic imaging cholangiopancreatography may be developed as the future intraoperative cholangiogram.

Biliary Tract Surgical Procedures↗
PubMed2002

Modifications of coagulation and fibrinolytic parameters in laparoscopic cholecystectomy.

BACKGROUND: The incidence of deep vein thrombosis and pulmonary embolism following laparoscopic surgery is unknown and studies on alterations of hemostasis after laparoscopy are inconclusive. METHODS: In this study we prospectively evaluated changes in prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (Fg), antithrombin III (ATIII), prothrombin fragment F 1 + 2, beta-thromboglobulin (betaTG) and D-dimer (D-D), preoperatively and 24 h after laparoscopic surgery in 16 patients. RESULTS: Comparing pre- and postoperative values, no statistical differences were observed in aPTT, F1 + 2, and ATIII measurements. Postoperative PT values increased slightly (p approximately 0.05) after surgery. Conversely, Fg, betaTG, and D-D values were statistically higher in the 24-h evaluation (p = 0.008, 0.01, and 0.045, respectively). CONCLUSIONS: These data suggest that laparoscopic surgery induces activation of coagulation and fibrinolytic pathways and, additionaly, betaTG elevation, which has never been reported and might account for postoperative platelet activation and a greater risk of thrombogenicity. Therefore, routine thromboembolic prophylaxis in patients undergoing laparoscopic surgery is recommended.

Adult↗
PubMed1999

Ultrasonic dissectors and minimally invasive surgery.

As increasingly complex operations are performed laparoscopically, new problems arise regarding basic tasks such as dissection and retraction. Emerging technologies continue to reduce the technical demands of minimally invasive surgery. Recent studies have shown that ultrasonic devices have the potential to replace electrocautery without compromising safety in minimally invasive operations. With the combination of several functions into a single instrument, significant reductions in operative time and expense are possible and should increase the acceptance of this new technology.

Hemostasis, Endoscopic↗
PubMed1998

Bile duct injury after laparoscopic cholecystectomy. The United States experience.

BACKGROUND: Forty series reporting experience with laparoscopic cholecystectomy in the United States from 1989 to 1995 were reviewed. A total of 114,005 cases were analyzed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Intraoperative cholangiography (IOC) was attempted in 41.5% of the laparoscopic cholecystectomies and was successful in 82.7%. In major bile duct injuries, the common bile duct/common hepatic duct were the most frequently injured (61.1%) and only 1.4% of the patients had complete transection. METHODS: When reported, most of the bile duct injuries were managed surgically with a biliary-enteric anastomosis (41.8%) or via laparotomy and t-tube or stent placement (27.5%). The long-term success rate could not be determined because of the small number of series reporting this information. The management for bile leaks usually consisted of a drainage procedure (55.3%) performed endoscopically percutaneously, or operatively. RESULTS: The morbidity for laparoscopic cholecystectomy, excluding bile duct injuries or leaks, was 5.4% and the overall mortality was 0.06%. It was also noted that the conversion rate to an open procedure was 2.16%. CONCLUSIONS: It is concluded based on this review of laparoscopic cholecystectomies that the morbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore, bile duct injuries can be minimized by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-common bile duct junction.

Bile Ducts↗
PubMed1998

The clinical management and results of surgery for acute cholecystitis.

The laparoscopic approach to acute cholecystitis is not only feasible, but it is also a cost-effective, safe, and beneficial treatment option in selected patients. Patients undergoing laparoscopic surgery for acute cholecystitis seem to enjoy the same benefits of diminished pain and shorter hospitalization as those patients undergoing an elective laparoscopic cholecystectomy. The complication rates are also comparable with those for an open cholecystectomy. An early laparoscopic cholecystectomy within 4 days of the onset of symptoms has been shown to reduce the number of major complications and conversion rate, thus resulting in a decreased hospital stay. A low threshold for conversion to laparotomy also seems to be an important factor in maintaining a low incidence of operative complications. The conversion to laparotomy is therefore considered to be a good surgical option for experienced surgeons. Patients who are in the high-risk category or who have severe disease are best managed initially by gallbladder drainage unless they have perforated disease, which thus requires an emergency laparotomy.

Acute Disease↗
PubMed1998

Bile duct injury: management options during and after gallbladder surgery.

Proper management of iatrogenic bile duct injuries is mandatory to avoid immediate or late life threatening sequelae. Results of surgery depend mainly on the type of injury, the detection of the injury, and the timing of the surgery. Lesions detected during cholecystectomy should be repaired immediately, preferably with an end-to-side biliary anastomosis, a Roux-en-Y bilio-enteric anastomosis, or by the insertion of a T-tube. Bile duct injuries detected in the postoperative phase require a multidisciplinary approach and an algorithm for treatment of each type of lesion is proposed. In bile peritonitis with biliary obstruction and/or transection and in tight long strictures, which develop several months after cholecystectomy, a Roux-en-Y hepatico-jejunostomy is the most commonly performed operation. Other surgical techniques include a "mucosal graft" procedure and intrahepatic biliary enteric anastomoses, which may be required in difficult high-biliary lesions. Endoscopy and/or interventional radiology offer the best treatment options in bile duct leaks and in short ductal strictures that involve less than 50% of the bile duct lumen. In these injuries, surgical management should be performed only in the failure of nonsurgical methods. Because these lesions involve complicated biliary surgery, therapeutic endoscopy, and interventional radiology, treatment should be performed where there is expertise in all three areas.

Algorithms↗
PubMed1997

Gallbladder cancer and trocar site recurrences.

BACKGROUND: Critics of laparoscopic surgery cite an increased incidence of tumor recurrence at the trocar sites following laparoscopic cholecystectomy in patients incidentally found to have carcinoma of the gallbladder. The purpose of this review was to determine if laparoscopic cholecystectomy performed in patients with gallbladder cancer results in an increased incidence of abdominal wall recurrences. METHODS: The charts of all patients with gallbladder cancer registered at the University of Texas M. D. Anderson Cancer Center from January 1991 through April 1996 were retrospectively reviewed. Data were collected on initial and subsequent surgical procedures, tumor grade and histology, T stage, adjuvant therapy, and survival. These data were analyzed with regard to abdominal wall recurrences and outcome. RESULTS: Ninety-three patients with gallbladder cancer were seen during this period; 79 patients with complete follow-up information comprised the study population. Comparison of the incidence of abdominal wall recurrences among the categories of surgical procedure (laparoscopic versus open versus laparoscopic converted to open) did not reveal any statistically significant differences. Overall 5-year survival was 10%. CONCLUSIONS: Gallbladder cancer is an aggressive malignancy with few long-term survivors. In addition, these data show that the incidence of abdominal wall implantation is not increased with laparoscopic surgery but is more likely a manifestation of the aggressive nature of this tumor.

Abdominal Muscles↗
PubMed1995

Endoscopic jejunal access for enteral feeding.

Enteral (gut) alimentation appears to offer greater benefit for patients than calories delivered via a parenteral (intravenous) route. Enteral alimentation prevents mucosal atrophy, maintains normal gut flora, decreases bacterial translocation, and enhances enteral immunological competence. Reliable delivery into the jejunum without the placement of an operative feeding tube is difficult, however. We have been interested for some time in endoscopically placing a jejunal tube for enteral nutrition early (within 24 hours) after trauma resuscitation or operation. A simplified technique is described for the endoscopic placement of a jejunal feeding tube, with or without a concomitant percutaneous endoscopic gastrostomy.

Adolescent↗
PubMed1994

The economic considerations in laparoscopic surgery.

There has been increasing concern in the medical, business, and insurance communities and government agencies about the rising cost of health care. Since 1980 the cost of medical care has increased from $280 billion dollars per year to $670 billion dollars in 1990, and was estimated at $900 billion in 1993. Several factors have contributed to this increase, including the high cost of hospitalization and new expensive technology, such as laparoscopic cholecystectomy. This present cost analysis was undertaken to determine the cost variables in laparoscopic cholecystectomy to see if changes in physician, nursing, and administration work activities could decrease the cost of hospitalization. Fifty-four patients who had an uncomplicated elective cholecystectomy during a five-month period in 1993 were assessed in terms of cost components of hospitalization, including nursing unit labor costs, surgery personnel labor costs, supply/instrument cost, and ancillary costs. Nine general surgeons participated in this study, four of whom accounted for 71% of the annual volume of cases. This analysis was performed with the help of Baxter Corporate Consulting, a Division of Baxter Healthcare Corporation. From this study, it was found that the average cost for uncomplicated laparoscopic cholecystectomy patients was $1589 +/- $223. The operating room and supply/instrument component costs were the two largest expenses, accounting for 42% of the total cost. Reimbursement from various insurance agencies were also evaluated, and it was determined that a contract made with a local HMO caused the hospital to lose an average of $443.00 per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholecystectomy, Laparoscopic↗
PubMed1992

Laparoscopic repair of duodenal ulcer and gastroesophageal reflux.

The low morbidity and early recovery associated with laparoscopic procedures have heralded a new era for many types of surgery. In addition to the initial promising reports for duodenal ulcer disease and gastroesophageal reflux discussed above, there is a growing body of reports of gastric procedures performed laparoscopically, including omentopexy for perforated duodenal ulcer and laparoscopic repair of full-thickness stomach injury. Laws et al recently described the use of transthoracic vagotomy in recurrent peptic ulcer disease for four patients who had previously undergone a gastric drainage procedure. As with any new procedure, laparoscopic techniques for duodenal ulcer and Nissen fundoplication reviewed in this section need to be evaluated further for long-term effectiveness and comparability to existing therapy. At least one controlled multicenter trial is ongoing to compare the long-term results and cost-effectiveness of laparoscopic surgery for duodenal ulcer with those of standard medical therapy, and as surgeons gain more experience with these laparoscopic procedures, it is likely that other similar trials will be initiated.

Duodenal Ulcer↗