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G G Jamieson

Publications and source records attributed to G G Jamieson.

At least 19 recordsLinked to original sources
PubMed2003

Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery.

BACKGROUND: A systematic review was conducted to determine which of the methods of obtaining peritoneal access and establishing pneumoperitoneum is the safest and most effective. METHODS: Studies that met the inclusion criteria were identified from six bibliographic databases up to May 2002, the internet, hand-searches and reference lists. They were critically appraised using a validated checklist and data were extracted using standardized protocols. RESULTS: Meta-analysis of prospective, non-randomized studies of open versus closed (needle/trocar) access indicated a trend during open access towards a reduced risk of major complications (pooled relative risk (RR(p)) 0.30, 95 per cent confidence interval (c.i.) 0.09 to 1.03). Open access was also associated with a trend towards a reduced risk of access-site herniation (RR(p) 0.21, 95 per cent c.i. 0.04 to 1.03) and, in non-obese patients, a 57 per cent reduced risk of minor complications (RR(p) 0.43, 95 per cent c.i. 0.20 to 0.92) and a trend for fewer conversions to laparotomy (RR(p) 0.21, 95 per cent c.i. 0.04 to 1.17). Data on major complications in studies of direct trocar versus needle/trocar access were inconclusive. Minor complications in randomized controlled trials were fewer with direct trocar access (RR(p) 0.19, 95 per cent c.i. 0.09 to 0.40), predominantly owing to a reduction in extraperitoneal insufflation. CONCLUSION: The evidence on the comparative safety and effectiveness of the different access methods was not definitive, but there were trends in the data that merit further exploration.

Controlled Clinical Trials as Topic↗
PubMed2002

Excision of laparoscopic port sites increases the likelihood of wound metastases in an experimental model.

BACKGROUND: Case reports of patients developing tumor metastases at port sites following laparoscopic surgery have prompted the development of preventive strategies to address this potential problem, including local excision of the port sites. While it has been suggested that this strategy could be used clinically, its efficacy has not been established. METHODS: Twenty four immune-competent Dark Agouti rats underwent laparoscopy and standardized intraperitoneal laceration of an implanted abdominal flank tumor, using an established laparoscopic cancer model. Rats were randomized to either control (n = 12) or wound excision (n = 12) groups. Both groups underwent laparoscopy using carbon dioxide (CO2) insufflation and two mini-laparoscopy ports. In the wound excision group, one of the port site wounds was excised following desufflation of the abdominal cavity. One week later, the port site wounds were excised for histological examination. RESULTS: Wound involvement with tumor was significantly more common following wound excision than with untreated control wounds (nine of 12 vs two of 12, p = 0.002). In the wound excision group, tumor metastases arose preferentially in the excised port site wound. CONCLUSION: This study suggests that excision of laparoscopy port site wounds following laparoscopic surgery for cancer does not prevent the subsequent development of port site tumors. Furthermore, the excision of port sites may actually increase the risk of tumor metastases arising in port sites, suggesting that the clinical application of this strategy should be avoided pending further evaluation.

Abdominal Neoplasms↗
PubMed2002

Metallothionein in human oesophagus, Barrett's epithelium and adenocarcinoma.

The potential of the metal-binding protein, metallothionein, in assessing the progression of normal oesophagus through Barrett's to adenocarcinoma was investigated. Metallothionein was quantitatively determined in resected tissues from patients undergoing oesophagectomy for high grade dysplasia/adenocarcinoma and in biopsies from patients with Barrett's syndrome. In 10 cancer patients, metallothionein concentrations in adenocarcinoma were not significantly different from normal oesophagus, although six had elevated metallothionein concentrations in the metaplastic tissue bordering the adenocarcinoma. In 17 out of 20 non-cancer patients with Barrett's epithelium, metallothionein was significantly increased by 108% (P<0.004). There was no association between the metallothionein levels in Barrett's epithelium and the presence of inflammatory cells, metaplasia or dysplasia. Metallothionein is a marker of progression from normal to Barrett's epithelium but is not increased in oesophageal adenocarcinoma.

Adenocarcinoma↗
PubMed2002

A further modification of fundoplication. 90 degrees anterior fundoplication.

BACKGROUND: Laparoscopic Nissen fundoplication is the most widely applied procedure for the surgical treatment of gastroesophageal reflux. However, it can be followed by adverse outcomes, including dysphagia and "wind-related" problems. To reduce the likelihood of side effects, we have progressively modified this procedure to an anterior 90 degrees partial fundoplication. METHODS: The procedure entails posterior hiatal repair, posterior esophagopexy, accentuation of the angle of His, and construction of a 90 degrees anterior partial fundoplication. Clinical follow-up was performed prospectively using a standardized questionnaire. RESULTS: From February 1999 to June 2001, 83 patients underwent 90 degrees anterior fundoplication for gastroesophageal reflux disease. In 45 the procedure was chosen because of specific patient or surgeon preference, and in 38 it was performed within the context of an ongoing randomized trial. Operating time ranged from 20 to 140 minutes (median, 52 min), and all but one of the procedures were completed laparoscopically. One patient experienced a major postoperative complication--small bowel injury from Veress needle. Follow-up extends up to 2 years (median, 1 year). Two patients have undergone further surgery, both for recurrent reflux. Control of reflux has been acceptable, with a reduction in heartburn symptom scores and high overall satisfaction. Postoperative dysphagia measured using a visual analog scale was less following surgery compared with preoperative scores. Eighty-two percent of patients could belch normally 3 and 12 months after surgery. CONCLUSIONS: Ninety-degree anterior fundoplication achieves good control of reflux and a low incidence of side effects. To further evaluate its potential, we are currently undertaking a prospective randomized trial.

Adult↗
PubMed2002

Helium vs carbon dioxide gas insufflation with or without saline lavage during laparoscopy.

BACKGROUND: Helium is an inert gas that, if used for insufflation during laparoscopy, may be followed by less postoperative pain than carbon dioxide (CO2) insufflation, due to a more limited effect on intraabdominal pH and metabolism. Saline lavage has also recently been shown to reduce postoperative pain following laparoscopic surgery. To evaluate these possibilities and to better define the clinical safety of helium insufflation, we undertook a prospective randomized trial comparing CO2 and helium insufflation with or without saline lavage in patients undergoing elective laparoscopic upper abdominal surgery. METHODS: From January to November 2000, 173 patients undergoing elective laparoscopic cholecystectomy or fundoplication were randomized to undergo laparoscopy with either CO2 or helium insufflation. Within each group, patients were further randomized to undergo peritoneal lavage with 2 L of 0.9% saline at the end of the surgical procedure. This yielded the following four patient groups; CO2 (group 1, n = 47), CO2 + saline lavage (group 2, n = 43), helium (group 3, n = 43) and helium + saline lavage (group 4, n = 40). Patients were blinded to their randomization, and post-operative assessment was also performed by a blinded investigator, who applied a standardized scoring system to assess postoperative pain. RESULTS: The study groups were well matched for age, sex, weight, American Society of Anesthesiologists (ASA) status, duration of surgery, and volume of gas utilized, and 81% of patients were discharged within 48 h. There were no differences in the incidence of postoperative complications among the study groups, and postoperative pain scores were not significantly different when all four groups were compared. When helium (groups 3 and 4) was compared with CO2 (groups 1 and 2), no differences in pain score were seen. When no lavage (groups 1 and 3) was compared with lavage (groups 2 and 4), less pain was found in the group undergoing saline peritoneal lavage (mean 4-h pain score, 5.9 vs 5.2; 24-h pain score, 4.8 vs 4.1; p > 0.05). CONCLUSIONS: The use of helium insufflation for laparoscopic surgery, while not associated with any significant adverse sequelae, was not associated with less postoperative pain in this trial. The use of saline peritoneal lavage was associated with less pain in the early postoperative period.

Abdominal Pain↗
PubMed2002

Laparoscopic fundoplication for patients with symptoms but no objective evidence of gastroesophageal reflux.

In general terms, all patients who undergo a laparoscopic fundoplication procedure should have objective evidence of gastroesophageal reflux. However, occasionally patients without objective evidence of reflux disease are referred for surgery. This study assessed the outcome of a highly selected group of patients who underwent laparoscopic fundoplication without objective evidence of reflux at either preoperative endoscopy or pH monitoring. Data from all patients undergoing laparoscopic fundoplication in our department over a 9-year period from December 1991 to January 2001 were collected prospectively. From a total of 1,003 patients, a subgroup of 15 patients was identified who had no evidence of ulcerative oesophagitis at endoscopy or abnormal reflux on 24-h pH monitoring. Eight of these patients had typical symptoms of reflux (four had predominantly heartburn, four had predominantly volume regurgitation) and seven patients had atypical symptoms such as cough, bloating, chest pain, or sore throat. All patients had tried medication for acid suppression before surgery, with five gaining little or no benefit. The mean acid exposure time was 2% (range 0.1-3.6%). A correlation between typical symptoms and reflux events of over 50% was noted in three patients. All patients underwent laparoscopic fundoplication, with one conversion to an open procedure. Mean patient satisfaction score (0-10 linear score) was 8.7 at 3 months and 1 year postoperatively. Three patients failed to improve following surgery. These three all had atypical symptoms, a symptom correlation of less than 50% with acid reflux on pH monitoring, and two of the three had a poor response to medication. All other patients benefited symptomatically from surgery. We concluded that the absence of objective evidence of reflux should not always preclude patients from a laparoscopic fundoplication. Carefully selected patients with typical reflux symptoms can have a good outcome. However, patients who do not have typical symptoms and who respond poorly to acid suppression are not likely to benefit from surgery.

Adolescent↗
PubMed2001

Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia.

BACKGROUND: Although surgical myotomy is considered the gold standard, many different treatments have been advocated for achalasia. There are now a number of reports of cardiomyotomy being performed laparoscopically. METHODS: This is a prospective study of 82 patients (47 male and 35 female; median age, 47 years) who underwent laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia. RESULTS: Four of the 82 procedures required conversion to open surgery, all during the early stages of the series, and two required early reoperation for a postoperative problem. The median operating time was 80 min (range, 32-210). the median hospital stay was 3 days (range, 2-18), and normal physical activity was resumed after a median of 2 weeks (range, 3 days to 12 weeks). Follow-up ranged up to 8 years (median, 2). Postoperatively, symptoms of dysphagia (to both solids and liquids), heartburn, odynophagia, chest pain, regurgitation, and cough were significantly reduced in all patients. The median overall satisfaction score (graded from 0 to 10, with 10 representing total satisfaction) was 9 (range, 0-10), and 90% of patients were highly satisfied with the surgical outcome. CONCLUSION: Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity.

Adolescent↗
PubMed2001

Laparoscopic Nissen fundoplication: five-year results and beyond.

HYPOTHESIS: Laparoscopic Nissen fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. DESIGN: Prospectively evaluated case series. SETTING: University teaching hospital. PATIENTS: From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. This included all patients having laparoscopic Nissen fundoplication, from the first procedure onward. INTERVENTIONS: Long-term follow-up for 5 or more years after laparoscopic Nissen fundoplication was obtained by an independent investigator who interviewed patients using a structured questionnaire. MAIN OUTCOME MEASURES: Prospective evaluation of clinical symptoms using a structured questionnaire. RESULTS: Outcome data covering a period of 5 or more years after surgery was available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follow-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revision surgery for recurrent reflux; 87% of the 176 patients remained free of significant reflux. Reoperation was required for dysphagia in 7 patients (3.9%), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patients (7.3%). Of the reoperations, 56% were performed within 12 months of the original procedure, and 22% during the second year of follow-up. Further surgery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. CONCLUSIONS: The long-term outcome of laparoscopic Nissen fundoplication is similar to that following open fundoplication. Good results are obtained in most patients.

Follow-Up Studies↗
PubMed2001

A prospective randomized trial of laparoscopic Nissen fundoplication with anterior vs posterior hiatal repair.

HYPOTHESIS: The technique used for repair of the esophageal hiatus during laparoscopic Nissen fundoplication can influence the likelihood of postoperative dysphagia. DESIGN: A prospective double-blind randomized control trial. SETTING: A university teaching hospital. PARTICIPANTS: A total of 102 patients with proven gastroesophageal reflux disease, undergoing a laparoscopic Nissen fundoplication were randomized to undergo fundoplication with either anterior (47 patients) or posterior (55 patients) repair of the diaphragmatic hiatus. Patients were excluded for the following reasons: they had esophageal motility disorders, required a concurrent abdominal procedure, had undergone previous antireflux surgery, or had very large hiatus hernias. INTERVENTIONS: Laparoscopic Nissen fundoplication with anterior vs posterior hiatal repair. MAIN OUTCOME MEASURES: Independent assessment of dysphagia, heartburn, patient satisfaction, and other symptoms 1, 3, and 6 months following surgery, using multiple standardized clinical grading systems. Objective measurement of lower esophageal sphincter pressure, esophageal emptying time, distal esophageal acid exposure, and endoscopic assessment of postoperative anatomy and esophageal mucosa. RESULTS: Symptoms of postoperative dysphagia, relief of heartburn, and overall satisfaction 6 months after surgery were not influenced by the hiatal repair technique. However, to achieve a similar incidence of dysphagia, more patients who initially underwent posterior hiatal repair required a second surgical procedure (6 vs 0 patients). The hiatal repair technique did not affect the likelihood of early postoperative paraesophageal herniation. CONCLUSION: Anterior suturing of the hiatus appears to be at least as good in the short-term as posterior suturing as a method of narrowing the hiatus during laparoscopic Nissen fundoplication.

Adult↗
PubMed2001

Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery.

BACKGROUND: Symptoms following antireflux surgery are often seen as unavoidable sequelae of the operation. The aims were to determine the frequency of new adverse sequelae following antireflux surgery and the preoperative incidence of similar symptoms. METHODS: Patients undergoing fundoplication underwent prospective assessment of symptoms using a structured interview before and 6 months after surgery. In addition to the presence or absence of symptoms, Visick scores, visual analogue scales and a composite dysphagia score were used. RESULTS: Some 312 patients were evaluated. Antireflux surgery significantly diminished the symptoms of heartburn, epigastric pain, regurgitation, bloating, odynophagia, nausea, vomiting, diet restriction, nocturnal coughing and wheezing. In contrast, there was a significant increase in inability to belch, diarrhoea and increased passage of flatus. The symptoms of dysphagia, postprandial fullness or early satiety and anorexia were not significantly altered by antireflux surgery. There was, however, a group of patients who experienced new or worsened dysphagia after surgery and were more likely to do so if they had no dysphagia before surgery (31 per cent) than if dysphagia was present before surgery (19 per cent). Some 93 per cent of patients were satisfied with the overall outcome of the operation. CONCLUSION: The majority of patients undergoing laparoscopic fundoplication for gastro-oesophageal reflux derive symptomatic benefit and are satisfied with the outcome. Many of the so-called postfundoplication sequelae are present before surgery in many patients. Overall, antireflux surgery does not lead to increased dysphagia or bloating.

Adolescent↗
PubMed2001

Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: a randomized clinical study.

BACKGROUND: Previous studies using animal models have demonstrated that carbon dioxide (CO2) pneumoperitoneum during laparoscopy is associated with adverse physiological, metabolic, immunological and oncological effects, and many of these problems can be avoided by the use of helium insufflation. The present study was performed in patients to compare the effect of helium and CO2 insufflation on intraperitoneal markers of immunological and metabolic function. METHODS: Eighteen patients undergoing elective upper gastrointestinal laparoscopic surgery were randomized to have insufflation achieved by using either helium (n = 8) or CO2 (n = 10) gas. Intraperitoneal pH was monitored continuously during surgery, and peritoneal macrophage function was determined by harvesting peritoneal macrophages at 5 min and 30 min after commencing laparoscopy, and then assessing their ability to produce tumour necrosis factor-alpha (TNF-alpha), and their phagocytic function. RESULTS: Carbon dioxide laparoscopy was associated with a lower intraperitoneal pH at the commencement of laparoscopy, although this difference disappeared as surgery progressed. The production of TNF-alpha was better preserved by CO2 laparoscopy, but the insufflation gas used did not affect macrophage phagocytosis. Patients undergoing helium laparoscopy required less postoperative analgesia. CONCLUSION: The choice of insufflation gas can affect intraperitoneal macrophage function in the clinical setting, and possibly acid-base balance. The present study suggested no immunological advantages for the clinical use of helium as an insufflation gas. The outcomes of the present study, however, are different to those obtained from previous laboratory studies and further research is needed to confirm this outcome.

Carbon Dioxide↗
PubMed2001

Expandable metallic stents should not be used in the treatment of benign esophageal strictures.

Expandable metallic stents have become popular in recent years for the treatment of esophageal strictures. While they are undoubtedly of great value in the palliation of malignant strictures and tracheo-esophageal fistulas, there is concern over their use for the treatment of benign diseases. We report three cases, in which such problems were seen following stent insertion for benign esophageal strictures. All three patients developed further strictures above the stents, one was complicated by a tracheo-esophageal fistula and two stents (in one patient) migrated distally into the stomach. Two of the patients underwent subsequent esophageal surgery. In both cases, this proved extremely difficult and hazardous because of the intense fibrotic reaction induced by the stents. Expandable mesh stents should not be used for the treatment of benign esophageal strictures without careful consideration of the potential problems, which can include rendering the problem inoperable.

Aged↗
PubMed2001

Obesity and its effect on outcome of laparoscopic Nissen fundoplication.

Obesity has long been suspected as predisposing to gastroesophageal reflux disease, and it has also been claimed that it is an important cause of poor outcome following laparoscopic anti-reflux surgery. This study was performed to determine the validity of this proposition. The outcome of 194 patients from an overall experience of 971 laparoscopic anti-reflux procedures was determined in this study. Patients were included if they had undergone a laparoscopic Nissen fundoplication, had completed a minimum 12 months follow-up using a structured questionnaire, and had data available for the calculation of their preoperative body mass index (BMI). Patients were divided into three groups based on BMI: normal weight (BMI < 25), overweight (BMI 25-29.9), and obese (BMI >30). The association between BMI and outcome data from their most recent follow-up was analyzed. There was no correlation between increasing BMI and a poorer overall outcome. There was a slight trend toward less satisfaction with the surgical outcome in patients of normal weight. Preoperative obesity is not associated with a poorer outcome following laparoscopic Nissen fundoplication.

Body Mass Index↗
PubMed2001

Evidence-based investigation for reflux disease.

Hiatal hernia and gastroesophageal reflux disease are measurable conditions. Evidence-based evaluation techniques should be applied to quantify these conditions, to standardize investigations, to define indications, and to provide objective results.

Evidence-Based Medicine↗
PubMed2001

The staging of severity in gastroesophageal reflux disease.

The concept of staging gastroesophageal reflux disease (GERD) has evolved in past decades. In 1974, it was recommended that a standardized method be used to assess the severity and degree of reflux; in 1988, it was proposed that staging be used to evaluate and to report GERD objectively. Some clinicians have since experimented with the staging system by reporting on definite forms of GERD, and others have offered ideas to improve the objectivity of evaluating and reporting GERD.

Gastroesophageal Reflux↗
PubMed2001

Reflux disease without mucosal damage: is there a place for surgery?

Patients in whom regurgitation is a major problem usually require antireflux surgery even though they may have no evidence of esophageal mucosal damage. The most common symptom of reflux is heartburn, and there is good evidence that the severity of this symptom does not correlate with the degree of mucosal damage in the esophagus. With the advent of laparoscopic surgery and the great reduction in the morbidity of antireflux surgery, many patients now are looking for cure of their reflux rather than just symptom relief. Patients in this category do well with laparoscopic antireflux surgery regardless of whether thee have endoscopic evidence of mucosal damage or not; indeed, if the data in the literature are a guide, it seems that esophageal mucosal damage is not a necessary indication for antireflux surgery. An "acid-sensitive esophagus" is not yet an established indication for laparoscopic antireflux surgery, however.

Esophagitis, Peptic↗
PubMed2000

Laparoscopic antireflux surgery in the treatment of gastroesophageal reflux in patients with Barrett esophagus.

BACKGROUND: Patients with gastroesophageal reflux and Barrett esophagus may represent a group of patients with poorer postoperative outcomes. It has been suggested that such patients should undergo open rather than laparoscopic antireflux surgery. HYPOTHESIS: The laparoscopic approach to antireflux surgery is appropriate treatment for patients with Barrett esophagus who have symptomatic gastroesophageal reflux disease. METHODS: The outcome of 757 patients undergoing laparoscopic surgery for gastroesophageal reflux disease from January 1, 1992, through December 31, 1998, was prospectively examined. Barrett esophagus was present in 81 (10.7%) of these patients (58 men and 23 women). The outcome for this group of patients was compared with that of patients undergoing surgery who did not have Barrett esophagus. RESULTS: The types of operation performed were similar for the 2 patient groups. The mean +/- SD length of columnar mucosa was 47.4 +/- 43.6 mm. The average +/- SD operation time was 79.0 +/- 33.4 minutes. Conversion to open surgery occurred in 6 patients. Postoperative outcomes were as follows. Esophageal manometry and 24-hour pH studies before and after laparoscopic fundoplication demonstrated a significant increase in lower esophageal sphincter resting and residual relaxation pressures and a significant decrease in distal esophageal acid exposure. Four patients have developed high-grade dysplasia or invasive cancer within 4 years of their antireflux surgery, and all of these have subsequently undergone esophageal resection. CONCLUSIONS: The outcome of laparoscopic antireflux surgery is similar for patients with Barrett esophagus compared with other patients with gastroesophageal reflux disease. This suggests that laparoscopic surgery is appropriate treatment for this patient group.

Barrett Esophagus↗