Biomedical subjects
Publications and source records attributed to H B Devlin.
This article considers the problems encountered by the ostomate, reviews the present structure and effectiveness of hospital and community-based resources and offers a basis for improving the quality of stoma care.
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Between mid 1970 and mid 1982, 696 patients underwent 718 operations for primary inguinal hernias by the Shouldice surgical technique. Follow-up to 31 December 1983 revealed 6 recurrences, 40 patients died during the follow-up period and 37 were lost to the study. Five patients required re-operation for complications of the suture material. Polypropylene was the most efficacious of the suture materials used during the study. Duration of hospital stay and age at operation do not influence the probability of recurrence. The operation gave consistently good results when performed by either a consultant surgeon or a surgeon in training. Using the Shouldice surgical technique the probability of recurrence of the inguinal hernia at 10 years is only 1 per cent.
One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible.
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A refinement of the technique for constructing the temporary loop ileostomy using a subcutaneous absorbable bridge is described. This leaves the skin surface uncluttered and allows immediate fitting of a watertight appliance. Clinical experience in 22 patients confirms that this is a safe, simple defunctioning stoma with few complications and in our practice has also replaced the loop colostomy as the covering stoma for difficult colorectal anastomoses.
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A review of twelve years surgical practice in a district in the North East of England is presented. During this period 63 562 surgical operations were undertaken. Analyses of these operations show that the amount of elective general surgery undertaken has almost doubled and the rate of emergency general surgery has remained remarkably constant. There has been a significant increase in the number of gallbladder, varicose vein and minor general surgical procedures performed. There has also been a significant increase in urological surgery and in orthopaedic surgery which has doubled over the study period.
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Oesophagogastric tubes were inserted into 16 patients with malignant strictures of the distal oesophagus by a method employing the flexible fibreoptic endoscope, and these patients were compared with 28 patients in the same hospital whose tubes were inserted by surgical methods. Four patients (25 per cent) in the endoscopic group died in the immediate post-insertion period as a result of the procedure, compared with 13 patients (45 per cent) in the surgical group. Of the remainder, the majority were mobilized and taking diet on the day following the procedure, and the morbidity associated with the surgical method was not seen in the endoscopic group. It is concluded that the endoscopic insertion of oesophagogastric tubes has advantages over surgical insertion in the palliation of malignant oesophageal strictures.
The experience with inflammatory bowel disease in a stable, defined population in northeast England is described. In this population, the incidence of inflammatory bowel disease was higher than expected. In particular, a high incidence of colorectal and anal Crohn's disease was found. The literature is reviewed in order to identify some of the factors responsible for this unusual prevalence of inflammatory bowel disease in the study population. No explanation for our unexpected findings can be advanced.
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