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Biomedical subjects

L G Henry

Publications and source records attributed to L G Henry.

11 recordsLinked to original sources
PubMed1996

Laparoscopic Nissen fundoplication for gastroesophageal reflux disease: clinical experience and outcome in first 100 patients.

Using retrospective chart review, the authors evaluated the results of laparoscopic Nissen fundoplication in their first 100 patients. All patients were diagnosed with gastroesophageal reflux disease. More than 90% of the patients in this series were symptomatically improved, and 92% of those studied endoscopically had healed esophagitis and intact fundoplication. No deaths, esophageal injuries, or splenic injuries occurred. Laparoscopic fundoplication can be performed safely and efficiently. Using a linear stapler enables rapid and safe fundi mobilization. Selective manometrics and ambulatory pH monitoring provide excellent results. Laparoscopic Nissen is safe and as effective as the open procedure. Research centers have noted some differences in postoperative function of the lower esophageal sphincter, but symptomatically patient satisfaction is comparable.

Adult↗
PubMed1994

Rectal prolapse.

Marlex rectopexy is a popular and effective procedure for the repair of rectal prolapse. Heretofore, this operation has required a generous laparotomy. As videolaparoscopy provides superior pelvic exposure, performing a modified Ripstein procedure was a logical progression of minimally invasive surgery. Experience with the first sutured Marlex rectopexy suggested the need for a simple fixation device to secure the mesh to the sacrum. A commercially available orthopedic staple allows quick and secure fixation. Five cases of laparoscopic Marlex rectopexy provide our initial clinical experience. The LCR staple has reduced operating times by up to 1 h. Results in these cases show virtual complete repair of the prolapse, minimal postoperative analgesic requirements, and no postoperative incontinence. There was one postoperative complication requiring reoperation. There were no deaths. Laparoscopic stapled Marlex rectopexy is a promising modality for the treatment of procidentia.

Aged↗
PubMed1994

Laparoscopically assisted colon resections compare favorably with open technique.

To date, 14 patients have undergone laparoscopic or laparoscopically assisted colon resections for malignant disease. Margins of resection and lymph nodes (LNs) recovered were compared with those of 20 consecutive controls treated over the preceding 6-month period at the same institution. Of these 14 procedures, one was completed entirely via laparoscopy, 13 were laparoscopically assisted (a small transverse incision was used to deliver the colon and lesion after laparoscopic mobilization). One other patient required conversion to open colectomy. An average of 10.5 LNs (range 0-32) were recovered via the laparoscopic technique per case; 0.4 LNs showed positive signs of metastatic disease (range 0-4). Average margins of resection were 11.1 cm proximally and 10.0 cm distally (range 3-34) cm proximally, 2-23 cm distally). In no case did the margins contain tumor. These results compare favorably with those for the 20 concurrent controls, among whom an average of 7.6 LNs were recovered per case, 0.5 LNs with positive signs of metastatic disease (range 2-19 LNs total, 0-4 positive). Similarly, proximal margins averaged 7.4 cm, and distal margins averaged 14.2 cm (range 1.5-20 cm and 2-30 cm, respectively). Only one postoperative complication was directly related to the surgical procedure--a herniation of small bowel into a trocar site. One anastomotic stricture occurred 6 weeks after surgery, and one partial small-bowel obstruction was noted at 4 weeks. Both were treated nonoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Initial experience with laparoscopic appendectomy.

As experience with laparoscopy increases, new applications in general surgery are being identified. Treatment of acute appendicitis through the laparoscope has been proposed. We present our initial experience with this new technique. Over a 12-month period, laparoscopic appendectomy was attempted in 29 patients. There were no intraoperative complications. Two cases required conversion to the open technique owing to gangrene at the appendiceal base. The average operating time was 64 minutes. Two of nine patients with perforated appendicitis developed a pelvic abscess, and one patient developed wound cellulitis. Pain medication requirements were minimal, bowel function returned rapidly, and half of the patients were discharged on postoperative day one or two and returned to normal activity within one week. Based on our initial experience, it appears that laparoscopic appendectomy is a safe and effective technique for managing acute appendicitis and offers advantages in terms of decreased pain, decreased hospital stay, and a rapid return to normal activities.

Acute Disease↗
PubMed1993

Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy.

The routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1978

Abdominal aortic aneurysm and retroperitoneal fibrosis. Ultrasonographic diagnosis and treatment.

Until changes of ureteric or vascular compromise are noted, retroperitoneal fibrosis usually goes unnoticed. When symptomatic retroperitoneal fibrosis has been associated with abdominal aortic aneurysm, ureteral involvement has uniformly been present. Three cases demonstrate a new ultrasonographic picture that can aid in early identification of retroperitoneal fibrosis before complications are manifest. In patients with abdominal aortic aneurysms, routine sonography may identify unsuspected retroperitoneal fibrosis, a factor that may be important in preoperative planning for safe surgical intervention.

Aorta, Abdominal↗
PubMed1978

Ureteral pathology associated with aortic surgery: a report of three unusual cases.

Intravenous pyelography is a necessary prerequisite to safe aortic surgery. Although urological complications of aortic pathology have been recognzized for 30 years, visualization of the urinary tract has not necessarily been routine practice in preoperative planning. With increasing frequency of aortic reconstruction, careful preoperative evaluation will continue to lower morbidity and mortality rates. Three unusual cases--one of perigraft ureteral fibrosis causing obstruction, one of ureteral obstruction due to retroperitoneal fibrosis, and one of ureterocutaneous fistula in a patient with an infected aortic prosthesis--are reviewed. These uncommon problems support the contention that information gained from routine excretory urograms will aid in careful preoperative assessment. Furthermore, the intravenous pyelogram will facilitate early recognition of postoperative urological complications.

Aged↗
PubMed1976

Ablative surgery for necrotizing pancreatitis.

We have confirmed again that bile and trypsin injected in dogs under high pressure produce highly lethal necrotizing pancreatitis responsive to fluid resuscitation. Animals undergoing pancreatectomy show a reduction in serum amylase levels and hemoconcentration (reflected in hematocrit levels) after pancreatectomy, an effect that may be related to removal of the source of vasoactive substances liberated in pancreatitis. Qualitatively, survivors of pancreatectomy exhibit accelerated convalescence. Pancreatectomy, however, does not increase survival once the disease process is established and may be harmful. This experimental study does not support the clinical use of pancretectomy but rather emphasizes the utility of adequate fluid resuscitation in the treatment of severe pancreatitis.

Animals↗
PubMed1975

Ergotism.

Severe extremity ischemia developed in four patients who had ingested methysergide maleate or ergot for the relief of headache. Symptoms involved the upper extremity in two patients and the lower extremity in two. Spontaneous reversal of the ischemic picture was obtained by simple discontinuation of ergot in most instances, although intra-arterial vasodilators were used in one case. Angliography disclosed arterial spasm and was a useful adjunct in confirming the cause of ischemia in each of the patients. It was especially useful when a history or ergot ingestion was not immediately available.

Adult↗
PubMed1975

Risk of recurrence of colon polyps.

At Wood Veterans Administration Center, 268 patients who had a polypectomy have been followed up to 20 years with semiannual proctosigmoidoscopic and barium enema examinations. For the present review of benign polyp disease, patients having coexisting carcinoma, chronic inflammatory disease, and those lost to followup have been excluded; 154 patients followed for a mean of 7 years comprise the study group. Thirty per cent of patients developed recurrent polyps. The risk of recurrence during the first year was 16 times that expected in a population of similar age and sex, but thereafter diminished steadily. After 48 months risk of polyp recurrence was little higher than the incidence expected in a normal population. Neither patient age, presenting symptoms nor the site or size of the initial polyp(s) were of any prognostic value regarding recurrence. Patients presenting with a villous adenoma or with more than 3 polyps had a significantly increased risk of recurrence may persist indefinitely. The overall incidence of colonic carcinoma may have been increased, but the location of subsequent cancer was not related to the site of a previously excised polyp.

Adult↗