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Biomedical subjects

M Gagner

Publications and source records attributed to M Gagner.

At least 91 records · Page 5Linked to original sources
PubMed1997

Left hepaticogastrostomy for biliary obstruction: long-term results.

PURPOSE: To evaluate the long-term results of peripheral biliary diversion by means of anastomoses of the left lobe of the liver to the stomach. MATERIALS AND METHODS: Transhepatic perforation of the left lobe of the liver into the lesser curvature of the stomach was performed in 35 patients with a presumed diagnosis of malignant obstructive jaundice. Jaundice was found to be caused by a malignant stricture in 32 patients and a benign stricture in three. Perforation was performed under fluoroscopic, endoscopic, and laparoscopic guidance in 33 patients and without laparoscopy in the other two. The hepaticogastric anastomosis was secured with a gastrostomy tube; patency of the tract was maintained with placement of a metallic stent. Kaplan-Meier analysis was used to evaluate survival, anastomosis patency rate, and jaundice recurrence. RESULTS: Technical success was achieved in all patients. Two (6%) patients had anastomotic obstruction. The actuarial survival rate was 91%, 80%, 59%, and 26% at 1, 3, 6, and 12 months. The mean patency was 234 days +/- 252. The jaundice-free rate among surviving patients was 100%, 96%, 93%, and 80% at 1, 3, 6, and 12 months. The reintervention rate was 14%. Late cholangitis occurred in seven (20%) patients. CONCLUSION: This peripheral diversion procedure appears to be safe and shows good long-term patency.

Adult↗
PubMed1997

Laparoscopic antireflux surgery.

Laparoscopic antireflux surgery is a safe and effective alternative surgical approach for the treatment of gastroesophageal reflux disease (GERD). However, the same rigorous evaluation required for open fundoplication is mandated for patients undergoing laparoscopic antireflux surgery. For successful laparoscopic antireflux surgery, both the mastery of laparoscopic techniques and the application of the principles of antireflux surgery are required. Operative mortality and morbidity compare favorably with those of open antireflux procedures, and there is a marked reduction of certain complications. Meticulous laparoscopic technique during the mobilization of the gastric cardia and esophagus will limit mortality and intraoperative and postoperative complications. Although laparoscopic antireflux surgery shortens postoperative recovery and speeds return to work, it may be the double-edged sword causing early failures. Short and intermediate term results compare similarly with open antireflux surgery. Laparoscopic antireflux surgery is an important and significant advancement in the evolution of GERD therapy, its definitive role in the surgeon's armamentarium is dependent on evaluation of long-term data.

Gastroesophageal Reflux↗
PubMed1997

Laparoscopic Roux-en-Y gastric bypass for morbid obesity: a feasibility study in pigs.

According to randomized prospective studies in humans, the Roux-en-Y gastric bypass provides more effective weight loss than vertical banded gastroplasty for morbid obesity. Ten pigs underwent laparoscopic Roux-en-Y gastric bypass to assess the feasibility of this procedure with conventional laparoscopic techniques and instruments. The procedure took an average of 4 h 20 min. Of the first five pigs killed immediately, four had correct anastomoses. Of the five remaining pigs with postoperative follow-up, three survived with an intact anastomosis and staple line at autopsy. Two died within 48 h, one from peritonitis (perforation of the small bowel), the other from unknown causes. A definite learning curve exists for this procedure primarily because of the extent of gastrointestinal reconstruction, but there is potential for it to be used in humans.

Anastomosis, Roux-en-Y↗
PubMed1996

Laparoscopic transgastric suturing for bleeding peptic ulcers.

BACKGROUND: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing. METHODS: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a "lift and cut technique." Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots. RESULTS: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm3/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement. CONCLUSIONS: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.

Animals↗
PubMed1996

Early experience with laparoscopic resections of islet cell tumors.

BACKGROUND: Diagnostic laparoscopy and laparoscopic ultrasonography have been applied recently for diagnosis and localization of islet-cell tumors. A further step was taken by performing resection of these tumors with laparoscopic techniques. METHODS AND RESULTS: We studied a retrospective series of 12 patients operated on with laparoscopic techniques since January 1992. The seven female and five male patients had a mean age of 43 years. The mean tumor size was 3 cm. Thirty-six percent of the tumor site could not be identified before operation. Eight patients underwent planned laparoscopic distal pancreatectomy (five insulinomas, two gastrinomas, and one unknown origin), and four underwent planned laparoscopic enucleation (one insulinoma and three unknown origin). Of the eight distal procedures, three had conversions (one inability to localize the tumor and two metastatic gastrinomas). Average operating time was 4.5 hours, with an average hospital stay of 5 days. Of the four explorations for possible enucleation, one was performed and one was converted to a Whipple procedure for nesidioblastoma of the head of the pancreas. The other two had negative explorations. The successful enucleation of an insulinoma of the anterior body of the pancreas was performed in 3 hours, and the hospital stay was 4 days. No recurrence was seen in the enucleated or distal pancreatectomy group in follow-up (15 to 38 months). CONCLUSIONS: Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery.

Adenoma, Islet Cell↗
PubMed1996

Is laparoscopic adrenalectomy indicated for pheochromocytomas?

BACKGROUND: Since the introduction of laparoscopic adrenalectomy there has been major concern about proper indications for its use, including in pheochromocytoma. In this study we reviewed pheochromocytomas resected by means of laparoscopy to establish that procedure's usefulness. METHODS: Between January 1992 and June 1995, 90 laparoscopic adrenalectomies were performed in 82 patients. Three to five trocars were used intraperitoneally in each patient to remove the gland, and extraction was performed with a sterile plastic bag. RESULTS: Twenty-three pheochromocytomas were operated on. Six patients had a bilateral adrenalectomy. Pheochromocytomas were significantly larger than other tumors, required more operating time, and necessitated longer hospital stays in patients. Of all the intraoperative complications 87% occurred in the pheochromocytoma group; 67% of all postoperative complications occurred in this group. In four patients metastasis from pheochromocytoma to the liver was unexpectedly found, and in one case metastasis from a medullary thyroid carcinoma was found. There has been no local recurrence after laparoscopic adrenalectomy. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytomas is difficult because tumors are larger and more complications are seen related to their hormonal secretions, in spite of adequate pharmacologic blockade. However, metastatic extensions can be diagnosed and laparoscopic ablation can be performed in most instances without recurrence. It is not, therefore, a contraindication for this approach.

Adrenal Gland Neoplasms↗
PubMed1996

Laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has become a viable option for removal of adrenal pathology and is becoming preferred over the conventional technique. With the conventional technique, many approaches are available, which vary according to pathology, diameter of the adrenal mass, location of the lesion, and patient morphology. Knowledge of anatomy is essential, because careful hemostasis and delicate tissue handling are necessary to make adrenal surgery a success.

Adrenal Gland Diseases↗
PubMed1996

Laparoscopic Treatment of Acute Necrotizing Pancreatitis.

Laparoscopic debridement and necrosectomy are described for the treatment for acute necrotizing pancreatitis. Three techniques are described: (1) retrogastric retrocolic debridement; (2) a full retroperitoneoscopic approach; and (3) a transgastric drainage. These three techniques were performed for necrotizing pancreatitis in a group of patients from 1993 to 1994. These techniques have resulted in 75% success of drainage and debridement of necrotizing pancreatitis. No mortalities were encountered during this time period, and reintervention was necessary in 25% of patients. Apart from a cosmetic advantage, less stress has resulted from the procedure, therefore promoting earlier recovery with potentially less fistula complications, which are often observed after open drainage.

Journal Article↗
PubMed1996

Laparoscopic repair of large incisional hernias.

Conventional repair of large incisional hernias is often associated with a painful postoperative recovery and a delayed return to normal activities. We describe here a technique of laparoscopic incisional hernia repair and review our experience with 30 cases. Hernias ranging in size from 10 to 420 cm2 (mean, 104 cm2) were repaired using a polytetrafluoroethylene patch (16 cases) and a Prolene mesh (14 cases). Operating room time ranged from 45 mins to 190 min (mean 108 mins). Postop stay ranged from 1 to 17 days (mean, 4.3 days; median, 3 days). Follow-up extends beyond 18 months. Postoperative complications included ileus (three cases) trocar site infection (one case) and urinary retention (two cases). There has been one hernia recurrence to date. Our experience with the laparoscopic repair of incisional hernias reveals it to be technically feasible with minimal morbidity, allowing patients prompt resumption of regular activities. Prospective comparison with conventional repair and longer follow-up are needed.

Adult↗
PubMed1995

A porcine model for laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has been successfully performed and described in humans. Though it is presently not widely employed it offers tremendous potential for adrenal surgery. It remains, however, an advanced technique requiring demonstration and practice. The aim of this study is to develop a porcine model of adrenalectomy for teaching and advancing the technique applicable to human surgery. Five female pigs weighing 10-20 kg underwent bilateral adrenalectomy by the lateral approach using endotracheal intubation. The left adrenal was resected with the pig in the right decubitus position. The animal was repositioned to left decubitus and the right adrenal was resected. In each case four 10-mm trochars were placed over the respective flanks. There was no need to mobilize the colon or liver (in the pig model). The peritoneum over each gland was incised and the gland dissected in a cephalocaudal manner. The vessels were ligated and divided particularly those from the vena cava. Upon completion blood loss (< 100 cc) and operating times (mean 60 min for the left and 90 min for the right) were assessed and the animal was sacrificed. The glands were weighed (mean 1.23 g R and 1.15 g L) and measured. Using this model, experience is gained in positioning the subject as well as trocars, in fine dissection in a lateral orientation, and in techniques of hemostasis. Although porcine and human adrenal anatomy differ in some details the pig constitutes an excellent model for the development of the technical experience required to perform adrenalectomy in humans.

Adrenalectomy↗
PubMed1995

Percutaneous stent placement for treatment of stenosis of a portacaval H-graft shunt.

Surgical treatment of an occluded or stenotic portacaval shunt carries a high risk of mortality, but the rate of restenosis after transluminal angioplasty is also high. The authors report high-grade stricture of a portacaval H-graft shunt in a 51-year-old man, who presented with hematemesis and melena. The patient was treated with concomitant balloon angioplasty and placement of a metallic stent through a percutaneous venous approach. The procedure was tolerated well by the patient, and stenosis had not recurred at follow-up 1 year later.

Angioplasty, Balloon↗
PubMed1995

A robotic camera for laparoscopic surgery: conception and experimental results.

The aim of this project was to replace the surgical assistant for common laparoscopic procedures with a robotic camera. The motions of the human camera operator were defined and expressed mathematically by a spherical displacement model. A revolving robotic arm with six degrees of freedom was employed in conjunction with this model as an automated camera in the performance of cholecystectomy, Taylor and Nissen procedures in animals, and cholecystectomy in humans. It represents a first step toward the introduction of robotic technology in laparoscopic surgery.

Animals↗
PubMed1994

Laparoscopic adrenalectomy. The importance of a flank approach in the lateral decubitus position.

Adrenalectomy is usually performed via transabdominal or posterior approaches. Unfortunately, both approaches are associated with painful postoperative syndromes. Recently, laparoscopic surgery was applied to organ removal. During a period of 12 months, we performed a series of successful laparoscopic adrenalectomies (10 of the right and 11 of the left gland). The pathologies were medullary cyst (1), angiomyolipoma (1), DHEAS hyperplasia (1), primary aldosteronism (2), Cushing's adenoma (3), pheochromocytoma (4), Cushing's syndrome (4), and nonfunctional adenoma (5). A flank approach was taken with four 11-mm trocars. Electrocautery and blunt forceps were used for dissection. The vessels were secured with medium-large titanium clips, and the adrenal was removed in a sterile plastic bag. The average operating time was 2.3 h, and median postoperative stay was 4 days. Two patients required blood transfusion of 2 units postoperatively. We believe this technique is adequate for the surgical removal of adrenal tissue, resulting in less postoperative pain and in rapid recovery. It may also change the surgical management of asymptomatic adrenal lesions.

Adrenal Gland Diseases↗
PubMed1994

Laparoscopic pylorus-preserving pancreatoduodenectomy.

A case of chronic pancreatitis localized in the head of the pancreas with pancreas divisum was treated by laparoscopic pylorus-preserving pancreatoduodenectomy. The laparoscopic technique of resection and reconstruction with a gastrojejunostomy, hepaticojejunostomy, and pancreaticojejunostomy is described. The postoperative period was complicated by a jejunal ulcer and delayed gastric emptying necessitating a prolonged hospitalization and intravenous hyperalimentation. No fistulas occurred, a follow-up CT scan revealed no pancreatic abnormalities, and the patient was discharged in good condition on the 30th postoperative day. Although technically feasible, the laparoscopic Whipple procedure may not improve the postoperative outcome or shorten the postoperative recovery period.

Adult↗
PubMed1994

Malignant biliary obstruction: preliminary results of palliative treatment with hepaticogastrostomy under fluoroscopic, endoscopic, and laparoscopic guidance.

PURPOSE: To report a technique of peripheral biliary decompression by means of anastomosis of a bile duct in segment II of the liver to the lesser curvature of the stomach. MATERIALS AND METHODS: Seven patients with unresectable biliary neoplasm were treated. After transhepatic catheterization of a segment II bile duct, the left lobe of the liver and the lesser curvature of the stomach were perforated under fluoroscopic and laparoscopic guidance. Anastomosis between the biliary tree and the stomach was maintained with a gastrostomy tube placed across the tract. After 2 weeks, the tube was removed and patency of the tract was preserved with a metallic stent. RESULTS: Three patients died, at 3, 6, and 9 months, respectively, without reocclusion; the other four were alive at 5 months without jaundice. One patient had an episode of cholangitis, which was resolved with antibiotic therapy. CONCLUSION: This method yields a good patency rate with few problems. Further investigation is required to evaluate long-term patency and the necessity of laparoscopic guidance.

Aged↗