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Biomedical subjects

P Goh

Publications and source records attributed to P Goh.

At least 37 records · Page 2Linked to original sources
PubMed1996

Comparison between laparoscopic and conventional omental patch repair for perforated duodenal ulcer.

BACKGROUND: The aim of the study is to evaluate the safety and efficacy of laparoscopic omental patch repair. METHOD: This is a retrospective review of 53 consecutive patients with omental patch repair for perforated duodenal ulcer; 38 underwent conventional open approach and 15 underwent laparoscopic patch repair. The only selection criterion was availability of expertise for laparoscopic repair on the day of admission. By chance, the open group had poorer ASA scores. There were four deaths and five postoperative complications in the open group. RESULTS: Laparoscopic repair was successful in 14 cases with one postoperative complication. Operative time was longer in the laparoscopic group (80 vs 65 min in open group, p = 0.02). Patients required less postoperative analgesics in the laparoscopic group (median amount of pethidine was 75 mg vs 175 mg in the open group, p = 0.03). There was no statistically significant difference in terms of hospital stay and return to normal activities between the two procedures. Follow-up Visick scores were comparable in both groups. CONCLUSIONS: Laparoscopic omental patch repair offers a safe alternative to the conventional method and causes less postoperative pain.

Adolescent↗
PubMed1996

Laparoscopic-assisted large bowel resection.

Laparoscopic colon resection is a viable alternative to open colectomy. For non-malignant lesions, laparoscopic resection of the affected large bowel is attractive. For malignant lesions, where resection for cure is highly dependent on lymph node clearance, laparoscopic resection has met with criticisms regarding the adequacy of nodal clearance that can be achieved laparoscopically. Several published studies have shown that the operation though technically demanding, does not compromise the extent of resection. We report a series of 43 cases of laparoscopic colon resection done sequentially and successfully from January 1992 to June 1995. The operative time averaged 180 minutes (range 120 to 300 minutes). Five patients developed postoperative complications, which were mainly pulmonary and wound infections. There were no anastomotic leaks or perioperative deaths. The mean hospital stay was 5.3 days (range 4 to 9 days). By the third postoperative day, all patients were feeding and ambulatory. Long-term complications included one small bowel obstruction and one port site recurrence. In our selected group of patients, laparoscopic colon resection has not shown any adverse outcome. Prospective randomised studies are underway in various centres and their preliminary results are favourable.

Adult↗
PubMed1995

Combination therapy using adrenaline and heater probe to reduce rebleeding in patients with peptic ulcer haemorrhage: a prospective randomized trial.

A prospective randomized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage. Some 153 consecutive patients were randomized to receive either local injection of adrenaline (1:10,000) followed by heater probe thermocoagulation (74 patients) or no endoscopic treatment (79 patients). The two groups were well matched with regard to age, haemoglobin concentration on admission, non-steroidal anti-inflammatory drug usage and endoscopic findings. More patients in the treatment group were in shock on admission (21 versus 13). Initial haemostasis was achieved in all patients randomized to endoscopic therapy. Rebleeding occurred in fewer treated than control patients (five versus 16, P = 0.01). The treated group also had fewer deaths (zero versus two) and requirement for operation (two versus six). The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage.

Adult↗
PubMed1995

Pyloric channel ulcers: management and three-year follow-up.

Twenty-five patients with pyloric channel ulcers are presented. They were predominantly males (84%), with a mean age of 54 years. Four patients were operated upon in the initial admission because of gastric outlet obstruction in three and persistent bleeding in one. Twenty-one patients received H2-antagonist treatment (ranitidine 150 mg or cimetidine 400 mg twice a day). Clinical and endoscopic healing rates were 76% and 38% respectively at 6 weeks, and 91% and 85% respectively at 12 weeks of treatment. The recurrence rate at an average of 3 years of follow-up period on maintenance treatment (ranitidine 150 mg or cimetidine 400 mg nightly) was 65%. Three patients were operated upon during the follow-up period due to persistent symptoms in two and recurrence with obstruction in one Surgical procedures were vagotomy + drainage (five patients) and vagotomy + antrectomy (two patients). There were no recurrences in surgically treated patients at an average of 3.5 years of follow-up, and all were graded as Visick I or II.

Cimetidine↗
PubMed1994

Laparoscopic Billroth II Gastrectomy.

The totally intra-abdominal laparoscopic Billroth II gastrectomy offers a minimally invasive option for gastric resection that is remarkably less traumatic and more "patient friendly." Initial experience in this operation around the world has largely concentrated on resection for benign gastric ulcer, but recently the indications have been extended to both benign and neoplastic lesions of the stomach. Experience with a small experimental series of 16 cases has shown that this operation has many advantages over open surgery in terms of postoperative pain, quicker mobilization, fewer wound problems, better cosmesis, and quicker discharge. The main problem remains the cost of disposable stapling devices.

Journal Article↗
PubMed1994

Endoscopic sphincterotomy for the treatment of cystic duct leak following laparoscopic cholecystectomy.

Two patients who underwent laparoscopic cholecystectomy had postoperative cystic duct leak from slipped metallic clips. One patient presented with biliary ascites and the other with biliocutaneous fistula. Open surgery done in the first patient was not successful in controlling the fistula. Rapid closure of the fistulae was achieved in both cases using endoscopic sphincterotomy.

Adult↗
PubMed1993

Future developments in high-technology abdominal surgery: ultrasound, stereo imaging, robotics.

The surgical world is experiencing a revolution brought about by the proliferation of minimally invasive techniques. These developments have had most impact on abdominal surgery and chest surgery, but there are ramifications affecting other fields as well. One feature of this change is the increasing dependence of surgeons on technology. Developments in video imaging, ultrasound and robotics are required to make complex endoscopic procedures surgeon-friendly, just as the minimally invasive approach has made surgery more patient-friendly. In the future, integration of stereo imaging systems, computers, microrobots and robotic manipulators will result in technically sophisticated but ergonomic operating systems that will allow surgeons to perform endoscopically almost any type of surgery that can be done today.

Abdomen↗
PubMed1993

Laparoscopic Billroth II gastrectomy: a review.

The operation of Billroth II gastrectomy has not changed substantially in concept or technique since it was first performed in 1885 by Theodor Billroth. The advent of stapling has made the procedure faster for the surgeon but the operation has remained as painful and as traumatic for the patient. The totally intra-abdominal laparoscopic Billroth II gastrectomy offers a minimally invasive option that is remarkably less traumatic and more 'patient friendly'. Initial experience in this operation around the world has largely concentrated on resection for benign gastric ulcer but the possibility of resection for cancer is not inconceivable. Experience with a small experimental series of eight cases showed that this operation has many advantages over open surgery in terms of postoperative pain, quicker mobilization, fewer wound problems, better cosmesis and quicker discharge. No anastomotic leak, chest or wound complications were encountered. The main problem remains the cost of disposable stapling devices.

Aged↗
PubMed1993

Papillary carcinoma arising in a thyroglossal cyst.

Carcinoma arising in a congenital thyroglossal cyst is rare, with less than 150 cases reported worldwide. This is a case report of a papillary carcinoma arising within a thyroglossal cyst in a 51 year old woman. Management of this condition remains controversial. Most of these tumours arise from ectopic thyroid tissue within the cyst. Prognosis is good as metastasis is uncommon. Sistrunk procedure is adequate if histology does not reveal extracystic extension.

Carcinoma, Papillary↗
PubMed1993

A rare wandering splenic cyst removed with laparoscopic assistance.

This is a report of the first case of a true cyst arising in a wandering spleen. Laparoscopic splenectomy was attempted. The spleen was mobilized under laparoscopic control and the cyst aspirated. Dissection of the pedicle was technically feasible. However, the procedure was aborted due to uncontrollable bleeding from a moderate-sized artery. Although the whole procedure was not completed laparoscopically, laparoscopic assistance facilitated extirpation of the spleen through a 5-cm oblique left iliac fossa incision in a minimally invasive fashion.

Adult↗
PubMed1993

Laparoscopic-assisted right hemicolectomy--a case report.

Laparoscopic colon resection has recently attracted attention as a viable option to open colectomy due to its excellent postoperative recovery. We report the first right hemicolectomy done laparoscopically in Asia in a 62-year-old female patient with Dukes-B2 caecal carcinoma. Bowel sounds were present on the first post-operative day (POD) and diet was resumed on the third. The patient was discharged on the fourth POD. There was no complication of anastomotic leakage or wound infection.

Adenocarcinoma, Mucinous↗
PubMed1992

Technical modification to laparoscopic appendectomy.

An alternative technique for laparoscopic appendectomy is described. The isolated appendix is exteriorized through the trocar wound, ligated, and resected. The cecum is then returned to the abdomen.

Appendectomy↗
PubMed1992

Laparoscopic cholecystectomy in a patient with empyema of the gallbladder and situs inversus.

The successful performance of laparoscopic cholecystectomy in a patient with situs inversus viscerum and empyema of the gallbladder is reported. The 62-year-old man presented with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and a palpable globular mass in the same region. CT scan demonstrated a distended gallbladder with thick shaggy walls which contained a 2 cm gallstone in the neck and also revealed dextrocardia and situs inversus. The patient's postoperative recovery was uneventful.

Cholecystectomy, Laparoscopic↗
PubMed1992

The surgical treatment of multiple small bowel strictures in Crohn's disease by combined resection and stricturoplasty.

Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.

Adult↗
PubMed1992

The technique of laparoscopic Billroth II gastrectomy.

This report describes the technique of totally intra-abdominal Billroth II gastrectomy. Because the procedure is minimally invasive, patient recovery is remarkable compared with the conventional open technique. The development of this procedure completes the minimally invasive revolution in the management of peptic ulcer disease, which began with the introduction of laparoscopic vagotomy.

Aged↗