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Biomedical subjects

R S Chung

Publications and source records attributed to R S Chung.

At least 19 recordsLinked to original sources
PubMed1999

Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs.

BACKGROUND: Despite randomized controlled trials, the merits of laparoscopic hernia repair remain poorly defined. A meta-analysis may provide a timely overview. METHODS: An electronic MEDLINE search, supplemented by a manual search, yielded 14 randomized controlled trials with usable statistical data, involving 2,471 patients. The trials were grouped for separate meta-analyses according to the control operation, either a tension-free or sutured repair, used for comparison. The effect sizes for operating time, postoperative pain, return to normal activity, and early recurrence were calculated, using a random-effects model when the effect sizes were heterogeneous and without subcategories. RESULTS: In all meta-analyses, the laparoscopic operation was significantly longer. When compared with tension-free repairs, the laparoscopic operation showed no advantage in terms of postoperative pain, but resulted in a shorter recovery (marginal significance). As compared with sutured repair, both postoperative pain and recovery were in favor of the laparoscopic operation. When all 14 trials were analyzed together, laparoscopic repairs still had moderately reduced postoperative pain and recovery time. CONCLUSIONS: Laparoscopic hernia repair has a modest advantage over conventional repairs. This advantage is more apparent when laparoscopic repairs are compared with sutured repairs rather than tension-free repairs.

Hernia, Inguinal↗
PubMed1999

A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy.

BACKGROUND: Despite many randomized controlled trials, the merits of laparoscopic appendectomy remain unclear. A meta-analysis may provide insights not evident from any individual studies. DATA SOURCES: Systematic literature search yielded 17 trials (1,962 subjects) of true randomized design with usable statistical data comparing laparoscopic and conventional appendectomy in adults. The effect sizes for operating time, hospitalization, postoperative pain, return to normal activity, wound infection, and intra-abdominal abscess were calculated, using the random effects model to allow for heterogeneity. An estimate of the robustness of all positive findings was also calculated. RESULTS: Modest but statistically significant effect sizes were found for four of the six outcome measures. Laparoscopic appendectomy takes 31% longer to perform, but results in less postoperative pain, faster recovery (by 35%), and lower wound infection rates (by 60%). CONCLUSION: Laparoscopic appendectomy offers significant improvement in postoperative outcomes at the cost of a longer operation.

Adolescent↗
PubMed1999

Impact of a dedicated trauma service on the quality and cost of care provided to injured patients at an urban teaching hospital.

BACKGROUND: To determine the impact of a dedicated trauma service on cost and quality of care in an urban teaching hospital, a before-and-after study was designed. The key elements of the trauma service were dedicated in-house trauma attending surgeons and residents, and continuity and integration of trauma care. METHODS: Injury Severity Scores and probabilities of survival for each patient were calculated from the hospital International Classification of Diseases, Ninth Revision, codes, and individual patient costs were estimated from charges using the Medicare Cost Report. RESULTS: The trauma service resulted in a significant increase in the severity of injuries. There was a highly significant (p<0.001) increase in the mean probability of death (from 0.16 to 0.21). There was no change in actual mortality. Although the mean cost of care increased by 16.6%, there were small reductions in the cost of care of the most severely injured patients. CONCLUSION: A dedicated trauma service has a positive impact on the quality of care.

Adult↗
PubMed1998

Efficacy of routine laparoscopy for the acute abdomen.

BACKGROUND: Laparoscopic surgery of selected acute abdominal conditions has been shown to be highly effective. Therefore, we investigated the diagnostic accuracy and therapeutic efficacy of routine laparoscopic surgery for the acute abdomen. METHODS: After appropriate investigations, patients with acute abdomen, with or without a specific diagnosis, were offered the options of either laparoscopic or open surgery. Postoperatively, we analyzed the outcome measures of diagnostic accuracy, complications, and operating time of laparoscopy. The hospital stays for our patients were compared to case-matched controls. RESULTS: The accuracy of laparoscopic diagnosis is the same as laparotomy. The 62% of our patients who were managed totally laparoscopically required shorter hospitalization than the case-matched controls treated by open operation. Morbidity was not increased by laparoscopy in patients who required conversion to open operation. The additional cost of laparoscopy appeared modest. CONCLUSIONS: Routine laparoscopy for the acute abdomen is safe and accurate. Patients eligible for laparoscopic treatment also require less hospitalization time.

Abdomen, Acute↗
PubMed1998

Unsuspected choledocholithiasis first diagnosed at laparoscopic cholecystectomy: treatment by trans-cystic duct stenting and elective stent-guided sphincterotomy.

BACKGROUND: Despite advances in laparoscopic surgery, management of unsuspected choledocholithiasis diagnosed at laparoscopic cholecystectomy is controversial. We propose a simple maneuver of laparoscopic trans-cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option. METHODS: We studied retrospectively 16 patients with choledocholithiasis first diagnosed in the course of laparoscopic cholecystectomy, treated with laparoscopic stenting of the papilla via the cystic duct using a short Cotton-Leung stent before completion of cholecystectomy. Elective stent-guided, needle-knife sphincterotomy and stone clearance was performed 2 to 3 weeks postoperatively. RESULTS: Of 16 patients attempted, the procedure failed in one due to an impacted stone that prevented passage of the guidewire. Stenting time was 13 +/- 5 minutes (n = 15). Two stented patients had no stones at endoscopic retrograde cholangiography. Thirteen patients had successful elective stent-guided sphincterotomy with stone clearance without complications. CONCLUSIONS: Laparoscopic biliary stenting combined with stent-guided sphincterotomy is a simple, safe, and cost-effective option for the management of uncomplicated choledocholithiasis.

Adult↗
PubMed1998

An anatomical study of the junction of the orbital septum and the levator aponeurosis in Orientals.

The anatomical relationships of the orbital septum and levator aponeurosis has been studied in 40 eyelids subjected to blepharoplasty and corrective ptosis surgery by dissection in 10 cadavers and in histological sections. The orbital septum originates from the arcus marginalis of the frontal bone and consists of two layers. The whitish outer (superficial) layer, containing vertically running vessels, descends just inside the orbicularis oculi muscle to interdigitate with the levator aponeurosis with loose connective tissue, then disperses inferiorly. The inner (deep) layer follows the superficial one initially, then reflects at the levator aponeurosis and continues posteriorly with the levator sheath. We reconfirmed Whitnall's original description that the levator sheath thickens to form the superior transverse ligament runs continuously inferiorly anterior to the levator aponeurosis and forms the inner layer of the orbital septum. This detailed anatomical analysis should assist in performing upper eyelid surgery such as the Oriental double fold operation or levator resection.

Asian People↗
PubMed1997

One-on-one mentor-resident rotation for improving continuity of care in a surgical training program.

The modern resident team, staffed by multiple attendings, often makes sacrifices on continuity of care due to scheduling conflicts. We investigated a one-on-one mentor-resident rotation where all clinical activities were synchronized to produce near-perfect continuity of care, and we compared the objective and subjective outcome measures to those of control rotations of the same resident during the same year. The results showed that continuity of care close to 100% was possible in such rotations, but work hours were increased by 25%. Also, the number of patients seen was decreased by over 50%. The rotation was well-received by both mentors and residents. Continuity of care per se can be improved by this rotation. However, theoretical disadvantages, mainly narrow training due to exposure to only one mentor and fewer patients, make it unsuitable for extended use.

General Surgery↗
PubMed1997

Colectomy for sigmoid volvulus.

PURPOSE: Volvulus of the sigmoid carries a high mortality. This minimally invasive technique is designed for poor-risk patients. TECHNIQUE: Aided by laparoscopy, the mobile sigmoid is exteriorized through a mini-incision without preliminary dissection. The entire resection and anastomosis is performed on the surface of the abdomen. The options of end colostomy, primary anastomosis with or without fecal diversion, can all be used with this method. RESULTS: No mortality or leakage occurred in four patients. CONCLUSION: This rapid operation does not require advanced laparoscopic skills. Preliminary results should be confirmed by others.

Clinical Competence↗
PubMed1997

Palliative gastrojejunostomy. A minimally invasive approach.

Palliative bypass for neoplastic gastric outlet obstruction should be minimally invasive. We designed a laparoscopically assisted approach that appears to meet the need. The proximal jejunum is exteriorized by laparoscopy via an epigastric trocar-site incision. An EEA anvil is installed in the exteriorized jejunum, which is returned to the abdomen. Through this mini-incision, the anterior wall of the stomach is opened for insertion of the EEA stapler, which penetrates the posterior gastric wall. When snapped to the anvil and fired, an antecolic gastrojejunostomy is created. No mortality or anastomotic leak occurred in two cases. The operation and recovery appeared to be faster than historic controls. This operation is minimally invasive and expeditious, ideal for patients requiring palliative bypass.

Biopsy↗
PubMed1997

In vitro effects of simulated gastric juice on swallowed metal objects: implications for practical management.

BACKGROUND: Swallowed metal objects often pose a technical challenge for the endoscopist. We studied in vitro the effects of simulated gastric juice on metal objects commonly encountered in endoscopic practice and measured the physical-chemical changes. METHOD: Razor blades, disc batteries, and pennies were incubated in simulated gastric juice at 37 degrees C. The weights of the objects were recorded hourly. When no change could be detected, the solution was subjected to mass spectrometry to verify absence of effect. The findings were correlated with clinical observation in one patient who swallowed razor blades repeatedly. RESULTS: Dissolution of the razor blade was proportional to the duration of acid immersion. At 24 hours, the blades weighed 63% of the original weight. Double-edged razor blades could be broken with a snare at 15 hours. The thickened back of the single-edged blade totally dissolved in 2 hours. No leak of contents could be detected with disk batteries. Pennies were unaffected. CONCLUSION: Corrosion of razor blades occurs rapidly in the normal stomach. Within 24 hours double-edged blades become fragile and can be broken with a snare. This observation may guide the timing of endoscopic removal. Modern disk batteries are acid resistant for 24 hours.

Adult↗
PubMed1997

Client satisfaction data and quality improvement planning in managed mental health care organizations.

Quality improvement (QI) planning is enhanced when TQM administrators ensure appropriate analysis of client satisfaction (CS) survey data. A cost-effective QI strategy is to shift "moderately satisfied" into "maximally satisfied" clients. Use of a categorical variable derived from CS data and development of a predictive model with Chi Square Automatic Interaction Detection (CHAID) produces recommendations for quality improvement.

Chi-Square Distribution↗
PubMed1996

Closure of trocar wounds using a suture carrier.

We developed a hook suture carrier for closure of trocar wounds, making use of the vertical rather than the horizontal space, which is limited in small wounds. The technique is simpler than all the laparoscopically assisted devices currently available, and it has no learning curve. No complications developed in 6 months of use.

Equipment Design↗
PubMed1995

Incomplete excision of the gallbladder during laparoscopic cholecystectomy.

Dissection and transection of the cystic duct close to the gallbladder has been advocated as a means of avoiding common bile injury during laparoscopic cholecystectomy (LC). We present three cases in which inadequate identification of the gallbladder-cystic duct junction resulted in incomplete cholecystectomy. In two patients an unsecured gallbladder infundibulum presented as cystic duct leaks and one patient developed recurrent symptomatic cholelithiasis. These cases emphasize the need for complete dissection and visualization of the cystic duct at the gallbladder prior its division and secure ligation during LC.

Adult↗
PubMed1995

Closure of trocar wounds in laparoscopic operations. The threading technique.

A method of fascial closure utilizing a hypodermic needle as a conduit for threading the suture through the fascia is described. This technique is designed to make use of vertical space rather than horizontal space, which is lacking in the small trocar wounds. The technique is easy to master and teach and has resulted in secure closures in over 150 wounds.

Fasciotomy↗