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Biomedical subjects

Richard J Hendrickson

Publications and source records attributed to Richard J Hendrickson.

28 records · Page 2Linked to original sources
PubMed2003

Management of giant omphalocele in a premature low-birth-weight neonate utilizing a bedside sequential clamping technique without prosthesis.

Management of giant omphalocele in a full-term neonate is a challenging clinical situation. Even more challenging is giant omphalocele in a premature low-birth-weight infant. The authors describe a successful staged noninvasive technique for the management of giant omphalocele in a premature, low-birth-weight neonate without the use of prosthetic material until delayed primary closure could be attempted.

Female↗
PubMed2003

Spectrum of anorectal anomalies in pygopagus twins.

BACKGROUND/PURPOSE: The literature lacks a concise description of the anorectal anomalies encountered in pygopagus twins. METHODS: This is a retrospective literature review of 34 pygopagus twins highlighting their anorectal malformations. RESULTS: Overall pygopagus twins represent 17% of all conjoined twins. Live-birth pygopagus twins are more commonly female (86%), whereas stillborns are commonly male (80%). Half of the twins had nonfused rectums, and half had fused rectums. The nonfused had 2 rectums (80%) or one rectum and one rectovaginal fistula (20%). The fused had high (46%) or low (54%) rectal junctions. All reported living male pygopagus twins have had nonfused rectums. All can be managed applying the principles of posterior sagittal anorectoplasty. CONCLUSIONS: In general, live-born male pygopagus twins are likely to survive with a nonfused rectum and good bowel function, whereas live-born female pygopagus twins have a good chance of surviving with a fused rectum (high or low), which requires appropriate operative reconstruction.

Abnormalities, Multiple↗
PubMed2002

Cryoablation of unresectable pancreatic cancer.

BACKGROUND: Most patients with pancreatic cancer are not candidates for curative resection. The goal of this study was to evaluate the safety of an intraoperative ultrasound-guided cryosurgical procedure in a phase I study of unresectable pancreatic cancer. METHODS: From March 1995 to March 1999, 10 cryosurgeries using intraoperative ultrasound were performed on 9 patients with unresectable cancers at laparotomy. Four patients had a concurrent gastrojejunostomy, 2 had a chemical splanchnicectomy, and 1 underwent a concurrent hepatic cryosurgical procedure. RESULTS: There was no intraoperative morbidity or mortality. No patients developed postoperative pancreatitis or fistula. All patients had good pain control postoperatively and were tolerating a regular diet at the time of discharge. Pain control at discharge was achieved with an oral formulation (4/9), transdermal patch (3/9), no pain medication (1/9), and intravenous patient controlled analgesia (1/9). CONCLUSIONS: Ultrasound-guided cryoablation for unresectable pancreatic cancer appears safe and may contribute to improved postoperative pain control. Future studies to determine its therapeutic role in the management of unresectable pancreatic cancer are indicated.

Cryosurgery↗
PubMed2002

Small bowel obstruction due to a paracolonic retroperitoneal hernia.

Hernias involving the retroperitoneum are unusual. The most common of these are the paraduodenal hernias. A retroperitoneal hernia occurring from a lateral defect in the colonic retroperitoneal attachments is presented. We believe that this case represents a newly recognized variant of retroperitoneal hernias.

Aged↗
PubMedDate not supplied

Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents.

OBJECTIVE: Pediatric gastric access for long-term enteral feeding may be performed via a laparotomy, laparoscopy, or a percutaneous approach. In children and adolescents, laparoscopic-assisted gastrostomy may be difficult due to a thick abdominal wall. Therefore, if the abdominal wall is estimated to be >2 cm on physical examination, or in children in whom a percutaneous endoscopic gastrostomy was unsuccessfully attempted by a gastroenterologist, we routinely perform a laparoscopic-assisted percutaneous endoscopic gastrostomy. METHODS: From January 1998 through February 2003, we retrospectively reviewed 15 cases of a laparoscopic-assisted percutaneous endoscopic gastrostomy. Instruments used to perform this technique are a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and one 5-mm STEP port placed through an infraumbilical incision for a 5-mm, 30-degree scope. RESULTS: Age range was 2 years to 20 years (mean, 10). Operative time ranged from 20 minutes to 45 minutes. When a concurrent laparoscopic Nissen fundoplication was performed (n = 6), the percutaneous endoscopic gastrostomy was placed after completion of the Nissen fundoplication. No intraoperative complications occurred, and all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. To date, no postoperative complications have occurred, and revision has not been necessary. CONCLUSIONS: Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents is safe and effective. Utilizing laparoscopy permits evaluation of the peritoneum and lysis of adhesions, if necessary. Moreover, laparoscopy provides excellent exposure for accurate placement of the PEG, while avoiding injury to other organs.

Adolescent↗
PubMedDate not supplied

Early experience with laparoscopic pyloromyotomy in a teaching institution.

OBJECTIVE: Hypertrophic pyloric stenosis is a common pediatric surgical condition. A Ramstedt pyloromyotomy is performed either via laparotomy or laparoscopy. We report our first 25 cases of laparoscopic pyloromyotomy at an academic children's hospital. METHODS: From January 2002 through February 2003, we retrospectively reviewed our first 25 laparoscopic pyloromyotomies. All patients had documented hypertrophic pyloric stenosis by ultrasound criteria. Three incisions were made, one 5-mm umbilical port, one 3-mm right upper quadrant port, and a third left upper quadrant working stab incision. A 4-mm, 30 degrees scope was used in all cases. A longitudinal pyloromyotomy was performed using an arthrotomy scalpel. The pylorus was further separated with a laparoscopic Benson spreader. At the completion of the pyloromyotomy, the stomach was insufflated with air to identify any mucosal injury. RESULTS: Age range was 2.3 weeks to 8.4 weeks. Operating time has decreased from 70 minutes to 15 minutes. Two conversions to an open procedure were necessary, both during the first 10 cases. No mucosal perforations or incomplete pyloromyotomies have occurred. Feeds were started within 4 hours and advanced to goal. Time to discharge ranged from 12 hours to 30 hours. One patient developed umbilical cellulitis that was successfully treated with antibiotics. CONCLUSIONS: Laparoscopic pyloromyotomy is a safe, effective procedure for hypertrophic pyloric stenosis in a resident teaching environment. Laparoscopy permits excellent visualization, has comparable postoperative recovery, and superior cosmesis.

Digestive System Surgical Procedures↗
PubMedDate not supplied

Laparoscopic guidance or revision of ventriculoperitoneal shunts in children.

BACKGROUND: Ventriculoperitoneal shunt is the preferred treatment for hydrocephalus. Known complications include infection, obstruction, and disconnection with the fractured fragment migrating in the peritoneal cavity. We report 17 cases of laparoscopic evaluation and revision of ventriculoperitoneal shunts in children. METHODS: From January 2000 through October 2002, we retrospectively reviewed our experience with laparoscopy and ventriculoperitoneal shunts. RESULTS: Laparoscopy was performed in 17 children with a malfunctioning shunt, presumed shunt dislodgment or disconnection, reinsertion of a shunt after externalization, and primary shunt placement. Six patients (35%) were converted to an open laparotomy due to dense adhesions. Eleven patients (65%) underwent successful laparoscopic-assisted ventriculoperitoneal shunt placement: 5/11 (45%) had lysis of adhesions or pseudocyst marsupialization with repositioning of a functional shunt, or both; 3/11 (27%) had successful retrieval of a disconnected catheter with reinsertion of a new catheter; 2/11 (18%) had laparoscopic confirmation of satisfactory placement and function, requiring no revision; 1/11 (9%) had an initial shunt placed with laparoscopic guidance due to the obesity. Operative time for the laparoscopic procedure ranged from 30 minutes to 60 minutes. All laparoscopic procedures used 1-mm or two 5-mm ports. Perioperatively, no adverse neurological sequelae occurred due to the pneumoperitoneum. CONCLUSIONS: Laparoscopic guidance or revision of ventriculoperitoneal shunts permits (1) direct visualization of catheter insertion within the peritoneal cavity, (2) satisfactory positioning, (3) lysis of adhesions or marsupialization with catheter repositioning, or both, and (4) retrieval of fractured catheters.

Adolescent↗
PubMedDate not supplied

Preservation of an aberrant left hepatic artery during laparoscopic nissen fundoplication.

OBJECTIVE: Laparoscopic Nissen fundoplication is performed in neonates and children for significant gastroesophageal reflux. An aberrant left hepatic artery encountered during laparoscopic Nissen fundoplication makes dissection around the esophageal hiatus more difficult if the artery is not transected. Although some suggest division of the aberrant left hepatic artery, this is associated with risk of significant hepatic injury from ischemia. We routinely preserve the aberrant left hepatic artery and sought to determine (1) the incidence of aberrant left hepatic artery and (2) the results following preservation of the aberrant left hepatic artery. METHODS: Between January 2000 and October 2002, 195 laparoscopic Nissen fundoplications were performed. We documented intraoperative findings of each procedure, and reviewed postoperative radiographic studies and clinic visits. RESULTS: In 30 patients (15%), an aberrant left hepatic artery was identified. All dissections were performed laparoscopically with the Nissen fundoplication positioned cephalad to the aberrant left hepatic artery. Postoperatively, 2 patients (6%) have had evidence of wrap failure. The remainder of the patients has had normal radiographic studies or no clinical evidence of reflux during clinic visits. CONCLUSION: During laparoscopic Nissen fundoplication in neonates and children, an aberrant left hepatic artery may be encountered in approximately 15% of patients. When an aberrant left hepatic artery is identified, it should be preserved to avoid the potential risk of hepatic ischemic injury.

Child↗