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Biomedical subjects

S Horgan

Publications and source records attributed to S Horgan.

24 records · Page 2Linked to original sources
PubMed1997

Use of laparoscopic techniques improves outcome from adrenalectomy.

BACKGROUND: Laparoscopic adrenalectomy is a promising alternative to open approaches but safety and efficacy remain unproven. METHODS: A recent experience with laparoscopic adrenalectomy at the University of Washington was analyzed for efficacy, complications, evolution of technical steps, and clinical outcome. RESULTS: Nineteen adrenalectomies were performed in 16 patients with a mean age of 52 years. Indications included pheochromocytoma (4), functional adenoma (12), and uncontrolled Cushing's disease (3). All patients had computed tomography scans. Meta-iodo-benzyl-guanidine (MIBG) or iodocholesterol scans were done in selected patients. Three patients had bilateral procedures, 7 were on the left and 6 on the right, all via a transperitoneal flank approach. There were no conversions and all procedures were successful. Complications included subcapsular liver hematomas (2), one transfusion, and a bleeding port site requiring repeat laparoscopy. Except for 1 patient with COPD, the mean length of stay was 2.9 days. CONCLUSIONS: Laparoscopic adrenalectomy in appropriate patients is safe and effective. For endocrine surgeons with advanced laparoscopic skills, it should be considered a new standard therapy for benign adrenal tumors.

Adenoma↗
PubMed1997

Surgical treatment of gastroesophageal reflux disease.

Modern techniques have substantially improved the outcome of surgical therapy for reflux. Surgery, therefore, should not be considered a method of last resort but instead a reasonable alternative to treat patients with abnormal reflux. Adequate preoperative staging of the disease helps design the most appropriate operation. Minimally invasive techniques improve exposure and enhance recovery. Control of symptoms is achieved in the great majority of patients, and complications are minimal if the operation is performed following basic principles of sound operative technique.

Fundoplication↗
PubMed1996

Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias.

BACKGROUND: Early surgical treatment has been recommended in patients with paraesophageal hiatal hernias. Recently, the laparoscopic approach has emerged as an ideal way to perform the operation. But whether or not an antireflux procedure should be done remains controversial. PATIENTS AND METHODS: Four patients with type II and eleven with type III hiatal hernias were treated. Twelve of them manifested symptoms of reflux preoperatively. The operative technique consisted of resection of the sac, closure of the crura and gastric fundoplication, anchored to the diaphragm. RESULTS: All but two patients were completed laparoscopically. Mean operative time was 320 (+/-49 SD) minutes, and mean hospital stay was 3 (+/-1.2 SD) days. Early postoperative complications were subcutaneous emphysema (two patients) and atrial fibrillation (one patient). At one year all patients were asymptomatic without dysphagia, reflux, or recurrence of the hernia. CONCLUSION: The addition of fundoplication to paraesophageal hernia repair restores competency of the sphincter in patients with reflux associated to the hernia and prevents postoperative gastroesophageal reflux that results from the extensive dissection required. In addition, it provides an ideal means of fixing the stomach in the subdiaphragmatic position, decreasing the long term-risk of recurrence.

Adult↗
PubMedDate not supplied

Clinical presentation and evaluation of malignant pseudoachalasia.

Malignant pseudoachalasia can be indistinguishable from primary achalasia on routine clinical evaluation, often resulting in a delay in diagnosis. To better define the clinical features and appropriate management of this disease, the course of five patients discovered to have pseudoachalasia after being referred for a minimally invasive Heller myotomy was reviewed, as were 67 cases of pseudoachalasia previously reported in the literature. Patients with an occult malignancy tended to present with shorter durations of symptoms, greater weight loss, and at a more advanced age than patients with primary achalasia. Since contrast radiography and endoscopy frequently failed to differentiate these two diseases, persons with presumed achalasia meeting these criteria who are referred for minimally invasive surgery should undergo additional imaging to rule out an occult malignancy, since this condition cannot be reliably detected during the course of a thoracoscopic or laparoscopic esophagomyotomy.

Adolescent↗
PubMedDate not supplied

Videoendoscopy: an effective and efficient way to perform multiple visceral biopsies in small animals.

Because major surgery is usually required to obtain biopsies of abdominal organs, regulations tend to limit the number of procedures on individual animals to one. This study was conducted to develop a more humane, minor, comparatively cost-effective, minimally invasive surgical procedure, which reduces surgical trauma and the number of animals used. Biopsy techniques were developed in two nonsurvival rabbit surgeries. Safety and efficacy of multiple procedures were assessed in survival studies on four rabbits. Anesthesia was induced with ketamine/xylazine and maintained with isoflurane. Initial carbon dioxide insufflation (6 mmHg) was achieved through a Veress needle. A triangulated 5-mm port technique allowed introduction of pediatric 3.5- to 5.0-mm laparoscopic instruments. Biopsies of liver, spleen, kidney, and full-thickness bowel were obtained and evaluated for suitability (size) for polymerase chain reaction, in-situ hybridization, and histopathology studies. Animals in survival studies were assessed for infection, pain, bleeding, adhesion development, bowel function, and intestinal stenosis. All had normal appetite and stools within 48 h postoperatively. Biopsies obtained from either a Tru-Cut Biopsy Needle, 3.5- to 5.0-mm biopsy cups, or with the aid ofa pre-tied loop were adequate for all studies. There was no postoperative bowel obstruction, wound infection, or bleeding. Mean hematocrit decrease at 24 h postoperative was 3.4% +/- 6.7%. Adhesions formed at 9/52 (17%) evaluable sites. Multiple visceral organ biopsy under videoendoscopic guidance constitutes a minor procedure and is a promising means for longitudinal studies in animals. Utility for ill animals remains to be determined.

Abdomen↗