Waiting times for non-urgent specialist appointments.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to T B Hugh.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Ingested biliary foreign bodies occur most frequently in patients who have had previous biliary operations, which predisposes them to enterobiliary reflux. This report describes an unusual ingested foreign body of the common bile duct in a patient with no history of previous gastrointestinal surgery.
Explore the source record for details and available documents.
OBJECTIVE: To describe the outcome of laparoscopic (percutaneous) cholecystectomy in the management of gallbladder stones. PATIENTS AND METHODS: One hundred unselected consecutive patients referred for cholecystectomy, or admitted as emergencies with complicated gallbladder disease. Ten patients had acute cholecystitis, three had empyema, three had gallstone pancreatitis, and 11 had a history of recent jaundice. Common bile duct stones were dealt with by endoscopic sphincterotomy. OUTCOME MEASURES: Intraoperative and postoperative complications, 30-day mortality rate, duration of hospital stay, and length of postoperative disability. RESULTS: Three patients were excluded and underwent open cholecystectomy. Laparoscopic cholecystectomy was attempted in the remaining 97, and successfully completed in 87; 10 were converted to open cholecystectomy. There were no significant intraoperative complications. Two patients had a postoperative haemorrhage and one had a transient bile leak; none required reoperation. There was one death from myocardial infarction 12 days after operation. Minor complications occurred in 12 patients. Mean operating time was 88 minutes. The average length of hospital stay was 72 hours, and most patients returned to normal activities after seven days. CONCLUSIONS: Laparoscopic cholecystectomy offers an outcome comparable to standard cholecystectomy and is applicable to 90% of patients requiring removal of the gallbladder. Laparoscopic cholecystectomy has significant advantages over open cholecystectomy in terms of reduced postoperative pain and disability.
Explore the source record for details and available documents.
Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is important. We reviewed the anatomy of the cystic artery and its variations as seen through the video laparoscope. A "normal" cystic artery was found in only 72% of patients. The most important laparoscopically noted variations were doubling of the cystic artery (22%) and an artery that ran inferior to the cystic duct (6%). Small branches of the cystic artery, which we suggest be named Calot's arteries, supply the cystic duct and may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. A scissor dissection technique was found most useful for identifying the arterial anatomy. Careful identification of arterial anomalies should help to reduce the incidence of bile duct injuries during laparoscopic cholecystectomy.
Explore the source record for details and available documents.
A sharp dissection technique, using specially designed curved insulated scissors, is described for use in laparoscopic cholecystectomy. This technique is a suitable alternative to laser and electrocautery, and produced a significant shortening of operating time.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.