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PubMedDate not supplied

Prospective study of the functional results of transanal endoscopic microsurgery.

BACKGROUND/AIMS: Most clinical research addresses the technological advances and oncological outcomes of transanal endoscopic microsurgery. Our aim was to examine the functional results. METHODOLOGY: From August 1999 to November 2000, 22 Taiwanese patients (14 men, 8 women; median age, 68 years) undergoing transanal endoscopic microsurgery were prospectively examined. Functional questionnaires and anorectal manometry were assessed before surgery and at 2 weeks, 6 weeks, 3 months, and 1 year. RESULTS: The median distance from the anal verge to the tumor was 10 cm. The median tumor diameter was 2.0 cm. The median duration of surgery was 120 minutes. No surgical mortality or morbidity and no local recurrence occurred during a median follow-up of 23 months. The mean stool frequency and consistency were significantly better at 3 months after surgery than before surgery. The maximal resting pressure significantly decreased after surgery. The maximal contraction pressure and maximal tolerated volume were significantly lower at 2 and 6 weeks than before surgery; these values recovered at 1 year. CONCLUSIONS: Transanal endoscopic microsurgery is safe for the cure of benign tumors and the palliative excision of malignant tumors in middle and upper rectum. Anorectal function was preserved and improved, though some anorectal manometric parameters changed over time.

Adenocarcinoma↗
PubMed2003

Diagnosis and treatment of mucobilia: report of 8 cases.

OBJECTIVE: To better understand mucobilia as well as its diagnosis and treatment. METHODS: The etiological factors, diagnosis, and treatment of 8 patients with mucobilia were discussed. RESULTS: Mucobilia characterized by copious mucin secretion in the extrahepatic bile duct resulted in obstructive jaundice and cholangitis. Four patients receiving curative resection of primary lesions were free from jaundice and cholangitis while the other 4 who had had palliative biliary drainage showed persistent symptoms. CONCLUSIONS: Mucobilia is attributable to biliary mucous metaplasia, and benign or malignant biliary tumors. Cholangioscopy and biopsy can offer precise information about the location and extension of the primary lesion. The best choice of treatment is curative resection of the primary lesion.

Adult↗
PubMed2004

Surgical and endoscopic palliation for pancreatic cancer.

Patients with pancreatic cancer often present with locally advanced or metastatic disease and are deemed not to be candidates for a curative resection. Palliation in these patients focuses on relief of biliary obstruction, gastroduodenal obstruction and pain. Palliative treatment modalities include both surgical and nonsurgical approaches. Biliary obstruction is often initially treated with endoscopic biliary stenting. Two major types of biliary stents are used, plastic and metallic stents. Both of these provide similar initial relief of biliary obstruction, however, plastic stents have a greater propensity for occlusion and should primarily be used in patients with anticipated short survival duration. Metallic stents have a greater initial cost, but provide an overall cost-saving in patients with expected survival duration of over 6 months. Surgical palliation for biliary obstruction should be primarily considered in patients who fail endoscopic biliary decompression or who develop clinical evidence of gastroduodenal obstruction. In these patients, surgical palliation should consist of biliary decompression with a choledochojejunostomy when ever feasible, a gastroduodenal bypass and a chemical splanchnicectomy for pain relief. An initial prophylactic gastroenterostomy at the time of endoscopic biliary decompression is rarely indicated. The role of palliative pancreaticoduodenectomy remains controversial and to date there are no prospective randomized data to support its role in palliation of locally advanced pancreatic cancer. This review examines the available data from prospective trials for surgical and nonsurgical palliation of locally advanced and metastatic pancreatic cancer.

Choledochostomy↗
PubMed2004

[Clinical signs, diagnostics and treatment of the benign mesenchymal (submucosal) tumors of the gastrointestinal tract].

Benign mesenhimal tumors (submucosal) of the gastrointestinal tract are rarely found. They develop in the submucosa of the digestive tract. The tumors are covered by normal mucosa, have slow growth and tendency to ulcerations and bleeding. The clinical manifestations are not characteristic and depend on tumors size localization and complications, which often lead to diagnostic difficulties. The three cases of benign mesenchimal tumors localized in the stomach, colon and rectum, surgically removed during 2001/2002 year are represented. Typical clinical symptoms include abdominal pain, gastrointestinal bleeding and anaemia. The presented clinical cases are of great interest, because of the very low grade of incidence, non-specific clinical manifestations and different diagnosis. Expressive intraoperative histological confirmation of the diagnosis is absolutely necessary. Recurrences are not found in the treated patients.

Adult↗
PubMed2005

[Thromboembolic risk and prevention of deep venous thrombosis in open and laparoscopic surgery].

Deep Vein Thrombosis (DVT) and pulmonary embolism are the dangerous and serious complications in patients undergoing surgery. It is known that prognosis is strictly linked to timely recognition of the pathogenetic-clinical phase of the thromboembolic disease and that prevention, therefore, plays the leading role in patients at risk. The most recent series show that, in absence of prophylaxis, the frequency of DVT, diagnosed by objective tests, is still significant in abdominal surgery. Modern diagnostic tools make possible to identify relatively silent clinical thrombosis, also with laboratory tests (i.e., D-dimer plasma levels). The Authors report a study on thromboembolic episodes in patients who underwent pneumoperitoneum with CO2 during laparoscopic abdominal surgery, compared to a control group submitted to open surgery. They underline the importance of a careful preoperative evaluation of the venous system, by Doppler study, in order to identify, patients at risk of DVT and establish a suitable anti-thrombotic prophylaxis.

Anticoagulants↗
PubMed1991

[Digestive tuberculosis].

On a experience of 123 patients with intestinal and/or peritoneal TBC, the author do a complete review of the epidemiological and environmental factors and about the anatomo-pathological types of the disease. The review remarks the value of the clinical picture evaluation, the diagnostic methods and therapeutic schemes of medical treatment and the complications management.

Age Factors↗
PubMed1987

Chemoprophylaxis in clean-contaminated surgery.

Prophylaxis should be restricted to operations for which its benefit has been established. These are mainly operations in which a viscus colonized by bacteria is opened and in which bacterial contamination is unavoidable. The most important principle is to ensure adequate blood levels of antibiotic at the time of surgery. The choice of antibiotic should be based on knowledge of bacteria likely to cause infection.

Administration, Oral↗
PubMed1993

[Surgical endoscopy--analysis of 6 years' activity].

Fibroscopy of the digestive system which in the majority of developed countries is quite common is in our country still not available in an adequate extent. The authors evaluate their experience in a surgical department covering a six-year period. A total of 4436 fibroscopic examinations were made incl. 3821 gastroscopies 615 ERCP and examinations of the papilla Vateri. They describe their experience with urgent endoscopy on account of haemorrhage into the GIT, pancreatitis or cholangitis. They emphasize the advantages of a maximal extension of endoscopic methods and their advantages, as compared with classical examination methods.

Adolescent↗
PubMed1998

[Digestive anastomosis in general surgery].

Still today the digestive anastomoses are a subject very discuss and controversial in relation to the better technique. In fact the introduction of mechanical suture has placed the problem between this instrumentation and the classic technique. The Authors, comparing these two techniques, observe the peculiar aspects of each one and relate on the progresses, in last years, whether of the mechanical suture, with the improvement of the handy and the resistance of the anastomosis, or the threads of suture, ever more inert and resistant. Subsequently, the Authors relate your experience showing the form of realization of the anastomoses in the esophagogastric surgery, small intestine, colon-rectum, hepato-biliary and pancreatic surgery. In particularly, about the hand-sewn anastomosis, the Authors relate personal technique of reconstruction with extramucosal continuous suture, one-layer, with synthetic slow absorbable one-filament (PDS). In conclusion, the Authors declare that the introduction of the mechanical suture has certainly influenced the development of the new therapeutic solutions and has allowed intestinal anastomosis in sites of difficult access (abdominal esophagus, low rectum), but they think that the surgeon must to learn to know when is useless or neoplastic mechanical suture and he can realize manually the same anastomosis with quickness and safety.

Anastomosis, Surgical↗
PubMed2002

Adjusting surgical mortality rates for patient comorbidities: more harm than good?

Background. Studies of medical admissions have questioned the validity of using claims data to adjust for preexisting medical conditions (comorbidities), but the impact of using comorbidities from claims data to risk-adjust mortality rates for high-risk surgery is not well characterized. The purpose of this study was to evaluate the relationship between comorbidities and mortality in administrative data in surgical populations and identify better risk-adjustment methods. Methods. Using the national Medicare database (1994-1997), we identified admissions for elective abdominal aortic aneurysm repair (140,577) and pancreaticoduodenectomy (10,530). We calculated the relative risk of mortality (adjusted for age, sex, race, and admission acuity) for 5 chronic conditions that are known (from clinical series) to increase the risk of postoperative mortality and are commonly used in claims-based risk-adjustment models. To explore the potential value of alternative risk-adjustment strategies, we examined relationships between surgical mortality and comorbidities using diagnosis codes identified from previous admissions. Results. Overall, in-hospital mortality for elective abdominal aortic aneurysm (AAA) repair and pancreaticoduodenectomy were 5.1% and 10.4%, respectively. For both procedures, 3 of the 5 comorbidities were associated with decreased risk of mortality: prior myocardial infarction (MI) [RR = 0.38; 95% confidence interval (CI), 0.33-0.43 for AAA; RR = 0.38; 95% CI, 0.21-0.69 for pancreaticoduodenectomy), malignancy (RR = 0.67; 95% CI, 0.59-0.76 for AAA; RR = 0.74; 95% CI, 0.45-1.21 for pancreaticoduodenectomy], and diabetes (RR = 0.76; 95% CI, 0.64-0.84 for AAA; RR = 0.59; 95% CI, 0.49-0.69 for pancreaticoduodenectomy). Using comorbidities identified from prior admissions increased the mortality risk estimates for prior MI (RR = 1.22; 95% CI, 1.08-1.38 for AAA; RR = 0.80; 95% CI, 0.49-1.30 for pancreaticoduodenectomy) and diabetes (RR = 1.41; 95% CI, 1.25-1.59 for AAA; RR = 0.94; 95% CI, 0.78-1.14 for pancreaticoduodenectomy). Conclusions. Because comorbidities coded on the index admission appear protective, incorporating them in risk-adjustment models for studies comparing surgical performance may penalize providers for taking care of sicker patients. When available, comorbidity information from prior hospitalizations may be more useful for risk adjustment.

Aortic Aneurysm, Abdominal↗
PubMed2004

Tracheal agenesis: management of the first 10 months of life.

Tracheal agenesis is a potentially lethal congenital anomaly, appearing only at birth. We describe a newborn preterm infant who presented with immediate respiratory distress and no audible cry. There was almost complete tracheal agenesis with a very short segment of distal trachea (only two tracheal rings) arising from the anterior wall of the esophagus, before dividing into the mainstem bronchi. The anomaly was unsuspected prenatally, as the scan showed pyloric atresia and complex congenital cardiac disease. Despite the patient's difficult course, with correction of the rare-associated malformations (cardiac and gastrointestinal tract anomalies), the fact that the child is lively and neurologically normal for her age, requires that we now consider the patency of the airway and the possibility of surgical correction, in accordance with a good quality of life.

Abnormalities, Multiple↗
PubMed1993

[Palliative biliary-digestive bypass with a Kehr tube for neoplastic surgical cholestatic jaundice].

The authors, in some rare cases of surgical neoplastic icterus operation, had to adopt a technique of biliary-digestive bypass with prosthesis on account of the technical-anatomical and general conditions of the patients. That prosthesis has been made out of the typical Keher's duct which can be generally found in every general surgery. The above mentioned authors describe the operations they have carried out, their directions and the results of six cases which have been treated with a technique similar to Kron's.

Aged↗