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In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept.
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BACKGROUND: The trauma caused by pancreatoduodenectomy for periampullary carcinoma of vater is often severe and extensive. The purpose of this study was to evaluate the effect of extended local resection in the treatment of periampullary carcinoma of vater. METHODS: The extra-hepaticobiliary tract, the confluence of the pancreatic and biliary duct, vater ampulla and duodenal papilla were resected en bloc in 8 patients with periampullary carcinoma from 1995 to 1998. RESULTS: One patient died perioperatively. Duodenal obstruction developed postoperatively in one of 7 survived patients and was relieved after reoperation. All the 7 patients were followed up for more than 6 months without recurrence. CONCLUSION: Extended local resection fulfils the task of radical treatment of periampullary malignancy.
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BACKGROUND: Haemorrhoids are a common surgical problem seen in the outpatient department. Rubber band ligation using suction is an effective treatment for symptomatic haemorrhoids but associated with significant morbidity. This prospective observational study was carried out to assess the efficacy, effectiveness and complications of rubber band ligation performed in outpatient for symptomatic haemorhoids using suction ligator. The results and outcome of procedure performed by the consultants and senior residents were also compared. METHODS: 56 consecutive patients with symptomatic haemorrhoids underwent rubber band ligation in the outpatient clinic of the department of general surgery, Pakistan Institute of Medical Sciences. Outcome measures were symptomatic cure i.e. stoppage of bleeding and reduced mucosal prolapse. Complications were categorized as immediate, early (within one week) and late (within 3 months). RESULTS: Symptomatic cure was achieved in 50(89.20%) patients (stoppage of bleeding and reduced mucosal prolapse). Six (10.72%) patients required further banding. Pain (mild to severe) was most common immediate and intermediate complication (14 and 20 patient's respectively). CONCLUSION: Rubber band ligation is an effective, outdoor procedure for symptomatic haemorrhoids, but associated with certain degree of morbidity.
Interventional therapy and above all the endoscopic interventions have gained importance in the last years. There are a lot of interventional procedures with curative or palliative intention, which value have to be compared with surgical therapy as the therapeutical gold standard. Today the endoscopic hemostasis for ulcer or variceal bleeding are the therapy of choice with very good results. Thus the need for surgery is low. The treatment of benign esophageal stenosis is a domain of the endoscopic therapy. Dilatation with bougies or balloon dilatation get comparable results. In patients with achalasia age and comorbidity of the patients are of great importance for the choice of therapy. In young patients the botulinum toxin injection should be avoided because of a very low long-term efficiency and because surgery become more difficult after botulinum toxin injection. As colorectal cancer is a frequent tumor endoscopic polypectomy and mucosectomy are very important endoscopic procedures, because there is a possibility of cancer prevention and when risk factors are be considered a curative therapy of early colorectal cancer is possible.
153 patients with swallowed foreign bodies in gastrointestinal tract (GIT) were treated for the last 10 years (1988-1997). In 85 (55.5%) cases foreign bodies (FB) were swallowed by psychopathic persons, in 45 (29.4%)--with the aim of mutilation, in 23 (15.0%)--due to carelessness. In 105 (68.63%) patients the foreign bodies were single, in 48 (31.37%) there were multiple foreign bodies of GIT. In 73 (47.71%) cases FB were found in the stomach. Clinical picture in patients with swallowed FB was variable. Dynamic roentgenological examination together with thorough anamnesis is the most important diagnostic tool in this pathology. The indications for urgent surgical treatment were sticking of the FB, peritonitis, gastro-duodenal bleeding, gastrointestinal obstruction. Elective surgery was used in patients with sticked F.B., with multiple FB, which formed conglomerates, as well as in single FB. with the length over 12-15 cm. Active expectant policy is valid FB of GIT with tendency for passage, due to conservative treatment.
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