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PubMed1988

Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery.

Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy.

Combined Modality Therapy↗
PubMed2004

Pain control with low-dose alfentanil in children undergoing minor abdominal and genito-urinary surgery.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children. METHODS: During sevoflurane-nitrous oxide atracurium anaesthesia for minor abdominal or genito-urinary surgery, three groups of children aged 0-8 yr received 25 microg kg(-1) alfentanil intravenously (n = 28), or peripheral nerve blockade using 1 mLkg(-1) ropivacaine 0.475% (n = 24), or 12.5 microg kg(-1) alfentanil intravenously with peripheral nerve blockade using 1 mL kg(-1) ropivacaine 0.475% (n = 30). Changes in blood pressure and heart rate were measured during the procedures. Postoperative pain was assessed using the face, legs, activity, cry, consolability (FLACC) observational tool for quantifying pain behaviour and a numerical scale scored by nurses, doctors, parents and children. RESULTS: There was no significant difference in intra- or postoperative analgesic efficacy among the three groups. Patients who received alfentanil had significantly lower heart rates than those who received nerve blockade only (96.0+/-15.6 vs. 115.9+/-23.2 beats min(-1), P < 0.001). FLACC and numerical scale scores did not differ among the groups. There were no significant differences in incidence of vomiting or use of pain medications. CONCLUSIONS: It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.

Abdomen↗
PubMed2000

Urinary continence following radical prostatectomy assessed by a self-administered questionnaire.

OBJECTIVES: A total aim of this study was to assess the incidence of urinary incontinence in patients following radical prostatectomy and determine the factors that may influence this incidence. METHODS: A total of 135 men underwent radical retropubic prostatectomy at our center between 1987 and 1997. 120 patients were sent a questionnaire regarding preoperative and postoperative voiding habits. Data collected included preoperative and postoperative continence status, interval to postoperative continence status, associated urinary symptoms, willingness to undergo radical prostatectomy again if need be and additional postoperative procedures. Patient age, date of surgery, number of neurovascular bundles resected at prostatectomy and duration of follow-up were also noted. RESULTS: Of the 120 patients, 116 (96.7%), a mean of 65.2 (range 48-76) years old, responded to the questionnaire. Mean follow-up was 4.3 years (range 1-10.8). Continence was defined as no regular use of pads. Our overall urinary incontinence rate was 14.4%. Of the respondents, 88. 8% (103/116) had achieved final continence status by 6 months postoperatively, and 95% (110/116) would undergo surgery again if need be. Of the patients considered incontinent postoperatively, 66. 6% had associated urgency. Age, year of surgery, number of neurovascular bundles resected at prostatectomy, preoperative urinary leakage of postvoiding dribbling, postoperative pelvic floor exercises, and anastomotic stricture had no significant impact on postoperative continence status. CONCLUSIONS: Using an anonymous self-administered questionnaire, we found a 14.4% incontinence rate after radical prostatectomy. These results allow patients to have realistic expectations when counseled prior to this operation.

Aged↗
PubMed1975

Catheterization in anorectal surgery.

Urinary retention and catheterization are among the complications involved in anorectal surgery. One hundred patients who underwent hemorrhoidectomies were able to avoid both of these complications due to a combination of operative and postoperative procedures, including the following: (1) meticulous surgical technique; (2) restriction of fluids; (3) adequate doses of narcotics, and (4) preeducation of the patient and nursing staff, which resulted in spontaneous voiding in all of the patients by the morning after the operation, with or without a hot bath.

Health Education↗
PubMed2003

Intraoperative ketorolac and eye pain after viteoretinal surgery: a prospective, randomized, placebo-controlled study.

PURPOSE: To compare the efficacy of one intraoperative dose of intravenous ketorolac tromethamine to saline placebo in controlling postoperative eye pain, nausea, and sedation following vitreoretinal surgery. STUDY DESIGN: Prospective, randomized, placebo-controlled clinical trial. METHODS: One hundred fourteen vitreoretinal surgical patients were randomized over a 7-month period to a single intraoperative intravenous dose of ketorolac tromethamine or placebo. All patients underwent surgery with intravenous sedation and retrobulbar anesthetic injection and had access to a standard postoperative analgesic regimen. After 2 and 5 hours, eye pain, nausea, and sedation levels were recorded using a standard visual analog scale. Analgesic requirements were tabulated. RESULTS: Patients given ketorolac were significantly less likely to have postoperative eye pain than were placebo-treated patients (P = 0.0043). Fewer ketorolac patients required postoperative analgesia than placebo patients did (P < 0.0001). Four ketorolac patients (7%) required a narcotic compared to 11 placebo patients (20%) (P < 0.0001). Fewer ketorolac patients experienced nausea and sedation than placebo patients did, but this difference was not statistically significant. CONCLUSION: Ketorolac tromethamine is an effective nonnarcotic choice for postoperative pain control following vitreoretinal surgery. Pain control is particularly important in this group of patients, whose compliance with postoperative procedures and positioning may significantly affect surgical outcome.

Aged↗
PubMed1986

Postoperative flexible choledochoscopy for residual primary intrahepatic stones.

Postoperative flexible choledochoscopy was carried out in 103 patients with residual biliary calculi. Forty-one patients had residual stones in the common duct, and 63 patients had residual stones in the intrahepatic ducts with or without stones in the common duct. The majority of the intrahepatic stones were primary stones. Postoperative choledochoscopy was very effective in removing residual common duct stones (95% removed, no morbidity). For intrahepatic stones, removal was more difficult and was associated with a higher morbidity (11.2%). Stone extraction through the stenotic intrahepatic ducts was made possible by the balloon dilatation of the ducts. Repeated endoscopic access to the biliary system was made easier by the construction of a hepatico-cutaneous-jejunostomy, which also provides a route to the biliary tree for future stone removal if stone reformation occurs. Complimented by these procedures, postoperative choledochoscopy was successful in removing the residual intrahepatic stones in 82.3% of the patients. At a median follow-up of 17 months, the majority of the patients who had all the stones removed as well as those who had stones left behind were symptom free.

Adolescent↗
PubMed2005

Strictures of the terminal bile duct--who profits from the surgery?

BACKGROUND: Elucidation of the etiology of terminal bile duct strictures is oftentimes challenging. In choosing the optimal treatment method, a multidisciplinary approach is necessary. AIMS AND METHODS: To demonstrate the advantages and indications of surgical management, 153 patients with terminal bile duct strictures were retrospectively analysed. All patients had been treated during a period of eight years (1st January 1995 - 31st December 2002) in same department. The principal datas studied were surgical morbidity, thirty-days' mortality rates and recurrence of jaundice. RESULTS: During a period of eight years, 153 patients (100%) underwent laparotomy. Radical surgery (duodenopancreatectomy) was performed in 79 patients (51.6%), while 74 others (48.4%) benefited from bypass procedures. Postoperative morbidity reached 13.1%; nine patients (5.9%) died within the thirty days of surgery. Recurrence of jaundice was observed in three patients (1.9%). CONCLUSION: Surgical management of terminal bile duct strictures is indicated in most patients with benign strictures, strictures of unknown origin and with malignant strictures, where the patients are in a reasonably satisfactory clinical condition. The surgical approach provides the potential advantage to obtain a definite histological diagnosiscare and to remove the tumour in many patients. Patients with non resectable tumours could benefit from bypass procedures ensuring long-term and effective drainage of the bile.

Cholestasis↗
PubMed2005

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay].

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Adolescent↗
PubMedDate not supplied

Deep sclerectomy with collagen implant: initial experience.

OBJECTIVE: To evaluate complications of deep sclerectomy with collagen implant (DSCI), a recently introduced nonpenetrating glaucoma-filtering surgical technique. PATIENTS AND METHODS: 30 eyes of 23 patients with open-angle glaucoma were included in this prospective, noncomparative, interventional case series. In all eyes, preoperative intraocular pressure (IOP) was lowered inadequately by topical antiglaucomatous medications. After undergoing DSCI, the patients were followed prospectively. If necessary, the procedure was combined with cataract surgery or mitomycin C application. RESULTS: In 27 (90%) of 30 eyes, DSCI could be performed. In 3 (10%) of 30 eyes, DSCI had to be transformed intraoperatively into a trabeculectomy because of a large trabecular penetration. Microperforations without further consequences occurred in 2 (7%) of 30 eyes. The mean follow-up was 6.6 +/- 3.8 months. IOP dropped from 26.0 +/- 6.7 to 13.6 +/- 4.7 mm Hg (p < 0.05). Medical glaucomatous treatment was reduced from 2.3 +/- 3.8 to 0.3 +/- 0.6 (p < 0.05). In cases without cataract, visual acuity decreased from 0.7 +/- 0.3 to 0.66 +/- 0.4 at the last visit (p > 0.1). Postoperative complications included Seidel (1/27, 4%), encapsulated bleb (4/27, 15%), astigmatism (1/27, 4%), iris capture (2/27, 7%), microhyphema (3/27, 11%) and peripheral anterior synechiae (4/27, 15%). Fifteen (56%) of the 27 eyes needed the following postoperative procedures: laser goniopuncture (8/27, 30%), needling of the filtering bleb (4/27, 15%), surgical revision in the operating theater (3/27, 11%). All 3 eyes where trabeculectomy was performed instead of DSCI had a favorable course. CONCLUSIONS: During the evaluation period, complications occurred in about half of the cases. None of the complications was severe or irreversible. Target pressure and a reduction in drug treatment could be achieved in all of the patients.

Aged↗
PubMed1999

Intrahepatic cholangiocarcinoma in Thailand.

Intrahepatic cholangiocarcinoma is defined as adenocarcinoma originating from bile ductules and segmental and lobar intrahepatic ducts. Four types of surgical pathology have been identified in the Khon Kaen endemic area in Thailand: peripheral, type I; intermediate, type II; central, type III; and diffuse, type IV. We report our experience with intrahepatic cholangiocarcinoma with emphasis on the surgical pathology, operative procedure, and associated survival time. We reviewed the records of patients treated for cholangiocarcinoma at Srinagarind Hospital from January 1, 1992 to February 28, 1997. There was a total of 411 patients, and 138 were intrahepatic and non-jaundiced. Tumors in the proximity of the gray zone i.e., portal, periportal with jaundice, were excluded. Patient profiles, surgical pathology, operative procedure, postoperative morbidity, and mortality were recorded. The data were analyzed using Kaplan-Meier survival curves. Of the 138 patients with intrahepatic disease who were non-jaundiced, 116 had type I, 10 had type II-III, and 12 had type IV. The wear ages of the patients were: 53.0, SE 9.2 years in type I; 57.1, SE 4.6 years in type II-III, and 50.2, SE 9.2 years in type IV. The male-to-female ratios in the three groups were 1.4 : 1, 1.5 : 1, and 5 : 1, respectively. The mean survival times in the three groups were 556, SE 63 days 374, SE 149 days and 97, SE 35 days. Most of the surgical procedures were tumor excisions (108/138). Right hepatectomy was performed in 63 patients, extended right hepatectomy in 8, left hepatectomy in 18, and extended left hepatectomy in 1. Palliative procedures were performed in the other patients because tumors were in both lobes. The mean survival time was 582 days (SE, 75), for right lobe surgery; 458 days (SE, 89) for left lobe surgery; and 127 days (SE, 58) for the other procedures. Mean survival time was 1039 days (SE, 201) in tumor stage III, 773 days (SE, 123) in stage IVa, and 382 days (SE, 60) in stage IVb. There were no significant differences in survival time according to age or sex. The results of surgery in type I and type II-III were better than the results in type IV. Survival time after right hepatectomy was better than that after left hepatectomy, although without statistical significance, but survival time was significantly better after both operations than after palliative procedures. The results of surgery according to pathological staging showed that survival time in stage III was better than that in either stage IVa or IVb, but only the difference from stage IVb was significant.

Adult↗
PubMed1997

Twenty-year experience with jejunal conduits.

OBJECTIVES: To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. METHODS: From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop (10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. RESULTS: Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. CONCLUSIONS: Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.

Adolescent↗
PubMed2003

Percutaneous needle aponeurotomy: complications and results.

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture.

Adult↗
PubMed2001

[Percutaneous needle aponeurotomy. Complications and results].

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was six years. Rupture of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely at digital level in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during the second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). Reoperation rate was 24%. In the group controlled at 3.2 years follow up, recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and a predominant MP contracture.

Adult↗
PubMed2004

Surgical experience of syringomyelia with reference to the findings of magnetic resonance imaging.

We present our surgical experience of 20 patients with syringomyelia, who were divided into two groups based on the findings of magnetic resonance (MR) imaging: a "non-visible cisterna magna" group, in which MR imaging did not reveal cerebrospinal fluid (CSF) in the cisterna magna, and a "visible cisterna magna" group. Patients with non-visible cisterna magna were associated with Chiari malformation (14 patients) or tight cisterna magna (4 patients) and underwent craniocervical decompression. Intradural exploration was performed when CSF movement in the cisterna magna or CSF outflow from the fourth ventricle appeared to be insufficient. It is important to confirm CSF outflow from the foramen of Magendie. Patients with visible cisterna magna were associated with tuberculous meningitis (2 patients) and underwent shunting procedures. Postoperatively, improvement in symptoms and a reduction in syrinx size were demonstrated in all patients except one. Two patients experienced recurrence of symptoms and syrinx dilatation.

Adolescent↗
PubMed1987

A decade of lower extremity venous trauma: patency and outcome.

Eighty-two patients with infrailiac venous injuries were reviewed. Veins were repaired in 75 patients and ligated in 7 patients. Clinical outcome could be correlated with anatomic patency for 41 patients who had postoperative venograms. Sixty-three percent of the repairs proved to be patent. Simple repairs were successful more often than complex ones. Site of injury and perioperative therapeutic adjuncts did not affect results. Eleven limbs were amputated, none solely because of venous injury. Edema was present at last follow-up in fewer patients with patent repairs than occluded repairs or ligations. Repair of major lower extremity venous injuries should be attempted routinely in stable patients. Improved patency of complex repairs may require increased use of balloon catheter thrombectomy and other adjunctive procedures. Postoperative venography is very useful for the evaluation of results.

Adolescent↗
PubMed2004

Autologous blood donation in total knee arthroplasties is not necessary.

BACKGROUND: This study intends to prove the hypothesis that preoperative autologous blood donation in total knee arthroplasties (TKA) is dispensable. PATIENTS AND METHODS: The study comprises a prospective analysis of 81 consecutive TKA without preoperative autologous blood donation (AB-donation). Guidelines for blood retransfusion were used. Surgery, as well as the pre- and postoperative procedures were identical for each patient. In the analysis of the data, the consecutive TKAs were divided into patients who were eligible for preoperative autologous blood donation (group 1, n = 46) and those with relevant risk factors not permitting preoperative autologous blood donation (group 2, n = 35). RESULTS: None of the patients in group 1 needed a blood transfusion. 14 of 35 patients in group 2 needed an allogenic blood transfusion. INTERPRETATION: Total knee arthroplasty can be managed without preoperative AB-donation if it is performed using a tourniquet, if a postoperative collection and direct retransfusion system is used for the wound blood, and if the transfusion algorithm is defined according to compulsory and practical guidelines.

Aged↗
PubMedDate not supplied

Topical diclofenac in the treatment of ocular pain after excimer photorefractive keratectomy.

BACKGROUND: Following excimer laser photorefractive keratectomy, patients experience significant ocular pain until corneal reepithelialization. Despite the use of cold compresses, bandage soft contact lenses, cycloplegics, narcotics, and topical corticosteroids, the pain has not been adequately controlled in many patients. METHODS: A randomized, double-masked, parallel-group study of diclofenac sodium 0.1% ophthalmic solution and its placebo vehicle was evaluated. Patients undergoing excimer myopic photorefractive keratectomy on their second eye were admitted overnight. Postoperative procedures included two drops of diclofenac or placebo immediately after surgery and then qid until reepithelialization, topical tobramycin (qid), 0.1% fluorometholone (q2h), cycloplegics, and a disposable soft contact lens. Thirty-two patients (diclofenac = 16, placebo = 16) were evaluated from +30 minutes to +96 hours by several types of questionnaires. RESULTS: Most patients who received placebo experienced pain, starting within 1 hour, peaking at 4 to 6 hours and lasting 36 to 48 hours. The diclofenac-treated patients rarely experienced the early peak in pain, had less pain overall until 72 hours postoperatively, and experienced significantly less photophobia and burning/stinging. Significantly fewer patients on diclofenac required oral narcotics. Three patients (diclofenac = 2, placebo = 1) developed corneal infiltrates, the etiology of which is not known. In a separate study we conducted, there was no difference in epithelial healing times between the diclofenac-treated eyes and those not receiving the drug. CONCLUSIONS: Diclofenac appears to significantly reduce the ocular pain following excimer photorefractive keratectomy.

Administration, Topical↗
PubMed2004

Current recommendations for extended out-of-hospital thromboprophylaxis following total hip arthroplasty.

Patients who have undergone total hip arthroplasty are at risk for venous thromboembolic disease, including deep venous thrombosis, pulmonary embolism, and postphlebitic syndrome. Although the number of annual total hip arthroplasties in the United States has steadily risen in the past decade, the rate of venous thromboembolic disease within that patient group has declined as a result of advances in surgical and postoperative procedures, including prompt mobilization and safety and efficacy of thromboprophylactic alternatives. This paper reviews the therapeutic options for deep venous thrombosis prophylaxis following total hip arthroplasty, with an emphasis on recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. The implications of recent randomized clinical trials on care provided by physiatrists in the rehabilitation facility setting are also discussed. The low-molecular-weight heparins have become widely accepted alternatives to aspirin, heparin, and warfarin as results from randomized clinical trials have proved their superior safety and efficacy in the postoperative period. Prolonged prophylaxis up to 30 to 35 days postoperatively in total hip arthroplasty may offer additional protection against venous thrombosis. Therefore, to prescribe optimal thromboprophylactic regimens following total hip arthroplasty, physicians require an understanding of the current recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and the implications of recently concluded clinical trials.

Anticoagulants↗