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At least 1,117 records · Page 62Linked to original sources
PubMed1994

Method of thoracoscopic pleurectomy.

A method of thoracoscopic pleurectomy using hydrodissection is presented. The results of its use in 8 patients are described, and pleurectomy as a form of pleurodesis is discussed.

Dissection↗
PubMed1996

Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema.

BACKGROUND: Prolonged air leak is the major complication after lung reduction surgery for emphysema and the major determinant of hospital length of stay. METHODS: Twenty-five of 107 patients (24%) (mean age, 66 years) with an average forced expiratory volume in 1 second of 0.55 L experienced a prolonged air leak (>5 days) after lung reduction surgery. These persistent air leaks were treated by replacing the chest drainage system with Heimlich valves to facilitate earlier hospital discharge even though 64% of the patients had apical air spaces that measured 1 to 7 cm. RESULTS: These patients had a mean postoperative stay of 9.1 days. Chest tubes were then removed an average of 7.7 days later. All apical air spaces resolved, and there were no deaths, empyemas, or pneumonias. CONCLUSIONS: In conclusion, the use of the Heimlich valve after operation for emphysema was associated with minimal morbidity and shortened the mean hospital stay for patients with prolonged air leaks by 46%. This study demonstrates an important concept in the postoperative management of these patients--do not use suction on severely emphysematous lung.

Aged↗
PubMed1993

Preservation of the ileocecal valve and right colon in total colonic aganglionosis.

A new surgical technique for the treatment of total colonic aganglionosis is described. Preservation of the right colon and the ileocecal valve is possible by performing an end-to-back anastomosis between a prececal short ileum segment and the uneffected ileum, and by creating a side-to-side anastomosis between an isolated ileal loop and the right colon. The ileorectal anastomosis is performed with a curved EEA 21 circular stapler (USSC, Norwalk, CT). After a neonatal ileostomy, the operation is performed as a one-stage procedure. The advantage of preserving the right colon and the ileocecal valve is discussed.

Anastomosis, Surgical↗
PubMed1995

Application of Collis gastroplasty to the management of esophageal atresia.

Establishment of esophageal continuity in the presence of an isolated esophageal atresia frequently requires deferred esophageal substitution. The author describes the use of Collis gastroplasty as an esophageal lengthening technique for the distal esophagus. This technique permitted the performance of primary repair of the esophagus in an infant with a 6-cm gap that otherwise would have required an esophageal substitution procedure. Morbidity after this procedure is comparable to that occurring after a number of established techniques.

Anastomosis, Surgical↗
PubMed1995

Sufentanil-isoflurane-nitrous oxide anesthesia for a patient treated with monoamine oxidase inhibitor and tricyclic antidepressant.

We report a case in which sufentanil was given to a patient who was already taking both a monoamine oxidase (MAO) inhibitor and a tricyclic antidepressant. Anecdotal reports have recommended discontinuing MAO inhibitors 2 to 3 weeks prior to elective surgery. However, current anesthesia literature suggests this practice may be unnecessary. This case report involved a patient who refused to stop her antidepressant medications. She was given an uneventful elective anesthetic with measures to minimize the risk of an adverse drug reaction involving the antidepressants she was taking. Our experience suggests that the use of an opioid other than meperidine may allow the anesthetist to proceed cautiously to provide an anesthetic for an elective surgery patient who is also currently receiving MAO inhibitor therapy.

Adult↗
PubMed2006

Colorectal resection in patients with ovarian and primary peritoneal carcinoma.

OBJECTIVE: This study examines the operative details and complications of colorectal resection in patients with ovarian and primary peritoneal carcinoma. STUDY DESIGN: Patients who underwent colorectal resection for ovarian and primary peritoneal cancer were identified in our surgical database for the period 1988 through 2002. RESULTS: Of the 125 patients who were identified, 73% were undergoing primary cytoreduction; 18% were undergoing secondary cytoreduction, and 7% were undergoing interval cytoreduction. The mean length of colon that was removed was 15.7 cm. The method of anastomosis was stapler in 63% and hand sewn in 22%; 15% patients had no anastomosis performed. A protective ostomy was used in 13% of patients. Optimal cytoreduction (<1 cm) was achieved in 74%. Operative complications occurred in 37% of patients, with the most common being hemorrhage (25%). Anastomotic leaks occurred in 2.5% of the patients, and the most common postoperative complication was ileus (28%). Postoperative bowel function returned to normal in 71% of patients. CONCLUSION: To obtain optimal cytoreduction in patients with ovarian cancer, colorectal resection often is necessary. Colorectal resection can be performed with a low risk of anastomotic complications, and patients frequently have the return of normal bowel function.

Adult↗
PubMed2005

A prospective evaluation of ultrasound-directed transparenchymal vascular control with linear cutting staplers in major hepatic resections.

BACKGROUND: We prospectively evaluated a novel ultrasound-directed technique of major hepatic resection using transparenchymal application of vascular staplers intending to minimize blood loss, operative time, and hepatic warm ischemia time. METHODS: Beginning in 1998 many major hepatic resections for hepatic tumors were performed with ultrasound-directed transparenchymal application of vascular linear cutting staplers. An endoscopic flexible neck vascular linear cutting stapler was used for control of the hepatic veins. RESULTS: From December 1998 to April 2003, 346 patients undergoing hepatic resection using this technique were identified from a prospective hepatobiliary tumor surgery database. Records were reviewed for blood loss, transfusion requirement, inflow occlusion (Pringle maneuver) time, overall operative time, and perioperative and postoperative complications. The average blood loss for all patients was 396 +/- 28.4 mL. The inflow occlusion time was 13.7 +/- .64 minutes with a total operative time of 140.7 +/- 3.7 minutes. Additional liver-related procedures were performed in 52% of the patients. The overall complication rate was 29.5% with a 90-day mortality rate of 1.4%. CONCLUSIONS: Ultrasound-directed transparenchymal application of vascular staplers to control inflow and outflow during major liver resection minimizes blood loss, warm ischemia time, and operative time compared to published reports of patients undergoing resection using other techniques.

Blood Loss, Surgical↗
PubMed2005

Laparoscopic restoration of intestinal continuity after Hartmann's procedure.

BACKGROUND: Colostomy closure after a Hartmann's procedure typically requires a laparotomy. It also carries the risk of significant morbidity including anastomotic leak, wound infection, and incisional hernia. The aim of this study was to review our experience with laparoscopic restoration of intestinal continuity after Hartmann's procedure. METHODS: After institutional review board approval, we retrospectively reviewed the medical records of patients undergoing laparoscopic colostomy reversal between July 1997 and July 2004. RESULTS: Twenty-two patients were identified; all patients had left colon colostomies. A laparoscopic technique was used in 21 patients, and 1 patient underwent hand-assisted colostomy reversal concurrently with right radical nephrectomy. The laparoscopic approach was successful in 20 cases, and there were 2 conversions to open (9%) secondary to dense adhesions around the rectal stump. The mean time to closure of the colostomy was 168 days (range 69-385 days). The mean operative time was 158 minutes (range 84-356 minutes). The estimated blood loss averaged 114 mL (range 30-250 mL). The average length of hospitalization was 4.2 days (range 2-6 days). Bowel function returned on an average of 3.5 days (range 2-5 days). Three patients (14%) developed postoperative wound infections. There were no anastomotic leaks and no mortality. At a mean follow-up of 14.7 months, the only long-term complication has been a small hernia at a colostomy site. CONCLUSIONS: Laparoscopic colostomy reversal after Hartmann's procedure can be performed with low morbidity and a short hospital stay. The need for conversion to open surgery is uncommon despite patients' previous surgeries. A laparoscopic approach to colostomy takedown is safe and feasible and may result in a reduction in complications and length of stay as has been seen with other minimally invasive procedures.

Adult↗
PubMed2005

Arthroscopic reconstruction of the posterior cruciate ligament using tibial-inlay and double-bundle technique.

Biomechanical research has suggested that the double-bundle and tibial inlay technique is superior to the single-bundle and the transtibial tunnel method for posterior cruciate ligament (PCL) reconstruction. A combination the posterior tibial inlay and femoral double-bundle technique is thought to be an ideal method for PCL reconstruction. Recently, we successfully performed arthroscopic PCL reconstruction using the tibial-inlay and double-bundle technique. Achilles tendon-bone allograft is used and the bone plug for the arthroscopic tibial inlay fixation is designed in a cylindrical shape and perpendicular to the fiber texture of the Achilles tendon. Achilles tendon is manually split into deep and superficial layers to reconstruct anterolateral and posteromedial bundles as the natural insertion of PCL. The intra-articular lengths of each bundle between tibial tunnel and 2 femoral tunnels are measured to achieve fixation of the graft to the original PCL attachment. After tibial bone plug fixation with an absorbable interference screw and additional suture anchoring, the anterolateral bundle is fixed in a reduction position with the knee in 90 degrees of flexion and the posteromedial bundle is fixed nearly in extension. This procedure makes it possible not only to reproduce the original concept of PCL tibial inlay graft arthroscopically without posterior arthrotomy, but also to achieve a more anatomic PCL reconstruction of the 2 bundles.

Achilles Tendon↗
PubMed2006

Pulmonary artery dissection complicating lung transplantation for primary pulmonary hypertension.

We report a case of pulmonary artery (PA) dissection complicating lung transplantation. A 30-year-old man with primary pulmonary hypertension underwent bilateral single lung transplantation. Thirty hours postoperatively he had signs of obstruction of the right main pulmonary artery develop due to dissection demonstrated on transesophageal echocardiography and pulmonary arteriography. Surgical repair of the dissection with reanastomosis of the pulmonary artery was successfully carried out, and the patient subsequently improved to a favorable condition. Pulmonary hypertension is a risk factor of pulmonary artery dissection; our case suggested that underlying chronic pulmonary hypertension might have led to this rare and life-threatening anastomotic problem after lung transplantation.

Adult↗
PubMed2006

Experimental study of one-shot vascular anastomostic device for proximal vein graft anastomoses.

PURPOSE: A new type of sutureless aortic-vein-graft vascular anastomostic device, One-Shot Vascular Anastomostic Device (Horologe Factory of Jinan City, Shandong Province, China) has been recently designed to create a one-shot anastomosis between the aorta and vein grafts for coronary artery bypass grafting surgery. DESCRIPTION: Twelve pigs were scheduled for the test of the feasibility of the One-Shot Vascular Anastomostic Device for artery to vein graft anastomosis. In each animal one proximal anastomosis was performed by means of the One-Shot Vascular Anastomostic Device and the distal end was sutured in a conventional manner to serve as the animal own control. The anastomosis incorporating the abdominal main artery to the segment of a free external carotid vein to the external iliac artery is for the simulation of the aorta-vein anastomosis. EVALUATION: The mean duration of the completion of the proximal anastomosis was 1.2 +/- 1.2 minutes (range, 0.3-5.0 minutes). There was a significant difference between the control groups (p < 0.01). All vein grafts were still functioning at the end of the procedure. Pathologic studies and angiography demonstrated that the results were satisfactory. CONCLUSIONS: This device enables rapid and safe completion of vascular anastomostic procedure. The vein graft was functioning well and incorporated into the vessel intima smoothly.

Animals↗
PubMed2006

Modified pharyngogastrostomy by a stapler technique.

Pharyngolaryngoesophagectomy is the gold standard treatment for the majority of larynx, pharynx and cervical esophagus advanced tumours. Reconstruction of these pharyngoesophageal defects is complex, and implicates additional time, morbity and mortality to the procedure. Gastric pull up and pharyngogastrostomy with hand sewing technique is the commonest way of doing it. The authors describe a modified technique to execute it using a stapler device.

Anastomosis, Surgical↗