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At least 1,135 records · Page 63Linked to original sources
PubMed2006

Thrombosis of a large portal vein aneurysm: treatment by thrombectomy, aneurysmorrhaphy, and portocaval shunt.

An otherwise healthy 32-year-old woman had unspecific upper abdominal complaints. Diagnostic work-up, including a helical computed tomography (CT) scan and indirect splenoportography, revealed a giant extrahepatic portal vein aneurysm (PVA) extending to the central part of the splenic vein. On laparotomy, a thrombectomy and creation of a portocaval side-to-side shunt were performed. Thirteen days later, she was readmitted for re-thrombosis of the aneurysm. She underwent another laparotomy with thrombectomy and tapering of the portal venous wall (aneurysmorrhaphy) by vascular staplers. On follow-up 25 months after the operation, full relief of symptoms was noted. She was on warfarin therapy. Her portal venous system was patent.

Adult↗
PubMed2006

Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results.

Laparoscopic wedge resection of the stomach (LWS) has become the treatment of choice for patients with benign gastric tumors. The technical consideration and long-term follow-up data of LWS for gastrointestinal stromal tumors (GISTs) of the stomach are limited. We present our experience of 28 LWSs for gastric GISTs with a mean follow-up of 43 months. From October 1995 to December 2002, we successfully performed 28 LWSs for 29 patients with GISTs of the stomach, and one patient needed conversion to laparotomy because of suspected bowel injury when establishing pneumoperitoneum. Patient demographics, perioperative parameters, and outcomes of the 28 patients were assessed retrospectively. The tumors were located in the upper third of the stomach in 13 patients, in the middle third, in eight patients, and in the lower third, in seven patients. The mean size of tumors was 3.4 +/- 1.6 cm in diameter. The duration of operation ranged from 95 to 390 minutes: 189.6 +/- 79.5 minutes with the stapler method and 194.3 +/- 50.5 minutes with the hand-sewn method (P = 0.8870). No blood transfusion was given in the perioperative period in all cases. Cholecystectomy in three patients and repair of hiatal hernia in one patient were performed during the same operation. The oral intake was restored at the third to fourth postoperative days. The hospital stay ranged from 3 to 11 days (mean, 6.7 +/- 1.8 days). The follow-up period ranged from 12 to 95 months (mean, 43.3 +/- 23.5 months, median 42 months). There has been no evidence of tumor recurrence, including one patient with microscopic invasion of section margin. LWS can be performed safely with a satisfactory remission rate for patients with gastric stromal cell tumors.

Adult↗
PubMed2006

The split-stomach fundoplication after esophagogastrectomy.

Two complications associated with esophagogastrectomy are anastomotic leak and gastroesophageal reflux. We describe here a modification of an intrathoracic esophagogastrostomy using the gastric fundus to address these issues. After completion of the esophagogastrectomy, the fundus is divided to produce "wings." After the esophagogastrostomy is performed, the wings are used to form a wrap around the anastomosis. This wrap is secured to the esophagus and to the stomach. All patients undergoing the split-stomach fundoplication were compared with all patients undergoing standard esophagogastrectomies. End points were in-hospital mortality, anastomotic leak, and postoperative endoscopic dilation. All living patients were contacted and questioned about refluxlike symptoms and completed the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) symptom severity questionnaire. Twenty-six patients underwent the split-stomach fundoplication (wrap group), compared to 54 patients undergoing standard resection (no wrap group). Occurrence of end points in the wrap vs. no wrap groups were, respectively, in-hospital mortality, 3.8% vs. 7.4% (P = NS); anastomotic leak, 0% vs. 17% (P = 0.03); reflux symptoms 20% vs. 60% (P < 0.001); postoperative dilation, 40% vs. 30% (P = NS). The median total GERD-HRQL score was 5 for the wrap group vs. 14 for the no wrap group (P = 0.03). The addition of the split-stomach fundoplication to esophagogastrectomy may decrease the incidence of anastomotic leak and postoperative refluxlike symptoms.

Aged↗
PubMed2005

Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy.

OBJECTIVE: To describe the use of mechanical anastomoses in cases of laparoscopically assisted vaginal rectosigmoidectomy for the treatment of rectosigmoid endometriosis. METHODS: Pilot study evaluating eight patients with rectosigmoid endometriosis referred for surgical treatment. All patients were submitted to laparoscopically assisted vaginal segmental resection of the rectosigmoid with anastomoses performed using linear and circular staplers. RESULTS: The average length of the surgical procedure was 177.5 min and average duration of hospitalization was 4.13 days. There were no intra-operative complications and integrity of the anastomoses was confirmed in all patients. One patient reported partial improvement of symptoms and 7 patients presented complete clinical remission 12 months following surgery. CONCLUSION: Laparoscopically assisted vaginal segmental resection of the sigmoid infiltrated by endometriosis is a feasible surgical procedure. The technique combines transvaginal access with mechanical intestinal anastomoses performed using linear and circular staplers, and achieves good results with low morbidity.

Adult↗
PubMed2004

Outcomes of novel transanal operation for selected tumors in the rectum.

BACKGROUND: Transanal endoscopic microsurgery facilitates access to proximal tumors in the rectum, but there is limited possibility for tumors above the peritoneal reflection because of high cost, training, and long operative time. The objectives of this study are to delineate the results achieved by novel transanal local excision (minimally invasive transanal surgery [MITAS]) with the use of a new anal retractor, stapler device, and several modified surgical techniques for selected rectal tumors. STUDY DESIGN: Ninety-one patients with 93 tumors undergoing MITAS between 1993 and 2000 were retrospectively reviewed for prospectively collected data with a minimum 2 years followup and without adjuvant radiation or chemotherapy. RESULTS: MITAS was accomplished in a median of 20 minutes with negligible blood loss, no mortality, and low morbidity for tumors locating 9 cm (range 5 to 20 cm) from the anal verge and measuring 25 mm (range 8 to 83 mm) of maximum diameter. No recurrent disease was observed in patients with 32 adenomas, 37 Tis, 5 low-risk pT1, and 14 high-risk pT1 carcinomas. Eight underwent additional operation, two patients with high-risk pT1 tumors who refused additional operations had recurrent disease, and the sole patient with surgical margin positive underwent a reexcision with MITAS for recurrence without further disease during a median of 63 months followup. CONCLUSIONS: MITAS is a feasible transanal local excision procedure that allows access to proximal rectal tumors and "total excisional biopsy" with short operative time, negligible blood loss, and low morbidity for carefully selected adenomas and early carcinomas.

Adenocarcinoma↗
PubMed2004

Results of a mechanical Duhamel pull-through for the treatment of Hirschsprung's disease and intestinal neuronal dysplasia.

BACKGROUND/PURPOSE: The authors analyzed the results of a modified entirely mechanical Duhamel pull-through for the treatment of Hirschsprung' disease or type B intestinal neuronal dysplasia. The aim of the follow-up was to evaluate results of a Duhamel procedure entirely performed with the use of staplers. METHODS: Fifty-six patients were followed up to detect complications and outcome. Patients were evaluated clinically, and, when symptoms were present, a suction biopsy with histochemical analysis, an x-ray contrast enema, or an endoscopy was performed. RESULTS: Early complications developed in 4 cases (7%) including a case of leakage (1.8%). No patient experienced recurrence. During a mean follow-up of 49 months, further complications occurred in 16 other patients: 4 adhesive obstructions requiring surgery, 3 strictures, 5 chronic bleeding, 4 fecaloma formation, 2 urinary problems, and 13 postoperative enterocolitis. Four patients (7%) had more than 3 passages of liquid stools per day, and 3 of them who had an ileal pull-through had constant soiling. Thirty-seven children (68.5%) had 1 to 2 bowel movements per day and were continent. Seven (13%) had less than 3 bowel movements per week. Three children who underwent total colectomy were incontinent (5.5%). Three more children (5.5%) have not yet reached the age for continence. Forty-nine parents (87%) judged the outcome satisfactory. CONCLUSIONS: Follow-up of mechanical Duhamel pull-through showed an acceptable long-term outcome. An increased risk of incontinence is present in case of ileal pull-through, whereas constipation is more frequent after partial colon resection, regardless of the type of intestinal neuronal malformation.

Abnormalities, Multiple↗
PubMed2005

Serial transverse enteroplasty in intestinal atresia management.

In intestinal atresia, resection of the proximal dilated bowel segment, if long, might lead to bowel length compromise. Although tapering enteroplasty and plication are well described to avoid such a resection, the use of serial transverse enteroplasty is proposed here as an alternative in this situation.

Anastomosis, Surgical↗
PubMed2005

Serial transverse enteroplasty as primary therapy for neonates with proximal jejunal atresia.

Small bowel atresia is associated with a large size discrepancy between the proximal and distal segments of bowel that has traditionally been managed by resection of the dilated segment, tapering enteroplasty, or plication. Longitudinal intestinal lengthening is rarely performed at the time of the initial operation. Many patients with small bowel atresia also have a short length of residual small intestine secondary to in utero resorption. The authors present the clinical application of the novel intestinal lengthening procedure, the serial transverse enteroplasty, in a neonate with proximal jejunal atresia and suggest that it become part of the armamentarium for surgeons treating patients with this anomaly.

Adult↗
PubMed2005

Serial transverse enteroplasty is associated with successful short-term outcomes in infants with short bowel syndrome.

BACKGROUND: The serial transverse enteroplasty (STEP) has been shown to improve nutritional indices in an animal model of short bowel syndrome. The aim of this study was to review short-term surgical and nutritional outcomes in the first cohort of infants to undergo the STEP procedure at our institution. METHODS: All patients who underwent the STEP procedure during a 26-month period from February 2002 to March 2004 were reviewed. Paired t tests were used for comparisons between values pre-STEP and post-STEP (P < .05 deemed significant). Data are expressed as mean and range. RESULTS: The STEP was performed on 5 patients, including 1 newborn. The STEP was used as a primary lengthening operation in 4 patients. Intestinal length was significantly increased in all patients with 18 (10-26) stapler applications. There were no perioperative complications and no evidence of intestinal leak or obstruction on routine postoperative contrast study. Nutritional follow-up was available on 3 subjects at 17 (11-26) months post-STEP. Percentage of enteral nutrition was significantly increased in these subjects (P < .05). One subject was fully weaned from total parenteral nutrition 6 weeks after the STEP, and bilirubin in another patient with profound cholestasis who had been listed for liver-small bowel transplant normalized after the STEP. An additional patient, with established cirrhosis before operation, underwent successful liver-small bowel transplantation 8 months after intestinal lengthening. CONCLUSION: The STEP procedure is a simple bowel-lengthening procedure with promising early surgical and nutritional outcomes. Further data from a multicenter registry are needed to demonstrate its long-term efficacy.

Digestive System Surgical Procedures↗
PubMed2005

Totally laparoscopic aortobifemoral bypass: a review of 22 cases.

OBJECTIVE: Laparoscopic aortobifemoral bypass (LABF) has been performed for diffuse aortoiliac occlusive disease in a few large centers. We hypothesize that in selected patients LABF can be performed safely and is a viable, minimally invasive approach to aortoiliac occlusive disease. METHODS: We conducted a retrospective review of all individuals undergoing LABF over a 2.5-year period in a community-based vascular surgery practice. RESULTS: From January 2002 to August 2004, LABF was performed successfully in 20 of 22 patients. The age of the patients ranged from 49 to 75 years, with 11 male and 11 female subjects. LABF required a median duration of 267 minutes (range, 199 to 365 minutes) to complete. Median aortic cross-clamp time was 89.5 minutes (range, 64 to 14 minutes) with an aortic anastomotic time of 37 minutes (range, 30 to 56 minutes). Blood loss averaged 0.69 +/- 0.081 L. Median intensive care stay was 1 day, and hospital stay was 4 days. The median duration of postoperative intravenous narcotics via patient-controlled analgesia pump was 2 days. No patients received epidural analgesia. Nearly all patients began a liquid diet 1 day and a solid diet 4 days after surgery. Complications occurred early in our experience and included one death secondary to mesenteric infarction possibly caused by excessive visceral traction. There was one pelvic abscess, one ureteral injury, and two limb occlusions necessitating thrombectomy and revision. The last six patients had uneventful operative procedures and recoveries. Of the two LABF failures, one patient required open conversion because of inadequate aortic exposure and the other required a short upper midline incision to complete the aortic anastomosis. Compared with conventional open aortobifemoral bypasses performed concomitantly during this period, selected LABF patients required fewer narcotics, experienced less bowel dysfunction, and were discharged home sooner. CONCLUSIONS: Aortobifemoral bypass can be performed through a minimally invasive laparoscopic approach. Although technically demanding with a steep learning curve, experience should reduce the significant complication rate. Compared with a conventional open aortobifemoral bypass, advantages include less pain, minimal postoperative bowel dysfunction, and a shorter hospital stay.

Aged↗