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At least 1,513 records · Page 84Linked to original sources
PubMed1988

Relaparotomy for postoperative intra-abdominal sepsis in jaundiced patients.

During the period 1979-84, 30 abdominal re-explorations were performed for postoperative intra-abdominal sepsis and single or multiple organ failure in jaundiced patients. Postoperative sepsis was caused by intra-abdominal abscess in 16 cases (53 per cent), by suture line leakage in 9 cases (30 per cent) and by technical error in 5 cases (17 per cent). Abscesses occurred most commonly in the subphrenic space (6 cases), in the subhepatic space (6 cases) and in the lesser sac (5 cases). Sepsis was associated with single organ failure in 20 cases and with multiple organ failure in 10 cases. The overall mortality rate was 50 per cent (15/30). Factors that were statistically associated with fatal outcome were: serum bilirubin greater than 100 mumol/l (P less than 0.008), positive blood culture (P less than 0.013), malignant disease (P less than 0.02), multiple organ failure (P less than 0.02) and age greater than 60 years (P less than 0.031). Mortality rose with the number of failed organs. Autopsy revealed continuing sepsis in 12 of the 15 fatal cases. Because mortality was high in spite of adequate operative drainage at relaparotomy, it is concluded that earlier definitive diagnostics are needed to lower the mortality rate.

Abdomen↗
PubMed2005

Percutaneous implantation of an aortic valve prosthesis.

Recently, percutaneous aortic valve implantation has become an alternative technique to surgical valve replacement in patient at high risk for surgery. Our animal experimentation evaluated the technical feasibility of aortic valve replacement using a bovine pericardium valve sutured on a self-expandable stent in a sheep model. Precise implantation with satisfactory attachment on the adjacent tissues and absence of migration was obtain in 8 out of 14 animals. This study confirmed the feasibility of the endovascular implantation of a pericardium valve sutured on a self-expandable stent in a sheep model.

Animals↗
PubMed2006

Use of the U-clip for microvascular anastomosis.

Microvascular anastomosis is a demanding skill requiring technical excellence and a thorough knowledge of anatomy and physiology. Every suture placed in a microvascular anastomosis should be considered critical as each has the potential to compromise the delicate reconstruction. As such, any device that can facilitate microvascular suture placement deserves thorough evaluation. The U-clip (Coalescent Surgical, Sunnyvale, CA) is such a device in that it eliminates the often time consuming process of tying knots. We evaluated use of the U-clip in microvascular anastomosis of a 1.5 mm artery. We found the U-clip to offer some advantages including ease of use, traditional feel of directed suture placement (as compared to couplers), and elimination of time needed for knot tying. Its shortcomings include size (in diameter, the "pop-off" section of the device appears larger than standard 8-0 suture), the significant force required to "pop-off" the device and difficulty removing the device.

Adult↗
PubMed2005

[Incisional hernia].

With a long-term incidence of 10-20%, incisional hernias remain one of the most common surgical complications. Beside technical causes, wound-healing problems are increasingly being discussed. Conventional suture repair shows disappointing results and should be used only in selected cases. By the implantation of mesh prostheses, notable improvement could be achieved, with recurrence rates of <10%. Its main principle is retromuscular mesh reinforcement of the entire scar. Particularly in the neighbourhood of osseous structures, only retromuscular placement allows sufficient subduction of the mesh by healthy tissue of at least 5 cm in all directions. Preparation must take into account the special anatomic features of the abdominal wall, especially in the area of the Linea alba and Linea semilunaris.

Abdominal Wall↗
PubMed2003

Open-surgery management of morbid obesity: old experience-new techniques.

Bariatric surgery is well established to treat morbidly obese patients (BMI >40 kg/m(2)) with various techniques. Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28-33 kg/m(2) after 5 years), but they are less effective in super-obese patients and in sweet-eaters. For that group combined techniques, such as duodenal switch, gastric bypass or bilio-pancreatic diversion, could produce a better weight loss (between 60 and 160 kg or BMI of 25-30 kg/m(2)) with acceptable long-term side effect; however, due to malabsorption, a lack of minerals and vitamins, even protein, could occur and have dangerous side effects. Both basic techniques have their place in the treatment of morbid obesity. The surgical approach-open or mini-invasive-is only of minor importance. Technical complications should be avoided, especially band dislocation (2-12%) or suture leak. Long-term follow-up is very important because obesity is a chronic disease with a high risk of recurrence, even after bariatric surgery.

Biliopancreatic Diversion↗
PubMed1977

Construction of a pseudolarynx after laryngectomy and radical neck dissection. A preliminary report.

Voice rehabilitation is a major problem after laryngectomy. A new method to construct a pseudolarynx after total laryngectomy by suturing the trachea to the hyoid bone is described. The surgical technic is relatively simple. Patients are able to speak in the immediate postoperative period without intensive therapy. The quality of speech is good. Aspiration of liquids is a common problem, but in time patients learn to swallow with minimal or no aspiration. This procedure could be utilized in selected cases for good voice rehabilitation after total laryngectomy.

Carcinoma, Squamous Cell↗
PubMed1982

Management of traumatic peripheral vein injuries. Primary repair or vein ligation.

The management and outcome of 83 patients who had 86 venous injuries were retrospectively reviewed to identify optimal management techniques in patients with peripheral vein injuries. Venous injuries of the arms were associated with no long-term sequelae, and management with vein ligation appears safe. In patients with venous injuries of the legs, primary repair by lateral suture or primary end-to-end reanastomosis is recommended when technically easy. In patients who are unstable or in whom primary repair cannot be performed, vein ligation is recommended. Autogenous vein interposition grafting appears indicated only in the popliteal area when vein reconstitution should be aggressively sought. Vein ligation in peripheral vein injuries should be followed with aggressive postoperative management to prevent the development of distal edema. Limb elevation is effective in minimizing the development of adverse sequelae.

Adolescent↗
PubMed1986

A technique for safe transanal passage of the circular end-to-end stapler for low anterior anastomosis of the colon.

Two techniques are currently available for the creation of low anterior rectal stapled anastomoses. The first technique requires the placement of a pursestring suture at the superior margin of the rectal cuff, which is technically difficult. In the second technique, the rectal cuff is closed with a linear stapler. The circular end-to-end stapler, with the anvil removed, is then passed through an enterotomy in the rectal remnant. We describe an easy and safe method that obviates difficulties during the transanal passage of the stapler and minimizes the risk of injury to the rectum. This method uses an inexpensive and readily available rubber catheter and metal guide.

Catheterization↗
PubMed1995

Extracorporeal pneumoperitoneum access bubble for endoscopic surgery.

The extracorporeal pneumoperitoneum access bubble (EPAB) creates a transparent extension of the pneumoperitoneum and has been developed to facilitate large organ extraction and tissue approximation in patients undergoing endoscopic surgical procedures. When fully deployed, the EPAB excludes the abdominal parietes from the emergent organ and dilates the exit wound by an average of 48.5%, irrespective of its location. It thus eliminates the problems of contamination and tumor seedling implantation during the removal of resected organs, aside from expediting the extraction. The operating version of the EPAB enables the introduction of the surgeon's or assistant's hands or instruments into the bubble and thence into the peritoneal cavity without deflation of the pneumoperitoneum. By this means, it reduces the technical difficulties required to dissect organs and achieve reconstruction by hand suturing or stapling.

Animals↗
PubMed1980

Argon laser office procedures.

The seldom-reported value of argon laser photocoagulation in the office has been discussed. The technic of treating recurrent trichiasis, and managing deep or irritating eyelid sutures or postoperative cataract sutures with argon laser light was described. Hopefully, further investigation will be focused on this modern modality in the management of various eyelid and ocular conditions.

Adult↗
PubMed1993

Guided tissue regeneration in mucogingival surgery.

The use of expanded polytetrafluoroethylene (ePTFE) membranes in the treatment of mucogingival problems such as gingival recession, has been recently described. The major issues raised dealt with creating and maintaining space under the membrane and designing a flap that could be coronally positioned and at the same time capable of maintaining a good blood supply. The authors proposed the use of a trapezoidal flap and some technical space-making solutions, such as the use of a suturing technique and different metal structures to support the membranes.

Adult↗
PubMed2000

Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination.

PURPOSE: Recently a new technique for vasoepididymostomy was described which included tubular invagination by the triangulation method with a patency rate of 92%. Although these early data were encouraging, some technical problems were noted with the technique. After placing the first suture there was often tubular leakage and collapse. The tubulotomy was difficult and in some cases a suture was inadvertently cut. A modified technique is presented for vasoepididymostomy with tubular invagination, including some methods described in rat models. Only 2 sutures are used with simultaneous double needle placement. MATERIALS AND METHODS: The 2-suture technique was used on 19 men who had undergone at least 1 vasoepididymostomy during vasectomy reversal procedures. RESULTS: Patency was demonstrated in 7 of 9 men (77.7%) who underwent modified bilateral vasoepididymostomy and 6 of 7 (85.7%) who underwent unilateral vasoepididymostomy and unilateral vasovasostomy. Pregnancies were reported in both groups. The overall operating time for the modified technique was about 35 to 45 minutes per side. CONCLUSIONS: Modified vasoepididymostomy with simultaneous needle placement, tubulotomy and invagination resulted in early patency in a high percentage of patients. Tubular invagination may have advantages compared to other conventional methods of vasoepididymostomy but more followup is needed.

Humans↗
PubMedDate not supplied

[Late post-traumatic diaphragmatic hernia: unusual cause of colonic occlusion].

Traumatic diaphragmatic rupture is not an uncommon problem, particularly in the last few years because of the increasing number of road accidents, improved diagnostic techniques and resuscitation techniques after serious traumas. In a certain number of cases, post-traumatic diaphragmatic hernias may become clinically manifest only months or years after thoracic or abdominal trauma and are still a challenge to surgeons because of the vague clinical symptoms and the diagnostic difficulties involved. The Authors report a case of acute colon occlusion due to diaphragmatic hernia 24 months after thoraco-abdominal trauma. None of the radiological or endoscopic examinations demonstrated the presence of diaphragmatic hernia. Laparoscopy showed a diaphragmatic rupture with incarceration of the left colonic segment. The laparoscopic procedure was converted for technical reasons and the diaphragmatic defect was closed with a primary suture.

Adult↗
PubMed2003

[All arthroscopic treatment of rotator cuff tears].

Although shoulder arthroscopy was initially performed solely for subacromial decompression, at present it is widely used for rotator cuff repairs and reconstruction. All arthroscopic rotator cuff repairs have been performed increasingly over the past decade and favorable long-term results have been reported in the literature. All arthroscopic rotator cuff repair has advantages over mini-open, or open rotator cuff repair, because it is associated with less postoperative pain and morbidity, and a more rapid improvement in shoulder motion. However, complete arthroscopic rotator cuff repair is a technically difficult procedure, with some limitations including relative weakness of tendon sutures and the need for more experience. It is essential that the merits and demerits associated with this technique should be balanced depending on the individual condition of the patient and the degree of experience gained. This article revisits all arthroscopic rotator cuff repair with regard to advantages and disadvantages, surgical techniques, indications, postoperative rehabilitation, and the results both in the light of the literature and our experience.

Arthroscopy↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗
PubMed2002

Robot-assisted laparoscopic intestinal anastomosis.

INTRODUCTION: Robotic telemanipulation systems have been introduced recently to enhance the surgeon's dexterity and visualization in videoscopic surgery in order to facilitate refined dissection, suturing, and knot tying. The aim of this study was to demonstrate the technical feasibility of performing a safe and efficient robot-assisted handsewn laparoscopic intestinal anastomosis in a pig model. METHODS: Thirty intestinal anastomoses were performed in pigs. Twenty anastomoses were performed laparoscopically with the da Vinci robotic system (robot-assisted group), the remaining 10 anastomoses by laparotomy (control group). OR time, anastomosis time and complications were recorded. Effectiveness of the laparoscopic anastomoses was evaluated by postoperative observation of 10/20 pigs of the robot-assisted group for 14 days and by testing mechanical integrity in all pigs by measuring passage, circumference, number of stitches, and bursting pressure. These parameters and anastomosis time were compared to the anastomoses performed in the control group. RESULTS: In all cases of the robot-assisted group the procedure was completed laparoscopically. The only perioperative complication was an intestinal perforation, caused by an assisting instrument. The median procedure time was 77 min. Anastomosis time was longer in the laparoscopic cases than in the controls (25 vs 10 min; p <0.001). Postoperatively, one pig developed an ileus, based on a herniation of the spiral colon through a trocar-port. For this reason it was terminated on the sixth postoperative day. All anastomoses of the robot-assisted group were mechanically intact and all parameters were comparable to those of the control group. CONCLUSION: Technical feasibility of performing a safe and efficient robot-assisted laparoscopic intestinal anastomosis in a pig model was repeatedly demonstrated in this study, with a reasonable time required for the anastomosis.

Anastomosis, Surgical↗
PubMed2001

Laparoscopic repair of traumatic diaphragmatic injuries.

BACKGROUND: Laparoscopy has been proposed as a diagnostic and potentially therapeutic modality for penetrating diaphragmatic lacerations. The purpose of this study was to assess the technical feasibility and strength of various laparoscopic repairs of diaphragmatic injuries. METHODS: Swine underwent either open suture repair or laparoscopic repair by staple, suture, or patch technique of a 2-cm laceration to both the right and the left muscular or tendinous diaphragmatic leaflets. Six weeks after operation, diaphragms were harvested for either histologic analysis or bursting strength measurements. RESULTS: All methods of repair proved technically feasible. There was no significant difference in bursting strength measurements between treatment groups. Bursting was due to tissue failure either at or adjacent to the repair site. Histologic analysis confirmed healing of all specimens with the laparoscopic patch technique inciting less inflammation and greater fibroblastic proliferation than the other techniques. CONCLUSIONS: Laparoscopic repair of diaphragmatic lacerations can be accomplished using any of the currently available techniques. Laparoscopic stapling, suturing, or patch techniques all result in complete healing with a strong and durable repair. When selecting a particular technique, familiarity of the surgeon should be used as a guideline.

Animals↗
PubMed2001

[Viability monitor of free flaps in hypopharynx reconstruction].

Single-stage microvascular reconstruction of neck defects with jejunum or other free flaps are well established methods. However, these flaps usually are buried subcutaneously and viability surveillance is difficult. Alternatively to technical monitoring devices, we present a simple method using a "sentinel" part of the free jejunum flap transposed outside to the skin surface or sutured into the skin when using fasciocutaneous or myocutaneous flaps. Although this method is not new, it is rarely used. Compared to pure technical monitoring devices, it is easily performed and monitoring of buried free flaps especially in the neck region is reliable.

Esophageal Neoplasms↗