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PubMed1976

[Late results of the Noble operation. Clinical and radiological follow-up examination].

The results of 58 Noble operations performed during the period between 1964 and 1973 are reported. A partial operation was carried out in 9 cases. In 4 cases there were fatal complications due to technical errors such as too long a terminal ilial loop and direct suture to the intestine. Two cases of late ileus were observed after 2 and 6 months respectively following a partial plication. Follow-up examination at an average of 4 years after Noble operation showed that 26 patients were free of complaint. The Noble operation is best suited for cases with chronic recurrent adhesion ileus when a permanent folding of the small intestine is necessary. For other indications, the newer alternative procedures. (Childs and Phillips and Reiffersceid and Phillip's small intestine splinting) should be used.

Humans↗
PubMed1998

Intraoperative assessment of cerebral ischaemia during carotid surgery.

BACKGROUND: This study aimed to evaluate the reliability of somatosensory evoked potentials (SEPs) in identifying clamping ischaemia during carotid surgery under general anaesthesia. METHODS: We reviewed the records of 196 consecutive carotid endarterectomies (CEA) performed under general anaesthesia, out of 1550 patients operated on between 1975 and 1993. SEPs were monitored after contralateral median nerve stimulation at the wrist in all patients. Moreover they received an intravenous bolus of 2500 IU of heparin and the stump pressure was measured. A completion angiography was performed in all patients. An intraluminal shunt was inserted when the amplitude of the N20-P25 SEPs complex decreased by more than 50% of pre-clamping value (pathologic SEPs) or when a preoperative CT-scan showed an ischaemic area in the contralateral hemisphere. In some patients the shunt was not inserted because of technical difficulties or because the pathological SEP complex decrease developed when the suture of the arteriotomy was almost complete. RESULTS AND CONCLUSIONS: As the preclamping amplitude (Ab) of N20-P25 was extremely variable, ranging from 0.9 and 7.5 microV, we adopted the ratio: deltaA=(At-Ab)/Ab (At=amplitude measured during clamping every 2 min at time t). Mean decrease of deltaA measured in the whole group ranged between 15% and 20%, but mean deltaA values in patients with pathological SEPs were around 60%. Even patients with positive CT-scans or with a back-pressure lower than 50 mmHg developed a mean deltaA decrease of about 20%. A pathological SEP was present in 50 patients, but developed in only 12 during the clamping trial. An intraluminal shunt was inserted in 22 cases; the other patients received pharmacological treatment with anaesthetic or vasoactive drugs. Among the patients with pathological SEPs, 3 presented postoperative symptoms related to carotid cross-clamping; only 1 of these was shunted but without SEPs normalisation. No patients with normal SEPs developed a postoperative neurological deficit, giving a reliability of 86.7%, a sensitivity of 100% and a specificity of 86.5%.

Aged↗
PubMed1993

[Report of 25 eyes with transsclerally sutured posterior chamber IOLs].

25 eyes with transsclerally sutured posterior chamber IOLs were followed up 2-18 months, averaging 6.5 months. Disregarding 4 amblyopic eyes, 19 (90.5%) of the remaining 21 eyes obtained satisfactory visual acuities of 0.5 or over. The technical procedures of the surgery and points of note were described, and the authors emphasized the use of fixation sutures of non-biodegradable materials like mersilene or prolene.

Adolescent↗
PubMed1986

[Autotransplantation of the spleen. A new possibility in the conservative surgery of the spleen].

Conservative surgery to spleen is an ancient concept brought up-to date by improved knowledge of its fundamental roles in immunity and anti-bacterial defences. Suture of spleen and partial splenectomy ensure the best possible functional results but have technical limitations resulting frequently in splenectomy to provide hemostasis. Data from clinical and experimental studies and reports in the literature have demonstrated that autotransplantation of spleen is a simple, safe and effective method for preventing the true dangers of asplenia. Optimal results from autotransplantation of spleen are obtained when the injured organ is broken into small fragments which are then implanted into small spaces fashioned in the greater omentum. Clinical and biological tests to evaluate functional value of these transplants have shown that results approach those of a normal or sutured spleen. It is concluded that this procedure, which completes other conservative methods of splenic surgery, should definitely exclude hemostasis splenectomy from therapy of injuries to spleen.

Animals↗
PubMed1984

[Craniosynostoses: importance of the measurement of intracranial pressure and the application of J Jane's surgical technic].

We report the studies, treatment and follow-up of two children with the diagnosis of craniosynostosis for early closure of sagittal and coronal sutures. We paid special attention to the intracranial pressure (ICP) monitoring. Prognosis of the mental functions (Gessell's test) is related with findings of ICP and surgical treatment. We have performed as neurosurgical approach, a modification of the Jane's technic. The advantages of this technic and our results are discussed.

Craniosynostoses↗
PubMed1977

Transduodenal sphincteroplasty.

Sphincteroplasty is an inferior partial sphincterotomy followed by suture approximation of both the duodenal and common bile duct walls. We have described our operative technic employed in 770 sphincteroplasties performed in the past 14 years.

Ampulla of Vater↗
PubMed2000

[Biliary endo-to-end anastomosis with extramucosal titanium clips. Initial results of a new technique].

BACKGROUND: Bile duct anastomoses are still associated with a high failure rate. Although following iatrogenic bile duct transection only a positive selected group of patients get a primary end-to-end reconstruction, long-term results demonstrate an incidence of postoperative strictures up to 78%. Also in orthotopic liver transplantation biliary tract complications remain a significant cause of morbidity with an incidence of up to 49%. Since these complications can also be seen under optimal circumstances, the methodically based disadvantages of the conventional hand suturing like perforating needle injury of the choledochal wall with intraluminal suture material, the suboptimal approximation of the mucosal edges and an inhibited blood flow in the choledochal stumps caused by a suture related tissue strangulation may also responsible. Thus there is a search for alternative anastomosis techniques. METHOD: To test extramucous placed titanium clips for biliary reconstruction after complete division of the bile duct we performed an end-to-end-anastomosis in 9 pigs. Therefore we used the VCS (Vascular Closure Staples)-instruments (Auto Suture). RESULTS: The application of the VCS-clips (medium size) permitted the technical realization of a tension free, everted anastomosis with an exact approximation of the mucosal edges. One of the animals died from aero embolism intraoperatively. All the others showed a complication-free postoperative period without any signs of anastomotic leakage or stenosis (follow-up: 6 months). At histological examination there were smooth and intact mucosal surfaces in all pigs and--especially important for the development of strictures--only a very mild fibrosis and inflammation. CONCLUSIONS: The potential advantage of the VCS-clip-technique is the non-penetrating tissue approximation with optimal contact of the mucosal layers that does not compromise the blood flow in the choledochal stumps. Before clinical use can be recommended further studies are required.

Anastomosis, Surgical↗
PubMed2004

Posterolateral corner reconstruction using a hamstring allograft and a bioabsorbable tenodesis screw: description of a new surgical technique.

Capsuloligamentous posterolateral corner knee joint deficiencies cause increased anterior cruciate ligament forces during internal knee rotation and increased posterior cruciate ligament forces during external knee rotation. Undiagnosed posterolateral corner knee joint injury in combination with anterior cruciate ligament or posterior cruciate ligament injury can lead to failure of anterior cruciate ligament or posterior cruciate ligament reconstruction. The purpose of this technical note is to present a new posterolateral corner reconstruction technique for treating patients with chronic capsuloligamentous posterolateral corner deficiency. The technique uses a bioabsorbable tenodesis screw and a hamstring allograft to reconstruct the popliteofibular and lateral collateral ligaments.

Absorbable Implants↗
PubMed1998

Laparoscopic gastric antroplasty in children with delayed gastric emptying and gastroesophageal reflux.

BACKGROUND/PURPOSE: A significant number of children (50%) with gastroesophageal reflux (GER) have delayed gastric emptying (DGE). Although controversial, many pediatric surgeons use a gastric outlet procedure in conjunction with fundoplication for gastroesophageal reflux in these patients. This paper describes the technique and clinical outcome of 61 patients undergoing a laparoscopic gastric antroplasty at the time of the laparoscopic fundoplication. METHODS: The charts of 61 patients who underwent laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication between May 26, 1992 and October 17, 1996 were reviewed retrospectively. All patients had a documented DGE confirmed by a liquid isotope meal being retained in the stomach. After completion of the fundoplication, a laparoscopic antroplasty was performed by incising a 2 to 3.5-cm linear incision in the pylorus and distal gastric antrum. The seromuscular wall was divided to the level of the mucosa allowing the mucosa to bulge through the defect. The wound was closed transversely using interrupted 2-0 silk sutures. RESULTS: Four of the 61 patients underwent conversion to open antroplasty for technical reasons. The remaining 57 patients recovered uneventfully from the laparoscopic antroplasty with clinical resolution of both GER and DGE. Two of 57 patients had intermittent episodes of retching and were unable to tolerate large bolus feedings because of dumping. They were treated by dividing the feedings into two smaller portions. These symptoms cleared within 6 months. The remaining 55 patients have tolerated feedings well. Evaluation of the gastric emptying was performed randomly in selected patients with documented improvement of the emptying after antroplasty. An evisceration of omentum through the umbilical incision developed in one patient on the third postoperative day. CONCLUSIONS: Patients with delayed gastric emptying who need fundoplication can be treated with laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication. Laparoscopic antroplasty appears to be clinically efficacious in improving delayed gastric emptying.

Child↗