Home About us Contact
|
Home About us Contact | ||
|
|
||
Surgical Details (surgical + detail)
Selected AbstractsClosed lesser sac lavage in the management of pancreatic necrosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2004JAI DEV WIG Abstract Background and Aim:, Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. Methods:, Fifty-eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented. Results:, Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post-operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis. Conclusion:, Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re-operation rates and mortality. [source] Live donor liver transplantation for fulminant hepatic failure in childrenLIVER TRANSPLANTATION, Issue 11 2003Chi-Leung Liu The mortality rate among children with fulminant hepatic failure (FHF) on the waiting list for cadaveric donor liver transplantation (CDLT) is high. Results of emergency CDLT in this situation often are unsatisfactory, and a long-term survival rate less than 30% has been reported. Live donor liver transplantation (LDLT) for FHF in children has been advocated, but is reported rarely. We present our experience with LDLT in children with FHF. Between September 1993 and December 2002, primary LDLT was performed for 26 children; 8 of these children had FHF. Patient demographics, clinical and laboratory data, surgical details, complications, and graft and patient survival are reviewed. Four boys and four girls received left-lateral segment (n = 7) and full left-lobe (n = 1) grafts. Mean age was 2.9 ± 1.2 years (range, 3 months to 11 years). Causes of FHF were drug induced in 2 patients and idiopathic in 6 patients. One child received a blood group-incompatible graft. Two patients died; 1 patient of cytomegalovirus infection at 8.6 months and 1 patient of recurrent hepatitis of unknown cause at 2.8 months after LDLT. The child who received a mismatched graft had refractory rejection and underwent a second LDLT with a blood group-compatible graft 19 days afterward. He eventually died of lymphoproliferative disease. Another patient developed graft failure related to venous outflow obstruction and survived after retransplantation with a cadaveric graft. With a median follow-up of 13.2 months (range, 2.8 to 60.3 months), actuarial graft and patient survival rates were 50% and 62.5%, respectively. Survival results appear inferior compared with those of 18 children who underwent LDLT for elective conditions during the same study period (graft survival, 89%; P = .051; patient survival, 89%; P = .281). Although survival outcomes are inferior to those in elective situations, LDLT is a timely and lifesaving procedure for children with FHF. [source] Laparoscopic anterior resection for rectosigmoid cancer: Patient outcomes after implementation of a clinical pathwayASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010T.W. Hsu Abstract Introduction: A clinical pathway designed for a single type of laparoscopic colorectal surgery for cancer might be helpful in decreasing complication rates and total hospital costs. It has been reported to be effective in reducing costs and shortening length of hospital stays in many situations such as laparoscopic cholecystectomy, colon resection, total colectomy, and gastrointestinal bleeding, as well as when caring for patients in the intensive care unit. Materials and Methods: A clinical pathway, including surgical details and perioperative management, for patients undergoing laparoscopic anterior resection for rectosigmoid cancer was designed and implemented. From January 2003 to December 2006, it was applied to 80 patients. Results: The average length of a hospital stay for these patients was 9.06 d. The mean hospital stay and total cost decreased year by year. The overall complication rate was 8.75% without perioperative mortality, and 47.5% of patients with underlying diseases were treated safely. Discussion: Laparoscopic anterior resection for rectosigmoid cancer, with curative or palliative intent, was safe after standardization of surgical details and perioperative management. The total hospital costs for each patient was predictable and decreased year by year. [source] 4244: Posterior capsule surgery and posterior capsulorhexisACTA OPHTHALMOLOGICA, Issue 2010RI BARRAQUER Purpose To review the available intraoperative maneuvers to reduce the occurrence of posterior capsule opacification (PCO) after cataract surgery, including lens epithelial cell aspiration (LECA), posterior capsular membrane removal (PCMR), and posterior capsulorhexis (PCRX). Methods Review of the literature and of the available techniques to prevent PCO. Case-control retrospective studies on the efficacy of LECA for PCO prevention and on the safety of PCRX, namely its influence on vitreoretinal complications. Results To reduce PCO, a number of surgical maneuvers have been described, including LECA, PCMR and PCRX, with variable results. In a series of consecutive 1574 eyes of 1147 patients followed-up a minimum of 3 years, performing a meticulous LECA following phacoemulsification (PE) reduced PCO occurrence from 36.6% to 17.2% (p>0.01). In another series of consecutive 2.441 eyes operated of PE with or without PCRX, the rate of retinal detachment and cystoid macula edema was nonsignificantly higher after PCRX than cases with an intact capsule (respectively p=0.065 and p=0.32), while comparing favorably to Nd:YAG laser capsulotomy and with unplanned capsule tears. Conclusion Intraoperative capsular techniques such as LECA, PCMR and PCRX may effectively and safely reduce PCO. The variability of the results in the literature may be due to the multiple nonsurgical factors involved (lens design and materials, associated conditions, etc.), as well as minor surgical details indicating that the surgeon factor should not be understated. [source] | ||||||||||