Surgical Management (surgical + management)

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Distribution within Medical Sciences

Selected Abstracts


Ming-Ju Hsieh
Background: Although elderly patients with thoracic disease were considered to be poor candidates for thoracotomy before, recent advances in preoperative and postoperative care as well as surgical techniques have improved outcomes of thoracotomies in this patient group. The aim of this study was to investigate surgical risk factors and results in elderly patients (aged ,70 years) with thoracic empyema. Methods: Seventy-one elderly patients with empyema thoracis were enrolled and evaluated from July 2000 to April 2003. The following characteristics and clinical data were analysed: age, sex, aetiology of empyema, comorbid diseases, preoperative conditions, postoperative days of intubation, length of hospital stay after surgery, complications and mortality. Results: Surgical intervention, including total pneumonolysis and evacuation of the pleura empyema cavity, was carried out in all patients. Possible influent risk factors on the outcome were analysed. The sample group included 54 men and 17 women with an average age of 76.8 years. The causes of empyema included parapneumonic effusion (n = 43), lung abscess (n = 8), necrotizing pneumonitis (n = 8), malignancy (n = 5), cirrhosis (n = 2), oesophageal perforation (n = 2), post-traumatic empyema (n = 2) and post-thoracotomy complication (n = 1). The 30-day mortality rate was 11.3% and the in-hospital mortality rate was 18.3% (13 of 71). Mean follow up was 9.4 months and mean duration of postoperative hospitalization was 35.8 days. Analysis of risk factors showed that patients with necrotizing pneumonitis or abscess had the highest mortality rate (10 of 18, 62.6%). The second highest risk factor was preoperative intubation or ventilator-dependency (8 of 18, 44.4%). Conclusion: This study presents the clinical features and outcomes of 71 elderly patients with empyema thoracis who underwent surgical treatment. The 30-day surgical mortality rate was 11.3%. Significant risk factors in elderly patients with empyema thoracis were necrotizing pneumonitis, abscess and preoperative intubation/ventilation. This study also suggested that surgical treatment of empyema thoracic in elderly patients is recommended after failed conservative treatment because of the acceptably postoperative complication and mortality rate. [source]


Aydin Nadir MD
No abstract is available for this article. [source]


Don Wai Gin Lee
Background: Peripheral hospitals are perceived to be at a disadvantage in providing treatment for breast cancer, especially with regard to breast conservative surgery (BCS) because of the requirement of adjuvant radiotherapy. Wairau Hospital is a 100-bed peripheral hospital in New Zealand with no on-site radiotherapy unit. Methods: A retrospective audit of the surgical management of breast cancer between 1998 and 2002 was carried out. Results: One hundred and fifty-seven presentations during the audit period. Despite the lack of tertiary resources, we report an overall BCS rate of 58.6%, consistent with the appropriate New Zealand guidelines. Of screen-detected cancers, 81.6% underwent BCS. Only five patients requested mastectomy and of those undergoing BCS, five patients refused subsequent adjuvant radiotherapy. This was because of frailty from age and comorbidities and the inconvenience of travel. Conclusion: High rates of BCS are possible in peripheral hospitals. We postulate that intensive support and a visiting outpatient oncological service help empower patients to seek BCS if appropriate. A strong partnership between surgical, radiological and oncological services is also vital. [source]


John E. Greenwood
Background: There are many reasons for the development of patient pathways in burn surgery introduced at the Royal Adelaide Hospital in South Australia at the beginning of January 2005. These include education, standardization of technique, scheduling of surgical episodes and rationalization of the use of expensive therapies. Methods: A critical appraisal of both evidence based on published work and personal/peer experience has been used to generate the current pathways. Results: The year 2005 was the busiest in the history of the hospital, both in numerical terms and in the proportion of major burn injuries. These protocols were effective in enabling us to cope with negligible mortality. Conclusion: Although the first draft pathways work in our unit, they will undergo regular audit. It is hoped that they will form a template that can assist other services to create their own pathways. [source]


Suresh K. Jariwala
No abstract is available for this article. [source]

Surgical Management of Giant Condyloma Acuminatum (Buschke-Loewenstein Tumor) of the Perianal Region

First page of article [source]

Surgical Management of Pyoderma Gangrenosum: Case Report and Review

Murad Alam MD
Background. Commonly used treatments for pyoderma gangrenosum are medical, with immunosuppressive agents employed most often. Objective. To report a case and discuss the indications for radical surgical treatment of pyoderma gangrenosum. Methods. Analysis of a case of Crohn's disease-associated pyoderma gangrenosum treated with immunosuppression followed by amputation, and a review of the literature on surgical management of pyoderma gangrenosum. Results. In unstable patients with intractable multiple medical problems, surgical treatment of pyoderma gangrenosum may be indicated by the existence of these life-threatening comorbidities. The recent literature suggests that surgical management of pyoderma gangrenosum may also be appropriate in other special circumstances. Conclusions. Surgical management, including amputation, may have a role in the management of pyoderma gangrenosum. Further research is needed to delineate precisely the circumstances and patient factors that are appropriate indications for such surgery. [source]

Surgical Management of Stable Vitiligo: A Review with Personal Experience

Sharad Mutalik MB
Background. Various modalities are available for surgical management of stable, localized patches of vitiligo, which are resistant to conventional medical treatment. Cutaneous surgeons often struggle to select among various methods of surgical treatment that include camouflage tattooing, melanocyte transplants, excision, and melanocyte culture. The advantages, disadvantages, and limitations of all the available modalities are reviewed. Objective. The purpose of this review is to find out if any guidelines can be drawn regarding the surgical management of stable vitiligo. Methods. This article is based on a review of the medical literature and the author's personal experience over the last decade. Results. It is difficult to draw any fixed guidelines from this review. Treatment must be individualized depending upon the site and the extent of involvement. Conclusion. Although the retrospective nature of this article limits its validity, discussing the various therapeutic options is of value as continuing medical education. Surgical treatment may be individualized to obtain the best possible cosmetic result. [source]

Primary Pulmonary Artery Sarcoma: Surgical Management and Differential Diagnosis with Pulmonary Embolism and Pulmonary Valve Stenosis

Xiao-Peng Hu M.D.
We present six cases of primary pulmonary artery sarcomas and discuss clinical features, differential diagnosis, surgical treatment, and outcome of the tumors. Methods: Between January 1994 and July 2008, six patients were identified with the disease during operation. Three patients were initially diagnosed with pulmonary valve stenosis, and two patients had a presumptive diagnosis of chronic pulmonary embolism. Two patients had simple or partial tumor resection. Four patients had radical tumor resection and homograft reconstruction of the pulmonary arteries. Results: Histological examinations showed five malignant mesenchymomas and one fibrosarcoma. One patient died of refractory pulmonary hypertension during operation. Two patients died 4 months postoperatively because of brain metastases. Two patients were alive for 3 and 9 months, respectively after the operation with recurrent tumor. One patient is alive even 2 years after resection with no signs of recurrence or metastasis. Conclusions: Because of similar clinical features, pulmonary artery sarcomas are often confused with other pulmonary vascular obstructive diseases. Computed tomography scanning and gadolinium-enhanced magnetic resonance imaging could be useful methods for differential diagnosis. The prognosis is very poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis. Early diagnosis and radical surgical resection presents the only opportunity for a potential cure. [source]

Deep Hypothermia and Circulatory Arrest in the Surgical Management of Renal Tumors with Cavoatrial Extension

Panagiotis Dedeilias M.D.
Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus. Material: From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case. Method: Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease. Results: There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence. Conclusions: The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation. [source]

Surgical Management of Compressive Optic Neuropathy due to Orbital Osseous Lesions

Gregg H. Goldstein M.D.
No abstract is available for this article. [source]

Surgical Management of an Unresectable Trigeminal Nerve (V2) Plexiform Neurofibroma

Urmen Desai MD MPH
No abstract is available for this article. [source]

Surgical Management of Jugular Foramen Meningiomas: A Series of 13 Cases and Review of the Literature,

Mario Sanna MD
Abstract Objective: Primary meningiomas occurring within the jugular foramen are exceedingly rare lesions presumed to originate from arachnoid-lining cells situated within the jugular foramen. The objective of this study is to analyze the management and outcome in a series of 13 primary jugular foramen meningiomas collected at a single center. Study Design: Retrospective study. Setting: Quaternary referral otology and skull base private center. Methods: Charts belonging to 13 consecutive patients with pathologically confirmed jugular foramen meningioma surgically treated between September 1991 and May 2005 were examined retrospectively. The follow-up of the series ranged from 12 to 120 (mean, 42.8 27.5) months. Results: Four (28.5%) patients underwent single-stage tumor removal through the petro-occipital transigmoid (POTS) approach. In two patients with preoperative unserviceable hearing, a combined POTS-translabyrinthine approach was adopted. Two patients underwent a combined POTS-transotic approach because of massive erosion of the carotid canal. A modified transcochlear approach type D with posterior rerouting of the facial nerve and transection of the sigmoid sinus and jugular bulb was performed in two patients with a huge cerebellopontine angle tumor component with extension to the prepontine cistern together with massive involvement of the petrous bone and middle ear and encasement of the vertical and horizontal segments of the intrapetrous carotid artery. In one patient with evidence of a dominant sinus on the site of the tumor, a subtotal tumor removal via an enlarged translabyrinthine approach (ETLA) was planned to resect the intradural component of the tumor. Two patients in our series underwent a planned staged procedure on account of a huge tumor component in the neck. One of these patients underwent a first-stage infratemporal fossa approach type A to remove the tumor component in the neck; the second-stage intradural removal of the tumor was accomplished via an ETLA. The last patient underwent a first-stage modified transcochlear type D approach to remove the intradural tumor component followed by a second-stage transcervical procedure for removal of the extracranial component. Gross total tumor removal (Simpson grade I,II) was achieved in 11 (84.6%) cases. Subtotal removal of the tumor was accomplished in two patients. Good facial nerve function (grades I and II) was achieved in 46.1% of cases, whereas acceptable function (grade III) was achieved in the remaining cases 1 year after tumor removal. Hearing was preserved at the preoperative level in all four patients who underwent surgery via the POTS approach. After surgery, no patient recovered function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 61.5% of cases. Conclusions: Surgical resection is the treatment of choice for jugular foramen meningiomas. Among the various surgical techniques proposed for dealing with these lesions, we prefer the POTS approach alone or combined with the translabyrinthine or transotic approaches. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge. [source]

Prediction and Surgical Management of Difficult Laryngoscopy

Yayoi Suzuki Kikkawa MD
No abstract is available for this article. [source]

Histological Characterization of the Thyroglossal Tract: Implications for Surgical Management,

Rakesh K. Chandra MD
Abstract Objectives In the current report, we characterized the relationship between the central hyoid bone and the thyroglossal tract and determined the prevalence of ectopic thyroid follicles in the adjacent soft tissues. Study Design Retrospective pathological analysis. Methods The resected specimens from 104 patients who underwent a modified Sistrunk procedure with wide-field dissection were retrospectively analyzed. Under light microscopy, serial sections were examined to determine whether the thyroglossal tract passed anterior to, posterior to, or within the hyoid bone. Specimens were also examined for the presence of thyroid follicles in the periductal and pericystic soft tissues. Results In 50 cases (48%), the tract position in relation to the hyoid bone could not be identified secondary to extensive arborization, marked inflammation, specimen fragmentation or a combination of these. Thyroid follicles were observed in 9 (18%) of these specimens. In the remaining 54 cases (52%) the tract was located anterior to the central arch of the hyoid bone in 39 (72%) and posterior to it in 15 (28%). Thyroid tissue was observed in 46% of specimens (P = .004), regardless of whether the tract was anterior or posterior. Conclusions These results demonstrate that tract position often cannot be defined, but when a portion is dominant, it is likely to be anterior to the hyoid bone. Ectopic thyroid tissue can be found in almost 50% of specimens when the tract position is identifiable. With appropriate surgical management, a recurrence rate of less than 4% can be expected, despite the presence of ductule multiplicity, marked inflammation, tract position posterior to the hyoid bone, and ectopic thyroid follicles. [source]

Urinary Stone Disease: The Practical Guide to Medical and Surgical Management

John Fitzpatrick
No abstract is available for this article. [source]

Surgical Management of Pyoderma Gangrenosum: Case Report and Review

Murad Alam MD
Background. Commonly used treatments for pyoderma gangrenosum are medical, with immunosuppressive agents employed most often. Objective. To report a case and discuss the indications for radical surgical treatment of pyoderma gangrenosum. Methods. Analysis of a case of Crohn's disease-associated pyoderma gangrenosum treated with immunosuppression followed by amputation, and a review of the literature on surgical management of pyoderma gangrenosum. Results. In unstable patients with intractable multiple medical problems, surgical treatment of pyoderma gangrenosum may be indicated by the existence of these life-threatening comorbidities. The recent literature suggests that surgical management of pyoderma gangrenosum may also be appropriate in other special circumstances. Conclusions. Surgical management, including amputation, may have a role in the management of pyoderma gangrenosum. Further research is needed to delineate precisely the circumstances and patient factors that are appropriate indications for such surgery. [source]

Drainage of the Inferior Vena Cava to the Left Atrium

Haran Burri M.D.
Drainage of the inferior vena cava to the left atrium is an extremely unusual congenital heart disease. We describe a 54-year-old woman, in whom the diagnosis was suggested by transthoracic echocardiography, and then confirmed by a transesophageal exam and magnetic resonance imaging, which also revealed an associated secundum atrial septal defect. Surgical management involved reconstruction of the interatrial septum to include the inferior vena cava in the right atrium. The few previously reported cases in the literature are reviewed. (ECHOCARDIOGRAPHY, Volume 20, February 2003) [source]

Inguinal rupture with herniation of the urinary bladder through the scrotal fascia in a Shetland pony foal

M. Cousty
Summary Herniation of the urinary bladder in the inguinal region has not previously been described in the horse. A case of inguinal rupture with herniation of the bladder through the scrotal fascia in a 3-month-old Shetland pony, diagnosed by external palpation, urinary catheterisation and external ultrasonographic examination is reported. Surgical management of the case was by dissection of the scrotal fascia, partial cystectomy and unilateral castration. During the period of hospitalisation the only complication was a slight seroma, which resolved spontaneously. Follow-up after 6 months did not reveal any abnormality. [source]

Arthroscopic debridement of subchondral bone cysts in the distal phalanx of 11 horses (1994,2000)

Summary Reasons for performing study: Historically, there has been a consensus that conservative management of subchondral cystic lesions of the distal phalanx carries a poor prognosis. Surgical management has been advocated; however, there are no reports documenting its routine use and successful surgical treatment. Objectives: To describe arthroscopically-guided curettage of distal phalangeal subchondral cystic lesions (SCLs) and report the qualitative and quantitative results in 11 affected horses age 16,33 months. Methods: Medical records of horses with previously treated lameness resulting from SCLs of the third phalanx were reviewed. Arthroscopic debridement of the SCLs was described. Follow-up information was obtained from race records and telephone contact with owners and trainers. The sign-rank test was used to compare performance of operated racehorses to that of unoperated siblings. Results: Ten of the 11 horses (91%) in the study returned to athletic soundness after surgical treatment and had performance records similar to their siblings. Conclusions: Data show that arthroscopic debridement of distal phalangeal SCLs is a viable treatment for affected horses age 16,33 months and can result in a successful return to intended athletic performance. No horses younger than 16 months or older than 33 months were treated and results in horses younger or older than this group may vary in success. Potential relevance: The description of treatment and approach used for arthroscopic curettage will increase awareness of this option and increase treatment options for this condition. [source]

Caecal impactions managed surgically by typhlotomy in 10 cases (1988,1998)

Summary Surgical management of caecal impactions has included several different procedures suggested over the years. Complete bypass of the caecum through an ileocolic or jejunocolic anastomosis has become common practice for first time caecal impaction management, especially when dysfunction is suspected. In our practice, however, caecal impactions have been managed surgically by typhlotomy alone and of the 10 cases (July 1988-June 1998), 9 underwent surgery for first time caecal impactions, received a typhlotomy, and had survived an average of 43 months at time of case review. At the time of surgery, all were considered to have a dysfunctional caecum. All horses received routine postoperative care with the addition of anthelmintics as recovery of Anoplocephala perfoliata occurred in several cases. Typhlotomy should be considered an acceptable technique for surgical management of first time caecal impactions. Postoperative pyrantel pamoate and larvicidal anthelmintics should also be considered. [source]

Total joint arthroplasty in haemophilia

HAEMOPHILIA, Issue 5 2000
In severely affected haemophilic patients arthropathy is a common problem which can lead to considerable pain and functional deficit. Surgical management, including total joint arthroplasty, can be undertaken if conservative management fails. A search of the literature showed that a number of studies describing the use of total knee arthroplasty (TKA) and total hip arthroplasty (THA) in haemophilia have been published, whereas shoulder, elbow and ankle arthroplasties are confined to case reports. This paper reviews the functional outcome of arthroplasty in the different joints, the postoperative and long-term complications, and the impact of HIV. Although complications are commonly described and the surgery is technically demanding, the results suggest that arthroplasty, particularly of the hip and knee, can be a valuable option in the management of severe haemophilic arthropathy. [source]

Surgical management of hepatolithiasis

HPB, Issue 3 2009
Sujit Vijay Sakpal
Abstract Background:, Globalization and intercontinental migration have not just changed the socioeconomic status of regions, but have also altered disease dynamics across the globe. Hepatolithiasis, although still rare, is becoming increasingly evident in the West because of immigration from the Asia-Pacific region, where the disease prevails in endemic proportions. Such rare but emerging diseases pose a therapeutic challenge to doctors. Methods:, Here, we briefly introduce the topic of hepatolithiasis and describe features of intrahepatic stones, the aetiology of hepatolithiasis and the symptoms and sequelae of the condition. We then provide a comprehensive review of the various management modalities currently in use to treat hepatolithiasis. Conclusions:, In our opinion, and as is evident from the literature, surgery remains the definitive treatment for hepatolithiasis. However, non-surgical procedures such as cholangiography, although limited in their therapeutic capabilities, play a vital role in diagnosis and preoperative evaluation. [source]

Nonagenarian surgical admissions for the acute abdomen: who benefits?

Z. Toumi
Summary Introduction:, Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and materials:, Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period. Results:, Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50,59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50,59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50,59 year group]. Conclusions:, In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery. [source]

Large recurrent plexiform neurofibroma of the foot and ankle

MICROSURGERY, Issue 1 2004
Lee L.Q. Pu M.D., Ph.D.
Plexiform neurofibroma often causes significant pain, deformity, and functional problems in the affected part of the body. Surgical management of the condition can be challenging, and local recurrence is common because of inadequate resection of the tumor. One patient with a large recurrent plexiform neurofibroma of the foot and ankle was treated successfully with a complete resection of the tumor, followed by a free latissimus dorsi muscle transfer with a skin graft for soft-tissue reconstruction. The patient has regained good contour of the foot and ankle, and has been symptom-free with no evidence of local recurrence in the affected area for 18 months. The authors believe that thorough preoperative planning and state-of-the-art reconstructions, as described here, are the keys to their success. 2003 Wiley-Liss, Inc. [source]

Editorial comment Re: Surgical management of pelvic organ prolapse in women: A short version Cochrane review

Adrian Grant
No abstract is available for this article. [source]

US4 Pharmacotherapy complicating dental surgery

Planning dental treatments for patients taking antithrombotic can be difficult for the general dental practitioner, particularly when surgical interventions are needed. The drugs employed in the long-term treatment of such patients include platelet aggregation inhibitors and oral anticoagulants. Platelet aggregation inhibitors do not represent a contraindication to oral surgery. The activity of oral anticoagulants can be affected by many substances, for this reason it is necessary to monitor by INR the patients taking those drugs. When INR is within therapeutic limits for the more common conditions, most of the oral surgery interventions do not need any special precaution. Evidence indicates that suspending antithrombotic drugs is not indicate, as complications following a thrombotic accident are more frequent and serious than bleedings following oral surgery. It is well known that systemic corticosteroid therapy due to the effect on adrenal suppression can interfere with dental surgical procedures. However, that is largely dependent on the type and dose of corticosteroid that patient is currently taking, or has been taking in the last 12 months and on the type and extent of surgical procedure which is to be performed. Surgical management of dental patients with history of systemic corticosteroid therapy is proposed from the existing literature. [source]

Surgical management of benign duodenal tumours,

Ji-Qi Yan
Abstract Background:, While benign duodenal tumours are rare compared with malignant tumours, they comprise a wide variety of pathologies. Despite their diagnostic challenge, the optimal management of benign duodenal tumours remains undefined. We aimed to review the diagnosis and surgical treatment of benign duodenal tumours. Methods:, Records of all patients with post-operative pathological diagnosis of benign duodenal tumour were retrieved. Information on clinical presentations, diagnostic methods, tumour locations, surgical approaches, pathological results and patient outcomes were analysed. Results:, The operative spectrum included local resection in 8 cases, segmental duodenectomy in 1 case, subtotal gastrectomy in 1 case, papilla resection with sphincteroplasty in 3 cases and pancreaticoduodenectomy in 5 cases. The post-operative pathology results indicated 5 cases of adenoma, 2 cases of tubular adenoma, 2 cases of villous adenoma, 2 cases of tubulovillous adenoma, 2 cases of hamartoma and 1 case each of hamartomatous polyp, Brunner's adenoma, adenomyoma, fibromatosis and ectopic pancreas. Post-operatively, one patient died of unrelated disease, one case was lost in follow-up and the remaining patients survived recurrence-free with a good quality of life. Conclusion:, The presentation of benign duodenal tumours is non-specific, with upper abdominal discomfort and upper gastrointestinal bleeding as common symptoms. Surgical resection is the preferable therapeutic choice with satisfactory prognosis. [source]

Enterocutaneous fistula: a single-centre experience

D. E. Gyorki
Abstract Background:, Enterocutaneous fistulae (ECFs) present a difficult management problem and can cause significant morbidity. The aim of the study was to assess the outcome of these patients. Methods:, A retrospective chart review of all patients with ECF managed at a tertiary centre between 1996 and 2006 was performed. Demographic, management and outcome data including ECF closure, morbidity and mortality were recorded. Results:, A total of 33 patients (17 male) were identified with ECF (median age: 63 years, range: 27,84). The primary aetiology was Crohn's (30%), anastomotic leak (24%), iatrogenic (18%), mesh (6%), neoplasia (6%) and other (16%). Definitive surgery was undertaken in 21 (64%) at a median of 6.4 months (0.4,72 range) following presentation. Twenty percent of patients required emergency surgical intervention and 5 patients required preoperative total parenteral nutrition (TPN). Surgical management was formal resection and reanastomosis in all patients, with a mean operative time of 4.75 h (standard deviation = 1.8). The median hospital stay for the operative group was 19 days (7,85). Four patients required post-operative TPN with one patient requiring home TPN. Fistula closure rate was 97% (operative group: 21 out of 21; non-operative group: 11 out of 12). Mean follow-up was 37.3 months (0.5,217). Six (19%) operative patients developed fistula recurrence. There were two deaths at 2 and 5 months (fistula aetiology malignant colonic fistula and radiation enteritis, respectively). Conclusion:, Patients with ECF can be treated with low morbidity and low recurrence rate in a multidisciplinary setting. We believe that patients with ECF should be referred to specialist units for management. [source]

Surgical management of the petrous teratoma

Shi-Ting Li MD
No abstract is available for this article. [source]