摘要:

We reviewed the records of 160 adult patients undergoing intestinal resection to determine the outcome of this surgical procedure. Twenty-three patients (14%) underwent massive ( > 50%) resection and 18 developed the short bowel syndrome. Mesenteric vascular disease was the indication for resection in 16 (70%) of these patients. The most frequent indications for resection in the 137 patients (86%) undergoing less extensive resection were: obstruction (26%); tumor (23%); Crohn’s disease (22%), and trauma (10%). Previous resection had been performed in 22 of these patients and the short bowel syndrome resulted in 6 patients. The morbidity and mortality rates of massive intestinal resection were significantly greater than for lesser resection (87 vs. 42 and 43 vs. 12%, respectively, p < 0.05). Massive resection was also more frequently an emergency procedure (87 vs. 40%, p < 0.05) and more likely to necessitate ostomy formation (48 vs. 15 %, p < 0.005). Seventeen of the 24 patients with the short bowel syndrome survived and 14 required total parenteral nutrition (TPN) at home. Eleven patients remain alive on TPN with follow-up of 13–64 months. Intestinal resection is associated with greater morbidity than generally appreciated. The short bowel syndrome occurred in 15 % of patients and while it most often resulted from massive resection (75%), it also frequently followed sequential lesser resections (25%). Home TPN has made long-term survival possible for many patients (70%) with the short bowel syndr

ISSN:0253-4886    

DOI:10.1159/000171889

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We investigated how various types of gastric surgery influenced the effect of peptone on the lower esophageal sphincter (LES) (12 healthy volunteers, 10 patients following selective proximal vagotomy (SPV), 10 patients following Billroth I (B I), 10 patients following Billroth II (B II) and 10 patients following ⅔ resection and Roux-en-Y reconstruction). On two separate occasions we measured the LES response to the intragastral application of either 300 ml 0.9% saline or 300 ml 20% peptone solution from 15 min before to 60 min after instillation. The resting pressures in patients with SPV, B II or Roux-en-Y were significantly (p < 0.05) lower than those in the volunteers or patients with B I. Peptone causes a physiological LES pressure (LESP) increase only in healthy volunteers or in patients with SPV. After all gastric resection procedures the LESP decreases in response to peptone stimulation. There is no correlation with the maintenance of the duodenal passage. It appears, rather, that the destruction of the vagal connections from the duodenum to the LES is the reason for the pressure decrease.

ISSN:0253-4886    

DOI:10.1159/000171890

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We describe a new technique for surgically reducing the size of a dilated stoma following the Roux-en-Y gastric bypass operation (RYGB). Of 416 RYGB patients operated on between 1983 and 1986, 6 required correction of a dilated stoma in the absence of pouch distension or staple line dehiscence. Our technique creates a new outlet in the proximal Roux-en-Y jejunum by stapling across the intestinal lumen at the lower border of the gastrojejunostomy anastomosis leaving the original stoma intact. At 1-year follow-up, this procedure prevented weight gain in 4 patients and increased weight loss significantly in 2 patients. We recommend this technique only for those RYGB patients with stomal dilatation who have small pouch reservoirs and intact gastric staple lines.

ISSN:0253-4886    

DOI:10.1159/000171891

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

When cholelithiasis and gastroduodenal disease coexist, the surgeon must decide whether it is appropriate to perform a cholecystectomy at the same time as gastric surgery. The decision should be based on whether simultaneous cholecystectomy increases the risk of gastric surgery. We examined 38 patients who had undergone gastric resection or total gastrectomy and simultaneous cholecystectomy, and 38 patients who had undergone gastric surgery without cholecystectomy during the same period of time, who served as matched controls. The two groups were compared with respect to duration of operation, plasma and blood units transfused during and after surgery, duration of postoperative hospital stay, postoperative complications and mortality. Results regarding the two groups were compared by statistical tests. Analysis of the results did not reveal any significant differences between cases and controls, but the power of the test was quite low (1-β = 0.4). The results thus do not allow any final conclusion, but they would seem to support the possibility that simultaneous cholecystectomy does not increase the risks of gastric surgery

ISSN:0253-4886    

DOI:10.1159/000171892

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The surgical literature supports a negative laparotomy rate of 20% for patients who are explored for the diagnosis of appendicitis. It has been assumed that attempts at decreasing the negative laparotomy rate will increase the perforation rate to above 25%. We reviewed the experience at a community hospital with the treatment of appendicitis in 970 consecutive patients. Close inhospital observation was used to evaluate difficult cases. The negative laparotomy and perforation rates were 10 and 23%, respectively. No patients perforated under observation. The surgical standards for negative appendectomy rate can be revised downward to 10% without fear of increasing the perforation rate.

ISSN:0253-4886    

DOI:10.1159/000171893

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Over a 7-year period, 96 successive patients with intra-abdominal or retroperitoneal abscesses underwent 120 percutaneous punctures (PP), guided by computerized tomography (CT). The procedure was performed by several radiologists and surgeons according to the guidelines of our teaching hospital. Without PP, 73 patients (76%) would have required surgery. For 23 patients (24%), not eligible for surgery because of major anesthetic and/or surgical contraindications, PP was the only therapeutic possibility. 129 abscesses were recorded as follows: 75 postoperative abscesses (70 extraparenchymal locations, i.e. 93.3%) in 58 patients (60.4% of our collective) and 54 spontaneous abscesses (30 intraparenchymal, i.e. 55.5%) in 38 patients. Radical, definitive treatment was achieved by PP only in 74 patients (77%). In 13 patients (13.5%), PP allowed a postponed safer and easier surgical procedure, after evacuation and collapse of the collection entailing interruption of their septic shock state. PP thus proved effective in 90.5% of our cases, with a low morbidity rate (2%) and a mortality rate of 7.3% (represented by 7 patients, each at least 75 years old, all in septic shock). In view of these results, we have adopted this procedure as the first step when dealing with abdominal or retroperitoneal collections. If radical treatment is not achieved, a complementary, safer surgical procedure can be undertaken after percutaneous drainage, e.g. in case of digestive fistulae. A safe drainage route to the collection was the only limiting factor to the PP procedure. However, surgery remains the only curative treatment in case of failure or complication of PP.

ISSN:0253-4886    

DOI:10.1159/000171894

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A prosthesis was designed to protect the intestinal loop from external beam radiation therapy, when postoperative radiation is indicated. It is a silicone-made inflatable balloon, the implantation of which permits to drive the intestinal loops out of the irradiation field, and which is easy to remove after radiation therapy. The device has been used in 7 patients, 4 patients with a retroperitoneal soft tissue sarcoma and 3 patients with recurrent pelvic tumor. After surgical resection of the tumor the device is placed either in the retroperitoneal space or in the pelvic cavity. A polyglactine 910 mesh is placed between the spacer and the bowel to prevent loop incarceration. The prosthesis can be emptied between each radiation course and then removed through a 3-cm incision under local or locoregional anesthesia. The tolerance of the small intestine of the radiation therapy has been satisfactory in each case with no bowel injury due to radiation. Therefore, this simple device might be useful in order to prevent bowel injury during postoperative radiation in the treatment of abdominal and retroperitoneal tumor masses when indicated.

ISSN:0253-4886    

DOI:10.1159/000171895

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Hepatic cell adenoma associated with oral contraceptives may grow and become more vascular during pregnancy, and is at risk of rupture. The case is reported of a lady presenting as an emergency with rupture of an adenoma, treated by local resection, in the 22nd week of pregnancy.

ISSN:0253-4886    

DOI:10.1159/000171896

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We report a case of a 59-year-old woman with a primary esophageal melanoma. A review of the literature is included to support the importance of preoperative diagnosis. Clinical staging is extremely important for identifying patients who would benefit from radical surgery and those for whom surgical or nonsurgical palliation is indicated. The role of immunohistochemical markers, and the current status of nonsurgical therapeutic modalities for primary esophageal melanoma are discussed.

ISSN:0253-4886    

DOI:10.1159/000171897

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The deposition of the lipochrome pigment, lipofuscin, in the smooth muscle of the tunica muscularis has been termed the brown bowel syndrome. It is related to vitamin E deficiency, which causes changes in the structure and function of mitochondria. We discuss a case of brown bowel syndrome in a man with congenital malrotation of the gut.

ISSN:0253-4886    

DOI:10.1159/000171898

出版商:S. Karger AG    

年代:1989

数据来源: Karger