摘要:

We prospectively studied the course of quality of life and gastrointestinal and biliary symptoms after laparoscopic (n = 14) and conventional cholecystectomy (n = 17). It was found that cholecystectomy significantly improved quality of life and cured nausea, fatty food upset, stomach swelling and biliary pain. It was also found that laparoscopic cholecystectomy improved quality of life and symptomatology at an earlier stage than conventional cholecystectomy. Therefore, more circumstantial evidence is provided that laparoscopic cholecystectomy is superior to conventional cholecystectomy.

ISSN:0253-4886    

DOI:10.1159/000172323

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Trends regarding symptomatic (pancreatitis, jaundice, cholangitis; 221 patients) and asymptomatic (detected at cholecystectomy; 333 patients) common bile duct stones were studied by comparing the period 1970-1978 with the period 1979-1986. There was a significant increase in the population-based incidence of symptomatic stones (8-20 cases/100,000 inhabitants/year) and a slight decrease in the rate of asymptomatic stones diagnosed at cholecystectomy (12-10 cases/100 cholecystectomies/year). The proportion of patients aged 70 years or more increased from 31 to 60% in the symptomatic group. The proportion of patients undergoing cholecystectomy with choledocholithotomy as the primary procedure decreased from 75 to 44%. During the second period, endoscopic sphincterotomy accounted for 81 % of all primary procedures among patients with symptomatic stones. The type of treatment disregarded, the frequency of clinically overt retained or recurrent stones increased from 7 to 22%. Overall, the frequency of general complications decreased from 9.1 to 4.5%, mainly due to a decrease in the symptomatic group. The frequency of procedure-related complications also decreased in the symptomatic group (25.4-14.9%), whereas it increased in the asymptomatic group (13.5-23.4%). The mortality rate decreased in both groups (symptomatic 14.9-5.2%, asymptomatic 3.4-1.3%). The total duration of stay in hospital decreased by 48% for patients with symptomatic stones and by 23% for those with asymptomatic stones. Possible explanations for these changes are discussed.

ISSN:0253-4886    

DOI:10.1159/000172324

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The surgical management of 7 adult female patients with choledochal cysts, from December 1985 to December 1993, is presented. Upper abdominal pain was present in all cases, jaundice in 3 patients, and a palpable right upper quadrant mass in 1. The diagnosis was confirmed by ultrasonography, per-operative cholangiography, tube cholecystocholangiography, computed tomography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography – performed singly or in combination. An abnormal pancreaticobiliary junction was documented in 2 patients: on tube cholangiography in 1 and on endoscopic retrograde cholangiography in the other. The cysts in these patients were classified as follows: 2 type I, 1 type II, 3 type IVa, and 1 type V (Caroli’s disease). Internal drainage was performed in 2 patients, and both developed complications. Four patients underwent cyst excision with one anastomotic leak. Malignant and severe dysplastic changes were seen in 3 patients: 2 type IVa cysts and 1 type V cyst. We believe that cyst excision is essential to separate the pancreatic and biliary systems with Roux-en-Y hepaticojejunostomy to prevent long-term complicati

ISSN:0253-4886    

DOI:10.1159/000172325

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In order to determine preoperatively the severity of intestinal ischemia requiring resection, a multivariate analysis was performed, using nine preoperative parameters. A multiple-discriminant function, using body temperature and creatine kinase and glucose serum levels, could predict the need for intestinal resection with a discriminant rate of 86.5% in the retrospective study, and with a rate of 89.5% in the prospective study. These data suggest that the multiple-discriminant function may predict the severity of intestinal ischemia relative to the necessity for bowel resection.

ISSN:0253-4886    

DOI:10.1159/000172326

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We reviewed 13 cases of necrotizing fasciitis who presented between 1988 and 1992; of these 5 patients (38%) died. Early diagnosis and aggressive surgical debridement are essential to the successful management of necrotizing fasciitis.

ISSN:0253-4886    

DOI:10.1159/000172327

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

From January 1980 until December 1990, 1,779 colorectal polyps were resected with a snare endoscopically in a total of 944 patients. Complications occurred in 20 patients (1.12%), in 5 cases thereof with perforation (0.28%) and in 15 cases (0.84%) with bleeding. In 4 cases, bleeding presented as an intraluminal spurting bleeding, in 10 patients as an intraluminal oozing, and in 1 case as an extraluminal bleeding outside the rectal wall. Seventeen complications (0.95%) were treated conservatively. Only in 3 cases (0.17%) a surgical intervention was necessary. In 1 case extraluminal bleeding was controlled by oversewing the bleeding vessel, and in 2 cases with a free perforation a gut resection had to be performed. No patient died.

ISSN:0253-4886    

DOI:10.1159/000172328

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A clinical and histologic study of recurrent pilonidal sinus is presented. During a 5-year period 44 patients were treated for recurrent pilonidal sinus. Of these, recurrence had occurred within 1 year in 26 patients (76%). After 26 reoperations with excision and primary suture further recurrence was seen in 23% (6/26), and in 24% (6/25) after reoperations with open treatment. The histologic findings in recurrent sinuses (18 patients) were almost identical to that of primary disease. Recurrent sinuses were situated in the scar in 80% of the cases and caudal in 50% of the cases. A known wound infection had been present in 27% of the patients. Although keratin plugs were observed in 15/18 (83%) of those with a recurrence, the importance of this finding is uncertain. We conclude that recurrent pilonidal sinuses are chronic inflammatory processes usually located at the site of the surgical wound. The cause is uncertain, although there is an indication that wound infection plays a role. Keratin plugs have also been observed in scar tissue. Surgical treatment of recurrent disease has a higher recurrence rate than after that of primary disease.

ISSN:0253-4886    

DOI:10.1159/000172329

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The reported incidence of anorectal anomalies ranges from 1 in 3,500 to 1 in 5,000 live births. Malformations occur more commonly in boys and may be associated with other congenital anomalies. Although they are usually diagnosed and treated during infancy, some sporadic cases are reported in adults.

ISSN:0253-4886    

DOI:10.1159/000172330

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Rupture of the esophagus is a disease with grave clinical consequences if diagnosed late. Patients usually present with chest pain and signs of sepsis. A patient is described who presented, with tension pneumothorax, a previously undescribed sign which prompted early diagnosis and treatment.

ISSN:0253-4886    

DOI:10.1159/000172331

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Esophageal perforation is a rare complication following Nissen fundoplication. This paper presents 3 patients with esophageal perforation – 2 following open and 1 after laparoscopic surgery. Two of the perforations were overlooked perioperatively. All patients were treated with pleural or abdominal drainage procedures and 1 of them ended up with a total esophagectom

ISSN:0253-4886    

DOI:10.1159/000172332

出版商:S. Karger AG    

年代:1995

数据来源: Karger