ISSN:0007-1323    

DOI:10.1002/bjs.1800761102

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800761103

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractPrimary motor disorders of the oesophagus have distinct manometric patterns but require full oesophageal investigation to exclude a secondary cause. Myotomy and forceful dilatation give good results in achalasia, though myotomy is superior in the long term. Indications for surgery are rare in diffuse spasm and nutcracker oesophagus. Non‐cardiac chest pain may be related to reflux, diffuse spasm or nutcracker oesophagus, but correlation between motor abnormalities and symptoms is poor and psychological disturbances are frequen

ISSN:0007-1323    

DOI:10.1002/bjs.1800761104

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non‐specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17‐per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10–29 years (31 per cent) and 60–79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20–29 years). Fifty‐one deaths resulted in a 30‐day hospital mortality rate of 4·4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged ≥60 years, and patients aged 80–89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), perforated peptic ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and perforated ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and perforated peptic ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients s

ISSN:0007-1323    

DOI:10.1002/bjs.1800761105

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractThe cause, management and outcome of 23 patients with a pancreatic fistula following acute pancreatitis are reviewed. Nineteen patients developed an external fistula following necrosectomy or drainage of a pancreatic abscess or pseudocyst; four of these patients died. In the 15 survivors spontaneous closure occurred in 11 cases with low output fistulae; operative intervention was needed in the four cases with high output fistulae. Four patients with internal fistulae had not undergone previous surgery; two of them had a pancreaticopleural fistula with associated pancreaticogastric fistulae, while two had pancreatic ascites. All four of these patients required surgical intervention and one died.

ISSN:0007-1323    

DOI:10.1002/bjs.1800761106

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractIn a consecutive surgical series of 70 patients with chronic calcifying pancreatitis, 18 presented with fixed stenosis of the terminal common bile duct. Nine patients presented with jaundice and two had a palpable gallbladder. The most relevant laboratory datum in the series was a persistently high serum alkaline phosphatase level. Long tapering of the terminal common bile duct was the characteristic radiological sign in 45 of our patients. In five of the 18 cases compression of the terminal bile duct was due to cephalic pseudocysts. Hepaticojejunostomy‐en‐Y was the type of drainage chosen in 16 cases, and an end‐to‐side technique was used in 15 patients. Side‐to‐side choledochoduodenostomy was performed in two cases. In 14 patients, biliary drainage was associated with other surgical procedures on the pancreatic parenchyma. No postoperative complications due to the biliary drainage occurred in

ISSN:0007-1323    

DOI:10.1002/bjs.1800761107

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractPost‐transplantation pancreatitis is an infrequent complication with a high risk of mortality. In a 7‐year period, there were five patients who had documented pancreatitis out of a total of 488 renal homograft recipients, an incidence of 1 per cent. Two cases occurred in patients with an orthotopic transplant, one of them as a result of surgical injury of the pancreas and the other as a consequence of cytomegalovirus infection. The third case was an acute pancreatitis of hypercalcaemic origin, the fourth patient developed postoperative pancreatitis and acute acalculous cholecystitis, and the fifth had acute pancreatitis and sepsis associated with cytomegalovirus infection. Three patients died as a direct result of the complication. The mean incidence and mean mortality rate of post‐transplantation pancreatitis, as determined from our review of the literature of the last 15 years, are 2·3 and 61·3 per cent, respectively; these are similar to the figures found up to 1970 of 1·7 and 52·2 per cent. A multiplicity of factors present in the uraemic patient may be responsible for the continued frequency of post‐transplant pancreatitis despite advances in surgical technique and immunosuppress

ISSN:0007-1323    

DOI:10.1002/bjs.1800761108

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractOne hundred and sixty‐four patients operated on for calculus disease of the common bile duct during the period 1977–85 were followed in a special clinic; the attendance for follow‐up at 1, 3, 5 and 7 years was 90, 74, 60 and 54 per cent respectively. Eleven patients died during the study period (6·7 per cent), none of the deaths being attributable to biliary tract disease. The overall incidence of retained calculus was 2·4 per cent (four patients), but no cases of retained calculi were recorded in the last 4 years of the study; in this period, with the advent of choledochoscopy and fluoroscopic cholangiography, the incidence of the supraduodenal compared with the transduodenal approach to the common bile duct increased significantly (P<0·001). Twenty‐two of 56 patients (39 per cent) followed up for 5 years remained or became symptomatic after surgery, the majority of whom had underlying conditions unrelated to disease of the biliary or pancreatic tree. This specific follow‐up clinic has been of value in the long‐term audit of patients undergoing bile duct surgery for choledocholithiasis and it has verified that a change of policy from transduodenal to supraduodenal choledochotomy with preservation of the sphincter, and use of the choledochoscope and fluorocholangiography, produce

ISSN:0007-1323    

DOI:10.1002/bjs.1800761109

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractA new classification of patients with Mirizzi syndrome and cholecystobiliary fistula is presented. Type I lesions are those with external compression of the common bile duct. In type II lesions a cholecystobiliary fistula is present with erosion of less than one‐third of the circumference of the bile duct. In type III lesions the fistula involves up to two‐thirds of the duct circumference and in type IV lesions there is complete destruction of the bile duct. A total of 219 patients were identified with these lesions from 17 395 patients with benign biliary tract diseases undergoing surgery. The incidence of type I lesions was 11 per cent, type II 41 per cent, type III 44 per cent and type IV 4 per cent. The majority had obstructive jaundice. In type I lesions. cholecystectomy plus choledochostomy is effective. In type II lesions, suture of the fistula with absorbable material or choledochoplasty with the remnant of gallbladder can be performed. In type III lesions suture is not indicated and choledochoplasty is recommended. In type IV lesions, bilioenteric anastomosis is preferred. Operative mortality rate increases according to the severity of the lesion, as does postoperative morbidity. During cholecystectomy, partial resection is recommended in order to extract the stones, visualize the common bile duct and define the type and location of the fistula.Ttubes should be placed distal to the fist

ISSN:0007-1323    

DOI:10.1002/bjs.1800761110

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY

摘要:

AbstractWound sepsis is common following pyloromyotomy in children and in a retrospective study of 178 cases the incidence of wound infection was 21 (11·8 per cent). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure with polydioxanone was associated with a 1 per cent (one of 70) wound sepsis rate. Wound sepsis after pyloromyotomy is dependent on technique, and mass closure with polydioxanone is recommended. The routine use of tension sutures should be abandoned

ISSN:0007-1323    

DOI:10.1002/bjs.1800761111

出版商:John Wiley&Sons, Ltd.    

年代:1989

数据来源: WILEY