摘要:

AbstractSurgical exploration of the common bile duct carries considerable risks in elderly and frail patients. Peroral, fibreoptic duodenoscopy allows access to the papilla of Vater in sedated patients and the opportunity to perform a diathermy sphincterotomy for removal of bile duct stones. We have attempted sphincterotomy in 134 patients, most of whom had previously undergone cholecystectomy and had some contraindication to a further operation. Sphincterotomy was technically successful in 129 patients (96 per cent), and all duct stones were removed in 119 patients (92·5 per cent of successful sphincterotomies). The technique failed only once in 95 patients with stones less than 14 mm diameter. Immediate complications occurred in 10 patients, 3 of whom required emergency surgery; 1 patient died.Endoscopic diathermy sphincterotomy is a major therapeutic advance in the management of elderly and high risk patients with bile duct stones. No significant adverse effects have yet been revealed in follow‐up studies. However, the possibility of long term complications dictates the need for caution in offering this procedure to young patients who are fit for reoperati

ISSN:0007-1323    

DOI:10.1002/bjs.1800670102

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractForty‐six gallbladders were examined for the number, weight, size and shape of their gallstones, and for the volume of flow, under conditions of constant pressure, that was transmitted by the cystic duct. Eighteen gallbladders were from patients who had previously suffered an attack of acute pancreatitis, and the other 28 were from control patients who had not had a known attack of pancreatitis.Cystic duct flow rates, which we assumed were related to cystic duct calibre, were greater in the pancreatitis group (mean = 282 ml/min) than in the controls (mean = 134 ml/min) (P<0·01). There were more stones in the gallbladders of the pancreatitis patients, and the mean stone weight was lower in this group (0·31 g compared with 0·74 g; P<0·02). Large stones were more frequently seen in the control gallbladders. Small, irregular or mulberry‐shaped stones were the dominant stone type in 78 per cent of the pancreatitis group but in only 43 per cent of the controls (P<0·05).Thus a large‐calibre cystic duct and numerous small stones with an irregular shape appeared to be more common in patients who had suffered acute pancreatitis, and may be factors in the pathogenesis of

ISSN:0007-1323    

DOI:10.1002/bjs.1800670103

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractIn the investigation of 90 patients referred with severe post‐cholecystecomy problems, 8 patients were found at ERCP to have choledochoduodenal fistula. The clinical feature associated with the fistula included pain with fever, jaundice or hyperamylasaemia. Reviewing the details of the original surgery and the endoscopic findings, it is suggested that most, if not all, of these fistulas are iatrogenic. Treatment by biliary bypass is recommende

ISSN:0007-1323    

DOI:10.1002/bjs.1800670104

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe diagnosis and surgical treatment of carcinoma of the common hepatic duct present difficult problems. Accurate preoperative localization of the obstructive lesion is essential and slim needle transhepatic percutaneous cholangiography is the investigation of choice. Worth while palliation may be achieved if biliary‐enteric flow can be re‐established by introducing a plastic stenton through the obstructive lesion in the bile duct. Three patients are reviewed who survive 36, 31 and 26 months after this operation. A further patient died of metastases after 5 mon

ISSN:0007-1323    

DOI:10.1002/bjs.1800670105

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThis study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 per cent), 7 after a ‘pre‐cut’. Twenty‐three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9·5±5·9 days.Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death.It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile d

ISSN:0007-1323    

DOI:10.1002/bjs.1800670106

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractDiagnostic peritoneal lavage was carried out in 79 patients with acute pancreatitis, at a mean time of 7 h after admission to hospital. The presence of more than 10 ml of free peritoneal fluid, brown‐coloured free fluid or mid‐straw‐coloured lavage fluid was the criterion used for the prediction of a severe attack by lavage.Prior to lavage the attack was assessed as mild or severe by the clinician and reassessed by him at 24 and 48 h. All attacks were finally classified as mild or severe by means of a simple clinical grading scheme. There were 61 mild and 18 severe attacks (including 4 deaths).Initial clinical assessment correctly predicted only 39 per cent of the severe attacks compared with a 72 per cent success rate for diagnostic lavage. All the mild attacks were correctly predicted by clinical assessment but lavage was wrong in 3 out of 61 cases (95 per cent success rate).By 48 h after admission clinical assessment was comparable to systems using multiple criteria in its predictive value, success rates being 83 per cent and 82 per cent respectively for prediction of severe attacks. We did not find either the presence of methaemalbumin in the serum or the presence of hypocalcaemia to be of additional value.Diagnostic peritoneal lavage was the most accurate early guide to severity, and correctly predicted all patients who developed shock or

ISSN:0007-1323    

DOI:10.1002/bjs.1800670107

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractOne hundred patients with gastro‐oesophageal reflux and hiatus hernia were treated at the North Middlesex Hospital, Regional Cardiothoracic Centre, between 1968 and 1969. All patients received surgical treatment by the Belsey mark IV technique with no significant complications. The 9–10 year follow‐up has shown a recurrence rate of 10 per cent. The majority of recurrences occurred within 2 years of the initial operation. Seven of these recurrences had excellent results after a second mark IV repair. The improved quality of life in the successful cases was dramatic. This series indicates that a left transthoracic mark IV type of repair is a safe and reliable procedure and gives excellent results with relief of sym

ISSN:0007-1323    

DOI:10.1002/bjs.1800670108

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe aim of this study was to assess the clinical results after highly selective vagotomy (HSV) when used routinely at a district general hospital. A total of 229 patients with chronic duodenal or prepyloric ulcers was included in a 92 per cent complete follow‐up 1–6 years after an elective HSV without drainage. There was no postoperative mortality, and the frequency of postoperative complications was low. Transient dysphagia and early fullness each occurred in about a quarter of the patients, whereas persistent dumping was found only in 1·3 per cent and diarrhoea in 2·2 per cent of the patients. Recurrent ulcer was diagnosed in 12·7 per cent of the patients, but this figure decreased to 9·3 per cent after exclusion of one of the 24 surgeons involved. The overall clinical results according to the modified Visick classification were recorded as excellent or very good in 70 per cent and unsatisfactory in 20 per cent. The failures were almost exclusively due to a proved or suspected recurrence or to gastric retention, and further operations have been performed on 27 of these patients. After reoperation only 8 patients (3·5 per cent) remained failures according to the patient's own judgement at the time of follow‐up.The recurrence rate in this study was considered disquietingly high with regard to the short observation time. However, other obvious advantages of the method and the possibility of improved results after adjustment of the surgical technique were considered to justify continued use of HSV as a routine

ISSN:0007-1323    

DOI:10.1002/bjs.1800670109

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractFifteen out of 34 infants with intussusception admitted to a district hospital were found to require resection of gangrenous bowel or an anatomical lead point. This resection rate (44 per cent) is considerably higher than those reported from specialist centres which rely on hydrostatic reduction as their primary form of treatment. The difference is probably a reflection of the greater proportion of late cases seen in a district hospital. Complications were virtually confined to those children who had undergone resection and it is concluded that earlier referral to hospital is the single factor most likely to reduce morbidity. Operative management is advocated, although barium enema is a safe valuable adjunct to surgery.

ISSN:0007-1323    

DOI:10.1002/bjs.1800670110

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY

摘要:

AbstractFive cases of traumatic intramural haematoma of the duodenum occurring in children are presented. Four of the cases were treated conservatively with nasogastric aspiration and intravenous fluids and it is suggested that this should be the treatment of choice in the majority of cases. Two of the cases were diagnosed initially as having appendicitis and during the exploratory procedure in one of these cases the haematoma was evacuated.

ISSN:0007-1323    

DOI:10.1002/bjs.1800670111

出版商:John Wiley&Sons, Ltd.    

年代:1980

数据来源: WILEY