Lamb C.M.,General Surgery
Journal of the Royal Army Medical Corps | Year: 2010
Intra-abdominal hypertension and abdominal compartment syndrome are increasingly recognised as causes of serious morbidity and mortality in critically injured patients, particularly those with significant burns. Identification of at risk patients, routine monitoring of intra-abdominal pressures and appropriate, early treatment may reduce the incidence and complication rate of abdominal compartment syndrome and so improve outcomes in critically injured personnel. We present the case of an American Marine injured in an explosion while on patrol in Afghanistan, who despite the absence of significant intraabdominal injury, went on to develop abdominal compartment syndrome and required decompressive laparotomy.
Cariati A.,General Surgery
Updates in Surgery | Year: 2013
Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. The aim of the present study is to report our experience using a decisional algorithm on sphincter saving procedures that achieved us to obtain good results with low rate of complications. From 2008 to 2011, 206 patients underwent surgical treatment for anal fistula; 28 patients underwent perianal abscess drainage plus seton placement of trans-sphincteric or supra-sphincteric fistula (13.6 %), 41 patients underwent fistulotomy for submucosal or low inter-sphincteric or low trans-sphincteric anal fistula (19.9 %) and 137 patients underwent partial fistulectomy or partial fistulotomy (from cutaneous plan to external sphincter muscle plan) and cutting seton placement without internal sphincterotomy for trans-sphincteric anal fistula (66.50 %). Healing rates have been of 100 % and healing times ranged from 1 to 6 months in 97 % of patients treated by setons. Transient fecal soiling was reported by 19 patients affected by trans-sphincteric fistula (11.5 %) for 4-6 months and then disappeared or evolved in a milder form of flatus occasional incontinence. No major incontinence has been reported also after fistulotomy. Fistula recurred in five cases of trans-sphincteric fistula treated by seton placement (one with abscess) (1/28) (3.5 %) and four with trans-sphincteric fistula (4/137) (3 %). Our algorithm permitted us to reduce to 20 % sphincter cutting procedures without reporting postoperative major anal incontinence; it seems to open an interesting way in the treatment of anal fistula. © 2013 Springer-Verlag Italia.
Shariff U.S.,General Surgery |
Kullar N.,Center for Academic Surgery |
Dorudi S.,Center for Academic Surgery
Diseases of the Colon and Rectum | Year: 2011
PURPOSE: On occasion, the left colon is not available for rectal or low pelvic anastomosis either because of synchronous pathology, previous resections, or inadequate blood supply. The short middle colic pedicle prevents use of the transverse colon for this purpose. In this situation, the right colon is a good anastomotic conduit. The aim of this video is to demonstrate the right colonic transposition technique. METHODS: Intraoperative footage was filmed and edited in a multimedia format. Operative details were as follows: the diseased left colon and transverse colon are excised; the right colon is fully mobilized and transposed 180 degrees anticlockwise around the axis of the ileocolic pedicle, so the hepatic flexure reaches into the pelvis without tension. The hepatic flexure is then used for anastomosis within the pelvis either to the residual rectum or anus (see Supplemental Digital Content, Videos 1-3, http://links.lww.com/DCR/A46, http://links.lww.com/DCR/A47, and http://links.lww.com/DCR/ A48). Case notes were reviewed to analyze clinical outcome and bowel function. RESULTS: Three patients underwent the technique, 2 females and 1 male (median age, 45 (range, 30-55) years). Median operating time was 98 (range, 95-114) minutes. There were no anastomotic failures or other major complications. One patient had a superficial wound infection. The median in-hospital stay was 7 (range, 7-8) days. The median time to first bowel movement was 3 (range, 3-4) days; the median daily stool frequency was 4 (range, 3-4) on discharge, decreasing to 2 daily stools 12 months after surgery. Stoma formation and total colectomy were successfully avoided in each patient. CONCLUSIONS: Right colonic transposition is a useful technique to enable the construction of a tension-free rectal anastomosis with a good blood supply. The use of the right colon in these clinicopathological situations can be achieved with low morbidity and results in good short- and long-term bowel function in these patients. Careful preservation of the ileocolic pedicle and division of the right colic vessels are essential to facilitate successful anastomosis. ©The ASCRS 2011.
Orci L.,University of Geneva |
Chilcott M.,General Surgery |
Huber O.,University of Geneva
Obesity Surgery | Year: 2011
Because of an important burden of disease, obesity is a major public health challenge in the twenty-first century. Where medico-psychological management has shown its limitations, bariatric surgery is now acknowledged as the most efficient therapy potentially offered to severely obese patients. Among other options, Roux-en-Y gastric bypass (RYGBP) is the most frequently performed procedure. The objective of this review is to systematically evaluate the effect of the Roux- (alimentary) limb length on postoperative weight loss after RYGBP in severely obese patients. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched using terms related to Roux-limb, gastric bypass and obesity. To be included, studies had to be either randomized controlled trials, quasi-randomized controlled trials or prospective cohort studies comparing a shorter to a longer Roux-limb. Studies were critically appraised with regard to methodological components. Eight studies were reviewed. Variations in methodology, operation design and outcome assessment among studies caused considerable clinical heterogeneity, preventing us from performing a meta-analysis. The overall quality was questionable, owing to lack of rigor in methodological components reporting. Results were heterogeneous, but we identified a trend supporting that the construction of a longer Roux-limb is more efficient in super obese patients. This review suggests that the tailoring of a longer Roux-limb might only be efficient in super obese patients. The overall limited quality of the included studies prompts to call for improvement in trial design in surgery. © 2011 Springer Science + Business Media, LLC.
Subramonia S.,General Surgery |
Lees T.,Northern Vascular Center
European Journal of Vascular and Endovascular Surgery | Year: 2010
Objective: To compare the costs involved (from procedure to recovery) following radiofrequency ablation and conventional surgery for lower limb varicose veins in a selected population. Design: Prospective randomised controlled trial. Methods: Patients with symptomatic great saphenous varicose veins suitable for radiofrequency ablation were randomised to either RF ablation or surgery (sapheno-femoral ligation and stripping). The hospital, general practice and patient costs incurred until full recovery and the indirect cost to society, due to sickness leave after surgery, were calculated to indicate mean cost per patient under each category. Results: Ninety three patients were randomised. Eighty eight patients (47 - RF ablation, 41 - surgery) underwent the allocated intervention. Ablation took longer to perform than surgery (mean 76.8 vs 47.0 min, p < .001). Ablation was more expensive (mean hospital cost per patient £1275.90 vs £559.13) but enabled patients to return to work 1 week earlier than after surgery (mean 12.2 vs 19.8 days, p = 0.006). Based on the Annual Survey of Hours and Earnings (Office of National Statistics, UK) for full time employees, the cost per working hour gained after ablation was £6.94 (95% CI 6.26, 7.62). Conclusion: The increased cost of radiofrequency ablation is partly offset by a quicker return to work in the employed group (ISRCTN29015169http://www.controlled-trials.com). © 2009 European Society for Vascular Surgery.