bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restorative Proctocolectomy or Rectum‐Preserving Surgery in Patients with Familial Adenomatous Polyposis: Results of a Prospective Study
Authors: Tonelli Francesco , Valanzano Rosa , Monaci Iacopo , Mazzoni Paolo , Anastasi Alessandro , Ficari Ferdinando 
Published: August 2002

AbstractSurgical treatment of familial adenomatous polyposis (FAP) is still controversial. From 1984 we carried out a prospective evaluation of total colectomy with ileorectal anastomosis (IRA) and restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) to determine differences in postoperative complications, functional results, occurrence of desmoids, and recurrence of polyps in the rectal stump. IRA was performed below the peritoneal reflection and was indicated in the absence of rectal cancer and in the presence of fewer than 10 polyps or minute polyposis in the last 10 cm of the rectal mucosa. IRA patients underwent a regular endoscopic follow‐up and prolonged sulindac administration (100 mg twice daily). When criteria for IRA were absent, IPAA was performed adopting a manual anastomosis at the pectinate line. Fourteen patients were operated with IRA and 24 with IPAA. There was no difference in sex and age between the two groups of patients. The number of rectal polyps was significantly different in the two groups. Immediate postoperative complications were observed in only five IPAA patients, three of whom (12%) required reoperation. Late postoperative complications occurred more frequently in IRA patients (14%) than in IPAA patients (4%). Desmoids developed in both groups (five in the IRA group and four in IPAA group). The number of bowel movements was similar in both groups, but 25% of IPAA patients complained of nocturnal fecal soiling. Fulguration or polypectomy for recurrent polyps was necessary in all but two IRA patients at follow‐up. The rectal stump was easily eradicated by polyps in all but four patients with minute polyps at surgery. In the latter patients a diffuse or carpeting rectal polyposis occurred. IPAA can give optimum control of colorectal polyposis in FAP patients with an acceptable incidence of postoperative complications and satisfactory functional results. This type of surgical procedure is indicated in most FAP patients, and IRA should be reserved for patients without polyps or with fewer than 10 polyps in the rectal stump; otherwise growth of polyps cannot be adequately controlled.
Ultra‐low Anterior Resection and Coloanal Pouch Reconstruction for Carcinoma of the Distal Rectum
Authors: Guillem Jose G. 
Published: August 2002

AbstractFacilitated by an enhanced appreciation for pelvic anatomy and physiology along with a better understanding of patterns of rectal cancer spread, great advances have been made in our ability to perform restorative resections for an ever‐increasing proportion of mid and distal rectal cancers. Whereas oncologic results following a low anterior resection were the principal concern 20 years ago, recent efforts have focused on improving functional results as well. Aspirations for improved function need to be tempered by the realization that improved sphincter‐saving rates must follow improved oncologic results rather than jeopardize them. Some crucial questions are addressed in this paper: What are the variables involved in optimizing the oncologic and functional results of a low anterior resection and a coloanal reconstruction? What are the issues involved in selecting a particular coloanal reconstruction (straight versus pouch, stapled versus handsewn, with or without fecal diversion) for a particular patient? Who is not a good candidate for a coloanal reconstruction?
Determinants of Survival following Hepatic Resection for Metastatic Colorectal Cancer
Authors: Bakalakos Efthimios A. , Kim Julian A. , Young Donn C. , Martin Edward W. 
Published: August 2002

AbstractHepatic resection remains the only potentially curative treatment for metastatic colorectal cancer. This retrospective review study was undertaken in an attempt to identify factors that influence patient survival following hepatic resection for metastatic colorectal cancer. From January 1978 to December 1993, a total of 301 patients underwent a total of 345 planned hepatic resections for metastatic colorectal cancer. Of those, 245 patients had one resection, 44 had two resections, and 12 had three resections. For all patients the overall median survival was 20.6 months, operative mortality was 1.1%, and overall morbidity was 17.2%. Average hospital stay was 9 days. Statistical analysis included univariate analysis using log rank comparisons, Kaplan‐Meier survival curves, and multivariate analysis using Cox proportional hazards regression. The statistically significant factors that influenced survival were distribution of liver metastases, unilobar versus bilobar (p= 0.0001), resected versus nonresected (p < 0.0001), and tumor‐free surgical margins versus positive margins (p= 0.001). Surprisingly, the disease‐free interval and the original stage of the primary tumor did not predict survival (p= not significant). Other factors that had no influence on survival were type of resection, size and number of liver metastases, ABO blood group, and the number of perioperative blood transfusions. For those patients who underwent resection of unilobar metastases with tumor‐free margins, the 5‐year survival rate was 29% with a median survival of 35 months and eight survivors > 7 years. In addition, one patient with bilobar disease had survival > 7 years and five patients who had resection of hepatic metastases and extrahepatic cancer simultaneously had survival > 3 years. Our data support the concept that patients with unilobar metastatic disease who undergo surgical resection with tumor‐free surgical margins can be afforded a significant opportunity at long‐term survival with acceptable morbidity, mortality, and hospital stay. Also, certain patients with bilobar or extrahepatic disease (or both) who undergo complete resection can enjoy a long‐term survival. In these subgroups of patients resection should be considered on an individual basis.
Staged Physiologic Restoration and Damage Control Surgery
Authors: Moore Ernest E. , Burch Jon M. , Franciose Reginald J. , Offner Patrick J. , Biffl Walter L. 
Published: August 2002

AbstractThe fundamental objective of staged laparotomy is to accomplish definitive operative management in a calculated, stepwise fashion based on the patient's physiologic tolerance. This important concept has emerged from collective experience with massive acute abdominal injuries but clearly extends to elective operative procedures and surgical challenges in other torso compartments. Whereas the inability to achieve hemostasis is due most frequently to a recalcitrant coagulopathy following trauma, other scenarios include inaccessible venous injuries, coexisting extraperitoneal life‐threatening injuries, uncertain viability of abdominal contents, and the inability to reapproximate abdominal fascia due to reperfusion‐induced visceral edema. There are five critical decision‐making phases of staged laparotomy: I, patient selection; II, intraoperative reassessment; III, physiologic restoration in the surgical intensive care unit; IV, return to the operating room for definitive procedures; and V, abdominal wall reconstruction. The abdominal compartment syndrome (ACS) is a common, often insidious complication of staged laparotomy. In fact, during phases II and III there is often a delicate balance between effective pressure tamponade of capillary bleeding and the untoward effects of the ACS. During phases IV and V a frequent dilemma is how to enclose the abdominal contents to reduce protein loss and facilitate patient mobilization.
Thoracoscopic Surgery for Spontaneous Pneumothorax
Authors: Liu Hui‐Ping , Yim Anthony P.C. , Izzat M. Bashar , Lin Pyng Jing , Chang Chau‐Hsiung 
Published: August 2002

Abstract.Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video‐assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5‐year period. Surgical indications included persistent air leak (n= 165), recurrence (n= 325), radiologically demonstrated huge bulla (n= 12), spontaneous hemopneumothorax (n= 13), incomplete expansion of the lung (n= 212), and bilateral involvement (n= 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n= 312), argon beam coagulation (n= 6), endoscopic suturing (n= 52), and endoloop ligation (n= 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n= 16), localized empyema (n= 2), chest wall bleeding (n= 1), and persistent air leaks (bulla type III) (n= 31). The median duration of the operation was 55 minutes (15–160 minutes), and the average postoperative hospital stay was 4.5 days (range 0–27 days). There were 16 recurrences (2.1%), after a mean follow‐up of 30 months (range 1–60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video‐assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.
Transabdominal Extensive Esophagogastric Devascularization with Gastroesophageal Stapling for Management of Noncirrhotic Portal Hypertension: Long‐term Results
Authors: Mathur Surendra K. , Shah Sudeep R. , Nagral Sanjay S. , Soonawala Zahir F. 
Published: August 2002

Abstract.Outside Japan portosystemic shunts have been favored as the surgical procedure of choice for the management of portal hypertension of noncirrhotic etiology. Devascularization procedures have resulted in high rebleed rates probably owing to a limited extent of devascularization. We performed this study to assess the efficacy of our modification of Sugiura's procedure for long‐term control of variceal bleeding in patients with noncirrhotic portal hypertension. Forty‐six patients with extrahepatic portal venous obstruction (EHPVO) and 22 with noncirrhotic portal fibrosis (NCPF) were subjected to transabdominal extensive esophagogastric devascularization with esophageal or gastric stapled transection (modified Sugiura's procedure), 38 in an emergency situation and 30 electively. Follow‐up endoscopies were performed every 6 months. Operative mortality, morbidity, variceal status, and causes of recurrent bleeding were evaluated. The postoperative mortality was 4%. Early procedure‐related complications were seen in 6%, and esophageal strictures formed in 7 of 45 survivors undergoing esophageal transection (15%). Over a mean ± SD follow‐up of 53 ± 34 months, 95% of patients were free of varices. Seven survivors (11%) had a rebleed, but only 5% were due to varices (two esophageal, one gastric). Six (9%) patients developed gastropathy. The 5‐year survival was 88%. The modified Sugiura's procedure is safe and effective for long‐term control of variceal bleeding especially in the emergency setting and in patients with anatomy unsuitable for shunt surgery or if surgical expertise for a shunt operation is not available.
Principles of Economic Evaluation in Surgery
Authors: Krahn Murray 
Published: August 2002

Abstract.This document reviews the key principles of economic evaluation as they pertain to the evaluation of surgical questions. It addresses the role of economic evaluation in health care decision making, describes the central issues in performing or evaluating an economic evaluation, and finally offers several examples of recent economic evaluations from the surgical literature. A concise annotated reference section is provided for those wishing to read further.
Relaparotomy in Peritonitis: Prognosis and Treatment of Patients with Persisting Intraabdominal Infection
Authors: Koperna Thomas , Schulz Franz 
Published: August 2002

AbstractSome patients are prone to persisting intraabdominal infection regardless of initial eradication of the source of infection. Our aim was to characterize patients who had to undergo relaparotomy for persisting abdominal sepsis using simple clinical parameters and to define those patients who are susceptible to benefit of aggressive surgical treatment by early and repeated reoperations to control multiple organ dysfunction syndrome (MODS) caused by ongoing intraabdominal infection. Persisting abdominal sepsis was the cause of death in all of our patients who had to undergo relaparotomy. Controlling persisting abdominal sepsis should achieve a reduction in the tremendously high mortality rate. Performing a case‐control study, we retrospectively reviewed 523 consecutive patients with secondary peritonitis treated from 1986 to 1996 and focused our attention on 105 patients, in whom standard surgical treatment of secondary peritonitis failed and who had to undergo relaparotomy for persisting abdominal sepsis (study group). Overall, there was no significant difference in the postoperative mortality rate between “planned relaparotomy” and “relaparotomy on demand” (54.5% versus 50.6%). Equally clear risk estimations were given preoperatively by both the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Goris scores. There was a significant difference between patients of the control group and patients of the study group with regard to preoperative APACHE II score, Goris score, age >70 years, albumin <30 g/L, extent of peritonitis, and outcome (p= 0.0001). Reexploration performed more than 48 hr after the initial operation resulted in a significantly higher mortality rate (76.5% versus 28%; p= 0.0001). However, the time of reoperation had no significant impact on survival in patients with an APACHE II score of ≥26, because physiologic derangement is such that only a few patients could benefit from reoperation. The lowest mortality rate (9%) was achieved in patients who underwent reoperation on demand within 48 hr. We conclude that patients >70 years of age with secondary peritonitis extending over the entire abdomen and a greater degree of physiologic compromise (serum albumin levels <30 g/L, preoperative APACHE II scores >20, and existing organ failure measured by the Goris score) are at high risk for developing persistent intraabdominal infection. Our data show that timely relaparotomy provides the only surgical option that significantly improves outcome. However, aggressive surgical treatment has reached its limit in patients whose source of infection could not be controlled at the initial operation. To improve overall survival the decision to perform a relaparotomy on demand after an initially successful eradication of the source of infection must be made within 48 hr, at least before MODS emerges.
Five‐year Prospective Audit of Routine Intravenous Cholangiography and Selective Endoscopic Retrograde Cholangiography with or without Intraoperative Cholangiography in Patients Undergoing Laparoscopic Cholecystectomy
Authors: Pietra Nicola , Sarli Leopoldo , Maccarini Pierangelo Ugo , Sabadini Guido , Costi Renato , Gobbi Sara 
Published: August 2002

AbstractConsensus has never been reached regarding the need or the imaging technique for evaluating the common bile duct (CBD) in patients considered for cholecystectomy. With the advent of laparoscopic cholecystectomy there has been a resurgence of interest in the role of preoperative intravenous cholangiography (IVC) as an alternative for evaluating the CBD. The purpose of this audit was to assess whether a diagnostic workup based on IVC, which permits selective use of intraoperative cholangiography (IOC) and endoscopic treatment of CBD stones before surgery, could be useful in patients undergoing laparoscopic cholecystectomy (LC). In patients without jaundice, gallstone pancreatitis, a prior diagnosis of CBD stones, a prior history of contrast allergy, or a risk of contrast‐associated acute renal failure, IVC was performed routinely. Patients suspected to have CBD stones based on IVC results or with inconclusive IVC and patients with a strong clinical suspicion of CBD stones were referred for endoscopic retrograde cholangiography (ERC). IOC was carried out in patients who had a history of contrast allergy or risk of contrast‐associated acute renal failure and whenever the surgeon was in doubt as to the biliary anatomy or CBD clearance. IVC was carried out in 1155 patients, ERC in 225, and IOC in 54. IVC was conclusive in 1132 patients, with a diagnostic accuracy of 99%. Our workup permitted the sequential endoscopic‐laparoscopic treatment of cholecystocholedocholithiasis in 162 cases. During the follow‐up period residual CBD stones were detected in four patients. Our diagnostic workup showed that routine IVC exposes the population to a large radiation burden, and the cost is high for the small number of patients who benefit. Moreover, it does not seem helpful in reducing the incidence of CBD injuries during LC.
Hepatic Vein Reconstruction by External Iliac Vein Graft Using Vascular Clips
Authors: Kaneoka Yuji , Yamaguchi Akihiro , Isogai Masatoshi , Hori Akihiro 
Published: August 2002

AbstractThe utility of hepatic vein reconstruction following resection of segments VII and VIII plus the right hepatic vein (RHV) is still controversial. The purpose of this study was to investigate the surgical benefits of hepatic vein reconstruction using stapled vascular clips and the draining area of hepatic vein using angiographic computed tomography (CT) to determine strict indications for hepatic vein reconstruction. Five patients underwent RHV reconstruction by external iliac vein graft using stapled vascular clips (VCS clips) following resection of segments VII and VIII, regardless of whether an inferior right hepatic vein (IRHV) was present. In eight other patients CT during arterial portography (CTAP) under temporary RHV occlusion using a balloon catheter was performed to determine the drainage area of the RHV. Operating times were 240 to 400 minutes (mean 336 ± 59 minutes), and the mean hepatic vein reconstruction time was 26 ± 5 minutes. There were no complications related to the surgery. Follow‐up examinations showed patency of the graft in all cases; three patients are still alive with long‐term graft patency of 10 to 24 months. CTAP under RHV occlusion demonstrated that segment VI and part of segment V were almost hypoattenuated in cases of absent or small IRHV, although those segments were hyperattenuated in thick IRHV and RHV‐IRHV communicating patients. In conclusion, this anastomotic technique using vascular clips resulted in sound patency of the graft, which was accomplished by a simple technique. Preoperative CTAP with the RHV occlusion method can be useful for determining whether hepatic vein reconstruction is necessary.
External Fixation of the Lumbar Spine in a Canine Model
Authors: Walker Tamara M. , Pierce William A. , Welch Robert D. 
Published: August 2002

Objective— To compare the mechanical properties of two types of external skeletal fixation of the lumbar spine with polymethylmethacrylate (PMMA)/Steinmann pin fixation in a canine unstable spine model.Study design— Cadaver study.Sample population— Lumbar spines of 17 mature large‐breed dogs.Methods— Spine stiffness (N‐m/deg) in flexion, extension, and rotation under physiological loading conditions and spine strength (N‐m) in flexion were determined. Spines were destabilized at L3‐L4, instrumented and retested. Fixation techniques included four‐pin PMMA (PMMA4), eight‐pin PMMA (PMMA8), eight‐pin biplanar type I external skeletal fixator (ESF) (SK), and eight‐pin spinal arch ESF (ARCHES).Results— All fixation groups were as stiff as intact spines in extension and rotation and were significantly stiffer in flexion. In flexion, both PMMA8 and ARCHES were significantly stiffer than SK, and PMMA8 was significantly stiffer than PMMA4. In rotation, PMMA8 and ARCHES were significantly stiffer than SK, and in flexion to failure, PMMA8 and ARCHES were significantly stiffer than PMMA4.Conclusions— External skeletal spinal fixation (ESSF) has mechanical properties comparable to more commonly used PMMA/pin internal fixation techniques.Clinical relevance— External fixation of the canine spine has several potential advantages over internal fixation including minimal dissection for pin placement, the ability to span affected vertebrae with placement of implants distant from the site of injury, postoperative adjustability, and complete removal of implants after healing. This study supports the biomechanical stability ESSF of the canine lumbar spine. Further studies are indicated to evaluate zones of consistently safe and secure placement of pins and clinical efficacy.
Effects of Degree of Acetabular Rotation after Triple Pelvic Osteotomy on the Position of the Femoral Head in Relationship to the Acetabulum
Authors: Tomlinson James L. , Cook James L. 
Published: August 2002

Objective—To assess the effect of rotating the acetabulum 20° and 30° on percent coverage (PC) of the femoral head by the acetabulum and Norberg angle (NA) after triple pelvic osteotomy (TPO).Study design—Retrospective study.Animal Population—Fifty‐six client‐owned dogs.Methods—PC and NA were measured from preoperative, immediate postoperative, first recheck, and second recheck radiographs to compare the effects of 20° and 30° of rotation of the acetabulum after TPO for treatment of hip dysplasia.Results—Within the 20° rotation group, PC and NA values were significantly greater at each subsequent evaluation time starting at the preoperative measurement except for NA between the first and second recheck times. Within the 30° rotation group, PC and NA values were significantly greater at each subsequent evaluation time starting at the preoperative measurement except for PC and NA between the first and second recheck times. No significant differences between the 20° and 30° rotation groups were found at any corresponding times for either PC or NA.Conclusions—Acetabular rotation of 20° provided the same degree of improvement in acetabular femoral head coverage as 30° of rotation after TPO at the immediate postoperative, first recheck, and second recheck evaluation times.Clinical relevance—Based on PC and NA, 20° rotation of the acetabulum provides as much benefit as 30° of acetabular rotation when performing a TPO.