Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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We report results from a single surgeon's 10-year team experience with laparoscopic total abdominal colectomy. We review our series, which includes a large subgroup of ill, high-risk patients with acute colitis requiring urgent surgery. From 1993 to 2003, we performed 65 laparoscopic total abdominal colectomies. ⋯ Subsequent operations, including restorative proctectomy, were also performed laparoscopically. Laparoscopic total abdominal colectomy is technically challenging and requires a team approach but offers patients significant benefit in length of stay and surgical recovery. This operation can be effectively used with minimal morbidity in difficult, ill patients requiring urgent surgery.
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J. Gastrointest. Surg. · May 2005
Comparative StudyIs routine placement of surgical drains necessary after elective hepatectomy? Results from a single institution.
Routine drainage is no longer used after many major abdominal procedures. However, the role of routine surgical drainage after hepatic resection is unclear. Of the two randomized trials published, one concluded drainage is unnecessary after hepatectomy, and another concluded it could be used after major resections only. ⋯ Multivariate analysis showed that intraoperative blood loss of 2000 ml or greater (relative risk [RR], 1.57; 95% confidence interval [CI], 1.39-1.75; P < 0.01), number of segments resected (RR, 1.4; 95% CI, 1.21-1.89; P < 0.01), and presence of steatosis/fibrosis or cirrhosis (RR, 1.6; 95% CI, 1.01-2.1; P < 0.05) to be predictive of postoperative complications. The presence of a surgical drain was not predictive of complications. Routine surgical drainage after elective hepatectomy is not necessary.
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J. Gastrointest. Surg. · May 2005
Case ReportsMirizzi syndrome and gallstone ileus: an unusual presentation of gallstone disease.
We discuss the case of a man with an unusual complication of gallstone disease. An 85-year-old patient presented to the emergency department with a 3-week history of abdominal pain in the right upper abdominal quadrant. Thoracoabdominal radiography demonstrated that the whole extrahepatic biliary tree, including the common bile duct, common hepatic duct, gallbladder, and left and right hepatic ducts, were visibly delineated by air. ⋯ This patient seems to have developed initially a cholecystohepatic fistula. Due to the acute inflammatory process, the stone eroded through the gallbladder wall and into the gastric antrum, passing from the antrum into the small bowel, where it became impacted. We suggest that the natural history of Mirizzi syndrome does not end with a cholecystobiliary fistula but that the continuous inflammation in the triangle of Calot may result in a complex fistula involving not only the biliary tract but also the adjacent viscera.
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J. Gastrointest. Surg. · Mar 2005
Review Comparative StudyCurrent management of acute pancreatitis.
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J. Gastrointest. Surg. · Mar 2005
Comparative StudyThe mechanism of microsatellite instability is different in synchronous and metachronous colorectal cancer.
MLH1 promoter hypermethylation has been described as the primary mechanism for high-frequency microsatellite instability (MSI-H) in sporadic colorectal cancers (CRCs). The underlying molecular mechanism for microsatellite instability (MSI) in synchronous and metachronous CRCs is not well described. A total of 33 metachronous CRC patients and 77 synchronous CRC patients were identified from 2884 consecutive patients undergoing cancer surgery in an academic center. ⋯ Although MSI occurred with equal frequency among patients with synchronous and metachronous CRCs, the underlying mechanism for MSI was different. Observed differences in MLH1 promoter hypermethylation and patient characteristics suggest most MSI-H synchronous CRCs in our population were sporadic in origin. In contrast, more MSI-H metachronous CRCs were associated with patient and tumor characteristics suggestive of underlying hereditary nonpolyposis CRC.