Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Dec 2008
Case ReportsAnaphylactic shock caused by nonruptured hydatid cyst of the liver.
Anaphylactic reaction is a known complication of cystic hydatid disease, a parasitic infestation caused by the larval/cyst stage of Echinococcus granulosus that usually happens after trauma or during interventions. Nontraumatic leakage of cyst contents into the blood circulation is an uncommon triggering factor for anaphylaxis, which is rarely reported in available literatures. We describe anaphylaxis in a 47-year-old lady who was admitted for evacuation of hydatid cyst of the liver. ⋯ However, the condition was controlled immediately, and she was taken to the operating theater for surgery. As she had not sustained any trauma in the ward and operative exploration did not reveal any macroscopic rupture, we assumed that her problem must have been caused by nontraumatic spillage of cyst material into circulation. Although the condition is not common, one should bear in mind the possibility of such diagnosis in all patients with Eccinococcous infection who develop shock especially in areas where this infestation is endemic.
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J. Gastrointest. Surg. · Dec 2008
After laparoscopic Heller myotomy, do emergency department visits or readmissions predict poor long-term outcomes?
Laparoscopic Heller myotomy is a first-line treatment for achalasia. To improve outcomes after myotomy and to determine if poor early results predict later outcomes, emergency department (ED) visits and readmissions within 60 days following laparoscopic Heller myotomy were studied. ⋯ ED visits and readmissions are infrequent following laparoscopic Heller myotomy. ED visits were generally due to complaints related to achalasia or edema after myotomy, while readmissions were generally related to complications of operative intervention or chronic ill health. Despite ED visits or readmissions early after myotomy, symptoms of achalasia are well palliated by myotomy long-term.
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J. Gastrointest. Surg. · Nov 2008
Comparative StudyManagement of preoperatively suspected choledocholithiasis: a decision analysis.
The management of symptomatic or incidentally discovered common bile duct (CBD) stones is still controversial. Of patients undergoing elective cholecystectomy for symptomatic cholelithiasis, 5-15% will also harbor CBD stones, and those with symptoms suggestive of choledocholithiasis will have an even higher incidence. Options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ERCP/ES) followed by laparoscopic cholecystectomy, laparoscopic cholecystectomy with intraoperative cholangiogram (LC/IOC), followed by either laparoscopic common bile duct exploration (LCBDE) or placement of a common bile duct double-lumen catheter with postoperative management. The purpose of this analysis was to determine the optimal management of such patients. ⋯ LCBDE has lower morbidity and mortality rates compared to preoperative ERCP/ES in the management of patients with suspected CBD stones even if the chance of CBD stones reaches 100%. Using a common duct double-lumen catheter may be considered if LCBDE is not feasible and the chance of CBD stone is less than 65%.
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J. Gastrointest. Surg. · Nov 2008
Review Meta AnalysisRole of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis.
The role of prophylactic antibiotics in laparoscopic cholecystectomy in low-risk patients is controversial. We conducted a meta-analysis to evaluate the efficacy of prophylactic antibiotics in low-risk patients (those without cholelithiasis or cholangitis) undergoing laparoscopic cholecystectomy. ⋯ Prophylactic antibiotics do not prevent infections in low-risk patients undergoing laparoscopic cholecystectomy.
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J. Gastrointest. Surg. · Nov 2008
Comparative StudyNodal microinvolvement in patients with carcinoma of the papilla of vater receiving no adjuvant chemotherapy.
To assess the prognostic significance of nodal microinvolvement in patients with carcinoma of the papilla of Vater. ⋯ The influence of occult tumor cell dissemination in LNs of patients with histologically proven carcinoma of the papilla of Vater supports the need for further tumor staging through immunohistochemistry.