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1.
Ersoy E Ozturk V Yazgan A Ozdogan M Gundogdu H 《The Journal of surgical research》2008,147(1):148-152
PURPOSE: The aim of the present study was to evaluate the efficacy of an absorbable polylactic acid film barrier in preventing postoperative intra-abdominal adhesions, inflammation, and fibrosis in an animal model. METHODS: Thirty Wistar albino rats were divided into treatment and control groups. All rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. The treatment group had a polylactic acid film barrier placed between the cecal and abdominal injured surfaces while control group received nothing. The animals were sacrificed on postoperative day 21. Three observers graded the intra-abdominal adhesions and resected specimens for histological examination of fibrosis and inflammation. Fibrosis, inflammation, and adhesions were graded using a quantitative scoring system. RESULTS: The treatment group showed significantly less adhesions and inflammation (P < 0.05), while there was no significant difference in the amount of fibrosis. Statistical correlations between adhesion-inflammation, adhesion-fibrosis, and inflammation-fibrosis were also significant (P < 0.05). CONCLUSIONS: Placement of polylactic acid film barriers between injured surfaces is associated with a significantly reduced rate of postoperative adhesions and inflammation. This may be a promising result for reducing the morbidity and costs related to postoperative adhesions. 相似文献
2.
Gungor B Malazgirt Z Topgül K Gök A Bilgin M Yürüker S 《The Indian journal of surgery》2010,72(6):475-480
After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to mesh had not been clarified.
We examined adhesion formation specific to the fixation material in rats. We designed an experimental laparoscopy setup, and
placed four intraperitoneal fixation materials on the peritoneum of rats without a mesh graft. Another group of researchers
documented the incidence and intensity of postoperative adhesion formation. The adhesion scores for the nickel-titanium anchor
were significantly greater than those for polylactic acid (p = 0.004), a titanium tacker (p < 0.0001), and fibrin glue (p < 0.0001).
No adhesions occurred in the fibrin glue group. Fibrin glue is the preferred fixation material because it produced no postoperative
adhesions. The nickel-titanium anchor produced heavy adhesions but may be applicable for recurrent hernia cases and in patients
with thin abdominal walls. 相似文献
3.
Rizal Lim Jonathan M. Morrill Ryan C. Lynch Karen L. Reed Adam C. Gower Susan E. Leeman Arthur F. Stucchi James M. Becker 《Journal of gastrointestinal surgery》2009,13(1):35-42
Introduction Intra-abdominal adhesions are a significant source of postoperative morbidity. Bioresorbable barriers composed of hyaluronic
acid and carboxymethylcellulose (HA/CMC) reduce adhesion formation by physically separating injured or healing peritoneal
surfaces. To assess whether the efficacy of a physical barrier can extend beyond the site of application, we evaluated the
effectiveness of an HA/CMC barrier in preventing adhesions distal to the site of placement.
Methods Adhesions were induced in rats by creating peritoneal ischemic buttons on either side of a midline incision. An HA/CMC barrier
(Seprafilm™ Genzyme) was intraoperatively placed either under the midline incision, unilaterally over half the ischemic buttons,
or bilaterally over all ischemic buttons. Control buttons received no HA/CMC. On day 7 adhesions were scored. In similar experiments,
peritoneal fluid was collected at 24 h to assess the effects of HA/CMC on tissue plasminogen activator activity.
Results Placement of HA/CMC under the midline incision did not reduce adhesion formation to distal ischemic buttons (72 ± 7%) compared
to controls (80 ± 8%). Unilateral placement of HA/CMC significantly (p < 0.05) reduced adhesion formation to those ischemic buttons over which the barrier was applied (35 ± 7%) compared to both
contralateral (83 ± 9%) and control (80 ± 8%) ischemic buttons. The bilateral application of HA/CMC also significantly (p < 0.05) reduced adhesion formation to all ischemic buttons compared to controls (22 ± 7% vs. 66 ± 7%, respectively). HA/CMC
did not affect peritoneal tPA activity.
Conclusions Effective adhesion reduction by the physical barrier HA/CMC appears to be limited to the site of application in this rat model.
Despite the presence of a bioresorbable membrane at predicted sites of adhesion formation in the peritoneal cavity, adhesions
readily form to distal unprotected sites.
Presented, in part, at the 49th Annual Meeting of The Society for Surgery of the Alimentary Tract, May 17–21, 2008, San Diego,
CA, USA
This work was supported in part, by the Smithwick Endowment Fund to the Department of Surgery at Boston University School
of Medicine. 相似文献
4.
An Assessment of the Effects of Two Types of Bioresorbable Barriers to Prevent Postoperative Intra-Abdominal Adhesions in Rats 总被引:2,自引:0,他引:2
Purpose This study assessed and compared the efficacy of two types of bioresorbable membranes in the prevention of postoperative adhesion
under clean contaminated and bacterial peritonitis conditions using a cecal ligation and puncture model in rats.
Methods Wistar albino rats (n = 72) were divided into six groups. Bacterial peritonitis was induced using a cecal ligation and puncture model in groups
2, 4, and 6. Groups 1, 3, and 5 served as controls for clean contaminated procedures in the absence of bacterial peritonitis.
Groups 1 and 2 were the untreated clean contaminated and bacterial peritonitis groups and served as controls for the effect
of the bioresorbable membranes in each condition. In groups 3 and 4, a 1.5 × 3 cm USP glycerol/sodium hyaluronate/carboxymethylcellulose
membrane was wrapped around the cecal resection area and a 2 × 4 cm membrane was left under the incision. The oxidized regenerated
cellulose membrane was similarly applied in groups 5 and 6. Four weeks later, the adhesions were evaluated. In addition, fibrosis
and inflammation were observed histopathologically.
Results Adhesion development (P = .008), fibrosis (P = .008), and inflammation (P = .0001) differed among the groups. Both materials increased adhesion formation in the bacterial peritonitis condition. Increased
fibrotic activity was detected in all material-applied groups under both conditions. In addition, more inflammation was detected
in the groups that received the application of a material, especially in the presence of bacterial peritonitis.
Conclusion Neither material prevented adhesions in clean contaminated conditions. Moreover, they increased adhesion formation in bacterial
peritonitis. 相似文献
5.
G. Karadeniz Cakmak O. Irkorucu B. H. Ucan A. U. Emre B. Bahadir C. Demirtas O. Tascilar K. Karakaya S. Acikgoz G. Kertis H. Ankarali H. Pasaoglu M. Comert 《Journal of gastrointestinal surgery》2009,13(9):1707-1716
Background Simvastatin is a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor commonly known as a cholesterol-lowering drug with
additional pleiotropic effects. Also, it is demonstrated that it prevents postoperative peritoneal adhesions in rat. This
study was designed to assess its effects on the healing process of colonic anastomosis.
Methods Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was
treated with simvastatin and the control group received only tap water instead. The rats were killed 3 and 7 days postoperatively.
Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment
were performed: bursting pressure, hydroxyproline content, histopathology, and biochemical analysis.
Results Compared to the control group, simvastatin-treated rats displayed a higher bursting pressure (p < 0.001) and anastomotic hydroxyproline content (p < 0.05). Simvastatin treatment leads to a significant decrease in malondealdehyde levels (p < 0.05) and increase in paraoxonase activity (p < 0.001) at both time points. Histopathological analysis revealed that simvastatin administration leads to a better anastomotic
healing in terms of reepithelialization, decreased granuloma formation, reduced ischemic necrosis, and inflammatory infiltration
to muscle layer.
Conclusion Clinically relevant doses of simvastatin do not have a negative impact on colonic anastomosis but improve intestinal wound
healing in rats.
Oral presentation at the “Turkish National Surgery Congress”, Antalya, Turkey, May 2008. 相似文献
6.
Emre Ergul Yigit Mehmet Ozgun Gulten Kiyak Gonca Barit Ozgun Birol Korukluoglu Ahmet Kusdemir 《Journal of gastrointestinal surgery》2009,13(4):798-803
Background Enoxaparin is an important molecule which had been using in prophylaxis and treatment of deep venous thrombosis. Also, it
is showed that it prevents postsurgical peritoneal adhesions in rats. It is aimed to evaluate its effects on gastrointestinal
wound healing.
Methods Thirty Wistar albino rats were divided into three groups as control, subcutan, and intraperitoneal enoxaparin groups. Left
colon anastomoses were performed. On postoperative seventh day, anastomotic healing was evaluated by measuring anastomotic
bursting pressure, tissue hydroxyproline levels, and histopathological examination.
Results The anastomotic bursting pressure was highest in subcutan enoxaparin group (p < 0.001), intraperitoneal enoxaparin group (p < 0.01) came the second, and the control group has the worst value. The hydroxyproline results were found nearly similar
to the bursting pressure values (subcutan (p < 0.001) > intraperitoneal (p < 0.05) > control). Neovascularization in subcutan group (p < 0.001) has a statistically significant difference to other groups.
Conclusion Enoxaparin did not interfere with colonic anastomotic resistance but improved the intestinal wound healing. 相似文献
7.
Hirasaki Y Fukunaga M Kidokoro A Hashimoto A Nakamura T Tsujimoto H Hagiwara A 《Surgery today》2011,41(7):970-977
Purpose
Postoperative intra-abdominal adhesion sometimes causes significant morbidity. The aim of this study was to compare the efficacy of our newly developed antiadhesive material, alginate flakes, to the most commonly used combination of hyaluronic acid and carboxymethyl cellulose film. 相似文献8.
Comparison of Prosthetic Materials in Incisional Hernia Repair 总被引:5,自引:0,他引:5
Demir U Mihmanli M Coskun H Dilege E Kalyoncu A Altinli E Gunduz B Yilmaz B 《Surgery today》2005,35(3):223-227
Purpose Incisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model.Methods We made a full-thickness 1.5 × 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 × 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings.Results The mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05).Conclusion Although there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions. 相似文献
9.
Nishimaki S Shima Y Sato M An H Fujita S Iwasaki S Horiguchi H Seki K Yokota S 《Pediatric nephrology (Berlin, Germany)》2011,26(12):2185-2191
It is important to identify premature infants with prenatal inflammation as it contributes to short- and long-term complications.
Our object was to study how prenatal inflammation affects the urinary β2-microglobulin (β2-MG) level. Preterm neonates were divided based on the presence of chorioamnionitis (CAM) into the CAM (n = 100) and non-CAM groups (n = 117). These were further subdivided into five groups each: 30 preterm neonates of 23–26; 42 neonates of 27–28; 54 neonates
of 29–30; 51 neonates of 31–32; and 40 neonates of 33–34 weeks’ gestation. The urinary β2-MG level within 48 h of birth was significantly higher in the CAM group than in the non-CAM group among the neonates of 23–26 weeks’
gestation (18.3 ± 6.9 vs 10.0 ± 5.6 × 104 μg/gCr, p = 0.0018) and the neonates of 27–28 weeks’ gestation (16.2 ± 10.8 vs 8.8 ± 3.3 × 104 μg/gCr, p = 0.0101). However, there was no difference in urinary β2-MG level between the CAM and the non-CAM group among the neonates ≥ 29 weeks ’gestation. Moreover, the elevated urinary β2-MG level in the neonates ≤ 28 weeks ’ gestation with CAM had disappeared by 1 week after birth. The reasons for the increase
in urinary β2-MG level within 48 h of birth in very preterm neonates (≤ 28 weeks’ gestation) with CAM are believed to be not only prematurity,
but also prenatal inflammation. It is suggested that the urinary β2-MG level during the early postnatal period can identify prenatal inflammation. 相似文献
10.
de Freitas PM Rapozo-Hilo M Eduardo Cde P Featherstone JD 《Lasers in medical science》2010,25(2):165-170
This study evaluated the effect of different parameters of erbium, chromium:yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser
irradiation on enamel mineral loss in a simulated caries model. Forty-five enamel samples obtained from third molar teeth
(3 mm× 3 mm) were randomly divided into five groups (n = 9): G1—Er,Cr:YSGG laser at 0.25 W, 20 Hz, 2.8 J/cm2; G2—Er,Cr:YSGG laser at 0.50 W, 20 Hz, 5.7 J/cm2; G3—Er,Cr:YSGG laser at 0.75 W, 20 Hz, 8.5 J/cm2; G4—sodium fluoride (NaF) dentifrice (positive control); G5—no treatment (negative control). After irradiation, the samples
were submitted to 2 weeks of pH cycling. After the acid challenge, the samples were assessed by cross-sectional microhardness
at different depths from the enamel surface. Analysis of variance (ANOVA) and Student–Newman–Keuls tests were performed (α = 5%).
The percentage of lesion inhibition for each group was: G1 37%; G2 38%; G3 64%, and G4 50.5%. Regarding the relative mineral
loss values (micrometers × volume percent), groups G1 (1,392 ± 522) and G2 (1,292 ± 657) did not differ significantly from
each other, but both had higher values than group G3 (753 ± 287); the groups irradiated with Er,Cr:YSGG laser did not differ
from group G4. Although the findings of the study revealed that Er,Cr:YSGG laser irradiation at 8.5 J/cm2 can be an alternative for the enhancement of the enamel’s resistance to acid, lower energy densities also produced a cariostatic
potential comparable to the use of fluoride dentifrice. 相似文献
11.
Ansgar M. Chromik Andreas Meiser Janine Hölling Dominique Sülberg Adrien Daigeler Kirsten Meurer Heike Vogelsang Matthias H. Seelig Waldemar Uhl 《Journal of gastrointestinal surgery》2009,13(7):1358-1367
Background Tertiary peritonitis (TP) is defined as a severe recurrent or persistent intra-abdominal infection after adequate surgical
source control of secondary peritonitis (SP). The aim of this study was to analyze the characteristics of patients with SP
who will further develop TP in order to define early diagnostic markers for TP.
Study Design Over a 1-year period, all patients on the surgical intensive care unit (ICU) with SP were prospectively assessed for the development
of TP applying the definition of the ICU consensus conference. The Mannheim Peritonitis Index (MPI), C-reactive protein (CRP)
and Simplified Acute Physiology Score II (SAPS II) were assessed at the initial operation (IO) that was diagnostic for SP
and in the postoperative period.
Results Among 69 patients with SP, 15 patients further developed TP, whereas 54 patients did not develop TP. Compared to SP, patients
with transition to TP had significantly higher MPI at IO (28.6 vs. 19.8; p < 0.001), relaparotomy rate (2.00 vs. 0.11; p < 0.001), mortality (60% vs. 9%; p < 0.001), duration of ICU stay (14 vs. 4 days; p < 0.005), as well as SAPS II (45.1 vs. 28.4; p < 0.005) and CRP (265 mg/dL vs. 217 mg/dL; p < 0.05) on the second postoperative day after IO.
Conclusions The MPI at IO as well as CRP and SAPS II at the second postoperative day helps to identify patients at risk for tertiary peritonitis.
This paper was presented by the principal author (A.M. Chromik) at the “Papers Session GS71 Trauma and Critical Care” of the
94th Annual Clinical Congress of the American College of Surgeons, October 12–16, 2008, San Francisco, (Abstract # NP2008-1246).
Ansgar M. Chromik and Andreas Meiser contributed equally to this publication. 相似文献
12.
Parmanand Prasad Om Tantia Nirmal M Patle Shashi Khanna Bimalendu Sen 《The Indian journal of surgery》2011,73(6):403-408
The laparoscopic ventral hernia repair with preperitoneal placement of mesh minimizes the complications related to the intraperitoneal
position of mesh and fixating devices. It allows safe use of conventional and less expensive polypropylene mesh. The prospectively
collected data of 68 patients who underwent laparoscopic transabdominal preperitoneal mesh hernioplasty, for different types
of ventral hernias between January 2005 and December 2009 was retrospectively reviewed. The study included 68 patients, 16
males and 52 females with a mean age 51.1 ± 11.1 years (range 23–74 years). Most of the hernias (67.6%) were in the midline
position. The mean size of the defect was 30.8 ± 24.4 cm2 (range, 4–144 cm2) and the mean mesh size was 237.8 ± 66.8 cm2 (range,
144–484 cm2). The mean operating time was 96.7 ± 16.7 min (range 70–150 min). All repairs were done with polypropylene mesh.
The mean postoperative hospital stay was 1.5 ± 0.6 days (range, 1–4 days). Nineteen patients (27.9%) suffered from postoperative
complications. Four patients (5.8%) were detected to have seroma formation. There were two recurrences (2.9%). The mean follow
up was 22.7 ± 13.4 months (range, 6–48 months). The laparoscopic preperitoneal ventral hernia repair with polypropylene mesh
is cheaper and has acceptable postoperative outcomes. Peritoneal coverage of the mesh not only acts as a barrier between mesh
and bowel and thereby prevents adhesions, it also provides an additional security of fixation. This is a safe and feasible
option of ventral hernia repair in expert hands. However, for proper validation of these conclusions a long term prospective
clinical trial is required. 相似文献
13.
Lazzati A Polliand C Porta M Torcivia A Paolino LA Champault G Barrat C 《Obesity surgery》2011,21(12):1859-1863
Anterior fixation via a gastro-gastric suture in laparoscopic adjustable gastric banding (LAGB) is commonly performed to prevent
band-related complications. However, the necessity of this common technique has never been proven. Not fixing the band would
be time sparing and would reduce adhesions on the stomach and probably make revisional surgery easier. This study was conceived
as a 3-year randomised clinical trial to test the safety and efficacy of the non-fixation technique. From December 2006 to
December 2007, 81 patients undergoing LAGB were randomly distributed into two groups: group A, with gastro-gastric sutures
(n = 41) and group B, without gastro-gastric fixation (n = 40). The two groups were equivalent regarding initial body mass index (BMI), age and sex ratio. The main outcome was postoperative
complications and secondary outcomes were operative time and weight loss expressed by the percentage of excess BMI loss (%EBMIL).
All patients were prospectively followed up for 2 years. The mean preoperative BMI was 42.5 kg/m2 (35–56). All patients were
available for follow-up at 2 years. The mean overall preoperative time was 82 ± 20 min for the fixation group and 72 ± 20 min
for the non-fixation group (p = 0.13). The mean hospital stay was 4.1 ± 1.5 days (no significant difference between the two groups). The 2-year %EBMIL
was 35.9 for group A and 39.4 for group B (p = NS). The mean BMI at 2 years was 36.3 and 36.1, respectively, with no statistical difference. We observed three early band
slippages in the non-fixation group and none in the fixation group. Three bands were removed during the second year of follow-up
for causes other than band slippage (no significant difference between the two groups). This study was interrupted before
a statistical significance could be reached, under the general agreement of all participating surgeons, because of the three
unexpected early band slippages. For the patients who did not suffer from this complication, we did not observe any differences
between the two groups in terms of late complications and weight loss. The operative time was shorter in the non-fixation
group. This randomised clinical trial suggests that care should be taken when not fixating the LAGB because of the risk of
early postoperative band slippage. We suggest that fixing the LAGB by gastro-gastric sutures should remain common practice. 相似文献
14.
M. Chousterman D. Heysselaer S. M. Dridi F. Bayet B. Misset L. Lamard A. Peremans C. Nyssen-Behets S. Nammour 《Lasers in medical science》2010,25(6):855-859
The purpose of this study was to compare the tensile bond strength of composite resin bonded to erbium:yttrium–aluminium–garnet
(Er:YAG) laser-prepared dentine after different durations of acid etching. The occlusal third of 68 human third molars was
removed in order to expose the dentine surface. The teeth were randomly divided into five groups: group B (control group),
prepared with bur and total etch system with 15 s acid etching [37% orthophosphoric acid (H3PO4)]; group L15, laser photo-ablated dentine (200 mJ) (laser irradiation conditions: pulse duration 100 μs, air–water spray,
fluence 31.45 J/ cm2, 10 Hz, non-contact hand pieces, beam spot size 0.9 mm, irradiation speed 3 mm/s, and total irradiation time 2 x 40 s); group
L30, laser prepared, laser conditioned and 30 s acid etching; group L60, laser prepared, laser conditioned and 60 s acid etching;
group L90, laser prepared, laser conditioned and 90 s acid etching. A plot of composite resin was bonded onto each exposed
dentine and then tested for tensile bond strength. The values obtained were statistically analysed by analysis of variance
(ANOVA) coupled with the Tukey–Kramer test at the 95 % level. A 90 s acid etching before bonding showed the best bonding value
(P < 0.05) when compared with all the other groups including the control group. There is no significance difference between
other groups, nor within each group and the control group. There was a significant increase in tensile bond strength of the
samples acid etched for 90 s. 相似文献
15.
Background We studied the usefulness of Bovine Pericardial strips (BPS) as a buttress in the prevention of complications from the gastric
staple-line in laparoscopic sleeve gastrectomy (LSG).
Methods LSG was carried out in 18 pigs. Resection of the stomach was performed with 4.8-mm/ 30-mm linear stapler either without (Control Group – n = 9) or with BPS (Buttress Group – n = 9). Intra- and postoperative blood losses were assessed. Leaks were evaluated with methylene blue
test intra-operatively and then clinically. The animals were sacrificed 2 weeks after surgery and the abdominal cavity was
evaluated for fluid collections and adhesions, and the burst pressure of the stomach was measured and histopathological study
of the staple-line was performed. Student t-test was used for statistical analysis.
Results No leaks were detected except for one small subclinical leak in the buttress group. Internal ulcers at the staple-line were
seen more frequently in the Buttress group (6 vs. 3, not significant). There was no significant difference between the two
groups with regards to operative time (65.3 ± 14.2 min, 69.7 ± 12.8 min), intra-operative bleeding (9.6 ± 2.2 ml, 8.2 ± 1.5 ml),
postoperative hemoglobin levels (11.3 ± 1.9 g%, 11.8 ± 2.2 g%), and burst pressure (152.6 ± 23.5 mmHg, 161.2 ± 15.8 mmHg)
for the Control and Buttress groups respectively. More intense adhesions and inflammatory response were observed in the Buttress
Group.
Conclusions In this experimental model, the use of bovine pericardium as a staple-line buttress in LSG was easy and safe; however, it
did not decrease the occurrence of complications. 相似文献
16.
Background Restrictive bariatric operations are efficient with low morbidity but entail high rate of failure on follow up of several
years. We present our experience in laparoscopic revision of patients who previously underwent silastic ring vertical gastroplasty
(SRVG) into laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).
Methods Data on 12 patients who underwent revisional operations after SRVG was prospectively collected. Six patients underwent LRYGB
and six patients underwent LSG. The pathogeneses for failures of SRVG were disruption of staple line, enlargement of gastric
pouch, and opening of the ring.
Results The average age and body mass index (BMI) were 39 and 43, respectively, in the LSG group versus average age and BMI of 39
and 45, respectively, in the LRYGP group (p = 0.45 and p = 0.35, respectively). The average operative time were 206 and 368 min in the LSG and LRYGB groups, respectively (p < 0.01). There were five postoperative complications among LSG group versus two complications in LRYGB group (p < 0.01). Patients who underwent LSG suffered from the following complications: staple line leak in two patients, intra-abdominal
hematoma in one patient, intra-abdominal collection in one patient, and gastric outlet obstruction in one patient. Anastomotic
leak and wound infection were the complications seen among patients underwent LRYGB. All complications were treated conservatively
without necessitating immediate reoperations. Follow-up has shown adequate reduction of body weight and improved quality of
life in both groups of patients.
Conclusions Revisional bariatric operation is a challenging laparoscopic procedure with higher morbidity compared to primary bariatric
operations. Morbidity of LSG compared to LRYGB as a revisional procedure for SRVG is significantly higher. 相似文献
17.
Jun Huang Bin-Kui Li Gui-Hua Chen Jin-Qing Li Ya-Qi Zhang Guo-Hui Li Yun-Fei Yuan 《Journal of gastrointestinal surgery》2009,13(9):1627-1635
Objective The present study aimed to evaluate the long-term outcomes and prognostic factors of elderly patients with hepatocellular
carcinoma (HCC) undergoing hepatectomy.
Material and Methods From January 1983 to December 2006, 2,283 patients with HCC received hepatectomy in Sun Yat-sen University Cancer Center.
The clinicopathological data and treatment outcomes of 67 elderly HCC patients (elderly group, ≥70 years of age) and 268 patients
(control group, <70 years of age) who were selected randomly from the 2216 younger patients were compared retrospectively.
Results The elderly HCC patients had lower hepatitis B surface antigen-positive rate (P < 0.001), lower rate of marked α-fetoprotein elevation (P = 0.004), higher infection rate of hepatitis C virus (P = 0.010), more preoperative comorbidities (P < 0.001), higher rate of tumor encapsulation (P = 0.040), and better overall survival rate (P = 0.017); whereas there were no significant differences between these two groups in other factors, including gender ratio,
liver function, accompanying cirrhosis, pathological tumor–node–metastasis (pTNM) staging, satellite nodules, vascular invasion,
tumor rupture, resection margin, intraoperative blood loss, incidence of postoperative complications, hospital mortality,
and disease-free survival rate. Multivariate analysis showed that pTNM staging was an independent prognostic factor of long-term
survival in elderly patients with HCC.
Conclusion HCC in the elderly was less HBV-associated, less advanced, and less aggressive. Hepatectomy for selected elderly patients
with HCC possibly have a better curative effect compared with younger patients. For the elderly patients without preoperative
comorbidities or with controlled comorbidities, hepatectomy is a safe and effective treatment. pTNM staging is the only independent
predictor of postoperative overall survival in elderly HCC patients. 相似文献
18.
Kwinta P Klimek M Drozdz D Grudzień A Jagła M Zasada M Pietrzyk JJ 《Pediatric nephrology (Berlin, Germany)》2011,26(7):1095-1103
We assessed the long-term renal complications in a regional cohort of extremely low birth weight (ELBW) children born in 2002–2004.
The study group, comprising 78 children born as ELBW infants (88% of the available cohort), was evaluated with measurement
of serum cystatin C, urinary albumin excretion, renal ultrasound, and 24-h ambulatory blood pressure measurements. The control
group included 38 children born full-term selected from one general practice in the district. Study patients were evaluated
at a mean age of 6.7 years, and had a median birthweight of 890 g (25th–75th percentile: 760–950 g) and a median gestational
age of 27 weeks (25th–75th percentile: 26–29 weeks). Mean serum cystatin C levels were significantly higher (0.64 vs. 0.59 mg/l;
p = 0.01) in the ELBW group. Hypertension was diagnosed in 8/78 ELBW and 2/38 of the control children (p = 0.5). Microalbuminuria (>20 mg/g of creatinine) was detected only in five ELBW children (p = 0.17). The mean renal volume was significantly lower in the ELBW group (absolute kidney volume 81 ml vs. 113 ml; p < 0.001, relative kidney volume 85 vs. 97%; p < 0.001). Abnormally small kidneys (<2/3 of predicted size) were detected in 19 ELBW and four control children (p = 0.08). Multivariate logistic regression revealed that the only independent risk factor for renal complications was weight
gained during neonatal hospitalization (odds ratio: 0.67; 95% confidence interval: 0.39–0.94). Serum cystatin C and kidney
volume are significantly lower in school-age ELBW children. It is important to include systematic renal evaluation in the
follow-up programs of ELBW infants. 相似文献
19.
Christopher Hughes Michael G. Hurtuk Karen Rychlik Margo Shoup Gerard V. Aranha 《Journal of gastrointestinal surgery》2008,12(11):1822-1829
Introduction Previous studies identified an association between dilated pancreatic and biliary ducts and lower rates of pancreatic leak
after pancreaticoduodenectomy, but it remains unclear whether elevated liver function tests are also associated with lower
rates of complications. The purpose of this study was to determine if preoperative liver function tests are associated with
postoperative complications.
Materials and Methods We identified 452 patients who received a pancreaticoduodenectomy from 1990–2007. Clinicopathological data was collected for
each patient, and regression analyses were performed to identify predictors of postoperative complications.
Results Of the patients studied, 289(64%) experienced no postoperative complications. In univariate analysis, patients with a low
or normal preoperative aspartate aminotransferase (p = 0.03) or alkaline phosphatase(p = 0.03), had higher rates of complications. Multivariate analysis confirmed an elevated alkaline phosphatase was associated
with a lower incidence of complications (OR = 0.56, p = 0.02), while preoperative anemia was found to be a predictor of complications following pancreaticoduodenectomy(OR = 2.01,
p = 0.02).
Conclusion Anemic patients and those with normal liver function tests were more likely to experience complications after pancreaticoduodenectomy.
This may represent extent of disease and tumors not causing biliary or pancreatic dilatation, respectively. Precautions, such
as intraoperative ductal stents, should be considered when operating on this group of patients to minimize complications.
Presented at the 49th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 17–21, 2008. San Diego Convention
Center, San Diego, California. 相似文献
20.
Yassar Youssef William O. Richards Kenneth Sharp Michael Holzman Nikilesh Sekhar Joan Kaiser Alfonso Torquati 《Journal of gastrointestinal surgery》2007,11(3):309-313
Background and Objective Quality of life (QoL) is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect
on the QoL along with their direct effect on the diseases they are targeting. The aim of the study was to assess the impact
of residual dysphagia on QoL after laparoscopic Heller myotomy for achalasia.
Methods QoL was evaluated using the short-form-36 (SF-36) and postoperative dysphagia was assessed using a dysphagia score. The score
(range 0–10) was calculated by combining the frequency of dysphagia (0=never, 1 = < 1 day/wk, 2 = 1 day/wk, 3 = 2–3 days/wk,
4 = 4–6 days/wk, 5=daily) with the severity (0=none, 1=very mild, 2=mild, 3=moderate, 4=moderately severe, 5=severe). Patients
were classified in the Nonresponder group when their dysphagia score was in the upper quartile.
Results Questionnaires were mailed to 110 patients. The overall response rate was 91% with 100 patients (54 female) returning the
questionnaires. The average follow-up was 3.3 years. There was a significative inverse correlation between dysphagia score
and mental component (P = 0.0001) and total SF-36 (P = 0.001) scores. According to their postoperative dysphagia scores, 77 patients were assigned to the Responder Group and
23 patients to the Nonresponder Group. The two groups were similar in terms of age, gender, rate of fundoplication, and length
of follow-up. Mental component and total SF-36 scores were significantly (P < 0.05) higher in the Responder group. Successful relief of dysphagia after Heller myotomy was associated with health-related
quality of life scores that were 13 higher in Vitality (P < 0.05), 11 points higher in mental health (P < 0.05), and 12 points higher in General Health (P < 0.05). Overall patient satisfaction with surgical outcome was 92%, with only eight patients not satisfied with the surgery.
Conclusion Laparoscopic Heller myotomy offers excellent long-term relief of achalasia-related symptoms, namely dysphagia, and this was
projected on a significant improvement in quality of life and patient satisfaction.
Presented at the 47th annual meeting at Digestive Disease Week 2006 相似文献