ACL injuries: operative vs. non operative treatment. Follow-up at five years

The purpose of this study was to provide evaluation elements for an objective therapeutic choice between operative and nonoperative treatment in anterior cruciate ligament (ACL) injuries in two comparable groups. Between 1992 and 1993, we examined 509 patients aged between 15 and 40 years, who had suffered knee joint injuries, resulting in isolated lesion of ACL. Between 1997 and 1998, 50 patients submitted to functional treatment and 50 operated patients were submitted to clinical, functional and instrumental tests by two operators. The evaluation criteria were the same for both groups and were based on 12 parameters: Results indicate that operation shows a statistically significant superiority in those parameters related to subjectivity, subsequent meniscal lesions, KT 1000, KAT 2000, IKDC and getting back to sports practice, whereas the difference does not appear statistically significant for patellofemoral chondropathy and radiological findings. There is no difference in articularity. Quadriceps tonotrophism is the only parameter favourable to nonoperative treatment. Received: 3 May 2001/Accepted: 14 January 2002     

Endoscopic monitoring of operative procedures during cardiac surgery

Both intracardiac repair and fine anastomotic procedures are hard to visualize in the sterile operative field. To overcome this problem, we have recently developed an endoscope video system for intraoperative monitoring in open heart surgery. The endoscope can be introduced into the cardiac cavity in a sterile fashion and thus be used to visualize intracardiac lesions as well as the operative procedures. This endoscopic video monitoring system is considered to be useful not only for thoracic surgery but also for cardiac surgery as well. A preliminary report of this work was presented at the 95th Annual Congress, Japan Surgical Society, 10 April 1995, Nagoya, Japan     

Minimalinvasive operative Korrektur von Kleinzehenfehlstellung

Lesser toe deformities are among the more frequent problems that need operative corrections. Common procedures are an Arthrodesis of the PIP-Joint, a flexor tendon transfer or a resection arthroplasty of the PIP-Joint. Recently, minimally invasive techniques have gained popularity. The main advantage of these techniques is that they are possible even with critical soft tissue conditions due to their less invasive character, a reduced infection rate and a reduction in operative time.Its main disadvantages are a steep learning curve and the need for special equipment like rotating burrs and image intensifiers.In this article, operative techniques are outlined and discussed. Clinical situations which can be solved with minimally invasive techniques are presented.     

Initial operative experience of single‐port retroperitoneal laparoscopic nephrectomy

This paper reports our early experience with single‐port laparoscopic nephrectomy via the retroperitoneal approach. Since April 2010, 23 patients have undergone single‐port laparoscopic surgery for simple nephrectomy (n = 11 patients) and radical nephrectomy (n = 12) by an experienced laparoscopic surgeon. The mean operative time was 265.2 min and the mean estimated blood loss was 96.7 mL. The procedure was completed in all patients without conversion to standard laparoscopy or open surgery. No intraoperative or acute postoperative complications occurred. When the single‐port retroperitoneal laparoscopic nephrectomy group was retrospectively compared with the group that had undergone standard retroperitoneal laparoscopic nephrectomy, no significant difference was noted with respect to age, body mass index, operation time, time to eat, catheter removal or length of hospitalization (P > 0.05). A significant difference in favor of the single‐port retroperitoneal laparoscopic nephrectomy group was noted with respect to the estimated blood loss (P = 0.027) and the visual analog pain scale score at discharge (P = 0.016). Although our findings show that retroperitoneal single‐port laparoscopic nephrectomy is feasible with advanced techniques and optimal instrumentation, further study is required to determine the future extent of its clinical application.     

肾脏开放性手术手术路径的选择

为了提高复杂性肾脏疾病外科治疗的手术水平,作者介绍开放性肾脏手术常用的路径与优缺点,提出肾脏手术路径选择的基本原则,重点讨论肾脏部分切除、巨大肾肿瘤、粘连性肾肾切除术三种高难度的手术经路的思路。     

Indications for operative management of abdominal aortic aneurysms

The increasing incidence of abdominal aortic aneurysms, along with the more frequent use of screening techniques, has resulted in greater numbers of patients with small abdominal aortic aneurysms. The questions of frequency of surveillance and timing of intervention are the two most controversial issues faced by surgeons dealing with this condition. Most management decisions are based on the size of the aneurysm but other factors must also be considered. This review makes recommendations on the management of small abdominal aortic aneurysms according to the current available evidence.     

Intracerebral haematoma: Operative versus non‐operative

Background: Spontaneous supratentorial intracerebral haemorrhage (ICH) accounts for 10–30% of all strokes resulting in a high mortality and major morbidity. Although guidelines for medical treatment and surgical intervention for ICH are available, selection of patients for surgery in this group of patients is controversial and varies greatly throughout the world. Objective: In the current study, we aimed to review our selection criteria for treatment and their management results. Methods: We had prospectively collected the data of patients admitted to our centre with spontaneous supratentorial ICH in a 2‐year period (January 2001–December 2002). We divided the patients into three main groups according to the anatomical site: putaminal, subcortical and deep basal ganglia. Surgical treatment was limited to patients aged below 65 years, with a clot size between 30 and 100 mL, and motor scores of normal flexion to localizing to pain. Results: One hundred and twenty‐four patients were recruited in the current study. Thirty‐four patients managed by early surgery had an 18% mortality, 29% were independent and 53% dependent at 6 months. Early surgery for subcortical haematoma carried the best prognosis (42% achieved independence), whereas deep basal ganglia haematoma carried the worst prognosis (none achieved independence). Conclusions: Although this prospective audit was not intended to be a case–control study, data from the present study support early surgery for patients with putaminal and subcortical haematomas with a clot size larger than 50 mL. For smaller haematomas less than 30 mL, conservative management is associated with a superior clinical outcome.      

腹腔镜结直肠癌根治术手术技术的探讨

目的:探讨腹腔镜结直肠癌根治术的手术技术,包括手术的整体配合、手术路径等.方法:回顾分析为60例结直肠癌患者施行腹腔镜结直肠癌根治术的全过程.结果:60例均顺利完成腹腔镜手术,无一例中转开腹.其中直肠癌根治术35例,包括Miles术式5例,直肠癌晚期姑息性乙状结肠造瘘2例,直肠腺瘤局部肠管切除1例,结肠癌根治术20例,...     

老年病人腹部术后早期肠内营养的临床应用

目的 研究老年病人在腹部大手术后早期肠内营养的I临床疗效及安全性、可行性。方法 30例腹部大手术的老年病人在术后24h给予维沃，第四天给茚沛，整个过程维沃维持8～12d，肠内制剂的投入通过术中留置空肠造瘘管或术后放置鼻肠管。结果 术后第7天均转入正氮平衡，血浆前白蛋白和转铁蛋白均明显回升。结论 早期肠内营养符合生理要求，简便、安全、实用有效，对体质差、年龄大的病人更为适合。     

Epilepsy after operative treatment of ruptured cerebral aneurysms

Summary A retrospective analysis of 183 consecutive patients operated on for ruptured cerebral aneurysms and surviving at least one year revealed appearance of postoperative epilepsy in 14 cases (8 per cent) on an average of 10 months (range 0–23 months) after the operation. Factors associated with the development of secondary epilepsy were localization of the aneurysm on the middle cerebral artery, temporary clipping intraoperatively, wrapping technique to treat the aneurysm, and vasospasm seen on the postoperative control angiogram. Intraoperative and/or postoperative ischaemia seems to be the crucial phenomenon favouring the development of epilepsy. Identification of the risk factors may help to focus the anti-epileptic prophylaxis in cases prone to develop seizures.     

Präoperative Antibioticaprophylaxe reduziert septische Komplikationen bei Colon- und Rectumeingriffen

Zusammenfassung Vor colorectalen Operationen wurde mit 3 g Neomycin und 3 g Erythromycin eine eintägige, orale Antibioticaprophylaxe durchgeführt (n = 36). Die Patienten der Kontrollgruppe hatten kein Antibioticum erhalten (n = 24). Die Rate septischer postoperativer Komplikationen konnte durch die Antibioticaprophylaxe signifikant gesenkt werden. Es traten zwei Bauchdeckenabscesse, eine Stuhlfistel und zwei tödliche Nahtinsuffizienzen in der Kontrollgrupppe und lediglich zwei Bauchdeckenabscesse in der Antibioticagruppe auf. Wesentliche Nebenwirkungen der Antibioticaprophylaxe wurden nicht beobachtet.

---

Preoperative prophylactic antibiotics reduce septic complications of colorectal operations

Summary On the preoperative day before colorectal operations (n = 36), 3 g neomycine and 3 g erythromycine were administered as oral prophylactic antibiotics. No antibiotics were administered to the controls (n = 24). The number of postoperative septic complications was reduced after preoperative prophylactic antibiotics. There were two abscesses of the abdominal wound, one fecal fistula, and two anastomotic disruptions in the control group but only two abscesses of the abdominal wound in the antibiotic group. No toxic effects were observed during this trial.

Vortrag gehalten auf der 97. Tagung der Deutschen Gesellschaft für Chirurgie     

Minimally invasive parathyroidectomy with operative ultrasound localization of the adenoma

Background Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Adequate perioperative adenoma localization is essential for this operation. We describe a technique using ultrasound to perform minimally invasive parathyroidectomy.Methods ^99mTc sestamibi scanning was performed on patients with primary hyperparathyroidism to localize parathyroid adenomas; no intraoperative gamma probe was used. We also performed pre- and intraoperative ultrasound scanning to localize these adenomas.Results All patients underwent successful localization and removal of their parathyroid adenomas. At follow-up, all patients were well, with calcium within normal limits.Conclusion The use of intraoperative ultrasound facilitates minimally invasive parathyroidectomy and may obviate the need for intraoperative ^99mTc sestamibi scanning.     

A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children

Background

It is not clear if robotically assisted surgery (providing articulating instruments, 3-dimensional vision, intuitive ergonomics) performed in pediatric patients offers the same advantages over conventional surgery as in adult patients. In the laboratory setting, robots require less time to perform certain tasks. Accordingly, we tested the hypothesis that the time required to perform a robotically assisted laparoscopic Thal semifundoplication is different compared with a conventional laparoscopic procedure in children.

Methods

The time required to perform single operative steps was prospectively recorded in 10 consecutively performed Thal semifundoplications with the use of a robot (da Vinci) and in 10 consecutively performed operations done by conventional laparoscopy.

Results

No conversion to an open operation was necessary, and there were no intraoperative complications throughout the study and no postoperative complications up to 14 months after surgery. Total operative time was similar in both groups. In the robotically assisted group, time for setup was significantly longer (20.8 ± 7.5 vs 34.6 ± 9.2 minutes, P < .05), but dissection of the hiatal region as the most challenging operative step was accomplished 34% faster in the robotically assisted group (30.8 ± 8.7 vs 20.2 ± 5.3 minutes, P < .05).

Conclusion

At the current level of technology, the robotic system is superior compared with established standard laparoscopic techniques requiring tissue preparation; however, the potential benefit in operating time is counterbalanced by the increased complexity of setting up the system.     

Does obesity influence the operative course or complications of robot-assisted laparoscopic prostatectomy

OBJECTIVE: To determine if obesity is associated with prolonged surgery or more complications during and after surgery in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS: Between December 2003 and September 2005 data were collected prospectively for all patients undergoing RALP. Obesity was defined as a body mass index of > or = 30 kg/m2. The duration of surgery was recorded, determining the duration of steps, including overall, robotic assistance, and vesico-urethral anastomosis. In all, 285 patients had RALP by one of two surgeons; 236 were classified as not obese and 49 as obese. RESULTS: The characteristics of the two groups were similar before and after RALP (mean age 60.7 vs 60.3 years, prostate-specific antigen level 7.9 vs 7.9 ng/mL, prostate weight 47.3 vs 45.3 g, length of stay 3.2 vs 3.5 days, and indwelling catheterization 8.3 vs 7.9 days). The mean duration of surgical steps was less for the non-obese than the obese group, with urethral dissection requiring 16 vs 19.3 min (P < 0.05), anastomotic time 30 vs 36 min (P < 0.01), and port closure 11 vs 14.5 min (P < 0.001), but the total duration of surgery, at 190 vs 205 min, was not significantly different (P = 0.07). In the non-obese group there were seven (3%) prolonged drain tube leaks, vs four (8%) in the obese group (P = 0.08). CONCLUSIONS: Obesity was associated with longer anastomotic times, but the overall duration was similar. Overall complication rates were not significantly different. The continuing follow-up will determine if obesity predisposes patients to greater long-term morbidity after RALP.