Background: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight
increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated.
Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD
is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for
this disease. Methods: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were
contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity
of their disease. Their preoperative symptoms were compared to those experienced postoperatively. Results: One hundred thirty
patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy,
8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were
nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped
from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively.
Conclusions: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both
with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a
RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications
is appropriate in selected cases. 相似文献
The aim of this study was to evaluate the potential for restoration of a large cartilage defect in the goat knee with hydroxyapatite (HA) loaded with chondrocytes. Isolated chondrocytes were suspended in fibrin glue, seeded on top of the HA, and then the composite graft was implanted in the defect. After transplantation, cell behaviour, newly synthesised matrix and the HA–glue interface were assessed histologically after 2, 4, 12, 26 and 52 weeks. Special attention was paid to the incorporation process of HA in the subchondral bone and interactions between this biomaterial and the fibrin-glue–chondrocyte suspension.
Chondrocytes in the glue proved to survive the transplantation procedure and produced new metachromatically stained matrix two weeks after implantation. The glue–cell suspension had penetrated the superficial porous structure of the HA. Four weeks after surgery, islands of hyaline-like cartilage were observed at the HA–glue interface. A layer of fibrous tissue was formed surrounding the HA graft, resulting in a relatively instable fixation of the HA in the defect. This instability of the graft in the defect, possibly together with early weight bearing, resulted in a gradual loss of the newly formed hyaline cartilage-like repair tissue. Progressive resorption of the HA occurred without any sign of active bone remodelling from the host site. One year after surgery part of the defect which extended down to the cancellous bone had been predominantly restored with newly formed lamellar bone. Only small HA remnants were still present at the bottom of the original defect. Resurfacing of the joint had occurred with fibrocartilaginous repair tissue.
The absence of adequate fixation capacity of the HA near the joint space resulted in a relative instability of the graft with progressive resorption. Therefore, HA is not a suitable biomaterial to facilitate the repair of large articular cartilage defects. 相似文献
A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent
inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and
small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy
has remained intact. This complication needs to be added to the differential diagnosis in patients who present inflammation,
abscess formation, or cutaneous fistula following laparoscopic hernia repair.
Received: 7 October 1996/Accepted: 14 October 1996 相似文献
Background: Ventral abdominal wall hernias are a common cause of morbidity and mortality. Opinion varies as to appropriate management.
A recent consensus meeting on incisional hernia identified the need to standardise repair. On this background, a survey of
current practice was performed. Method: A questionnaire was sent to 101 practicing general surgeons within the West of Scotland. Incisional, epigastric and para-umbilical
defects were subdivided into defect size <2, 2–5 and >5 cm. The surgeons were asked to indicate the most appropriate repair
(suture, mayo or mesh) for each. The influence of reducibility on the decision to repair was also assessed. Results: Sixty-one of 101 questionnaires were returned valid giving a response rate of 60%. Suture repair was significantly more
likely to be used in all defects <2 cm (P<0.001). Mesh repair was significantly more likely to be recommended in all defects >5 cm (P<0.001). Of defects >5-cm, mesh was recommended for 90% of incisional hernia compared with 81% of epigastric and 76% of para-umbilical
hernia (P<0.001). There was no significant difference in choice of repair for defect size 2–5 cm with opinion divided between suture
and mesh. Irreducibility increased the likelihood of recommendation for repair. Conclusion: This survey shows a lack of consensus on the appropriate repair of ventral abdominal wall hernia amonge practicing consultant
general surgeons. This reflects the contrasting views within the current literature. 相似文献
Summary BACKGROUND: Endometriosis is a relatively common pathology in women of childbearing age and of low parity but rarely shows
extraperitoneal involvement. The main aim of this paper is to raise the attention of specialists to the necessity of carrying
out penetrating diagnosis of nonspecific extraperitoneal masses occurring in women of reproductive age. METHODS: We performed
a retrospective review of six patients diagnosed with extraperitoneal endometriosis who were treated at the Vega Baja University
Hospital (Spain) during the last 5 years. RESULTS: Surgical treatment had positive results in five patients. The preoperative
diagnosis was correctly made in only two patients. The accurate aetiology of endometriosis remains unknown and diagnosis is
based on clinical and cytopathological findings. CONCLUSIONS: Surgical treatment of extraperitoneal endometriosis is recommended.
However, postoperative follow-up is obligatory and hormonal suppressive therapy may be necessary. Medical treatment with gestagens,
Danazol, or agonists of the gonadotropin-releasing hormone are ineffective in endometriomas which are bigger than 2 cm.
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