The American surgeon
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The surgical treatment of small bowel obstruction is evolving. Laparoscopic exploration and adhesiolysis is increasingly being utilized. We conducted a retrospective chart review of all patients who were operated on and discharged with the diagnosis of adhesiolysis for small bowel obstruction (SBO) from July 1999 to October 2000 at Cedars-Sinai Medical Center. ⋯ Statistically significant differences between the lap and open groups were also found in estimated blood loss (EBL) (P < 0.004), length of stay (LOS) (P < 0.01), bowel resection (P < 0.01) and op-time (P < 0.003). Laparoscopic release of adhesions is a viable option in the surgical management of small bowel obstruction. A prospective randomized trial comparing both surgical techniques is needed to further validate the laparoscopic approach to small bowel obstruction.
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The American surgeon · Nov 2003
Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting.
Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. ⋯ Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.
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The role of laparoscopy (LS) in abdominal trauma is controversial. Concerns remain regarding missed injuries and safety. Our objective for this study was to determine the safety and better define the role of LS in abdominal trauma victims. ⋯ LS was most valuable in penetrating trauma, avoiding laparotomy in more than two-thirds of patients with suspected intra-abdominal injury. LS can serve as a useful adjunct for the evaluation of blunt trauma. In a level I trauma center with LS readily available, the procedure is associated with a low rate of complications and missed injury.
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The American surgeon · Nov 2003
Case ReportsFalse-negative plain cervical spine x-rays in blunt trauma.
Although considered very accurate, false-negative plain cervical radiographs of blunt trauma patients will occur with potentially devastating complications. We sought to define the population of patients who fall into this category and the overall accuracy of adequate three-view cervical spine radiography in the blunt trauma population. A retrospective search was carried out of blunt trauma patients entered into our trauma registry. ⋯ Sensitivity was 90.3 per cent, specificity was 96.3 per cent, positive predictive value was 54.9 per cent, and negative predictive value was 99.5 per cent. Three-view plain radiograph series of the cervical spine remains a highly sensitive and specific test for cervical spine injury following blunt trauma. However, the fact that we identified three patients with significant fractures after negative plain radiographs suggests that serious consideration of computed tomography must be applied in treating symptomatic, high-risk blunt trauma patients when plain radiographs do not reveal an injury.