Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Aug 2007
Case ReportsHernia sac laparoscopy under spinal anesthesia for evaluation of reduced incarcerated inguinal hernia.
Hernia sac laparoscopy (laparoscopy through an inguinal hernia sac) is a useful method to evaluate the viability of the self-reduced bowel of incarcerated inguinal hernia that is suspected for strangulation, and avoid unnecessary exploratory laparotomy. On the other hand, peritoneal insufflation for laparoscopy is best avoided in patients with severe chronic obstructive pulmonary disease or poor cardiac output. ⋯ Bowel viability was in question, so hernia sac laparoscopy without gas was performed, which allowed us adequate evaluation of the reduced bowel by positioning alone, avoiding both exploratory laparotomy and peritoneal insufflation. In our case, hernia sac laparoscopy under spinal anesthesia without pneumoperitoneum was sufficient to obtain necessary information with minimal surgical stress.
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J. Gastrointest. Surg. · Aug 2007
Long-term outcome after resection for chronic pancreatitis in 224 patients.
Organ complications like biliary or duodenal stenosis as well as intractable pain are current indications for surgery in patients with chronic pancreatitis (CP). We present here our experience with pancreatic resection for CP and focus on the long-term outcome after surgery regarding pain, exocrine/endocrine pancreatic function, and the control of organ complications in 224 patients with a median postoperative follow-up period of 56 months. ⋯ Pancreatic resection leads to adequate pain control in the majority of patients with CP. Long-term outcome does not depend on the type of surgical procedure but is in part influenced by severe preoperative CP and by postoperative surgical complications (regarding pain). A few patients develop procedure-related late complications. Late mortality is high, probably because of the high comorbidity (alcohol, smoking) in many of these patients.
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J. Gastrointest. Surg. · Aug 2007
Modified jejunoileal bypass surgery with biliary diversion for morbid obesity and changes in liver histology during follow-up.
Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications including rapid progress of liver disease. The senior author (I.F.) has developed a modification of jejunoileal bypass, which we believe overcomes many of the shortcomings of the classic procedure. ⋯ The modified jejunoileal bypass is very effective in inducing and maintaining weight loss for 5 years and does not lead to hepatic failure or rapid progression of liver disease.