The British journal of surgery
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Five hundred and sixty-four patients reviewed 1 year after major abdominal surgery have been studied prospectively by a single observer for 10 years to determine the incidence and significance of incisional hernia. Of 337 (60 per cent) patients completing the 10 year follow-up 37 (11 per cent) developed an incisional hernia and 13 (35 per cent) of these first appeared at 5 years or later. One in three hernias caused symptoms. ⋯ In about half our patients (mainly those without symptoms) surgery was refused or advised against although the patients would have accepted it. Recurrence is common after surgical repair (40 per cent) but seems to be related to surgical technique. The possibility of complications occurring from an incisional hernia does not appear to be discussed with patients although obstruction occurred in 14 per cent of our patients with troublesome hernia.
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Theoretical considerations suggest that patients undergoing continuous ambulatory peritoneal dialysis (CAPD) may fare less well after renal transplantation than their haemodialysed (HD) counterparts. Review of 121 consecutive cadaveric renal allografts performed in this centre indicate this to be the case with graft survival rates at 1 year of 63.5 per cent in the HD group compared with 35.5 per cent in the CAPD-treated patients. This difference appeared to be independent of the duration of dialysis and, although a significant blood transfusion effect was seen in the HD group, no such trend was evident in the CAPD group. Studies of T cell subsets (using monoclonal antibodies) in the two groups suggests that, in part at least, the differences in graft survival rates may be attributable to the maintenance or restoration of immunological integrity in the CAPD group.
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We report our experience with an original procedure which we have applied to the management of acute necrotic caustic burns of the upper gastro-intestinal tract. Blunt thorax oesophageal stripping is performed through a cervicotomy and a laparotomy, thus avoiding a wide pleural exposure and the frequent and often fatal respiratory complications of a thoracotomy. The stripping method permitted survival of 13 of 17 patients and is thus considered to be a safer and more successful technique than open thoracic oesophagectomy.