Int Surg
-
Primary esophageal motility disorders include achalasia, diffuse and segmental esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter. Failed medical therapy frequently precedes the presentation of these patients for surgical intervention. Both laparoscopic and thoracoscopic techniques have been developed to successfully treat these spastic disorders of the esophagus. Laparoscopic and thoracoscopic operative techniques are described.
-
Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy (TPLIH) under regional anaesthesia.
In an attempt to investigate whether laparoscopy really is a major advance in the treatment of inguinal hernia, the authors performed laparoscopic transabdominal preperitoneal inguinal herniorrhaphy under regional anaesthesia in 15 consecutive patients, 7 of whom with severe medical conditions contraindicating general anaesthesia. ⋯ Although laparoscopy is a feasible and effective procedure in repairing inguinal hernias, it is not indicated in high-risk patients who can be safely, effectively, and less expensively treated with open tension-free repair techniques under local anaesthesia.
-
As urge is felt and defecation starts, it is postulated that the colon continuously feeds the rectum with stools until the colon is empty. The relationship of rectal distension at defecation to colonic activity is not yet fully explored. The current communication studies this relationship in 11 patients (mean age 48.4+/-18.8 years, 6 men and 5 women) with transverse colostomy performed after transverse colectomy for cancer of the transverse colon. ⋯ The left colonic contraction upon rectal distension, being reproducible and absent with the anesthetized rectum or colon, postulates a reflex relationship which we call "recto-colic reflex". This reflex acts at defecation to feed the rectum successively with fecal material until the colon is emptied. Reflex derangement may play a role in defecation disorders.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study.
Post-thoracotomy pain causes severe impairment of the respiratory function. Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects. Other low-risk and cost-effective analgesic treatments are therefore required. ⋯ Ketorolac tromethamine was effective in the treatment of post-thoracotomy pain. Extrapleural intercostal nerve block allowed a significant reduction in the consumption of opioids. These analgesic techniques could be useful as low-risk, cost-effective and reproducible treatments when more effective techniques, such as epidural analgesia, are contraindicated.
-
Comparative Study
Bile duct injuries in the era of laparoscopic cholecystectomy.
By the introduction of laparoscopic cholecystectomy a new field of surgical development has been opened, resulting in the reduction of conventional surgical trauma, and giving the chance to the patient seeking for less postoperative pain, short hospital stay and quick return to activity and work. In spite of these advantages, many laparoscopic cholecystectomy related complications occurred, especially in the period of the learning curve. ⋯ This rate is ten times more when compared with conventional cholecystectomy. The authors present a detailed account of the causes of the injuries, their typical localisation and the best way to avoid and treat them.