Surgery
-
Case Reports
Combination of diaphragmatic plication with major abdominal surgery in patients with phrenic nerve palsy.
The role of simultaneous prophylactic diaphragmatic plication during major abdominal operations is evaluated. In five patients with a history of phrenic nerve injury, postoperative ventilation requirements and hospital stay were significantly reduced when synchronous diaphragmatic plication was performed, compared with corresponding values obtained during previous abdominal operation without diaphragmatic plication. In addition, diaphragmatic plication was associated with postoperative improvement of respiratory mechanics and blood gas exchange.
-
Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia. ⋯ In patients with severe GERD, laparoscopic fundoplication decreases reflux symptoms to levels found in control subjects. These results appear to be stable over time. However, patients who underwent fundoplication experience more dysphagia and gas bloat than controls and patients with hiatal hernia-symptoms that should be seen as a side effect of the procedure and of GERD itself.
-
Many reports on blood loss and transfusion requirements during hepatectomy for metastatic liver cancer or hepatocellular carcinoma have been published; however, there are no reports on these issues in hepatectomy for biliary hilar malignancy. The aim of this study was to review our experience with blood loss and perioperative blood requirements in 100 consecutive hepatectomies for biliary hilar malignancy. ⋯ Despite the technical difficulties arising from hepatectomy for biliary hilar malignancy, approximately two thirds of hepatectomies can be performed in an experienced center without perioperative homologous blood transfusion using preoperative blood donation.