Acta chirurgica Scandinavica最新文献

A symptomatic leiomyoma of the upper esophagus was successfully removed through a fiberoptic endoscope in an 84-year-old man. Endoscopic resection via flexible endoscope may be considered as an option in treating selected cases of esophageal leiomyoma and for high surgical risk patients.

Thirty consecutive patients who underwent oesophageal replacement with a segment of colon (16 for malignant and 14 for benign disease) were reviewed. The operation was done in one stage in 28 cases and in two stages in two. The interposed colon was always placed isoperistaltically, in the bed of the oesophagus in 24 and retrosternally in 6 cases. In seven patients a valve was constructed to prevent gastrocolic reflux. There was one early postoperative death (3%). Early non-fatal complications occurred in 5 (17%), and late complications in 6 patients (20%). The functional results were excellent to good in 21 (73%), acceptable in 7 (24%), and poor in 1 (3%). The data suggest that colonic interposition offers a good alternative to stomach in selected cases with oesophageal malignancy and represents an excellent choice for reconstruction in benign oesophageal disease.

Because it is important to assess relevant prognostic factors when deciding which patients will profit from pancreatic resection and which will not, 484 patients with ductal pancreatic carcinoma who were operated on between 1 January 1978 and 31 December 1987 in the Department of General and Abdominal Surgery of Mainz Medical School were studied retrospectively. Prognostically favourable factors were: a history of 8 weeks or less, the presence of jaundice, the absence of back pain, a well to moderately differentiated carcinoma, a tumour less than 3 cm in diameter, a preoperative CA19-19 value of less than 400 U/ml, and no sign of lymph node metastases or other metastatic spread. Only 19 patients (3.9%) satisfied these criteria. Our objective is to now check these results in a prospective study with a larger number of patients and, in addition, to compare the quality of life of patients who were treated by resection with that of those who received palliative treatment.

A biofragmentable anastomosis ring (Valtrac-BAR) was used to construct anastomoses in 20 (group I) consecutive patients (11 women and nine men; mean (SD) age 54.5 (13 years) undergoing elective colonic resection. The results were compared with those of 20 consecutive patients who underwent elective colonic resection in this department during the same period (group II) who had their anastomoses hand-sutured or stapled. There was one death in hospital in each group (5%). There were four anastomotic complications requiring reoperation, leakage (n = 3), and stricture (n = 1) in group I (20%) compared with none in group II. Three patients in each group developed postoperative ileus; these were all initially treated conservatively. In most cases with a ring anastomosis the clinical course was uneventful. We conclude that the biofragmentable ring can be used for different types of colon anastomoses, but so far it has not shown any special advantage over more commonly used anastomotic techniques, and more experience is needed before its routine use can be recommended.

The efficacy of 32% dextran 70 (Hyskon) in the prevention of postoperative peritoneal adhesions was evaluated in nine different experiments in a total of 320 rats under standardised conditions. Hyskon reduced adhesion formation, only in rats that were also subjected to abrasion of the caecum. In the remaining eight experiments Hyskon was ineffective. We conclude that more extensive experimental and clinical studies are desirable before this agent is recommended for prophylaxis against adhesions; any prophylactic regimen should be tested in a wide range of experiments. In addition, analysis of the control data suggested that the stimulus for inducing adhesions in some experiments was so strong that it could not be countered by any prophylactic regimen. A new microsurgical method that resulted in a 50 per cent response and an equal number of low grade and high grade adhesions was used. This method is well suited for investigation of both the stimulatory and the inhibitory effects of a test agent.

The effect of trimetazidine (an antianginal drug that acts as a scavenger of oxygen radicals) in the prevention of peritoneal adhesions induced by complete vascular obstruction of an ileal segment for 30 minutes followed by reperfusion was investigated in rats. Group A (n = 20) acted as controls. Group B (n = 20) received trimetazidine intravenously in a dose of 2.5 mg/kg 30 minutes before the induction of ischaemia. Group C (n = 20) received the same dose of trimetazidine for 5 days before the experiment, twice a day intraperitoneally, and also intravenously 30 minutes before the induction of ischaemia. Group D (n = 20) received the same dose of trimetazidine intravenously immediately after reperfusion had started. Ten days later adhesions had developed in 90% of the animals of group A, 40% of those in group B (p less than 0.001), 5% of those in group C (p less than 0.001), and 60% of those in group D (p less than 0.05). The severity of adhesions was significantly less in the treated groups than in the control animals. Release of creatine phosphokinase during ischaemia and reperfusion significantly increase in groups A, B, and D. These results suggest that trimetazidine reduces the incidence and severity of peritoneal adhesion formation induced by ileal ischaemia and reperfusion, treatment before induction of ischaemia gave better results than treatment given afterwards.

A conservative surgical technique for treatment of necrotizing pancreatitis is described. Standardized since 1976, the technique is based on washout mechanical necrosectomy accomplished by lavages via intraoperatively placed wide-bore drainage tubes. The overall mortality rate from necrotizing pancreatitis was thereby reduced from 61% (with resective technique) to 18%, and in 106 cases observed from the onset of the disease the mortality fell to only 6.6%. The series included also patients with fulminant acute pancreatitis and multiorgan failure.