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Van Ye TM, Cattey RP, Henry LG. Laparoscopically assisted colon resections compare favorably with open technique. Surg Laparosc Endosc Percutan Tech 1994; 4:25-31. [PMID: 8167860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To date, 14 patients have undergone laparoscopic or laparoscopically assisted colon resections for malignant disease. Margins of resection and lymph nodes (LNs) recovered were compared with those of 20 consecutive controls treated over the preceding 6-month period at the same institution. Of these 14 procedures, one was completed entirely via laparoscopy, 13 were laparoscopically assisted (a small transverse incision was used to deliver the colon and lesion after laparoscopic mobilization). One other patient required conversion to open colectomy. An average of 10.5 LNs (range 0-32) were recovered via the laparoscopic technique per case; 0.4 LNs showed positive signs of metastatic disease (range 0-4). Average margins of resection were 11.1 cm proximally and 10.0 cm distally (range 3-34) cm proximally, 2-23 cm distally). In no case did the margins contain tumor. These results compare favorably with those for the 20 concurrent controls, among whom an average of 7.6 LNs were recovered per case, 0.5 LNs with positive signs of metastatic disease (range 2-19 LNs total, 0-4 positive). Similarly, proximal margins averaged 7.4 cm, and distal margins averaged 14.2 cm (range 1.5-20 cm and 2-30 cm, respectively). Only one postoperative complication was directly related to the surgical procedure--a herniation of small bowel into a trocar site. One anastomotic stricture occurred 6 weeks after surgery, and one partial small-bowel obstruction was noted at 4 weeks. Both were treated nonoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T M Van Ye
- Department of Surgery, Medical College of Wisconsin, Milwaukee Institute of Minimally Invasive Surgery at Columbia Hospital, WI 53211
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Carlson MA, Ludwig KA, Frantzides CT, Cattey RP, Henry LG, Walker AP, Schulte WJ, Wilson SD. Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy. J Laparoendosc Surg 1993; 3:27-33. [PMID: 8453125 DOI: 10.1089/lps.1993.3.27] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The routine versus selective use of intraoperative cholangiography has been the subject of debate for some time. Most authors currently advocate routine intraoperative cholangiography with laparoscopic cholecystectomy. The authors report their experience with the selective and routine utilization of intraoperative cholangiography at two institutions. At institution A, 155 laparoscopic cholecystectomies were attempted, and 21 cholangiograms were performed (based on preoperative criteria of ultrasound, liver function tests, and history of jaundice, or intraoperative anatomical uncertainty). At institution B, 164 laparoscopic cholecystectomies were attempted and 127 cholangiograms were performed (a routine intraoperative cholangiography policy). At institution A, there were no common bile duct injuries but there was one retained stone. At institution B, there was one common bile duct injury and no retained stones. The patient with the retained stone from institution A had a preoperative indication (total bilirubin = 4.4 mg/dl) for a cholangiogram, but it was not performed due to technical difficulties. This patient later required endoscopic sphincterotomy with stone extraction. One patient at institution B had a choledochotomy which was detected by intraoperative cholangiography (IOC). This was managed with a T-tube. The selective use of cholangiograms in laparoscopic cholecystectomy will not yield a higher incidence of common bile duct injuries or retained stones compared to routine use. Further, a cholangiogram may not necessarily prevent choledochotomy but can prevent extension of common bile duct injury. Thus, it should always be performed when there is anatomic uncertainty.
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Affiliation(s)
- M A Carlson
- Department of Surgery, Medical College of Wisconsin, Milwaukee
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Murray DP, Foley R, Whelton MJ, Moriarty KJ, Brooks S, Loft D, Mpoko N, Gardner V, Marsh MN, Stevens FM, Kearns M, Moran B, Sutton G, Taylor M, Karran SJ, Courtney MG, O’Brien M, McPartlin JM, Gibney MJ, Scott JM, Weir DG, Suzuki Y, Tobin A, Quinn D, Whelan A, O’Morain A, Waldron R, O’Riordan M, Kirwan WO, Ryan T, Lennon J, Crowe J, Shinkwin C, Kirwan W, Mackle EJ, Parks TG, O’Keefe L, Lanigan D, O’Donnell M, Harte P, O’Sullivan G, Foley DP, Dunne P, Dervan P, Crowe JP, O’Callaghan T, Chua A, Kennedy NP, MacMathuna P, Keating JJ, Weir DG, Keeling PWN, Leen E, McKenna D, Gilligan D, Ward R, Casey E, Tobin A, Hutchinson L, Sweeney EC, O’Morain C, Collins JSA, Sloan JM, Watt PH, Hamilton PW, Love AHG, Chua A, Kennedy NP, MacMathuna P, Keating JJ, Maxwell WJ, Brennan DP, Huang J, McDonald G, Weir DG, Keeling PWN, Brennan DP, Kennedy NP, Keeling PWN, McKenna D, Ward R, Gilligan D, Tobin A, Sweeney EC, O’Morain C, Ryan T, Lennon J, Crowe J, Diamond T, Rowlands BJ, Keating J, O’Reilly E, Burke P, McDonald GSA, Monson J, Stephens R, Corrigan O, Keeling PWN, Carey PD, Darzi A, Monson JRT, O’Morain C, Tanner WA, Keane FBV, Darzi A, Monson JRT, Carey PD, O’Morain C, Tanner WA, Keane FBV, Rogers E, McAnena OJ, Given HF, Keeling P, O’Sullivan G, DeMeester T, Skinner DB, Collins JK, O’Sullivan G, O’Donoghue M, O’Brien F, O’Donovan T, Corbett A, Hahnvaganawong C, Nolan S, Collins J, O’Sullivan G, Murray J, Hogan B, Sullivan M, Doyle JS, Butler P, Walker F, Murray J, Doyle JS, O’Dwyer PJ, Minton J, Enright H, Patchett S, O’Connell L, O’Donoghue DP, Afdhal NH, Collins JSA, Cattey RP, Hogan WJ, Helm JF, Ash R, O’Briain DS, O’Malley F, Courtney G. Irish society of Gastroenterology. Ir J Med Sci 1991. [DOI: 10.1007/bf02947651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cattey RP, Wilson SD. Cholelithiasis follows total gastrectomy in Zollinger-Ellison syndrome. Surgery 1989; 106:1070-3. [PMID: 2588114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The frequent occurrence of cholelithiasis noted in the follow-up of patients who underwent total gastrectomy because of Zollinger-Ellison syndrome prompted us to study this phenomenon. Cholelithiasis is known to be more common after truncal vagotomy, with or without concomitant subtotal gastric resection, and the prevalence of gallstones in these patients is reported to be 16% to 38%. To date, however, no long-term study has investigated the prevalence of gallstones after total gastrectomy in patients with the Zollinger-Ellison syndrome. Since 1961, 26 patients with the Zollinger-Ellison syndrome have undergone total gastrectomy and were enrolled in a Medical College of Wisconsin Clinical Research Center protocol that allowed follow-up to assess the development of cholelithiasis. Eight patients had cholecystectomy at the time of total gastrectomy (seven patients had stones), leaving 18 patients with a normal gallbladder and no gallstones at the time of total gastrectomy. Four patients died early, two of surgical complications, one of tumor progression, and one of alcohol-related trauma. During follow-up, cholelithiasis has developed in 10 of 14 patients (71%) at risk; the mean time to gallstones was 6.3 years (range, 1.2 to 12.9 years). The predictable occurrence of cholelithiasis after total gastrectomy in patients with the Zollinger-Ellison syndrome suggests that cholecystectomy should be performed at the time of total gastrectomy.
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Affiliation(s)
- R P Cattey
- Department of Surgery, Medical College of Wisconsin, Milwaukee 53226
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