395 research outputs found
Who will do general surgery?
The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Advantages to patients of a single anaesthetic for more than one operation are obvious; attracting generalist surgeons, training them and ensuring they have adequate credentials remain hurdles.Martin H Bruening and Guy J Madder
Left Extended Hemihepatectomy With Preservation of Large Inferior Right Hepatic Vein: A Case Report
For hepatic function to be preserved after an extended
hemihepatectomy adequate venous drainage
of the remaining liver is required. Most metastases
close to the confluence of the superior hepatic veins
are considered unresectable because hepatic venous
outflow after resection would be compromised. In
10–25% of people, the inferior right hepatic vein is
of large calibre. Thus the superior hepatic veins may
be sacrificed and hepatic function preserved if a
large inferior right hepatic vein is present
Sclerosing Haemangiomas of the Liver: Two Cases of Mistaken Identity
We describe two cases where patients undergoing hepatic resection for metastatic disease of colorectal origin were found to have concomitant sclerosing haemangiomas. The typical radiological and histological appearances of these lesions are discussed
Technical note: Facilitating laparoscopic liver biopsy by the use of a single-handed disposable core biopsy needle
Despite the use of advanced radiological investigations, some liver lesions cannot be definitely diagnosed without a biopsy and histological examination. Laparoscopic Tru-Cut biopsy of the liver lesion is the preferred approach to achieve a good sample for histology. The mechanism of a Tru-Cut biopsy needle needs the use of both hands to load and fire the needle. This restricts the ability of the surgeon to direct the needle into the lesion utilising the laparoscopic ultrasound probe. We report a technique of laparoscopic liver biopsy using a disposable core biopsy instrument (BARD (R) disposable core biopsy needle) that can be used single-handedly. The needle can be positioned with laparoscopic graspers in order to reach posterior and superior lesions. This technique can easily be used in conjunction with laparoscopic ultrasound.M. I. Trochsler, Q. Ralph, F. Bridgewater, H. Kanhere, and Guy J. Madder
Hepatic Surgery Facilitated by a New Jet Dissector
Increasing experience with major hepatic resections has stimulated the development of improved
resectional techniques and tools. A new high velocity water jet dissector is reported which offers
significant advances over previously developed ultrasonic and low pressure water jet machines. It has
been successfully used in 8 major hepatic resections with minimal blood loss, excellent visibility and
without complications. The dissector is also of value in the exposure of intrahepatic bile ducts for biliaryenteric
anastomosis
Painless Obstructive Jaundice Secondary to a Common Bile Duct Abscess: A Delayed Sequela of Cholecystectomy
Complications related to cholecystectomy are well described. Most occur in the early postoperative period and are recognised either at the time of, or shortly after surgery. Clinical sequelae occurring years following cholecystectomy are rare and infrequently reported. In addition, most delayed complications are related to the continuing presence or new formation of gallstones. In this paper we present a unique case of an abscess of the common bile duct wall, presenting with painless obstructive jaundice more than 30 years following an open cholecystectomy, without the presence of gallstones. The clinical presentation, investigations, and treatment are discussed with a review of other relevant reported cases in the literature
Hepatic Resection Using a Water Jet Dissector
The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure,
high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished
Atypical mycobacterial infection mimicking metastatic cholangiocarcinoma
Mycobacterial infections are rare in developed countries. Isolated involvement of the liver and biliary tree by mycobacterial infection is extremely rare. We report a case of a 45-year-old Caucasian female presenting with obstructive jaundice with a common bile duct stricture and multiple hypodense liver lesions raising suspicion of a metastatic cholangiocarcinoma. Percutaneous core biopsies of the liver lesions however suggested granulomatous process and histology at surgical excision confirmed this finding. Atypical mycobacteria (M. abcessus) sensitive to Amikacin were cultured from the surgical specimen proving the diagnosis. With the resurgence of tubercular and atypical mycobacterial infections in the developed world, it is important not to overlook these in differential diagnosis of various malignancies.Harsh A. Kanhere, Markus I. Trochsler, John Pierides, and Guy J. Madder
Merkel cell carcinoma metastasis to the pancreas: report of a rare case and a review of the literature
CONTEXT: Merkel cell carcinoma is a rare skin tumour which can metastasise to regional lymph nodes and occasionally to distant organs. Merkel cell carcinoma metastasis to the pancreas has been rarely reported. CASE REPORT: We describe the case of Merkel cell carcinoma metastasis to the pancreas and review the literature on this rare phenomenon. CONCLUSION: Merkel cell carcinomas metastasis should be considered as a differential in patients who present with a pancreatic mass with a previous history of Merkel cell carcinomas.Neil Bhardwaj, Sebastien Haiart, Harsh A Kanhere, Guy J Madder
The effect of communication between the right and left liver on the outcome of surgical drainage for jaundice due to malignant obstruction at the hilus of the liver
Debate continues regarding the optimal management of irresectable malignant proximal biliary obstruction. Controversy exists concerning the ability of unilateral drainage to provide adequate biliary decompression with tumors that have occluded the communication between the right and left hepatic ductal systems. Between October 1986 and October 1989, 18 patients with malignant proximal biliary obstruction were treated by an intrahepatic biliary enteric bypass. Patients were divided into two groups based on the presence or absence of a communication between the right and left biliary systems. In Group I (n = 9), there was free communication; and in Group II (n = 9) there was no communication. There were two perioperative deaths (11%) one due to persistent cholangitis and the other to myocardial insufficiency both with one death in each group. The median survival (excluding perioperative deaths) was 5.6 months. Comparison of pre- and postoperative serum levels of bilirubin and alkaline phosphatase showed a significant decrease in each group, but no difference between the groups in the size of the reduction. Sixteen patients survived at least three months and the palliation was judged as excellent in eight, fair in five, and unchanged in three. These results demonstrate the effectiveness of biliary enteric bypass regardless of communication between the left and right biliary ductal systems.H. U. Baer, M. Rhyner, S. C. Stain, P. W. Glauser, A. R. Dennison, G. J. Maddern, and L. H. Blumgar
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