Endoscopic transgastric procedures in anesthetized pigs: technical challenges, complications, and survival.

Background And Study Aims: An incisionless endoscopic peroral transgastric approach to the peritoneal cavity has shown promise in animals as a potentially less invasive form of surgery. We present our experience with various endoscopic peroral transgastric procedures, reporting on the technical aspects and challenges that arose.

Materials And Methods: The following procedures were performed in 10 anesthetized pigs using a double-channel endoscope: peritoneoscopy (10 pigs), liver biopsy (one pig), cholecystectomy (six pigs), fallopian tube excision (one pig), and hysterectomy (one pig).

Delayed presentation of ilio-iliac arteriovenous fistula following laparoscopic cholecystectomy treated with percutaneous graft-covered stent placement.

Major vascular injuries during laparoscopic cholecystectomy are rare, usually readily apparent, and immediately treated. We report a case of delayed presentation of a retroperitoneal vascular injury. The patient presented with abdominal pain and increasing edema of the lower extremities 1 year after laparoscopic cholecystectomy and was found to have an ilio-iliac arteriovenous fistula.

Elucidation of cytomegalovirus disease recurrence in an HIV-1-positive patient.

Background: Cytomegalovirus (CMV) is responsible for the most common opportunistic viral infection in patients with acquired immunodeficiency syndrome (AIDS). The colon is a common site for CMV infection in patients positive for the human immunodeficiency virus (HIV). The clinical diagnosis of CMV infection is based on the characteristic endoscopic appearance of extensive ulceration of the gastric mucosa.

Plexiglas (polymethylmethacrylate) implantation: technique, pre-clinical and clinical experience.

Over the past few decades, a great scientific effort has been made to treat gastroesophageal reflux disease (GERD). This reflects a trend in modem medicine toward optimizing quality of life, reducing health-related lost working hours, and minimizing costs of chronic treatments. It also reflects a revived interest in diseases that can be studied using novel equipment and that can be cured using minimally invasive techniques.

Implantation of microballoons in the management of fecal incontinence.

Purpose: The implantation of expandable microballoons has proved successful for the treatment of stress urinary incontinence. This led us to test its effectiveness in the treatment of severe fecal incontinence.

Methods: Six patients (four male), of average age of 43 (range, 29-60) years, with severe fecal incontinence, underwent implantation of expandable microballoons in the submucosa of the anal canal.

Endoscopic implantation of Plexiglas (PMMA) microspheres for the treatment of GERD.

Background: A gelatinous implant containing polymethylmethacrylate (PMMA) beads is successfully used to augment the diminished thickness of the chorium in patients with skin defects and wrinkles. The aim of the present study was to determine whether submucosal injection of PMMA microspheres into the lower esophageal folds decreases the severity of symptoms and acid reflux in patients with GERD.

Methods: Endoscopic submucosal implantation of PMMA was carried out in 10 patients with GERD who were either refractory to or dependent on proton pump inhibitors.

Duodenal obstruction caused by pancreatic head carcinoma: palliation with self-expandable endoprostheses.

Background: The risks of palliative operative intervention of gastric outlet obstruction for advanced pancreatic head carcinoma has been reported to be quite high. The present study reports the results of attempted endoscopic palliation of duodenal obstruction in these patients.

Methods: Ten patients with endoscopically documented malignant duodenal strictures from pancreatic head carcinoma in whom self-expandable endoprostheses were placed are retrospectively analyzed.

Palliation of large-bowel obstruction due to recurrent rectosigmoid tumor using self-expandable endoprostheses.

When large-bowel obstruction supervenes in patients with rectal tumor recurrence and extensive nonresectable disease, a proximal diverting colostomy may be indicated. In this study, nonsurgical palliation of the obstruction was attempted by inserting self-expandable endoprostheses to bridge the stenotic lesion. The endoprostheses were positioned in two patients with large-bowel obstruction due to recurrent stenotic tumor, and extensive disease excluding palliative resection.

Palliation of malignant gastric outlet obstruction with self-expanding metal stents.

Background And Study Aims: Self-expanding metal stents have long been used in the management of patients with malignant esophageal and malignant biliary obstruction. The aim of the present study was to report on the palliation of malignant gastric outlet obstruction using self-expanding endoprostheses.

Patients And Methods: Between March 1993 and December 1994, 12 patients (eight women, four men, mean age 64 years) suffering from malignant gastric outlet obstruction due to recurrent gastric carcinoma (seven patients) and pancreatic head carcinoma (five patients) presented with an inability to eat and intractable vomiting.

N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices: a randomized prospective study.

Background And Study Aims: N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding. The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates.

Patients And Methods: One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study.

Laparoscopic transcystic papillotomy under endoscopic control for bile duct stones.

We present here a laparoscopic transcystic papillotomy technique for the management of bile duct stones discovered either preoperatively or on intraoperative cholangiogram. Papillotomy is performed orthogradely with a hydrophilic wire-guided spincterotome inserted through the cystic duct. The correct position of the diathermic wire is verified with peroral duodenoscopy.

Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk.

Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%).

Endoscopic transpapillary catheterization of the gallbladder followed by external shock wave lithotripsy and solvent infusion for the treatment of gallstone disease.

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%).

Endoscopic hemostasis of esophageal and gastric variceal bleeding with Histoacryl.

Endoscopic injection of the tissue adhesive n-butyl-2-cyano-acrylate (Histoacryl) has been tried for esophageal or fundic variceal bleeding in 23 patients. Definitive hemostasis was achieved in 22 with a single injection of Histoacryl. Throughout the entire hospitalization period, which was completed with at least two weekly sessions of conventional sclerotherapy, only one recurrent bleeding was recorded.

Postoperative external and internal biliary fistulas, unassociated with distal bile duct obstruction: endoscopic treatment.

Endoscopic drainage was applied in 14 patients with either external or internal (bile ascites) postoperative biliary fistulas. Endoscopic sphincterotomy and/or insertion of a nasobiliary tube or an endoprosthesis was found to be a safe and effective treatment, achieving closure of fistula in all patients.

Endoscopic fistulotomy and biliary drainage as the ultimate palliative treatment for obstruction due to malignant tumors of the papilla of Vater.

This report describes the technique and results of endoscopic fistulotomy as a drainage procedure in cases of malignant obstruction of the biliary system from bulky and friable growths in the papilla of Vater. Fistulotomy, coupled with insertion of stents, was successful in seven of eight patients and was associated with relief of jaundice. It is suggested that the method be applied when conventional transpapillary insertion of stents is impossible either due to distortion of the papilla or bleeding of the growth on touch.

Serum and bile digoxin levels in patients subjected to cholecystectomy with or without choledochostomy.

Digoxin levels were measured perspectively in the serum of 12 patients subjected to cholecystectomy and in serum and bile (Kehr) of 15 patients who underwent cholecystectomy plus choledochostomy in order to assess adequate digitalization. All patients were volunteers with no cardiac problems. In the cholecystectomy group serum digoxin levels increased in all patients from the second to the fourth postoperative day (P = 0.

Serum phosphate levels in acute bowel ischemia. An aid to early diagnosis.

Serum phosphate levels were studied in 18 patients with acute intestinal infarction as proved by laparotomy. Serum phosphate was increased preoperatively (6.12 +/- 0.

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites.

The effect of preoperative treatment with cimetidine on postoperative wound sepsis.

The results of preoperative treatment of uncomplicated duodenal ulcer patients with Cimetidine are presented. Cimetidine given preoperatively increases the pH of gastric aspirates and alters the bacterial flora of the stomach at the time of operation, resulting in an increased incidence of postoperative wound sepsis. Discontinuing Cimetidine 2 days before surgery is a safe step against the risk wound sepsis.

Long term consequences of bacterial colonization of the biliary tract after choledochostomy.

We studied 48 patients--36 who underwent cholecystectomy and choledochotomy-choledochostomy for cholesterol gallstones and 12 patients as controls who underwent different types of extrabiliary operations. In our material, we observed that, in a high proportion of instances, infected bile during the early postoperative period remained contaminated for six months postoperatively--in an obviously unobstructed bile duct. In patients in whom Escherichia coli was isolated both early and late postoperatively, a statistical significancy was found.

The influence of corticosteroids on ileostomy discharge of patients operated for ulcerative colitis.

The ileostomy output and electrolyte loss was studied in 23 patients undergoing operation for ulcerative colitis, to determine corticosteroid influence. Ten patients did not use corticosteroids and 13 patients received postoperatively 400 mg hydrocortisone intravenously for 4 to 5 days followed by 90 mg prednisone per os thereafter. Ileostomy volume and electrolyte concentration and total loss were measured on the 4th and 8th postoperative days.