Open cholecystectomy: muscle splitting versus muscle dividing incision: a randomized study.

While laparoscopic cholecystectomy has become the standard procedure for symptomatic gallstones, it is likely that 10% of patients will require an open cholecystectomy whether owing to contraindications to the laparoscopic approach or because conversion to the open technique became necessary following laparoscopy. Although the trend towards smaller open cholecystectomy incisions has led to a reduced hospital stay, much of the postoperative morbidity can be ascribed to wound pain. Muscle splitting incisions tend to be less painful than muscle dividing incisions.

Toxic megacolon associated with anticancer chemotherapy.

The majority of gastrointestinal side effects associated with anticancer chemotherapy are relatively mild and self-limiting and can be managed empirically. However, severe side effects, such as necrotizing enterocolitis and ischemic colitis, sometimes do occur after chemotherapy. The authors present a case of toxic megacolon associated with anticancer chemotherapy.

Intraperitoneal prolene mesh in hernia repair: a comparison of two techniques.

Prolene (polypropylene) mesh is a useful material for technically difficult repairs of abdominal wall hernias. In this study, two insertion techniques were used and compared. The first method, in which 2-cm wide strips of mesh were cut perpendicular to the main part, pulled through the musculoperitoneal layer and anchored to the anterior fascial layer, was abandoned after use in 10 patients because of complications.

Cricopharyngeal myotomy.

Cricopharyngeal myotomy has been used in the treatment of pharyngoesophageal diverticulum and various neurogenic, myogenic and myoneurogenic disorders. An appreciable number of patients with pseudobulbar palsy due to cerebrovascular accidents and patients with idiopathic hypertrophy of the cricopharyngeal muscle will greatly benefit from this procedure. This paper describes the indications for, and results of, 20 consecutive cricopharyngeal myotomies carried out with or without diverticulectomy.

Right paraduodenal hernia.

Right paraduodenal hernias are uncommon. Approximately 50 cases have been reported and 2 more are reported in this paper. The diagnosis of internal hernia should be considered in all patients with abdominal cramps and intermittent small bowel obstruction.

Xeromammographic diagnosis of mammary hamartoma.

A mammary hamartoma was diagnosed by xeromammography prior to surgery.

Intraoperative common duct pressure and flow measurements.

Operative cholangiography is still the most accurate and available method for assessing the presence or absence of stones in the common duct. However, 30 to 40 percent of stones will still be overlooked with cholangiography. To reduce the incidence of overlooked common duct stones we recommended that pressure and flow measurements be obtained before cholangiography.

Cholecystectomy with and without drainage.

The authors studied the effect of intraoperative drainage, presence of postoperative pyrexia, influence of appendectomy, chest complications and wound infection in 200 patients who had undergone routine uncomplicated cholecystectomy. One hundred patients in whom no drain was inserted were matched with 100 patients whose cholecystectomies, performed during the same period, included placement of a drain. There were 10 males and 90 females in each group; the mean age was 40.

Acute cholecystitis.

The mortality rate for acute cholecystitis was 9.4 per cent. Those patients who underwent cholecystostomy had a mortality rate of 27.

The results of cholecystostomy for the treatment of acute cholecystitis.

Six of 22 patients with acute cholecystitis who had a cholecystosomy died. All six deaths were attributed to cholangitis, none of the patients had undergone common bile duct decompression at the time of cholecystosomy. Cholecystostomy must be accompanied by choledochotomy in the treatment of acute suppurative cholangitis.