Biliary web--a rare cause of extrahepatic biliary obstruction.

A case of an isolated mucosal web of the common hepatic duct is presented. Such extrahepatic biliary webs are extremely rare causes of biliary obstruction, likely congenital in nature, but presenting in later life due to the initial patency of these webs in allowing bile drainage from the liver. The relevant literature is reviewed; diagnostic and therapeutic aspects are discussed.

Redundant surgical publications: tip of the iceberg?

Background: A redundant publication is one which duplicates previous, simultaneous, or future publications by the same author or group or, alternatively, could have been combined with the latter into one paper. As there is no information about the extent of this problem in the surgical literature, we set out to assess the incidence, spectrum, and salient characteristics of redundant publications in 3 leading surgical journals.

Methods: Original articles (excluding reviews, editorials, abstracts, and letters) published during 1998 in the journals Surgery, The British Journal of Surgery, and Archives of Surgery were searched by using the on-line search engine PUBMED.

What American surgeons read: a survey of a thousand Fellows of the American College of Surgeons.

PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are "popular," and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the "popularity" of journals with their IFs.

Small bowel ischemia following laparoscopic cholecystectomy.

Background: Among a myriad of physiological adverse affects of pneumoperitoneum-associated intra-abdominal hypertension, compromise of the mesenteric circulation is well documented.

Methods: After experiencing a case of fatal small bowel ischemia in the aftermath of laparoscopic cholecystectomy, the literature was reviewed.

Results: A Medline and Index Medicus search revealed at least 6 cases of small bowel ischemia following laparoscopic cholecystectomy.

Surgical feeding gastrostomy: are we overdoing it?

Feeding gastrostomy is a commonly performed procedure in North America. Our aim was to study the outcome of patients undergoing feeding gastrostomy to better define patients who will benefit from the procedure as opposed to those in whom it may be futile. A cohort of the most recent 100 consecutive patients undergoing feeding gastrostomy in a community teaching hospital was retrospectively studied.

Spontaneous perforation of the hepatic duct in adults.

Background: Nontraumatic perforations of the extrahepatic biliary ductal system are a rare albeit recognized occurrence in the cystic duct, choledochus and main hepatic duct; the latter appears to be the rarest.

Methods: Recent experience with such a case prompted a thorough review of 26 similar cases previously reported.

Results: It appears that obstruction of the biliary tract by gallstones results in raised intraductal pressure leading to dilatation of the biliary tree, subsequent stasis and infection, causing ascending cholangitis and thrombosis of intramural vessels, leading to necrosis and perforation of the duct wall.

Liver enzymes are commonly elevated following laparoscopic cholecystectomy: is elevated intra-abdominal pressure the cause?

Background: A previous study disclosed 'unexplained' disturbances in postoperative liver function tests (LFTs) in up to 80% of 67 patients undergoing laparoscopic cholecystectomy (LC). No cause for these elevations was documented. Our objective was to assess the incidence, cause and clinical significance of 'unexplained' disturbances in liver enzymes following LC.

Laparoscopic inguinal hernioplasty: a community hospital's experience.

Although controversial, laparoscopic inguinal hernia repair has become increasingly popular among surgeons. The overall advantages of this procedure over conventional hernia repair have not as yet been substantiated. One hundred and three consecutive laparoscopic, transabdominal, preperitoneal inguinal hernia repairs in 91 patients were evaluated retrospectively.