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RESECTION ANASTOMOSIS
Niaz Ali A.K. Mohsin
The Professional Medical Journal , 1995,
Abstract: Perforation of the small gut during typhoid fever is a serious and life threatening problem which carries highmorbidity and mortality. OBJECTIVES: 1. To evaluate the male to female ratio of enteric perforation. 2.To know the distribution of disease in different age groups. 3. To evaluate the course of disease regardingthe occurrence of the perforation in different weeks of illness. 4. To choose between conservative andoperative treatment. 5. To select the best surgical procedure for the enteric perforation to lower the morbidityand mortality. SETTING: 108 cases of enteric perforation who presented at Tehsil Headquarters HospitalChiniot and District Headquarters Hospital Jhang between January 1991 to January 1994. DESIGN: Casestudy. PROCEDURES: Simple closure of perforation, wedge resection, wedge resection and modified ilealpatch application, resection anastomosis and right hemicolectomy. RESULTS: Male to female ratio was3.1:1.9. Common age group was between 21-30 years of age. Common period of perforation was third weekof illness. Resection anastomosis achieved lowest mortality (3.33%). CONCLUSIONS: Resectionanastomosis was found the best surgical procedure amongst all with lesser chances of leakage and with lowmorbidity and mortality.
Effect of VATS Wedge Resection and Mediastinal Lymph Node Sampling in Eldly Patients with Early Peripheral Lung Cancer  [cached]
Weihua LOU,Xiaohong ZHAN,Xinqing XIANG,Wei GUAN
Chinese Journal of Lung Cancer , 2012, DOI: 10.3779/j.issn.1009-3419.2012.01.10
Abstract: Background and objective The treatment for early-stage non-small cell lung cancer is primarily surgical. However, the optimal extent of mediastinal lymph node resection remains to be determined. The aim of the current study is to investigate the effect of a pulmonary wedge resection on aged patients with lung cancer. Methods A total of 15 lung cancer patients aged over 70 years were treated via video-assisted thoracoscopic surgery (VATS) wedge resection and mediastinal lymph node sampling from June 2004 to February 2008. Mediastinal lymph node sampling included stations 2R, 4R, 8 and 9 for the right-sided cancers and stations 5, 6, 8 and 9 for the left-sided cancers. Results VATS wedge resection and mediastinal lymph node sampling for aged patients with peripheral lung cancer are minimally invasive treatments with a short operative time and low postoperative morbidity. The 1-year and 3-year survival rates were 100% and 86.6%, respectively. Conclusion VATS wedge resection and mediastinal lymph node sampling can be an alternative treatment for aged patients with early peripheral lung cancer.
Laparoscopic wedge resection of synchronous gastric intraepithelial neoplasia and stromal tumor: A case report  [cached]
Yi-Ping Mou, Xiao-Wu Xu, Kun Xie, Wei Zhou, Yu-Cheng Zhou, Ke Chen
World Journal of Gastroenterology , 2010,
Abstract: Synchronous occurrence of epithelial neoplasia and gastrointestinal stromal tumor (GIST) in the stomach is uncommon. Only rare cases have been reported in the literature. We present here a 60-year-old female case of synchronous occurrence of gastric high-level intraepithelial neoplasia and GIST with the features of 22 similar cases and detailed information reported in the English-language literature summarized. In the present patient, epithelial neoplasia and GIST were removed en bloc by laparoscopic wedge resection. To the best of our knowledge, this is the first reported case treated by laparoscopic wedge resection.
TYPHOID PERFORATIONS
Naseer Ahmad Tariq
The Professional Medical Journal , 1998,
Abstract: Heal perforation is one of the most serious complications of the typhoid fever, a disease still common in thispart of world. Three hundred patients of typhoid perforations were managed by the surgical department ofNishtar Hospital Multan & B.V.H. Bahawalpur over a period of 42 months. Maximum number of patientspresent during second decade followed by the 3rd decade. 30% of the patients presented early within 24hours after the onset of the perforation. 18% cases presented between 24-48 hours and 52% werehospitalized after 48 hours. 70% of the patients belonged to the rural areas & majority of the patients whoreported late belonged to this group. Clinical diagnosis was made in 100% cases due to high index ofsuspicion. Preoperative fluid and electrolyte correction and blood transfusion were always given beforesurgical intervention. Primary closure of perforation was undertaken in early cases. Morbidity in the patientswith delayed presentation was higher as compared to the early cases, lleostomy for the patients with delayedpresentation ( > 48 hours) produced good results with significant decrease in the mortality. We recommendileostomy for the cases who are poor surgical risk or who are admitted to the hospital very late or the caseshaving friable gut wall at the time of laparatomy.
Oxidative and pre-inflammatory stress in wedge resection of pulmonary parenchyma using the radiofrequency ablation technique in a swine model
Theodoros Karaiskos, Periklis Tomos, Irene Asouhidou, Nikolaos Nikiteas, Theodoros Kontakiotis, Apostolos Papalois
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-7
Abstract: Fourteen white male swines, divided in two groups, the RFA-group and the control group (C-group) underwent a small left thoracotomy and wedge lung resection of the lingula. The wedge resection in the RFA-group was performed using the RFA technique whereas in C-group the simple "cut and sew" method was performed. We measured the malondialdehyde (MDA) and TNF-α concentration in the resected lung tissue of both groups.In C-group the MDA mean deviation rate was 113 ± 42.6 whereas in RFA-group the MDA mean deviation rate was significantly higher 353 ± 184 (p = 0.006). A statistically significant increase in TNF-α levels was also observed in the RFA-group (5.25 ± 1.36) compared to C-group (mean ± SD = 8.48 ± 2.82) (p = 0.006).Our data indicate that RFA-assisted wedge lung resection in a swine model increases regional MDA and TNF-a factors affecting by this oxidative and pre-inflammatory stress of the procedure. Although RFA-assisted liver resection can be well tolerated in humans, the possible use of this method to the lung has to be further investigated in terms of regional and systemic reactions and the feasibility of performing larger lung resections.Radiofrequency ablation (RFA) is performed by the delivery of electrical energy through a needle electrode to the area of interest, using high frequency alternating electrical current in order to cause a heat-based tissue damage. After hitting the target tissue, the current returns back to the generator through grounding skin pads. As the electrical energy increases the tissue temperature to 60-100°C there is denaturation of cellular proteins, melting of lipids, and instantaneous coagulative necrosis, resulting in irreversible cell damage.and destruction of tissue. Tissue destruction is enhanced by the creation of a secondary, wedge-shaped zone of damage due to vascular thrombosis. The RFA-created lesion heals with fibrosis and scarring [1].This technique has been widely used for the in situ destruction of small, usually m
Involutional Lower Eyelid Entropion: Combined Wheeler’s and Wedge Resection of Tarsal Plate
C Olali, V Burton, E Samaila
West African Journal of Medicine , 2010,
Abstract: BACKGROUND: Involutional entropion, a common eyelid condition, has different methods of surgical correction and attendant variable recurrence rates, depending to a large degree on the method used. OBJECTIVE: To describe and evaluate a modified technique of entropion repair where the Wheeler’s method is combined with wedge resection of the tarsal plate. METHODS: This was a chart review study of 49 patients who had the modified technique carried out to correct their involutional entropion. The technique essentially involves dissecting and separating the lower lid pre-tarsal orbicularis muscle from the tarsal plate, resecting a down-base triangular wedge of the tarsus followed by shortening the orbicularis and anchoring it to the tarsal plate superiorly. RESULTS: Over the three and a half-year review period, 54 eyelids of 49 patients underwent the procedure to correct their lower eyelid entropion. Of these, 28(57%) were females and 21(43%) males with a mean age of 73.5 years. The mean follow up period was 30.3 months. One (1.9%) recurrence was recorded in all the cases during the follow-up period. Complications were minimal. CONCLUSION: The combined Wheeler and wedge resection of the tarsal plate produces very good post-operative results and can be used in primary involutional entropion or as the procedure of choice if an initial different surgical technique used fails.
Partial wedge resection of nail, nail bed and nail matrix in ingrown toenail treatment  [PDF]
Vedat Uru?,Nuri Canseven,Cafer Tayyar Sel?uk,Mustafa D?nmez
Journal of Clinical and Experimental Investigations , 2010,
Abstract: Objectives: Ingrown toenail is a frequent problem which can be seen in all ages. There are many treatment methods both surgical and nonsurgical. In this study we evaluated the results of wedge resection of ingrown toe nail.Patients and Methods: A total of 80 toenails of 74 patients (55 female, 19 male) who complaint with discharge and deformity of their toenail underwent partial wedge resection of the nail and nail matrix. According to the Heifetz’s staging system, 34 toenails were grade II, 46 toenails were grade III. There was active drainage due to an infectious process in all effected toe nails. All patients were operated after 10 day of oral antibiotic treatment. We evaluated the recurrence, postoperative infection, patient satisfaction and time to return to work.Results: The mean follow up period was 8 months (4-12 months). There was no recurrence in any patient. Two patients came with wound drainage in postoperative 14th day. Intravenous antibiotic treatment, debridement and wound dressing with rifampicine every other day were accomplished. All patients expressed their satisfaction with surgery.Conclusion: In treatment of ingrown toenail; wedge resection of nail, nail matrix and nail bed is a very effective treatment. Recurrence rate following this technique is negligible if it is done properly and it has high patient satisfaction.
Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage  [PDF]
Alexander Shaw,John Jeffery,Laura Dias,Sarfraz Nazir
Case Reports in Gastrointestinal Medicine , 2013, DOI: 10.1155/2013/562642
Abstract: Background. Duodenal gastrointestinal stromal tumours (GISTs) are an uncommon malignancy of the gastrointestinal (GI) tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5?cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome. 1. Background Gastrointestinal stromal tumours (GISTs) are generally considered to be an uncommon soft tissue malignancy of the gastrointestinal tract. They predominantly occur in patients over the age of 50. They constitute 0.1% to 3% of all gastrointestinal tumours with an incidence equivalent to 10–20 cases per million [1, 2]. These tumours occur anywhere along the length of the gastrointestinal tract with the majority, 60%–70%, arising in the stomach. A further 20%–30% occur in the small bowel. On the whole GISTs of the duodenum are only found in 3%–5% of cases and it remains a rare location for their development [3]. When they do occur, the majority localise to the second portion of the duodenum (42/156 in one study) and as a result are frequently located close to the ampulla of Vater [3, 4]. Of all those that are surgically resected, 6%–21% are located in the duodenum [5, 6]. GISTs tend to present with vague nonspecific abdominal symptoms such as pain, a mass, or an occult gastrointestinal bleed. Occasionally patients will present with more severe symptoms such as obstruction, perforation, or severe acute bleeding as in the case described below [7]. The identification of the source of bleeding may be determined by upper gastrointestinal endoscopy when the tumour is located in the stomach or proximal duodenum. Those found incidentally tend to be small, with a mean diameter of 1.5?cm and carry a better
A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma  [cached]
Zhao Hongzhi,Han Keqiang,Li Jing,Liang Ping
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-199
Abstract: Background Gastrointestinal bleeding due to duodenal metastasis from renal cell carcinoma is extremely rare. Several previous reports have shown that embolic therapy or pancreatoduodenectomy (radical surgical resection) could be effective in controlling this type of clinical complication. Management is entirely dependent on the general condition and concurrent metastases at other sites. Optimizing the therapeutic strategies thus deserves further discussion and exploration. Methods In this report, we describe a patient with severe co-morbidities who underwent successful palliative wedge resection of duodenum and direct duodenal wall defect repair without reconstruction of duodeno-jejunostomy for acute upper digestive tract hemorrhage caused by duodenal metastasis from renal clear cell carcinoma. Results The patient recovered uneventfully and did not experience rebleeding and frequent vomiting after surgery. Since then (1.5 years) he has had no evidence of rebleeding. Conclusions Gastrointestinal bleeding due to duodenal metastasis of RCC may benefit from emergent resection even in the presence of severe co-morbidities, and for palliative treatment.
Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection  [cached]
Zhi-Bin Huo,Shu-Bo Chen,Jing Zhang,Hua Li
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i44.6489
Abstract: AIM: To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC), and enlarge the possibility of using laparoscopic wedge resection (LWR). METHODS: We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95%CI were calculated. We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate. RESULTS: In the univariate analysis, tumor size (P = 0.011), depth of invasion (P = 0.007) and lymphatic vessel involvement (P < 0.001) were significantly associated with a higher rate of LNM. In the multivariate model, tumor size (OR = 7.125, 95%CI: 1.251-38.218, P = 0.041), depth of invasion (OR = 16.624, 95%CI: 1.571-82.134, P = 0.036) and lymphatic vessel involvement (OR = 39.112, 95%CI: 1.745-123.671, P = 0.011) were found to be independently risk clinicopathological factors for LNM. Of the 85 patients diagnosed with poorly differentiated EGC, 12 (14.1%) had LNM. The LNM rates were 5.7%, 42.9% and 57.1%, respectively in cases with one, two and three of the risk factors respectively in poorly differentiated EGC. There was no LNM in 29 patients without the three risk clinicopathological factors. CONCLUSION: LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size, and when lymphatic vessel involvement is absent at postoperative histological examination.
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