Antegrade revascularization for chronic mesenteric ischaemia.

OBJECTIVE: to evaluate the short- and long-term results, obtained after open revascularization for chronic mesenteric ischaemia as a reference in a field with growing interest for PTA and stenting. MATERIALS AND METHODS: we reviewed 14 patients with 15 antegrade revascularizations for chronic intestinal ischaemia, between 1996 and 2003: ten bypasses either to the celiac trunk or to the mesenteric artery and five bifurcated bypasses to both arteries were performed. There was one reimplantation for Wilki syndrome. Graft patency was monitored for a mean period of 24 months (range 1-84 months) by clinical examination and duplex scanning. MAIN RESULTS: one patient had recurrence of symptoms that disappeared after successful reoperation. There was one perioperative death All the other patients (84%) had a long-term symptom free survival. CONCLUSION: antegrade mesenterial revascularization through an upper abdominal approach is an excellent technique with good long-term results. It sets a high standard that will be difficult to obtain with mesenteric PTA and stenting. It remains the preferred method of revascularization in low-risk patients.

Polydioxanone suture material in growing vascular anastomoses. Experimental study.

We studied the growth of vascular anastomoses after use of absorbable suture material in 21 piglets. In six piglets, end-to-end anastomosis of the infrarenal aorta was performed with 5-0 continuous polypropylene suture; stenosis developed in two of these animals. In 15 piglets, continuous polydioxanone sutures were used for the anastomoses, and no stenosis developed. On the contrary, 14 of these anastomoses showed some degree of dilation at the anastomotic site. Burst testing to 300 mm Hg caused no disruption. On histologic examination, only scar tissue at media and intima with good degree of differentiation was noted. Growth of a vascular anastomosis after use of absorbable polydioxanone suture material seems to be perfectly possible without stricture formation. Because the growing process takes years instead of months in human beings, with obviously less stress at the anastomotic site, it is likely that dilatation at the level of the suture line will not occur in clinical use.

Fistula survival in single needle hemodialysis.

This study presents an average follow up per patient of 33.5 +/- 3.7 and 70.1 +/- 5.9 months (hospital and home dialysis) showing an actuarial fistula survival rate of 86.2% and 85.5% respectively after 5 years. The data suggest a satisfactory survival rate of the fistula when a single needle technique is used in comparison to the survival observed with the two needles technique.

Peritoneal lavage after abdominal trauma: indications, technique, results.

This study represents our experience with 1461 patients who were seen in the Emergency Room of the University Hospital in Ghent with multiple traumatic lesions, between 1978 and 1982. In 43% of these polytraumata, we did an explorative peritoneal lavage in order to obtain a quick evaluation of intrabdominal haemorrhage. In 65% of the patients, the lavage was negative; 221 positive lavages (35%) underwent abdominal exploration; in 85% of these there were evident positive findings. The remaining 15% showed either no lesions, or minor lesions not involving risk of life. The overall accuracy-rate of the technique described above is at least 93%.

[Our experience in the treatment of imperforate anus. Anterior (Mollard's technic) versus posterior approach (Stephens' technic)]. / Onze ervaring met de behandeling van anus imperforatus. Anterieure (techniek volgens Mollard) versus posterieure toegangsweg (techniek volgens Stephens).

The present series concerns the method of treatment for anus imperforatus as it was performed at the Academic Hospital Ghent (Belgium) between 1971 and 1980. Two different technics are confronted one with the other: the anterior perineal approach according to Mollard and the posterior transsacral approach according to Stephens. In agreement with the recent literature the anterior way of acceding to the puborectalissling has undeniable advantage. Even with a very short follow-up period the number of children with supralevatoric localization of anus imperforatus treated by the technic of Mollard and showing a proven continence is now already outnumber.

[Surgical treatment of abdominal aortic occlusion (author's transl)]. / De chirurgische behandeling van de totale aortatrombose.

Forty-seven cases treated for atherosclerotic occlusion of the abdominal aorta are reported. The classical trans-abdominal approach used in all our cases is compared with alternative approaches. The reasons for this preference are discussed.

Cost-benefit analysis of endovascular versus open abdominal aortic aneurysm treatment.

OBJECTIVE: To compare the costs and benefits of open versus endovascular repair of abdominal aortic aneurysm (AAA). METHODS: A consecutive series of 29 elective patients (open treatment, N = 20 and endovascular treatment, N = 9) were compared retrospectively. RESULTS: Operating time was significantly shorter for endovascular treatment (mean 90 vs. 125 min, p = 0.026). No endovascular procedure was converted to open surgery; one early endoleak was seen which sealed spontaneously. Endovascular treatment resulted in a shorter ICU and hospital stay (0 days vs. 2 days, p. 0.001 and 5 days vs. 11 days, p = 0.01 respectively). Mean total cost did not differ 361,938 BEF (9,048 Euro) vs. 382,995 BEF (9,575 Euro), p = 0.46. Endovascular treatment generated significantly less hospitalization costs (73,162 BEF or 1,829 Euro vs. 18,2740 BEF or 4,568 Euro, p = 0.001) but required a more expensive implant (153,293 BEF or 3,832 Euro vs. 38,296 BEF or 957 Euro, p = 0.001). Mean total cost for the patient was significantly higher in the endovascular treatment group (66,309 BEF or 1,658 Euro vs. 24,969 BEF or 624 Euro, p = 0.003). CONCLUSION: Our experience confirms the feasibility and safety of endovascular AAA treatment. It is associated with a shorter ICU and hospital stay and less morbidity. Overall cost for society does not differ significantly as the benefit, of lower hospitalization costs is undone by the high cost of the endovascular graft.

[The McVay technic for inguinal hernia cure. Results of treatment in a teaching center (author's transl)]. / Resultaten van de behandeling van hernia inguinalis volgens McVay in een opleidingscentrum.

Over a 20 year period 390 adults underwent 454 operations for inguinal hernia using the technique of McVay. The recurrence rate after primary repair was 7.61% and 18.33% for secondary hernias. This was usually early in the postoperative period. These results must be interpreted taking into a ccount that the operations were performed at a teaching institution.

[Indications, method and results of autotransfusion in trauma and vascular surgery (author's transl)]. / Indikaties, methodiek en uitslagen van de autotransfusie in vasculaire en traumachirurgie

The authors have used the Bentley Ats 100 system, a disposable autotransfusion unit, in 31 cases of trauma and major vascular surgery. An original method of anticoagulation consisting in heparine (1 mg/kg bodyweight) and priming and flushing of the succion unit with ACD is described. The effect of the autotransfusion on the coagulation and the recent problems and advances are discussed.

The true value of the carotid steal syndrome after the carotid subclavian by-pass. Human experimental study.

Between 1964 and 1978 sixteen patients underwent a carotid subclavian by-pass in the Akademisch Ziekenhuis of Gent. Most of these patients were submitted to tests to evaluate the importance of the carotid steal effect. The patency of the vertebral artery was found to influence these tests. Two of the three patients with an occluded vertebral artery had cerebral symptoms when the peripheral resistance was lowered in the involved limb. No positive tests could be found in the twelve patients with a patient vertebral artery. These results indicate that the carotid subclavian artery by-pass performed in the presence of an occluded vertebral artery does not protect the patient from the carotid steal effect.

[Parenteral nutrition "à la carte" in major abdominal surgery with mixtures of Totamine concentrate and Vintène. A clinical study based on nitrogen balance]. / Parenterale voeding "à la carte" in maieure abdominale heelkunde met gebruik van Totamine concentre en Vintène. En klinische studie aan de hand van de stikstofbalansen.

The authors present a series of thirty patients who underwent major abdominal surgery. Each patient received preoperative total parenteral nutrition (TPN) during bowel preparation. After the operation the TPN was continued immediately, even if reanimation was necessary. The dosages of nitrogen and calories were individually adapted in function of the daily calculated nitrogen-balances. So the authors were able to administer a TPN "à la carte" using eight solutions mixed in a single bag, containing amino-acids (varying between 6 and 20 g of nitrogen), glucose (ad 150 Kcal/gN) lipids (constituting 40% of the calorie-intake), ions, vitamins and oligoelements. With a follow-up of minimum 10 days, the study proves the possibility of creating positive nitrogen-balances in 87% of the cases and an acceptable deviation in the daily measured glycemia and plasma-ionograms.

Bronchial rupture after direct chest trauma in a child.

Tracheobronchial injuries are rare in trauma patients, and most often occur after motor vehicle accidents. Occasionally, other mechanisms cause airway disruption. The pliability of the chest wall in children greatly adds to the differences in injuries when compared with adult trauma patients. We present the case of a six-year old girl with an isolated right-sided bronchial rupture after direct trauma to the chest.

[Hyperplasia of the thyroid gland. Surgical indications and treatment (author's transl)]. / Schildklierhyperplasie. Chirurgische indicaties en behandeling.

The surgical indications of a benign multinodular euthyroid struma are: compression of trachea and oesophagus or a possible malignity of the lesion. The operation of choice is a bilateral subtotal lobectomy. To avoid postoperative vocal cord paralysis or hypocalcemia due to damage of the parathyroid glands, it is important to demonstrate systematically the recurrent nerve and spare the inferior thyroid artery.

Carotid endarterectomy for cerebrovascular insufficiency. Long term follow-up of 141 patients followed up to sixteen years.

Between 1962 and 1978 one hundred and fifty-nine endarterectomies were performed on 141 patients. The operation was done under general anesthesia with the use of a shunt and hypertension as cerebral protection. The arteriotomy was closed using a dacron patch. The postoperative evolution of every neurological symptom was analysed after a follow-up of up to sixteen years. The patients were divided in three groups following their neurological and anatomical situation. On 43 totally asymptomatic patients (group I), there was one perioperative death, 41 remained totally asymptomatic and one developed a transient ischemic attack on the non operative side. On 25 patients (group II) operated after symptomatic contralateral total occlusion, fifteen became asymptomatic, six improved seriously, one remained unchanged, and one suffered from a stroke with complete recuperation. Two perioperative deaths were encountered in this group. On the 73 patients from group III, there were three perioperative deaths. Fifty-two patients became totally asymptomatic, nine patients had a serious amelioration of their residu. Three remained unchanged. Five patients suffered from a long term deterioration of their neurological condition and one patient developed an anastomotic aneurysm.

Treatment of alkaline reflux gastritis. A report of twenty cases.

The surgical treatment of twenty patients operated for postoperative alkaline reflux gastritis is discussed together with the pathogenesis of this syndrome as a late postoperative surgery syndrome. Diagnostic procedures and results of investigations and treatment were compared with data of the literature. Surgical treatment is of great benefit. The different surgical technics should be used according their own indication.

[Experience with peripheral vascular injures from 1965-1980]. / Ervaring met perifere vasculaire traumata van 1965-1980.

The authors analyse a series of 45 vascular trauma treated during the period 1965-1980. It is very important to make a diagnosis as soon as possible and to limit the interval accident-operation. In 40% of our cases we had to operate rather late. Most of those cases were secondary transfers of other hospitals. Arteriography should be performed if there is any doubt. Now we always perform an angiogram during the operation. If there is any associated orthopedic injury, this is handled first, if possible by external fixation. A fasciotomy can be of value to save a limb. Any venous injury should be repaired also.

[Surgical experiences with traumatic diaphragmatic rupture]. / Chirurgische ervaringen met traumatische diafragmaruptuur.

Between 1970 and 1981, 35 patients with traumatic rupture of the diaphragma were treated. Blunt trauma, mostly caused by traffic accidents, predominates. The localization, type and dimensions of the diaphragmatic tear are studied. Among the associated visceral lesions, lacerations of the spleen and the liver are most often seen. Clinical and diagnostic aspects are discussed. Traumatic diaphragmatic rupture is an absolute surgical indication. In the early cases, with few exceptions, a primary abdominal approach is advocated. In the delayed category a thoracotomy is mostly preferred. Operative mortality in the early cases is mainly due to the magnitude of the associated lesions. No mortality occurred in the delayed category. Long term results in controlled patients were very satisfactory.

[The use of nutritive mixtures in a surgical unit (author's transl)]. / Het gebruik van nutritieve mengsels in een chirurgische eenheid.

Fifty patients in whom different nutritive mixtures were used are presented. Eight solutions with increasing caloric and nitrogen contents were used. The purpose of the study was to improve the nutritional status of patients prepared to major surgical interventions. A daily nitrogen balance was made to find out in what measure a positive balance could be attained. The presence or absence of complication was of utmost importance in the evaluation.

[Renal autotransplantation]. / Renale autotransplantatie.

The progress of renal transplantation in the last 2 decades has made possible the development of autotransplantation and extracorporeal surgery of the kidney. By those techniques, it is possible to operate upon patients in which conservative conventional surgery is impossible. In this article the technique is described, and two typical cases are reported. The mean indications are renal vascular hypertension, malignant tumors of the kidney, traumatic lesions of the kidney and ureteral lesions. All these indications are described in detail.

Operative closure of patent ductus arteriosus in the neonatal intensive care unit.

Preterm infants undergoing surgical closure of patent ductus arteriosus are usually critically ill and are suffering from many concomitant diseases. The high risk of increased morbidity in transferring them from the neonatal intensive care unit (NICU) to a distant operating room is generally recognized. For this reason we report our experience in 33 premature infants with patent ductus arteriosus who have been operated in the NICU over a six-year period. There were no operative or immediate postoperative deaths and the 30 days hospital mortality was 6%. Based upon these findings we can confirm that operative closure of PDA can be performed safely in the NICU.