Laparoscopic cholecystectomy in Jamaica: the initial experience

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.(AU)

Laparoscopic cholecystectomy in Jamaica: the initial experience

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.

Definitive repair of abdominal wall hernias - abstract

Difficult abdominal wall hernias are often prone to recur after correction. We present a small series of eight cases requiring a more comprehensive approach to the abdominal wall repair. Repair involved exposing the abdominal wall from xiphoid to pubis and correcting superiorly, inferiorly and laterally if necessary. Prosthetic prolene mesh was used in three patients. Abdominal wall repair was followed by abdominal dermolipectomy which enhances the repair and improves the aesthetic appearance. Four patients had repair after more than one recurrence, two after one recurrence and two presented for primary repair (AU)

University of the West Indies: Doctor of Medicine(Surgery); case book

Cases were collected throughout the authors surgical training on the basis that they were found to be the more interesting ones encountered. Some of the cases presented are in the subspecialty of the thoracic surgeon or thoracic surgery related general surgical problems. The last four papers were published in the West Indian Medical Journal or presented at the Annual Conference of the Commonwealth Caribbean Medical Council

University of the West Indies: Doctor of Medicine(Surgery); case book

Cases were collected throughout the authors surgical training on the basis that they were found to be the more interesting ones encountered. Some of the cases presented are in the subspecialty of the thoracic surgeon or thoracic surgery related general surgical problems. The last four papers were published in the West Indian Medical Journal or presented at the Annual Conference of the Commonwealth Caribbean Medical Council

Leiomyoma of the trachea

A case of leiomyoma of the trachea is described. Only fourteen cases of this tumour have been previously reported in the literature. The importance of early diagnosis and treatment is discussed (AU)

Patent ductus arteriosus: result of operative intervention (1953-1984)

A retrospective study of all patients with patent ductus arteriosus treated surgically from 1953 to 1984 at the University and National Chest Hospitals revealed low morbidity and mortality rates associated with anaesthesia and surgical treatment. Patients with patent ductus arteriosus should, therefore, be considered for surgical correction. (AU)

Patent ductus arteriosus in West Indian children - abstract

Patent ductus arteriosus (PDA) is frequently seen in children presenting at referral clinics. These children are offered surgical correction as published reports indicate such therapy is quite satisfactory. This study reports the results of operative intervention (1953 to 1984) at the University Hospital (UH) and National Chest Hospital (NCH). A study of all children (<13 years) subjected to surgical correction of PDA was undertaken to evaluate the results of this operation. There were 140 females and 72 males and their ages ranged from a few weeks to 12 years (mean 4.6 years). A clinical diagnosis of PDA was made in all patients. Forty-two children were subjected to cardiac catheterisation to confirm the clinical diagnosis and/or to exclude other cardio-vascular abnormalities. Anaesthetic management included a balanced technique and induced moderate arterial hypotension to facilitate the great vessel surgery. The operative procedures performed were as follows:- PDA division + suture - 151; PDA ligitation - 48; PDA division + suture & coarctation repair - 5; PDA division + suture & sub-aortic stenosis repair (OHS) - 1; PDA aneurysm repair with LA-femoral bypass - 1; No PDA at thoracotomy - 6, --division of ligamentum arteriosum, --repair of aorto-pulmonary fistulae (OHS) -1, --subsequent repair of VSD (OHS). (OHS = open heart surgery with cardio-pulmonary bypass). There was 1 intra-operative death (<0.5 per cent mortality) due to bleeding from a torn ductus (in 1965) and 1 post-operative death (<0.5 per cent mortality) caused by digoxin toxicity which occurred on day 1 in the convalescent ward. The clinical diagnosis of PDA is accurate (96.5 per cent), and the techniques of anaesthesia and surgery are associated with low morbidity and mortality. Children with PDA should therefore be considered for surgical correction (AU)

Oesophageal varices - abstract

The treatment of bleeding oesophageal varices remains a frustrating exercise for physicians and surgeons. At the University Hospital of the West Indies, during the period January 1971 to December 1982, 53 patients were admitted with bleeding oesophageal varices. The diagnosis was confirmed by barium meal, oesophagoscopy, surgery or at post-mortem. Thirty-nine of these were males. Their ages ranged from 11 to 81 years. Forty-two belonged to the 40 to 60-year age group. Initially, all patients were treated with blood transfusion, intravenous pitressin and the Sengstaken Blakemore tube. In 10 patients the bleeding stopped and they were discharged home. Of the remaining 43 patients, 29 died without surgery. Sixteen patients died within 3 days of admission, 7 patients were not fit for surgery and 6 refused operation. Fourteen patients underwent surgery. Eleven had an emergency surgical procedure to control bleeding and only 3 of these survived. Three patients had elective operations following conservative control of bleeding and all of them survived. The overall mortality form bleeding oesophageal varices of 70 percent reflects our difficulty in controlling bleeding adequately in the initial stages as a prelude to elective portal decompression in these patients. The reason for this are: (a) difficulty in monitoring the patients with Sengstaken-Blakemore tube on the general wards, and the frequent non-availability of the tube, (b) difficulty in obtaining adequate amounts of blood, and (c) lack of early surgical intervention in cases where bleeding is not controlled by conservative means. It is our belief that patients with acute variceal haemorrhage should be manged in an Intensive Care Unit. In this setting we are more likely to be able to control bleeding and to prepare the patient for elective surgery. We also need to develop a more aggresive approach to those patients whose bleeding is not promptly controlled and to advise surgical intervention before the general conditions of the patient deteriorates to a point where he is no longer fit for surgery (AU)