Expert Surgical Team Research Articles

Early complications following pancreatico-duodenectomy.

To determine the mortality and morbidity in patients after Whipple's pancreaticoduodenectomy. Descriptive study. Department of General Surgery (Ward-2), Jinnah Postgraduate Medical Centre, Karachi. All the patients who underwent standard Whipple's procedure were followed up during their hospital stay for early postoperative complication. The indicators for the development of complications included daily nasogastric (NG) tube output for delayed gastric emptying, ultrasound abdomen for intra-abdominal collections, presence of blood in drains and NG tubes for haemorrhage and measuring serum amylase for pancreatitis. Out of 30 patients, 3 patients died in early postoperative period with 10% mortality while 26.67% had wound infection, 16.67% had chest complications, 13.34% developed intra-abdominal collections, 10% had haemorrhage, 3.34% had delayed gastric emptying, 3.34% had pancreatic fistula and 3.34% had organ failure. In this series the procedure was associated with decreased mortality due to increased experience and skills but morbidity was still high due to lack of facilities for the detection and management of postoperative complications. It should only be performed in tertiary care centres with expert surgical teams and facilities for adequate management of postoperative complications.

Maintenance Therapy in Gastro-oesophageal Reflux Disease

Gastro-oesophageal reflux disease (GORD) is a chronic condition. Symptom control and the maintenance of healing of erosive oesophagitis, if present, are important topics. In patients responding to a proton pump inhibitor (PPI) and showing no treatment symptoms it is appropriate to consider long-term treatment strategies, whether continuous, intermittent or on demand. Maintenance PPI therapy is well tolerated for up to 10 years of continuous use. Furthermore, tachyphylaxis does not occur during long-term maintenance PPI therapy. Previous concerns about risks of long-term PPI therapy in Heliobacter pylori-negative or H. pylori-positive patients have not materialized, while no cases of intestinal metaplasia with dysplasia or adenocarcinoma were found. The choice between medical and surgical therapy should depend upon informed patient preference. The optimal candidate for antireflux surgery is a young patient, with typical GORD symptoms, with erosive oesophagitis, with previous complete symptom resolution on acid-suppression therapy and unable to undergo continuous therapy, or alternatively in patients with regurgitation predominating over heartburn as long as the surgical procedures are conducted by an expert surgical team. Endoscopic therapy for erosive GORD should currently be regarded as experimental. The endoscopic procedures are safe, although they remain untested in patients with severe erosive oesophagitis and/or significant hiatal hernia.

Image fusion, virtual reality, robotics and navigation. Effects on surgical practice

In the new minimally invasive surgical era, virtual reality, robotics, and image merging have become topics on their own, offering the potential to revolutionize current surgical treatment and assessment. Improved patient care in the digital age seems to be the primary impetus for continued efforts in the field of telesurgery. The progress in endoscopic surgery with regard to telesurgery is manifested by digitization of the pre-, intra-, and postoperative interaction with the patients' surgical disease via computer system integration: so-called Computer Assisted Surgery (CAS). The preoperative assessment can be improved by 3D organ reconstruction, as in virtual colonoscopy or cholangiography, and by planning and practicing surgery using virtual or simulated organs. When integrating all of the data recorded during this preoperative stage, an enhanced reality can be made possible to improve intra-operative patient interactions. CAS allows for increased three-dimensional accuracy, improved precision and the reproducibility of procedures. The ability to store the actions of the surgeon as digitized information also allows for universal, rapid distribution: i.e., the surgeon's activity can be transmitted to the other side of the operating room or to a remote site via high-speed communications links, as was recently demonstrated by our own team during the Lindbergh operation. Furthermore, the surgeon will be able to share his expertise and skill through teleconsultation and telemanipulation, bringing the patient closer to the expert surgical team through electronic means and opening the way to advanced and continuous surgical learning. Finally, for postoperative interaction, virtual reality and simulation can provide us with 4 dimensional images, time being the fourth dimension. This should allow physicians to have a better idea of the disease process in evolution, and treatment modifications based on this view can be anticipated. We are presently determining the accuracy and efficacy of 4 dimensional imaging compared to conventional evaluations.

Traumatismos raqui-medulares. Consideraciones a propósito de 56 casos y revisión de la literatura

Summary The treatment of the spinal trauma is currently a matter of controversy between different authors. In this paper, the results in a serie_s of 56 patients with spinal trauma are presented and discussed. The etiopat­ hogenic factors, the clinical picture, the therapeutic ap­ proaches, and the follow-up were taken into account and compared with those published in the Iiterature. It is con­ cluded that men over 36 years are mainly affected. A car accident is the cause of the trauma in the majority of the cases. Surgical management is seldom required in the acute fase and, in few cases, it may be contraindicated. The surgical treatment is indicated in those patients with a good general condition, in whom the possible complica­ tions are usually minimal. In any case, the operation must be carried out by expert surgical teams.

Adult Lumbar Scoliosis: Treatment with Combined Anterior-Posterior Spinal Fusion

Innovative surgical approaches to current adult lumbar scoliosis result in faster recovery time and greater satisfaction regarding patient abilities after surgery. Combined ASF/PSF requires expert surgical team coordination throughout the perioperative period to achieve positive patient results.