Management Of Stump Research Articles

Prospective randomised pilot study of management of the pancreatic stump following distal resection

Background Numerous surgical techniques have been described in the literature for pancreatic stump management following left resection, but there is only one prospective, randomised study. A prospective randomised pilot study was designed to assess five different pancreatic stump management techniques after distal resection in an attempt to identify which was the most effective in terms of complications and ease of execution. Methods Sixty-nine consecutive patients were randomly assigned to five different treatment groups: manual suturing, suturing plus fibrin glue, suturing plus polypropylene mesh, pancreaticojejunostomy and suturing with a stapler. All presented a soft residual pancreas. Results The overall incidence of pancreatic fistula was 19%, ranging from 7% to 33% in the different treatment groups. None of the techniques Significantly reduced the incidence of postoperative complications. Discussion On weighing the complications observed against ease and speed of execution, the construction of a pancreaticojejunostomy and closure of the stump with a mechanical stapler may be regarded as the procedures to be tested in future.

Management of the leaking rectal stump after Hartmann's procedure

Hartmann's procedure is often selected in situations in which the construction of a colorectal anastomosis is considered unsafe. Paradoxically, the creation of the rectal stump involves placement of an intestinal suture line that is prone to leakage. We report our experience with 11 patients with a clinically significant leakage from the rectal stump after Hartmann's procedure, which was manifested as persistent postoperative intra-abdominal infection. A method for the treatment and prevention of this potentially lethal complication is presented.

Stump Management Increases Coppice Yield of Sycamore

Abstract Stumps of American sycamore (Platanus occidentalis L.) saplings cut during the dormant season produce larger and heavier sprouts after four years than those cut during the growing season. Stumps should be cut no more than 6 inches high to facilitate sprouting taproot development, and maneuverability of harvesting equipment. Coppice yields increase as stump diameter increases.

Amputation stump management—a preliminary report on the use of shrink plastic film as a surgical dressing in amputa

Amputation stump management—a preliminary report on the use of shrink plastic film as a surgical dressing in amputa

Comparison of Postoperative Stump Management

A study of 182 diabetic, largely geriatric, amputees has been presented to compare three different methods of postoperative care. In random selected groups, a standard soft dressing was compared with a rigid plaster dressing and both were then compared with plaster rigid dressing with an ambulatory pylon attached. The patient population was relatively homogeneous in that they all bore the diagnosis of diabetes. When rigid dressings were applied, they were provided by prosthetists trained specifically for this method of care. The results of this study support the view that the rigid dressing and ambulation do not deter wound healing and probably are a positive factor in achieving a healed wound and a physical and mental attitude able to accept the prosthetic use. However, additional evidence supports the idea that immediate ambulation may be an early deterrent factor to healing and should be delayed for several weeks. The rate of prosthetic use in this study has been greatly improved when compared with previous experience with essentially the same type of patient population ten years ago. Two major reasons for this improvement are the more frequent use of the below-the-knee amputation and the early use of temporary, total-contact prosthetic devices.

Peptic Ulceration: A Symposium for Surgeons

The foreword by Dr. Dragstedt adds immeasurably to this volume which contains more highly polished contributions to a symposium than it has been my good fortune to see in many other symposiums. In common with other British publications it has entrancing exotic touches such as the discussion of gastric dysfunction in California seals and a translation of Billroth's letter written on the fifth postoperative day with regard to his own first gastrectomy. If the volume contained no more than the excellent discussion of postoperative late complications, it would be well worth having. The section on the management of the duodenal stump is unusually clear and open-minded. Other articles, while adequate, are not as outstanding as they are well written and reasonably complete. Apparently the authors are not aware of the syndrome described several years ago by Dr. Wermer into which group many of their cases quoted on the cause of