Try a new search

Format these results:

Searched for:



Total Results:


Conversion in laparoscopic surgery: does intraoperative complication influence outcome?

Yang, Chunkang; Wexner, Steven D; Safar, Bashar; Jobanputra, Sanjay; Jin, Heiying; Li, Vicky KaMing; Nogueras, Juan J; Weiss, Eric G; Sands, Dana R
BACKGROUND:Conversion from laparoscopy to laparotomy can be expected in a variable percentage of surgeries. Patients who experience conversion to a laparotomy may have a worse outcome than those who have a successfully completed laparoscopic procedure. This study aimed to compare the outcomes of converted cases based on whether the case was a reactive conversion (RC, due to an intraoperative complication such as bleeding or bowel injury) or a preemptive conversion (PC, due to a lack of progression or unclear anatomy). METHODS:All laparoscopic colorectal procedures converted to a laparotomy were retrospectively reviewed from data prospectively entered into an institutional review board-approved database. Patients who underwent an RC were matched with patients who underwent a PC according to age, gender, body mass index (BMI), and diagnosis. Patients who underwent a laparoscopic colorectal resection (LCR) were taken as the control group. The incidence and nature of postoperative complications, the time to liquid or regular diet, and the length of hospital stay were recorded. RESULTS:Of 962 laparoscopic procedures performed between 2000 and 2007, 222 (23.1%) converted to a laparotomy were identified. The 30 patients who had undergone an RC were matched with 60 patients who had undergone a PC and 60 patients who had undergone an LCR. The reasons for RC were bleeding in 14 cases, bowel injury in 6 cases, ureteric damage in 3 cases, splenic injury in 3 cases, and other complications in 4 cases. The patients who had undergone RC were more likely to have experienced a postoperative complication (50% vs 27%; p = 0.028), required longer time to toleration of a regular diet (6 vs 5 days; p = 0.03), and stayed longer in the hospital (8.1 vs 7.1 days; p = 0.080). CONCLUSION/CONCLUSIONS:Preemptive conversion is associated with a better outcome than reactive conversion. Based on this finding, it appears preferable for the surgeon to have a low threshold for performing PC rather than awaiting the need for an RC.
PMID: 19319604
ISSN: 1432-2218
CID: 5051352

Anal fistula plug: initial experience and outcomes

Safar, Bashar; Jobanputra, Sanjay; Sands, Dana; Weiss, Eric G; Nogueras, Juan J; Wexner, Steven D
PURPOSE/OBJECTIVE:This study was designed to analyze the efficacy of the Cook Surgisis AFP anal fistula plug for the management of complex anal fistulas. METHODS:This was a retrospective review of all patients prospectively entered into a database at our institution who underwent treatment for complex anal fistulas using Cook Surgisis AFP anal fistula plug between July 2005 and July 2006. Patient's demographics, fistula etiology, and success rates were recorded. The plug was placed in accordance with the inventor's guidelines. Success was defined as closure of all external openings, absence of drainage without further intervention, and absence of abscess formation. RESULTS:Thirty-five patients underwent 39 plug insertions (22 men; mean age, 46 (range, 15-79) years). Three patients were lost to follow-up, therefore, 36 procedures to be analyzed. The fistula etiology was cryptoglandular in 31 (88.6 percent) patients and Crohn's disease associated in the other 4 (11.4 percent). There were 11 smokers and 3 patients with diabetes. The mean follow-up was 126 days (standard = 69.4). The overall success rate was 5 of 36 (13.9 percent). One of the four Crohn's disease-associated fistulas healed (25 percent) and 4 of 32 (12.5 percent) procedures resulted in healing of cryptoglandular fistulas. In 17 patients, further procedures were necessary as a result of failure of treatment with the plug. The reasons for failure were infection requiring drainage and seton placement in 8 patients (25.8 percent), plug dislodgement in 3 (9.7 percent), persistent drainage/tract and need for other procedures in 20 patients (64.5 percent). CONCLUSIONS:The success rate for Surgisis AFP anal fistula plug for the treatment of complex anal fistulas was (13.9 percent), which is much lower than previously described. Further analysis is needed to explain significant differences in outcomes.
PMID: 19279419
ISSN: 1530-0358
CID: 5051342

Laparoscopic diverticular resection with situs inversus totalis (SIT): report of a case [Case Report]

Jobanputra, Sanjay; Safar, Bashar; Wexner, Steven D
Situs inversus totalis (SIT) is a rare condition where the abdominal and thoracic cavity structures are opposite of their usual position. Laparoscopic colonic surgery for this patient population is not well described, with only 2 reported cases. Our patient was a 62-year-old female with a history of SIT who underwent a laparoscopic sigmoid colectomy for recurrent diverticulitis. The procedure included the use of 4 ports. The sigmoid colon was noted on the right side. Laparoscopic resection with stapled anastomosis was performed. The patient tolerated the procedure well and was discharged home on postoperative day 5 without complications. We present a third case of laparoscopic colectomy for diverticulitis in a patient with SIT and a description of the operative procedure.
PMID: 18178918
ISSN: 1553-3506
CID: 5051332


Jobanputra, Sanjay; Weiss, Eric G
Strictureplasty in patients with Crohn's disease is an option in the colorectal surgeon's armamentarium for fibrostenotic obstructive disease. Common types include the Heineke-Mikulicz strictureplasty, Finney strictureplasty, and the side-to-side isoperistaltic strictureplasty. The procedure has potential for significant morbidity; therefore, it should be chosen for the patient carefully. Strictureplasty complements bowel resection in Crohn's disease; it is an excellent procedure to reduce the risk of developing short-bowel syndrome and its associated complications.
PMID: 20011425
ISSN: 1530-9681
CID: 5051362

Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus [Case Report]

N'Kanza, Anne Lihau; Jobanputra, Sanjay; Farmer, Peter; Lovecchio, John; Yelon, Jay A; Rudloff, Udo
The central nervous system is traditionally considered as an uncommon site for metastatic disease from the female genital tract, and cerebral metastasis as the primary manifestation of an occult gynecological malignancy is even more rare. Here, we report the case of a 61-year-old female who presented with neurological symptoms of confusion, headache, cerebellar ataxia and right-sided weakness. Magnetic resonance imaging of the brain revealed two solid lesions in the frontal lobe and the left cerebellar hemisphere. Endometrial biopsy of a uterine mass detected during search for the primary lesion showed malignant mixed Mullerian tumor (MMMT). The patient refused surgery. Cranial radiotherapy for progressive cerebral disease led to resolution of her neurological symptoms. Two months after the diagnosis of MMMT the patient died from local complications of advanced pelvic disease. At autopsy, only the epithelial component of the tumor had metastasized to the brain. Attention should be paid to possibility of unusual distant metastases associated to MMMT in order to avoid delay in diagnosis and treatment of these patients.
PMID: 16010557
ISSN: 0932-0067
CID: 759162

Meckel's diverticulum complicating pregnancy. Case report and review of the literature [Case Report]

Rudloff, Udo; Jobanputra, Sanjay; Smith-Levitin, Michelle; Kessler, Edmund
INTRODUCTION: Symptomatic Meckel's diverticulum is a rare entity in pregnancy. The clinical presentation is variable and preoperative diagnosis is hampered by the various anatomical and physiological changes of pregnancy that can obscure serious underlying intra-abdominal pathology. CASE REPORT: We report a 14-year-old who presented at 32 weeks' gestation with worsening abdominal pain, distension, and leukocytosis. Abdominal computed tomography showed a pelvic fluid collection with extraluminal air suggestive of a perforated viscus and mechanical small bowel obstruction with features of a closed-loop obstruction. Explorative laparotomy revealed a perforated Meckel's diverticulum. Multiple adhesions between the appendix and the perforated diverticulum, and phlegmon sequelae led to the incarceration of an adjacent segment of ileum. DISCUSSION: Meckel's diverticulum in pregnancy can have serious consequences. There is a high rate of perforation due to delayed diagnosis and surgical intervention. Our report and review of the literature suggest that a high index of clinical suspicion can lead to earlier diagnosis and help to keep maternal and fetal morbidity and mortality to a minimum.
PMID: 15290167
ISSN: 0932-0067
CID: 2060622