Publications (6) View all
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Article: Laparoscopic versus open inguinal hernia repair: Expeditionary Medical Facility Kuwait experience.
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ABSTRACT: Inguinal hernia is a common surgical problem in the active duty population. The decision to perform a hernia repair in the traditional open manner versus a laparoscopic approach is somewhat controversial. Furthermore, the type of repair performed has not been analyzed in a systematic manner within an operational setting. We retrospectively reviewed all inguinal hernia repairs performed at Expeditionary Medical Facility Kuwait (EMFK) over an 18-month period, from April 2007 through October 2008. Operative times and time to return to duty were compared between active duty personnel undergoing open mesh repair and laparoscopic extraperitoneal inguinal hernia repair. One hundred seventy-six consecutive patients who underwent inguinal hernia repair by six different surgeons were analyzed. One hundred and four patients had an open repair and 72 patients underwent laparoscopic repair. The mean operative time was significantly longer in the laparoscopic group (20.2 minutes, p < 0.001). The mean time to return to duty was significantly shorter in the laparoscopic group (2.3 days, p = 0.008). Laparoscopic inguinal hernia repair is associated with longer operative times but shorter recovery periods. The laparoscopic approach may be a viable option for patients in the expeditionary setting.Military medicine 12/2009; 174(12):1320-3. · 0.92 Impact Factor -
Article: Endocavitary contact radiation therapy for ultrasonographically staged T1 N0 and T2 N0 rectal cancer.
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ABSTRACT: The purpose of this study was to determine the long-term outcomes of patients undergoing endocavitary contact radiation therapy (ECR) for stage I rectal cancer. A database of patients treated with ECR for biopsy-proven rectal adenocarcinoma from July 1986 to June 2006 was reviewed retrospectively. Only patients with primary, non-metastatic, ultrasonographically staged T1 N0 and T2 N0 cancer who had no adjuvant treatment were included. Patients received a median of 90 (range 60-190) Gy contact radiation, delivered transanally by a 50-kV X-ray tube in two to five fractions. Of 149 patients, 77 (40 T1, 37 T2) met the inclusion criteria. Median age was 74 (range 38-104) years, and median follow-up 69 (range 10-219) months. ECR failed in 21 patients (27 per cent) (persistent disease, four; recurrence, 17), of whom ten remained disease free after salvage therapy. The estimated 5-year disease-free survival rate was 74 (95 per cent confidence interval 63 to 83) per cent after ECR alone, and 87 (76 to 93) per cent when survival after salvage therapy for recurrence was included. ECR is a minimally invasive treatment option for early-stage rectal cancer. However, similar to other local therapies, ECR has a worse oncological outcome than radical surgery.British Journal of Surgery 05/2009; 96(4):430-6. · 4.61 Impact Factor -
Article: CT colonography predictably overestimates colonic length and distance to polyps compared with optical colonoscopy.
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ABSTRACT: The purpose of this study was to determine the discrepancy between CT colonography (CTC) and optical colonoscopy (OC) measurements for both anus-to-cecum length and anus-to-polyps distance and then determine whether a conversion factor could be generated to equate these CTC and OC distances. We retrospectively reviewed CTC and OC reports from patients who had undergone both procedures as part of an established protocol. The anus-to-cecum measurement recorded on a single proprietary CTC workstation was compared with the OC cecal length for each patient. Likewise, anus-to-polyp distances were compared as measured by the radiologist and endoscopist. Three hundred thirty-eight patients and 437 polyps were identified with complete data from both CTC and same-day OC. The average anus-to-cecum distance measured at CTC was 189 cm (range, 75-257 cm) and at OC, 108 cm (range, 65-150 cm). For polyps proximal to the splenic flexure (n = 145), the CTC anus-to-polyp measurement was on average 1.7 times that measured at OC. For left-sided polyps (n = 292), the CTC measurement was, on average, within 12 cm or 1.3 times that of the OC anus-to-polyp measurement. All the differences between CTC and OC measurements of cecal length and polyp distances were found to be statistically significant using a paired Student's t test of means (p < 0.001). Anus-to-cecum and anus-to-polyp distances are disparate but comparable using a conversion factor of 0.57 for the CTC anus-to-cecum measurement and 0.59 for right-sided CTC anus-to-polyp or 0.78 for left-sided CTC anus-to-polyp measurements. These anus-to-polyp conversion factors could potentially augment current CTC guidelines for accurate and precise polyp localization and removal at endoscopy.American Journal of Roentgenology 11/2009; 193(5):1291-5. · 2.78 Impact Factor -
Article: Venous thromboembolic disease in colorectal patients.
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ABSTRACT: Venous thromboembolic disease, which includes deep vein thromboses as well as pulmonary emboli, can be a significant complication in the postoperative patient. In particular, colorectal patients often carry a higher risk for venous thromboembolism when compared with patients undergoing other operative procedures. Features unique to colorectal patients are the high incidence of inflammatory bowel disease or malignancy. Typically, these patients will undergo lengthy pelvic procedures, which also contribute to a cumulative risk of venous thrombosis. It is critical that all patients and the proposed operative procedure are appropriately risk stratified. Risk stratification allows for easier implementation of an appropriate prophylactic strategy. There are a wide range of safe and effective mechanical and pharmacologic measures available. The authors provide very specific recommendations, but note that clinical judgment plays a significant role.Clinics in colon and rectal surgery. 02/2009; 22(1):34-40. -
Article: Benign pneumoperitoneum after colonoscopy: a prospective pilot study.
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ABSTRACT: Benign pneumoperitoneum is asymptomatic free intraabdominal air and is reported to occur occasionally with colonoscopy. Management of benign pneumoperitoneum after colonoscopy is controversial and may depend on incidence or etiology. No previous studies prospectively investigated the incidence or inciting factors of benign pneumoperitoneum resulting from colonoscopy. In this study, 100 patients underwent colonoscopy and then radiography of the chest and abdomen to detect free air. The average age was 58 +/- 6.2 years, and 48 of the colonoscopies were therapeutic. No cases of benign pneumoperitoneum were detected, estimating the incidence at 0% to 3% for diagnostic and therapeutic colonoscopy. These data indicate that benign pneumoperitoneum attributable to colonoscopy is rare and possibly nonexistent. Given the paucity of data favoring the occurrence of benign pneumoperitoneum after colonoscopy, we advocate treating all cases of free intraabdominal air after colonoscopy as perforations.Military medicine 08/2006; 171(7):648-9. · 0.92 Impact Factor
