Open surgery

Table 9. Effect of short-term preoperative treatment with rifaximin or placebo on fecal bacterial counts in 118 patients submitted to colonic open surgery (from Gruttadauria et al. [148])... 

The advent of less invasive procedures of laparoscopic cholecystectomy and endoscopic ductal stone removal have reduced the use of classical open surgery, and made drug-induced stone dissolution less attractive. 

It is clear from each of these tables that open surgery is more successful than percutaneous nephrolithotomy (93 versus 87 per cent for small stones, 73 versus 69 per cent for large stones), irrespective of the size of the kidney stone. 

Duda et al. prospectively studied 70 patients in the PROMPT trial of UK and abciximab versus UK alone. The trial showed the combination therapy resulted in a decreased infusion time, improved amputation free survival, and improved open surgery free survival at 90 days (46). Interestingly, a post hoc economic analysis of the PROMPT trial found an economic benefit to combination therapy at 90 days based on endpoints of amputation free survival, survival without open surgery, lack of major amputation and lack of major complications. The extra cost of abciximab was more than offset by the decreased costs through improved patient outcomes (47). 

Cuypers FW, Laheij RJ, Buth J. Which factors increase the risk of conversion to open surgery following endovascular abdominal aortic aneurysm repair The EUROSTAR collaborators. Eur J Vase Endovasc Surg 2000 20(2) 183-189. 

There are four possible surgical procedures to treat intracerebral hematoma simple aspiration, craniotomy with open surgery, endoscopic evacuation and stereotactic aspiration. Open surgery remains the technique of choice at present... 

Sangiorgi et al. (S2) described the effect of surgery on plasma MMP levels in patients with aortic aneurysms. After endovascular grafts and open surgery of aortic aneurysms, both plasma MMP-9 and MMP-3 decreased >50%. The authors proposed that a lack of decrease in plasma MMP levels after endovascular grafting may help to identify patients who will have postoperative endovascular leakage. 

If the aneurysm does recur, repeat angiography and embolization is indicated if there is still access and recanalization or recruitment of other arteries has occurred. CT guided percutaneous thrombin may also be used but it may be that open surgery is the only alternative. See Table 7.1 for details of technical requirements. 

Aneurysms and pseudoaneurysms causing haemobilia or associated with pancreatitis are potentially fatal. Imaging, particularly CECT, is vital to their diagnosis. Conservative therapy is a poor option and treatment, which was formally via open surgery, is now best carried out by angiography and percutaneous coil embolization in haemobilia and for Type la and b pancreatitis associated pseudoaneurysms. Percutaneous CT guided thrombin therapy is indicated for Type 2 aneurysms. 

Also the results of the analysis of deviance and the likelihood ratio test of the significance of the regression coefficients were positive for this model. Thus we can say that our model, created by the multidimensional logistic regression, is suitable to predict the morbidity of the patients who undergo the open surgeries of colon in The Faculty Hospital Ostrava. 

In the past AAAs were treated by open surgery which involved a large abdominal incision and implantation of a synthetic prosthesis as described in a previous chapter. Today, with the development of the endovascular stent graft, the less invasive EVAR is approach that has several advantages over the open procedure, chief among which is a lower perioperative morbidity and mortality rate (Teufelsbauer, 2002 Biebl, 2005). 

Australian, British and American surgeons have looked at the intermediate results of the US trial for the fenestrated graft to evaluate the safety and shortterm effectiveness of the device.Thirty patients with short proximal necks were enrolled in the trial and treated with the Cook Zenith custom-fenestrated devices. None of the visceral arteries, renal or superior mesenteric, were lost as a result of the surgery. After 24 months there were no aneurysm-related deaths, ruptures, or conversions to open surgeries. There were 6 incidences of type II endoleak at 12 months and 4 at 24 months. In all patients the diameter... 

Therefore, methods such as hybrid procedures, sandwiches, chimneys and snorkels, and on-site and in situ fenestrations have been developed. Hybrid procedures involve open surgery to create bypasses to the renal and mesenteric arteries, followed by covering all the branches with a conventional stent graft so as to extend the landing zone. Chimneys or snorkels involve placing a parallel, smaller sized covered stent into the renal arteries so that blood flows to the kidneys. However, there is concern that endoleaks will cause blood to flow between the aortic stent-graft and the renal chimney. There is a similar concern when more than one bifurcated device is inserted or sandwiched in the same aneurysmal sac so as to provide blood flow to several extensions simultaneously. The body of such devices needs to take on a D shaped cross-section so as to avoid endoleaks between the devices and the aneurysmal sac. 

The restoration of the normal blood flow can be achieved in two main ways one through open surgery, and the other through minimally invasive surgery, such as endovascular procedures, which are described in the next chapter. In open surgery general anesthesia is required for the procedure. An incision is made in the abdomen and/or in the limbs to expose... 

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