Allan Hjortrup

Anterior resection for mid-rectal cancer with the EEA stapling instrument

Early results of resection with primary anastomosis for cancer of the mid-rectum using a new stapling instrument are reported. Thirty patients with an adenocarcinoma 7 to 12 cm from the anal verge were operated on. One patient died postoperatively from respiratory complications but with no sign of anastomotic dehiscence. Two patients had a clinically recognizable leak that closed spontaneously within 3 days. Three patients had roentgenologically demonstrable leakage but no clinical symptoms. On examination 2 to 11 months after operation, all patients were continent for feces as well as gas, and none had more than four bowel movements per day. In four patients, all with a roentgenologically demonstrable leak, a stricture developed at the anastomosis within 3 months after discharge. All four patients were successfully treated by dilatation. Resection with anastomosis by means of the stapling instrument is practical even at the lowest level, is far less time-consuming and does not require the same degree of training as low anterior resection with conventional suture anastomosis.

Bladder dysfunction after low anterior resection for mid-rectal cancer

Twenty consecutive patients with carcinoma 7 to 12 cm from the anus underwent radical low anterior resection of the rectum; the anastomosis was performed by the EEA stapling instrument. One patient died from pulmonary complications. On urologic follow-up 6 to 8 months after the operation, five patients had significant symptoms from the urinary tract, and in three patients denervation of the bladder was demonstrated. The study establishes that bladder paresis, which is a well-known complication after extirpation of the rectum, also may follow very low anterior resection with anastomosis. The importance of careful follow-up is emphasized

Induction of immunosuppression by microemulsion cyclosporine in liver transplantation

Twenty-five liver transplant patients were administered liquid microemulsion cyclosporine (Neoral, 5 mg/kg b.i.d.) via a nasogastric tube until they could take oral medication. The first dose was given within 6 hr after surgery. Adequate trough levels of cyclosporine were obtained from the first postoperative day. The total exposure to the drug was low on the first postoperative day, but a significantly improved pharmacokinetic profile with a high maximal concentration and a low time to maximal concentration was found from the second postoperative day. The absorption from Neoral increased during the first week. After 1 week, a low within-patient variation coefficient for dose-adjusted cyclosporine trough levels was found (17%). The between-patient variation coefficient was low during the whole postoperative period (31%). We conclude that in liver transplant patients adequate immunosuppressant blood levels of cyclosporine can be obtained in the immediate postoperative period using Neoral without the need to go to the intravenous form of the drug.

Strictures of the Male Urethra Treated by the Otis Method

During a 5-year interval 72 consecutive patients with urethral strictures were treated by internal urethrotomy according to the method of Otis. The etiology, surgical technique, complications and postoperative management are discussed. The results after a mean followup of 29 months showed an over-all success rate of 82 per cent (95 per cent confidence limits 71 to 90 per cent). It is concluded that internal urethrotomy should be considered for primary treatment of urethral strictures, since the procedure is easy and complications are few.

Intraoperative measurement of graft blood flow — a necessity in liver transplantation

Abstract Portal venous and hepatic arterial flow was measured intraop‐eratively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6‐month‐old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patients graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.

Antibiotic prophylaxis in surgery for hip fractures

Totally, 185 patients, operated on for a fresh hip fracture, were randomly allocated to either methicillin antibiotic prophylaxis or no prophylaxis and followed for 1 month. Two superficial wound infections were recorded in the prophylaxis group and one in the control group. Prophylactic use of antibiotics in surgery for hip fractures seems unnecessary provided strict aseptic routines in the operating room are followed.

Intraincisional antibiotic in addition to systemic antibiotic treatment fails to reduce wound infection rates in contaminated abdominal surgery. A controlled clinical trial.

One hundred ninety patients with peritonitis at the time of abdominal surgery were allocated at random to systemic antibiotic treatment alone or systemic antibiotic treatment combined with topical application of antibiotics in the wound at the time of wound closure. The overall wound infection rate was 17 percent without significant difference between the two treatment groups (P>0.80).

New approach to treatment of severe incisional abscesses following laparotomy. Wound closure under systemic antibiotic cover four days after drainage.

Forty consecutive patients who developed subcutaneous abscesses after intraperitoneal operations were treated by incision and drainage followed by suture of the wound four days later under antibiotic cover. The wound was closed by means of interrupted Prolene® sutures. No sutures were placed in the wound cavity, and no drain was applied. The antibiotic used was clindamycin 600 mg intravenously peroperatively and 150 mg every six hours for four days.

Linear Incision and Curettage vs. Deroofing and Drainage in Subcutaneous Abscess. A Randomized Clinical Trial

Linear incision plus curettage under antibiotic cover was compared with conventional deroofing and drainage of subcutaneous abscess in a randomized study of 50 patients. The median healing time was 9 days following linear incision and curettage and 15 days after deroofing and drainage (p less than 0.05). There was no recurrence of abscess during follow-up for 6 months. Linear incision plus curettage under single-dose antibiotic cover thus proved to be a safe method with significantly shorter healing time than after conventional deroofing an drainage.