J.Manny Shore

Simplified repair of femoral and recurrent inguinal hernias by a “plug” technic

Abstract A new technic for the repair of femoral and recurrent inguinal hernias is presented. The use of a polypropylene mesh “plug” to occlude the defect corrects the hernia without extensive dissection. A five year experience has verified the efficacy of this simplified procedure.

Exploding the myths of hernia repair

Sacred prinicples guiding surgical repair of groin hernias have remained basically unaltered since their inception. This may explain the failure of results to improve significantly over the years. Ten hallowed concepts have been critically analyzed in the light of modern technology and contemporary experience. Although challenging established surgical traditions invariably invites debate, it is essential to scientific progress.

An improved rigid choledochoscope.

Abstract An improved miniaturized right angle choledochoscope based on the Hopkins optical system was designed and clinically tested. It eliminates the shortcomings of previous biliary endoscopes.

Operative fluoroscopy and cholangiography: The use of modern radiologic technics during surgery☆

Operative cholangiography as currently performed in many hospitals in the United States may be a cumbersome procedure yielding less than optimal information. For maximal accuracy and diagnostic yield, operative radiographic examination of the biliary tract should include fluoroscopic observation and aimed spot films. The advantages gained by using modern radiologic equipment and technics are increased image clarity, increased capability for functional assessment of a dynamic system, increased efficiency, and decreased radiation hazard. In a series of 100 patients undergoing operative cholangiography by our technic, only one retained stone was demonstrated by postoperative studies. Five anomalies of the ductal system were easily identified and possible injury to the anomalous ducts averted. Considering the morbidity and mortality attendant upon inadequate or inappropriate biliary tract operations, investment in the sophisticated equipment necessary for optimal operative radiography is small indeed.

Selection of an optimal procedure for decompression of the obstructed common bile duct. Experimental and clinical observations.

Abstract In biliary-intestinal anastomosis for permanent or palliative decompression of the obstructed extrahepatic biliary tract, the optimal procedures are either Roux-en-Y cholecystojejunostomy or choledochojejunostomy, preferably Roux-en-Y, when the condition and prognosis of the patient are favorable. If the anastomosis is to the common duct, the gallbladder must be removed since if left in situ , it will become the seat of progressive biliary tract inflammation and ascending infection. These principles are borne out by the experimental study described and clinical observations.

A direct approach to the differential diagnosis of jaundice. Laparoscopy with transhepatic cholecystocholangiography.

Summary o 1. Preliminary experience with laparoscopic transhepatic cholecystocholangiography for the diagnosis of the “problematic” jaundiced patient is presented. 2. The instrumentation and technic of this procedure are described and illustrated by case presentations. 3. This procedure is compared with other available methods of direct cholangiography, such as percutaneous transhepatic cholangiography, transjugular cholangiography, open transhepatic cholangiography, and duodenoscopy with retrograde cholangiography. 4. The advantages of laparoscopic transhepatic cholecystocholangrography are as follows: (1) direct visual diagnosis; (2) biopsy under visual control; (3) radiographic demonstration of the biliary tract in the absence of duct dilatation; (4) immediate laparotomy when a surgical lesion is demonstrated; (5) control of bile leak and/or bleeding under direct vision.

Improved cannula for operative (cystic duct) cholangiography

A new S-shaped cystic duct metal cannula was developed and used successfully in 200 cystic duct cholangiograms. It has the advantage of being easy to manipulate because the configuration does not obscure the vision and the resistance is less than that of plastic tubes, facilitating injection with lower pressure. It is much cheaper than the disposable cannulas because it can be reused (autoclaved).

A simple rapid technic for cystic duct cholangiography

Abstract A simplified technic for cystic duct cholangiography is described. The essential features are the use of a special pliable, thick-walled catheter which can rapidly be secured to the cystic duct by a hemoclip.