Louis R. Slattery

Benign fibrous stenosis of the bile ducts

Abstract Forty-eight patients with benign fibrous stenosis of the bile ducts were studied, seven of whom were operated upon primarily by us. A total of 182 operative procedures was performed, 110 before admission and seventy-two by us. Our surgical mortality was 12 per cent; operative mortality was 8 per cent. With repeated attacks of jaundice, intolerable itching, chills and fever, and weight loss lasting over a period of several years in many cases, these patients are miserable and doomed to death. Even though multiple, painstaking procedures are often required, satisfactory and improved results in 69 per cent of the patients in this study justify continued efforts towards restitution.

Intra-abdominal choledochography; preliminary report of a method of detecting stones in the common bile duct.

Abstract A method of intra-abdominal choledochography has been presented which obviates the principal difficulties of operative cholangiography. This is done by placing the x-ray film behind the common bile duct within the abdomen thereby eliminating the necessity for apnea during the exposure of the film. This visualizes the common bile duct where the majority of stones are overlooked.

Carcinoma of the colon; selection of the operative procedure.

Abstract In a series of eighty-nine consecutive resections of the colon for carcinoma resection and primary anastomosis was possible in seventyone or 79.7 per cent of the cases. Acute large bowel obstruction in sixteen patients or 17.9 per cent of the patients necessitated preliminary decompressive operations and was the most common contraindication to resection and primary anastomosis. Perforation prevented resection and primary anastomosis in three of six cases with this complication. The usefulness of a modified obstructive resection was illustrated in two of these patients with large free perforations and spreading peritonitis. Intraperitoneal anastomosis after obstructive resection seems to be preferable to spur crushing and extraperitoneal anastomosis. Cecostomy was a satisfactory decompressive vent for obstructing lesions proximal to the splenic flexure while loop colostomy in the right half of the transverse colon was more efficient for lesions more distally situated. There was no evidence in this series that complementary vents or routine preoperative intubation with one-stage resection and anastomosis are necessary. Closed anastomosis has demonstrated a lower wound morbidity than open methods. Succinyl sulfathiazole has prepared the bowel well, relieved incomplete obstruction in some instances and has seemed to further early return of bowel motility in the postoperative period. Six fatalities occurred a mortality rate of 6.7 per cent. In only one of these was the method of anastomosis a factor, the remaining being due to errors or factors uncontrollable at the present time.