Ralph Ger

Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac

Fifteen animals with indirect inguinal hernias were treated by closure of the abdominal opening of the patent processus vaginalis by the application of staples laparoscopically. The satisfactory results confirm those obtained in a previous study, where similar openings found during laparotomy for abdominal surgery were closed by the application of metal clips. Laparoscopic closure of the abdominal opening of a hernial sac may have advantages over the present operative management.

The carbon dioxide laser in plastic surgery

Abstract A self-contained portable apparatus comprising a continuous single-mode carbon dioxide laser with an articulated arm and manipulator with interchangeable attachments designed for clinical surgery is described and illustrated. The application of this instrument to various plastic surgical procedures in the light of past experience is discussed.

The Carbon Dioxide Laser in Clinical Surgery

Experimental work with the CO2 laser (Stellar et al., 1971a,b; Gonzalez et al., 1970; Goodale et al., 1970; Hall et al., 1971; Hall, 1971a,b; Kaplan and Ger, 1973) has led to the hypothesis that if the laser beam were to fulfill expectations it should be possible to excise or incise tissues without damage to adjacent tissue, while at the same time reducing bleeding to a minimum by sealing off at least all minor blood vessels. If this were so, then the following advantages would be immediately evident: 1. Blood loss would be reduced to a mimimum, thus reducing the requirement for blood replacement with its associated risks, such as incompatibility and virus infection. (The economic burden of acquiring and processing donor blood should not be underestimated.) 2. The operating time would be reduced by eliminating ligation of most bleeding points. 3. The reduction of the amount of necrotic tissue and hematoma formation in the wound would lead to a diminished infection rate. 4. In the event of existing sepsis, the laser beam would tend to sterilize the wound. 5. Wound healing would not be delayed, but might even be enhanced due to a combination of the above factors. 6. With the sealing off of vessels, the possible spread of malignant cells during extirpative surgery for malignant disease would be reduced to a minimum and, additionally, primary repair of the defect would not be precluded.

Laparoscopic sigmoid colostomy for perianal Crohn's disease.

Fecal stream diversion is not an uncommonly used procedure in the treatment of symptomatic Crohns disease of the rectum. We present a case report of a patient with documented Crohns proctitis with multiple rectovaginal and perianal fistulas; an end sigmoid colostomy was performed as part of the management of her disease.

The Coverage Of Vascular Repairs By Muscle Transposition

The coverage of exposed arteries, repaired by suture or grafting, may present difficulties. The currently accepted methods have been reviewed, and the use of transposed muscle is suggested as a possible alternative method. Success is partly governed by adhering to important principles. An illustrative case report is presented.

Splenic preservation with the use of a stapling instrument : a preliminary communication

Observation, ligation of the splenic artery, repair of the spleen by simple suturing with or without the use of hemostatic agents, omentum, an absorbable net or ladder, and partial splenectomy have all been proposed as a means of preserving the injured spleen. A new technique of partial splenectomy with the use of a stapling instrument is presented. The instrument has been used with success experimentally in dogs and in two patients.

Partial mastectomy and mammaplasty performed with a CO2 surgical laser: A Comparative Study

Abstract The practicality of performing mastectomy with a surgical CO 2 laser has been investigated. A comparative study shows that it is possible to carry out a simple mastectomy with the laser with less blood loss and with comparable healing to mastectomy with the scalpel.

Basic surgical training 4: American and British scenes compared

This report outlines the surgical residency program in the United States, with special reference to examinations in anatomy. During each of the 5–6 years of the program and in the first part of the surgical board examination, there are written (MCQ) examinations. The final board examination is oral. The anatomic content of each of these examinations is very small. This situation compares unfavorably with that in the UK in the 1940s and 1950s, when the colleges of surgeons demanded a high standard of anatomic knowledge, so that holders of the Fellowship (FRCS) displayed confidence in their diagnostic skills and in the operating room. In the United States today, surgical residents and attending surgeons (British = consultants) alike seldom have a sound overall knowledge of anatomy. They may become proficient in localized regions, but when drawn out of their area of expertise, their anatomic knowledge may be less than expert. It is disappointing to learn that the surgical colleges in the UK and Ireland are making changes in their Basic Surgical Training program that will inevitably result in a decline from their former high standards.

Squamous-cell carcinoma of the anal canal: A metastatic lesion

SummaryA case of a secondary squamous-cell carcinoma of the anal canal is presented, the primary lesion being bronchogenic in origin. A large, secondary lesion in the myocardium contributed to the fatal termination.

Transmetatarsal amputation of the toe: an analytic study of ischemic complications.

Transmetatarsal amputations of the toes are very common procedures, particularly involving patients with diabetes mellitus and peripheral vascular disease. A complication of these operations is the onset of gangrene of an adjoining toe, which is usually ascribed to the underlying disease. It is suggested that another explanation may be responsible for this occurrence, namely, a combination of the variability of the bifurcation of the dorsal metatarsal arteries and the operative technique. The former is either not described or has different levels in different texts. The operation in nearly all texts is a classic racquet incision, without mention of the width of the racket. The combination of an incision widely diverging from the handle of the racket is in danger of severing the dorsal metatarsal artery, its bifurcation, or the digital branch to the adjacent toe. A patient with a good blood supply may be able to salvage the situation by way of the plantar vessels, but when the vascular status is parlous, which is the case in many amputations, the adjacent digit is at considerable risk. Clinical, radiological, and anatomic evidence is presented to support this contention. Based on the above, a safer operative technique is suggested to avoid possible complications. Clin. Anat. 12:407–411, 1999.