Showing papers by "Andrew W. Bradbury published in 1997"

Subfascial endoscopic perforator surgery is associated with significantly less morbidity and shorter hospital stay than open operation (Linton's procedure)

Abstract: Background Subfascial endoscopic perforator surgery (SEPS) is the minimally invasive alternative to the open (Linton's) procedure. This new technique may allow perforating vein interruption with fewer complications and a shorter postoperative hospital stay. Methods This study was a case note review of 67 procedures: 30 SEPS and 37 Linton's. Results There were no significant differences between the two groups in age, sex and indication for surgery. SEPS was associated with a significantly reduced postoperative stay in hospital (median 2 (range 1-49) days) compared with the Linton's procedure (median 9 (range 3-36) days) (P<0.01). Nine patients who had Linton's procedure suffered a calf wound complication compared with none who had SEPS. The presence of an open ulcer at the time of surgery did not prolong the duration of stay in either group, nor did it increase the incidence of calf wound complications. Conclusion In patients undergoing calf perforator interruption for chronic venous insufficiency, SEPS is associated with significantly less morbidity and a shorter hospital stay than Linton's procedure. SEPS can be performed safely at the same time as skin grafting and in the presence of an open ulcer without any increase in wound complications.

Twelve‐year experience of the management of ruptured abdominal aortic aneurysm

Abstract: Background The operative mortality rate for elective repair of asymptomatic abdominal aortic aneurysm (AAA) is falling but the fate of patients with ruptured AAA may have changed little over the past decade. Methods This study was an analysis of a prospectively gathered computerized database. Results In the 12 years to 31 December 1994, 1144 patients underwent (attempted) repair of AAA. In 514 patients (44·9 per cent) who had an operation for ruptured AAA there was no significant change in the mean age, male: female ratio (418:96), or operative mortality rate (35·0 per cent) over the interval of the study. Forty-seven patients died before reaching the operating theatre, giving an ‘intention to operate’ mortality rate of 405 per cent. A further 68 patients (10·8 per cent of all patients who presented with a ruptured AAA) were not offered operation because of poor medical condition (n = 34) or extreme age (n = 34); three patients refused operation. A greater proportion of patients had surgery between 1989 and 1994 (276 of 323, 85·4 per cent) than between 1983 and 1988 (238 of 309, 77·0 per cent) (P <0·01, X2 test). Conclusion The proportion of aneurysms operated on for rupture in this unit remains high (almost 50 per cent). The results of surgery for ruptured AAA have not improved in the past 12 years.

Surgical aspects of Clostridium difficile colitis

Abstract: Background There has been a marked increase in the number of surgical patients developing Clostridium difficile colitis. The epidemiology, pathogenesis, diagnosis and management of C. difficile infection were reviewed from a surgical perspective. Methods A literature review was carried out based primarily on a Medline search of all English language publications containing the term C. difficile. Results The recent dramatic increase in diagnosis of C. difficile infection amongst surgical patients results from heightened awareness of the condition, better methods of diagnosis, more widespread use of antibiotics for treatment and prophylaxis, and the increasing numbers of elderly and immunocompromised patients with malignancy, sepsis, and (multiple) organ failure being cared for within intensive therapy and high-dependency units. In addition to morbidity and mortality, the economic burden of C. difficile infection in terms of delayed discharge and other hospital costs is considerable. Conclusion Appropriate use of antibiotics, isolation of affected patients and meticulous hygiene measures on the part of staff are vital if the morbidity, mortality and economic consequences of this nosocomial infection are to be minimized.

Supervised training in carotid endarterectomy is safe

Abstract: Background The number of carotid endarterectomies (CEAs) performed in the UK, and thus the need to train surgeons in this operation, has increased markedly in recent years and may continue to do so. The aim of the present study was to assess the quality, clinical outcome and case-mix of supervised training in CEA in this unit. Methods The study was an analysis of a prospectively gathered database of all CEAs performed in this unit since 1975. Results Between 1 January 1975 and 31 December 1991, 247 CEAs were performed of which only 12 were done by supervised trainees. By contrast, between 1 January 1992 and 1 July 1996, 219 CEAs were performed, 92 (42 per cent) by supervised trainees (P < 0·0001). In cases performed since 1 January 1992, there was no significant difference between trainee and consultant operations with regard to age and sex of patient, smoking history, ischaemic heart disease, hypertension, diabetes, presence of preoperative infarction on computed tomography, indications for operation, degree of ipsilateral carotid stenosis, status of the contralateral carotid artery, use of a shunt or patch angioplasty. Since 1 January 1992, the total perioperative neurological event rate for supervised trainees was seven of 92 (7·6 per cent) of which one was fatal (cerebral infarction). The total neurological event rate for operations done by a consultant was nine of 127 (7·1 per cent), of which one was permanent and disabling and two were fatal (one cerebral infarction and one haemorrhage). Conclusion Since 1991 there has been a tenfold increase in the proportion of CEAs being performed by supervised trainees. This has been accomplished without deterioration in clinical outcome. With adequate supervision, training in CEA can be safe, even when trainees are exposed to a true cross-section of low-, medium- and high-risk cases.