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  1. Article: Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults.

    Machado, Norman Oneil

    North American journal of medical sciences

    2016  Volume 8, Issue 2, Page(s) 65–74

    Abstract: Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its ... ...

    Abstract Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
    Language English
    Publishing date 2016-02-01
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2524195-3
    ISSN 1947-2714 ; 2250-1541
    ISSN (online) 1947-2714
    ISSN 2250-1541
    DOI 10.4103/1947-2714.177292
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome.

    Machado, Norman Oneil

    World journal of gastrointestinal surgery

    2016  Volume 8, Issue 4, Page(s) 335–344

    Abstract: Aim: To study the etiopathogenesis, management and outcome of duodenal injury post laparoscopic cholecystectomy (LC).: Methods: A Medline search was carried out for all articles in English, on duodenal injury post LC, using the search word duodenal ... ...

    Abstract Aim: To study the etiopathogenesis, management and outcome of duodenal injury post laparoscopic cholecystectomy (LC).
    Methods: A Medline search was carried out for all articles in English, on duodenal injury post LC, using the search word duodenal injury and LC. The cross references in these articles were further searched, for potential articles on duodenal injury, which when found was studied. Inclusion criteria included, case reports, case series, and reviews. Articles even with lack of details with some of the parameters studied, were also analyzed. The study period included all the cases published till January 2015. The data extracted were demographic details, the nature and day of presentation, potential cause for duodenal injury, site of duodenal injury, investigations, management and outcome. The model (fixed or random effect) for meta analyses was selected, based on Q and I (2) statistics. STATA software was used to draw the forest plot and to compute the overall estimate and the 95%CI for the time of detection of injury and its outcome on mortality. The association between time of detection of injury and mortality was estimated using χ (2) test with Yate's correction. Based on Kaplan Meier survival curve concept, the cumulative survival probabilities at various days of injury was estimated.
    Results: Literature review detected 74 cases of duodenal injury, post LC. The mean age of the patients was 58 years (23-80 years) with 46% of them being males. The cause of injury was due to cautery (46%), dissection (39%) and due to retraction (14%). The injury was noted on table in 46% of the cases. The common site of injury was to the 2(nd) part of the duodenum with 46% above the papilla and 15% below papilla and in 31% to the 1(st) part of duodenum. Duodenorapphy (primary closure) was the predominant surgical intervention in 63% with 21% of these being carried out laparoscopically. Other procedures included, percutaneous drainage, tube duodenostomy, gastric resection, Whipple resection and pyloric exclusion. The day of detection among those who survived was a mean of 1.6 d (including those detected on table), compared to 4.25 d in those who died. Based on the random effect model, the overall mean duration of detection of injury was 1.6 (1.0-2.2) d (95%CI). Based on the fixed effect model, the overall mortality rate from these studies was 10% (0%-25%). On application of the Kaplan Meier survival probabilities, the cumulative probability of survival was 94%, if the injury was detected on day 1 and 80% if detected on day 2. In those that were detected later, the survival probabilities dropped steeply.
    Conclusion: Duodenal injuries are caused by thermal burns or by dissection during LC and require prompt treatment. Delay in repair could negatively influence the outcome.
    Language English
    Publishing date 2016-04-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2573700-4
    ISSN 1948-9366
    ISSN 1948-9366
    DOI 10.4240/wjgs.v8.i4.335
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Laparoscopic repair of bochdalek diaphragmatic hernia in adults

    Norman Oneil Machado

    North American Journal of Medical Sciences, Vol 8, Iss 2, Pp 65-

    2016  Volume 74

    Abstract: Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its ... ...

    Abstract Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
    Keywords Bochdalek hernia (BH) ; congential diaphragmatic hernia (CDH) ; laparoscopic repair ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 610
    Publishing date 2016-01-01T00:00:00Z
    Publisher North American Journal of Medical Sciences
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Laparoscopic cholecystectomy in cirrhotics.

    Machado, Norman Oneil

    JSLS : Journal of the Society of Laparoendoscopic Surgeons

    2013  Volume 16, Issue 3, Page(s) 392–400

    Abstract: Background and objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review ...

    Abstract Background and objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure.
    Methods: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified.
    Results: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed.
    Conclusions: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate.
    MeSH term(s) Cholecystectomy, Laparoscopic/methods ; Gallbladder Diseases/complications ; Gallbladder Diseases/surgery ; Humans ; Liver Cirrhosis/complications ; Operative Time ; Treatment Outcome
    Language English
    Publishing date 2013-01-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2011211-7
    ISSN 1938-3797 ; 1086-8089
    ISSN (online) 1938-3797
    ISSN 1086-8089
    DOI 10.4293/108680812X13462882736493
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

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  5. Article ; Online: Pancreaticopleural fistula: revisited.

    Machado, Norman Oneil

    Diagnostic and therapeutic endoscopy

    2012  Volume 2012, Page(s) 815476

    Abstract: Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion ... ...

    Abstract Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP) or magnetic resonance cholangiopancreaticography (MRCP) may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.
    Language English
    Publishing date 2012-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1327325-5
    ISSN 1029-0516 ; 1070-3608
    ISSN (online) 1029-0516
    ISSN 1070-3608
    DOI 10.1155/2012/815476
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management-review.

    Machado, Norman Oneil

    International journal of surgical oncology

    2012  Volume 2012, Page(s) 602478

    Abstract: Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in ... ...

    Abstract Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the "Achilles heel" of pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to pancreatic fistula. The morbidity rate after pancreaticoduodenectomy remains high in the range of 30% to 65%, although the mortality has significantly dropped to below 5%. Most of these complications are related to pancreatic fistula, with serious complications of intra-abdominal abscess, postoperative bleeding, and multiorgan failure. Several pharmacological and technical interventions have been suggested to decrease the pancreatic fistula rate, but the results have been controversial. This paper considers definition and classification of pancreatic fistula, risk factors, and preventive approach and offers management strategy when they do occur.
    Language English
    Publishing date 2012-04-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2584964-5
    ISSN 2090-1410 ; 2090-1402
    ISSN (online) 2090-1410
    ISSN 2090-1402
    DOI 10.1155/2012/602478
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  7. Article ; Online: Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article.

    Machado, Norman Oneil

    JOP : Journal of the pancreas

    2012  Volume 13, Issue 1, Page(s) 18–25

    Abstract: Context: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to primarily therapeutic procedure. With this, the complexity of the procedure and risk of complication including duodenal perforation have increased. In ... ...

    Abstract Context: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to primarily therapeutic procedure. With this, the complexity of the procedure and risk of complication including duodenal perforation have increased. In this article, the recent literature is reviewed to identify the optimal management and factors influencing the clinical outcome.
    Method: Recent literature in English language from the year 2000 onwards, containing major studies of 9 or more cases on duodenal perforation post ERCP were analyzed.
    Results: Literature review revealed a total of 251 cases of duodenal perforation reported in 10 major reports presenting 9 or more cases each. The mean age of these patients was 58.5 years with nearly two third (62.9%) being female patients. The predominant location of the perforation was: duodenal wall (34.5%), perivaterian (31.3%), common bile duct (23.0%), and unknown in 7.9%.Early diagnosis within 24 hours was made in 78.5%, with 55.8% of these being diagnosed during or immediately after ERCP. CT scan was the most useful investigations in detecting perforations missed during ERCP (44.6%). Conservative management was employed in 62.2%, which was successful in 92.9% of these cases. Ten of these who failed conservative management required salvage surgery (6.4%) and one died of pneumothorax (0.6%). The predominant surgical intervention was closure of perforation (49.0%) with or without other procedures, retroperitoneal drainage (39.0%), duodenal exclusion (24.0%) and common bile duct exploration and T tube insertion (13.0%). The overall mortality was 8.0% which appears to be better than previously reported (16-18%). Among the 20 patients who died, six (30.0%) had salvage surgery, five (25.0%) had delay in diagnosis/intervention beyond 3 days and 3 (15.0%) required multiple operations.
    Conclusion: While the patients with duodenal perforation invariably require surgical intervention, most of the patients with perivaterian injuries can be successfully managed conservatively. The most important factors for recent better outcome were early detection and prompt treatment. Delay in diagnosis and intervention, salvage surgery after failed conservative management, multiple operations, and older age group contributed significantly to the poor outcome.
    MeSH term(s) Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Duodenum/diagnostic imaging ; Duodenum/injuries ; Duodenum/surgery ; Early Diagnosis ; Female ; Humans ; Intestinal Perforation/diagnosis ; Intestinal Perforation/etiology ; Intestinal Perforation/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome
    Language English
    Publishing date 2012-01-10
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2039637-5
    ISSN 1590-8577 ; 1590-8577
    ISSN (online) 1590-8577
    ISSN 1590-8577
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  8. Article ; Online: Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review.

    Machado, Norman Oneil

    Diagnostic and therapeutic endoscopy

    2011  Volume 2011, Page(s) 967017

    Abstract: Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 ... ...

    Abstract Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30° scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.
    Language English
    Publishing date 2011-06-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1327325-5
    ISSN 1029-0516 ; 1070-3608
    ISSN (online) 1029-0516
    ISSN 1070-3608
    DOI 10.1155/2011/967017
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  9. Article ; Online: Pancreatic Fistula after Pancreatectomy

    Norman Oneil Machado

    International Journal of Surgical Oncology, Vol

    Definitions, Risk Factors, Preventive Measures, and Management—Review

    2012  Volume 2012

    Keywords Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Oncology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2012-01-01T00:00:00Z
    Publisher Hindawi Publishing Corporation
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Neutropenic enterocolitis: A continuing medical and surgical challenge.

    Machado, Norman Oneil

    North American journal of medical sciences

    2011  Volume 2, Issue 7, Page(s) 293–300

    Abstract: Aim: Neutropenic enterocolitis is a life threatening complication occurring most frequently after intensive chemotherapy in acute leukemia and solid tumors. This review aims to explore the pathogenesis of the condition and appraise the option and ... ...

    Abstract Aim: Neutropenic enterocolitis is a life threatening complication occurring most frequently after intensive chemotherapy in acute leukemia and solid tumors. This review aims to explore the pathogenesis of the condition and appraise the option and outcome of conservative and surgical management based on the literature review.
    Material and methods: A Medline search was carried out and most of the relevant papers in English literature from 1973 onwards on neutropenic enterocolitis were reviewed
    Results: Twelve reports of single cases, 21 reports of 2 to 4 cases and 15 reports of 5 or more cases were identified. There were no prospective trials or case control studies on therapy of neutropenic enterocolitis. Among the total of 329 cases identified 69% were treated medically and 31% required surgical intervention . Even though a formal comparison of these 2 groups will not be appropriate, the mortality rate of 31% in the medically managed group was higher than those that required surgical intervention (23%)
    Conclusion: With the increasing use of multiple, new and aggressive chemotherapy for hematological and solid tumors there may be an increased frequency of neutropenic enterocolitis encountered in clinical practice. Clinicians should be acutely aware of the association of neutropenic enterocolitis with chemotherapy for the outcome would depend significantly on an early and appropriate treatment either conservative or surgical .
    Language English
    Publishing date 2011-11-03
    Publishing country India
    Document type Journal Article
    ZDB-ID 2524195-3
    ISSN 1947-2714 ; 2250-1541
    ISSN (online) 1947-2714
    ISSN 2250-1541
    Database MEDical Literature Analysis and Retrieval System OnLINE

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