Vasectomy reversal: is the microscope really essential?

OBJECTIVE: To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval. MATERIALS AND METHODS: We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon. The procedure was performed using a single layer, spatulate end to end anastomosis technique using 6 x 6-0 prolene. No loupe magnification was used. RESULTS: The median age of the men was 42 years (range 30-56). The median obstructive interval in years was 8.5 years (range 2-23). The procedure was a day case and the median surgical time under general anaesthetic was 75 minutes (range 45-90). None of the patients required hospital admission following discharge. 63 of the 70 patients had positive patency test postoperatively (90%). The sperm count was more than twenty million/ml. The pregnancy rate was 54% and the miscarriage rate was 7.1%. CONCLUSION: The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of "re- establishing" fertility in vasectomised men.

Multiple leiomyoma of the renal capsule.

Multiple renal capsular leiomyoma is an extremely rare tumour. We describe one such case which was managed by renal sparing surgery.

Open versus laparoscopic cholecystectomy: a comparison of postoperative temperature.

Laparoscopic cholecystectomy has been shown to allow better postoperative pulmonary function than open cholecystectomy, with less incidence of lung atelectasis. As atelectasis following abdominal surgery is responsible for most febrile episodes in the first 48 h, it was postulated that with minimally invasive surgery there may be a parallel improvement in the incidence of postoperative fever. This study was designed to evaluate this hypothesis. Seventy-eight patients were randomly divided into two groups. Thirty-eight had an open cholecystectomy and 40 underwent the laparoscopic approach. Twenty-one of the 38 patients (55%) following open cholecystectomy had early febrile episodes compared with only 6 of the 40 (15%) in the laparoscopic cholecystectomy group. We concluded that there was a lower incidence of febrile episodes following laparoscopic cholecystectomy and suggest that this was related to improved pulmonary function and minimal surgical trauma.

Needle prick injury to the surgeon--do we need sharp needles?

Needle prick injury is a well known hazard for surgeons and their assistants. This carries a risk of transmitting HIV and hepatitis infection. In this study the high incidence of sharp needle injury was confirmed (18.9%), with more than one third (8.7%) resulting in skin puncture. The highest incidence of injury occurred during hernia repair (27%) and abdominal wound closure (52%), where injury was sustained to the left index and middle finger as would be expected in right-handed surgeons. Blunt-tipped needles were used in 78 different procedures with technically satisfactory outcome particularly in abdominal wall wound closure and hernia repair, and even in colonic anastomosis, only two glove injuries were reported, with no skin injury. We concluded that the used of blunt-tipped needles is a practical option in eliminating needle prick injury to surgeon's hands.

The role of the radioisotope phallogram in the investigation of vasculogenic impotence.

Patients complaining of impotence were investigated through a multi-disciplinary approach to define the factors involved. Radioisotope phallography was performed on all the patients using 99Tcm-labelled red blood cells (RBCs) and dynamic records of the variation in activity over the penis were obtained. During the course of the study an intravenous injection of a vasodilator (isoxsuprine HCl) was administered. An analysis of the data provided quantitative parameters for measuring the changes in penile blood flow and penile blood volume in response to the vasodilator injection. The results indicate that the radioisotope phallogram is useful both in the diagnosis of vasculogenic impotence and in indicating the method of treatment.

Isotope phallogram: preliminary communication.

The isotope phallogram is an investigation which uses radioisotope-labelled red cells in the imaging of penile arterial blood flow. In a preliminary series of 12 impotent patients undergoing both internal iliac arteriography and isotope phallography, the penogram index described by Fannous et al. (1982) has been modified to derive an accurate indicator of vascular disease.

Juvenile xanthogranuloma of the testis.

A 7-month-old boy presented with numerous xanthomatous skin lesions and a hard irregular swelling of the right testis. Clinically, the testicular lesion was impossible to distinguish from a malignant neoplasm. Histological examination of a skin biopsy and of the testis following orchiectomy showed lesions typical of juvenile xanthogranuloma.

Prevention of post-appendicectomy sepsis by mezlocillin and metronidazole: a prospective, randomized, double-blind trial.

In a double-blind trial a 6% infection rate resulted from the use of a single peroperative dose of mezlocillin in emergency appendicectomy for non-perforated disease. No advantage was demonstrated by mezlocillin over the 8% infection rate achieved with metronidazole. There was only one anaerobic infection in the mezlocillin group although Bacteroides fragilis had been isolated at operation from all three infected cases and many other uninfected patients. No anaerobic infections were detected in the metronidazole group.

An unusual late complication of neonatal small bowel surgery.

A case of acute intestinal obstruction in a 23-year-old male patient is presented. He had previously undergone a laparotomy in infancy at the age of 36 hours. Two primary enteroliths were found in proximal dilated jejunum, one obstructing an anastomotic stricture. The predisposing factors of enterolith formation are reviewed.

Failure to obtain an autoimmune response following cryosurgery to the normal rat liver.

Smooth muscle antibody (SMA) and anti-liver-specific lipoprotein (anti-LSP) responses were investigated following five different freeze thaw regimes to the normal rat liver. The livers were examined histologically for evidence of autoimmune liver disease. No SMA or anti-LSP was found in any animal and on histological examination the unfrozen part of all livers was normal. It is concluded that cryosurgical damage to the liver is unlikely to provoke an autoimmune response.