MIDCABG followed by a gastrointestinal operation in the same anesthetic setting.

Cardiovascular complications continue to be a significant source of morbidity and mortality in patients having noncardiac operations. This especially is true in patients with known coronary artery disease facing intraabdominal operations. Minimally invasive direct coronary artery bypass grafting allows coronary artery grafting without cardiopulmonary bypass or a median sternotomy incision. Also, in combination with angioplasty (the "hybrid procedure"), it is possible to offer complete revascularization with far less surgical trauma. We present 2 cases of patients who had minimally invasive direct coronary artery bypass grafting followed by major gastrointestinal operations in the same anesthetic setting.

Incidence and prophylaxis of deep vein thrombosis in a high risk trauma population.

BACKGROUND: Pelvic fractures, lower extremity injuries, acute head or spinal injury, and extended bedrest place trauma patients at an increased risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). We reviewed patients with traumatic brain injuries (TBI), spinal cord injuries (SCI), and lower extremity fractures (LEF) to examine our DVT and PE incidence and evaluate the success of our DVT and PE prophylaxis. METHODS: From January 1, 1994 to March 1, 1995, the records of trauma patients with TBI, SCI, and LEF who were admitted to the trauma service and transferred to an inpatient rehabilitation facility were reviewed. RESULTS: Twenty-two patients had a TBI, 16 patients with SCI, and 12 patients with LEF. Forty-nine of the 50 patients received DVT prophylaxis, with 7 inferior vena cava (IVC) filters placed. The DVT incidence was 6% and the PE incidence was 2%. CONCLUSION: The 6% incidence of DVT was lower than expected due to diligent DVT prophylaxis and appropriate screening of symptomatic patients for clinically significant DVT. The 2% incidence of PE was also lower than expected, most likely due to our lower DVT incidence and the use of IVC filters. The lower DVT and PE incidence verifies our success at DVT and PE prophylaxis.

Laparoscopic cholecystectomy in pregnancy. A report of 6 cases and review of the literature.

BACKGROUND: Although pregnancy was initially considered an absolute contraindication to laparoscopic cholecystectomy, there have been several case reports of successful laparoscopic cholecystectomy in pregnant patients in the literature over the past 4 years. We report our experience with six patients managed successfully with laparoscopic cholecystectomy during pregnancy. METHODS: More than 1,300 laparoscopic cholecystectomies were performed by the Norfolk Surgical Group between May 1991 and June 1994. Six of these patients (approximately 0.5%) were operated on during pregnancy. We reviewed the management and operative technique used in these patients compared to our standard approach. The available literature was reviewed to identify any other factors which might be helpful in the management of these patients. RESULTS: In this series we were able to perform laparoscopic cholecystectomy successfully in all six patients in whom it was attempted, with an overall course similar to that of nonpregnant patients. There were no significant complications to the patient or the fetus. All six patients have delivered healthy children and continue to do well. DISCUSSION: With the addition of our 6 patients, there have been 32 successful laparoscopic cholecystectomies during pregnancy reported in the English literature. We feel laparoscopic cholecystectomy can be performed safely in pregnant patients and should be considered in any patient who presents with symptomatic cholelithiasis during pregnancy.