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Biomedical subjects

A Metzger

Publications and source records attributed to A Metzger.

At least 19 recordsLinked to original sources
PubMed1998

Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery.

BACKGROUND: We set out to analyze the technical aspects, intraoperative complications, morbidity, and mortality of laparoscopic cholecystectomy in a multi-institutional study representative of Switzerland. METHODS: Data were collected from 10,174 patients from 82 surgical services. A total of 353 different parameters per patient were included. RESULTS: We found intraoperative complications in 34.4% of patients and had a conversion rate of 8.2%. This rate was significantly increased in patients with complicated cholelithiasis and in those with previous upper-but not lower-abdominal surgery. In most cases, conversions to open procedures were required because of technical difficulties due to inflammatory changes and/or unclear anatomical findings at the time of operation. Bleeding was a common intraoperative complication, that significantly increased the risk of conversion. Patients with loss of gallstones in the peritoneal cavity had increased rates of abscesses. The rate of common bile duct injuries was 0.31%, but it decreased significantly as the laparoscopic experience of the surgeon increased. The rate of common bile duct injuries was not increased in patients with acute cholecystitis or in the 1.32% of patients undergoing laparoscopic common bile duct exploration. Intraoperative cholangiography did not reduce the risk of common bile duct injuries, but it allowed them to be diagnosed intraoperatively in 75% of patients. Local complications were recorded in 4.79% of patients, and systemic complications were seen in 5.59%. The mortality rate was 0.2%. CONCLUSIONS: Although laparoscopic cholecystectomy is a safe procedure, the rate of conversion to open cholecystectomy is still substantial. The conversion rate depends both on the indication and intraoperative complications. There is still a 10.38% morbidity associated with the procedure; however, the incidence of common bile duct injuries, which decreases with growing laparoscopic experience, was relatively low.

Cholangiography↗
PubMed1997

SDZ HTF 919 stimulates canine colonic motility and transit in vivo.

Effects of the nonbenzamide 5-hydroxytryptamine4 agonist SDZ HTF 919 on gastrointestinal motility are unclear. Our aim was to assess the in vivo effects on gastrointestinal and colonic transit of radiolabeled residue and on colonic phasic contractility. In six female dogs, transit was measured over a period of 2 days by radioscintigraphy and colonic motility was measured by pneumohydraulic perfusion manometry of the proximal and distal colon. SDZ HTF 919 was administered initially by bolus i.v. infusion, followed by s.c. injection 8 and 16 hr later. Doses tested were 0.03, 0.1 and 0.3 mg/kg, and isotonic saline and vehicle served as controls in each dog. Stomach and small bowel transit was not significantly altered by SDZ HTF 919. Overall, i.v. SDZ HTF 919 accelerated colonic transit during the first 1 hr, compared with controls. These effects were significant even with the lowest dose of SDZ HTF 919. Responses to higher infusion doses were more variable. SDZ HTF 919 did not cause significant changes in quantitative pressure indices, such as amplitude or motor index, in the small bowel or colon. Prolonged postprandial colonic contractions, each lasting >30 sec, were noted after each i.v. agent and were significantly more frequent with the 0.03 mg/kg dose than with control (vehicle) treatment. Thus, SDZ HTF 919 accelerates canine colonic transit in vivo during the first 1 hr after i.v. administration. SDZ HTF 919 appears to be a promising agent for stimulation of mammalian colonic transit.

Animals↗
PubMed1996

Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases.

BACKGROUND: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure. METHODS: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively. RESULTS: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%. CONCLUSIONS: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.

Acute Disease↗
PubMed1995

Injury to the diaphragm and its repair during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has now become the "gold standard" for the treatment of gallstone disease. Parallel with the conversion from the open to laparoscopic technique, some complications peculiar to the laparoscopic approach have been experienced. Such a technique-related complication, resulting in an injury to the diaphragm and its repair during laparoscopic cholecystectomy is presented.

Acute Disease↗
PubMed1995

[Laparoscopic cholecystectomy as standard therapy in acute cholecystitis. A prospective study].

Between November 1989 and May 1994 103 laparoscopic cholecystectomies were performed for acute cholecystitis. Conversion rate was 4.9%. Mortality was 0. Postoperative morbidity was 10.7% (6.8% local complications, 3.9% systemic complications). None of the complications lead to a reoperation, no injuries of the common bile duct occurred. These results compare favorably to randomized studies of open cholecystectomy and to published result of laparoscopic cholecystectomy for acute cholecystitis. Main determining factor for technical difficulty of the operation was the lapse of time between onset of symptoms and operation. This is expressed in statistically different mean operative times in patients with short (1-6 days) and long (7-14; 15-21 days) clinical history of acute cholecystitis. We therefore conclude that early surgery, in selected cases even emergency surgery is indicated and that in expert hands laparoscopic cholecystectomy can be the treatment of choice for acute cholecystitis.

Acute Disease↗
PubMed1995

Subcutaneous periumbilical metastasis of a gallbladder carcinoma after laparoscopic cholecystectomy.

The frequency of gallbladder carcinoma is 1.2 to 7.4% of all cholecystectomy specimens. In open cholecystectomy for gallstone disease, undetected gallbladder carcinoma is found postoperatively in the histological examination in 0.3%. Tumor cells of these clinically inapparent gallbladder carcinomas can be implanted at the trocar sites during laparoscopic cholecystectomies. We report a case with subcutaneous tumor seeding at the navel trocar insertion site in a 65-year-old woman.

Abdominal Muscles↗
PubMed1994

[Laparoscopic cholecystectomy in morbid obesity].

In the early days of laparoscopic cholecystectomy (LC) morbid obesity was considered a relative contraindication for this procedure. With increased experience the procedure has been used in obese patients too. To evaluate the influence of morbid obesity on feasibility and outcome of LC, we performed a prospective study in 136 patients in whom LC was attempted between January 1991 and January 1992. Conversion to open cholecystectomy was necessary in 26 cases (19%). The remaining patients were divided into two groups. Group 1 consisted of 92 normal or slightly obese individuals, whereas 18 morbidly obese patients were included in group 2. Intraoperative problems (42% vs 61%) and postoperative morbidity (2% vs 11%) were less frequent in group 1, although not statistically significant. There was no difference in operating time (median for both groups: 110 minutes) and length of hospital stay (4 days). The incidence of late complications (3% vs 6%) was similar. We conclude that LC in morbidly obese patients, as in open surgery, is technically more demanding than in normal individuals. The operative risk was elevated (p < 0.05) as evidenced by a tendency to higher intra- and postoperative complication rates. Cholecystolithiasis in morbidly obese patients is a good indication for LC in the hands of well trained laparoscopic surgeons who are ready to convert to open surgery if problems arise.

Adult↗
PubMed1994

[Acute cholecystitis: indication for emergency laparoscopic cholecystectomy?].

Between 1989 and 1992, 43 patients underwent laparoscopic cholecystectomy for acute cholecystitis. Conversion to open cholecystectomy was necessary in one case (2.3%). Morbidity was 14%, i.e. 7% local complications and 7% systemic complications. No lesions of the CBD occurred and no reoperations or reinterventions were required. Mortality was 0%. The main determining factor for the technical difficulty of laparoscopic cholecystectomy was the lapse of time between onset of symptoms and operation. We show the duration of laparoscopic cholecystectomy during the first 6 days of acute cholecystitis (mean 104 min) is statistically different in the following groups of patients (7-14 days p = 0.0049; 15-21 days p = 0.0037; Mann-Whitney-U-test). We therefore conclude that laparoscopic cholecystectomy is a safe method in acute cholecystitis and that the ideal time of operation is as soon as possible within the first 6 days after onset of illness. Performance of laparoscopic cholecystectomy should not be delayed during this period of acute cholecystitis. If the procedure is carried out by well trained laparoscopic surgeons the risks and complications are equal to those of open cholecystectomy.

Acute Disease↗
PubMed1994

[Laparoscopic intestinal surgery].

The objective of the present study was to demonstrate the feasibility of laparoscopic bowel surgery. From June 1990 to September 1993 14 small bowel and 15 colon operations were performed laparoscopically in the surgical department of Aarberg Hospital. The results have been analyzed retrospectively. The indication for all small bowel operations was intestinal obstruction. Adhesiolysis, hernia repair and resections were performed either by laparoscopy or by laparoscopically assisted surgery. There were no complications. Laparoscopy therefore has proven to be a good method for treating intestinal obstruction of various origin. 11 colon resections were performed without anastomotic leakage. There were two conversions to laparotomy. Three complications occurred but resolved spontaneously. Two patients died from causes unrelated to the laparoscopic procedure. Our results demonstrate that laparoscopic resections of the colon are feasible. Further evaluation is needed to assess their clinical value.

Adolescent↗
PubMed1994

[Laparoscopic cholecystectomy: current status].

Since its introduction a few years ago, laparoscopic cholecystectomy has become today the standard treatment of gallbladder stones. Compared to open surgery it involves little change in the preoperative investigations. There has been, especially in the beginning of the learning curve, a demand for preoperative visualization of the bile duct anatomy and for exclusion of intraductal stones. Thus the incidence of preoperative ERCP has risen with the development of laparoscopic cholecystectomy. For the advanced laparoscopic surgeon, the indications for laparoscopic cholecystectomy are the same as for open surgery. The benefits of laparoscopy for the patient are obvious and the results are favourable. Bile duct injury is a very severe complication and, at the beginning of the learning curve, the incidence has been somewhat higher than in open surgery. Therefore, proper training in laparoscopic surgery and quality control are necessary. Many reports on advanced laparoscopic procedures have already been published, but only the future will show the limits of this technique.

Bile Ducts↗
PubMed1994

[Second look laparoscopy after mesenteric infarct].

Second-look laparotomy is not always routinely performed after mesenteric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular disease. We developed a minimally invasive technique for second-look laparoscopy with the aim of decreasing the operative morbidity. With the patient under general anaesthesia, the old incision is opened at the umbilicus. The running suture in the abdominal wall is lifted with a clamp and the incision line is gently reopened. A trocar with a blunt tip designed for open laparoscopy is then inserted and fixed. Following insufflation of CO2 through the trocar it is possible to explore the entire small bowel and colon. We operated on five patients after bowel resection performed for mesenteric infarction. Second-look laparoscopy was diagnostic in all but one, in whom laparoscopy failed due to massive small bowel dilatation. The technique described here is very promising and deserves further evaluation.

Aged↗
PubMed1994

Cholecystocholangiography vs cystic duct cholangiography during laparoscopic cholecystectomy. A prospective controlled trial.

Intraoperative cholangiography performed during laparoscopic cholecystectomy provides an exact picture of the biliary anatomy. It may prevent iatrogenic bile duct injury and detect unsuspected common duct stones. Laparoscopic cannulation of the cystic duct can be difficult and time-consuming. We therefore evaluated the simpler technique of cholecystocholangiography by direct puncture and filling of the gallbladder with contrast medium. This technique was compared with cystic duct cholangiography in a prospective controlled trial of 69 patients. Cystic duct cholangiography (n = 38) showed significantly better results than cholecystocholangiography (n = 31) with optimal visualization of the biliary tree in 29 cases (76%) and seven cases (22%), respectively. The failure rate was 8% and 52%, respectively. Delineation of the cystic duct junction is important in order to prevent bile duct injury. The anatomy in this region was clearly delineated in 34 cases (89.5%) using cystic duct cholangiography but only in 11 cases (35.5%) with cholecystocholangiography. Cystic duct cholangiography revealed unsuspected common duct stones in three cases; however, choledocholithiasis was missed by cholecystocholangiography in at least two patients. Cystic duct cholangiography is clearly the optimal technique. In situations of unclear anatomy in which safe dissection of the cystic duct is not possible, cholecystocholangiography remains a useful alternative.

Adult↗
PubMed1994

Various stapling techniques in laparoscopic appendectomy: 40 consecutive cases.

The applicability and safety of a new operative technique for laparoscopic appendectomy using an automatic stapling device, the Multifire Endo-GIA 30, was evaluated. This instrument, which can be passed through a 12-mm trocar sleeve, compresses the appendix as well as the resting stump, occluding its lumen with three lines of titanium staples and cutting between them. Data from 40 laparoscopic appendectomy patients collected between August 1991 and March 1992 were analyzed prospectively. Using this stapler, the mean operation time was 58.33 min (range, 35-95 min), with no complications or mortality. In 35 cases, an acute, and in one case, a chronic, appendicitis was histologically confirmed; in four cases no inflammation was detected. Our preliminary results suggest that this new stapling device offers a simple and safe method for use in laparoscopic appendectomy.

Acute Disease↗
PubMed1993

[Cholecysto-cholangiography as an alternative to cystic duct cholangiography in laparoscopic cholecystectomy].

Intraoperative cholangiography may be an important adjunct to laparoscopic cholecystectomy in order to prevent bile duct lesions. Laparoscopic cannulation of the cystic duct can be very difficult and time consuming. We therefore developed a simple technique of cholecystocholangiography. The gallbladder is punctured and filled with contrast medium after having localised the cystic duct and put a metal clip as a landmark. The study included 52 patients having either cholecystocholangiography or cystic duct cholangiography. In 13 out of 26 patients (50%) cholecystocholangiography failed because of obstruction of the cystic duct. The cholangiograms showed complete filling of the bile ducts in 5 (19%) and incomplete visualisation in 8 cases (31%). Cystic duct cholangiography showed significantly better results with good delineation of the biliary tree in 19 cases (73%). Five cholangiograms were suboptimal (19%) and only 2 studies failed (8%). The relation between cystic duct and common bile duct was clearly visible in 24 cases (92%) with cystic duct cholangiography compared with 13 cases (50%) with cholecystocholangiography. Cystic duct cholangiography has better success rates in delineating biliary anatomy in order to prevent bile duct injury. Cholecystocholangiography is a good alternative in cases where the cystic duct cannot be initially visualized.

Adult↗
PubMed1993

[Laparoscopic appendectomy: techniques and results in Switzerland].

We have tried to assess the actual attitude towards laparoscopic appendectomy in Switzerland. An inquiry on preoperative investigations, operative approach and results in cases of suspected appendicitis in 26 surgical Institutions affiliated to the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) was performed. In a 20 month period a total of 3665 laparoscopic procedures were performed. Appendectomy was attempted in 457 cases in 19 institutions. Conversion to open appendectomy was necessary in 51 cases (11%). Average operative time was 62 minutes. There were 27 postoperative complications (7%). 8 patients (1.9%) needed reoperation. Mean hospital stay was 3.9 days. Opinions of the participating institutions on the actual role of laparoscopic appendectomy (feasibility, advantages or disadvantages) are shown.

Adolescent↗
PubMed1992

Isolation and characterization of Y chromosome DNA probes.

A sorted, cloned Y chromosome phage library was screened for unique Y chromosome sequences. Of the thousands of plaques screened, 13 did not hybridize to radiolabeled 46,XX total chromosomal DNA. Three plaques were characterized further. Clone Y1 hybridized to multiple restriction enzyme fragments in both male and female DNA with more intense bands in male DNA. Clone Y2, also found in female and male DNA, is probably located in the pseudosutosomal region because extra copies of either the X or Y chromosomes increased Y2 restriction enzyme fragment intensity in total cellular DNA. Clone Y5 was male specific in three of four restriction enzyme digests although in the fourth a light hybridizing band was observed in both male and female DNA. Clone Y5 was sublocalized to band Yq 11.22 by hybridization to a panel of cellular DNA from patients with Y chromosome rearrangements. Clone Y5 can be used to test for retention of the proximally long arm Y suggested to cause gonadal cancer in carrier females. The long series of GA repeats in Y5, anticipated to be polymorphic, may provide a sensitive means to follow Y chromosome variation in human populations.

Base Sequence↗