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Biomedical subjects

A Metzger

Publications and source records attributed to A Metzger.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1992

[Appendectomy: open or laparoscopic?].

Surgeons interest in laparoscopic surgery has grown considerably in the last years, mostly due to the explosive spread of laparoscopic cholecystectomy. Laparoscopic appendectomy is from a historical point of view the older procedure, since it was already performed 1982 by Semm. His technique was modified 1987 by Götz, who is also responsible for popularizing it in general surgery. Between April 1989 and April 1991 we have performed 107 laparoscopic appendectomies. 82 were completed successfully by laparoscopy, in 25 instances we had to convert to an open procedure, mostly as a result of the lack of proficiency in the learning period. There were 8 septic complication (9.7%), a rather high rate, which probably will be reduced with the increasing operative expertise. There were no deaths in this series. Further experience is demanded in order to establish laparoscopic appendectomy as the alternative to the conventional procedure.

Abdomen, Acute↗
PubMed1991

[Laparoscopic cholecystectomy: 100 consecutive cases without postoperative morbidity].

100 consecutive patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. We report our results and the management of choledocholithiasis. In two cases the laparoscopic procedure had to be converted into open cholecystectomy due to bleeding. There were no complications postoperatively. The results show that laparoscopic cholecystectomy is a safe procedure with real benefits. The main advantages are greater comfort for the patient, better cosmetic results, shortening of hospital stay and earlier return to full activity. We feel that, with a proper indication, laparoscopic removal of the gallbladder will establish itself as the procedure of choice in stone disease.

Adult↗
PubMed1991

[From diagnostic laparoscopy to laparoscopic surgery].

The analysis of 135 laparoscopic procedures since 1987 shows the possible indications of this new method. 77 cases were emergencies, mainly suspicion of acute appendicitis. 28 laparoscopic appendectomies were performed. Of the 58 elective operations 42 were laparoscopic cholecystectomies without complications. We believe that these minimally invasive procedures have many advantages compared to open surgery.

Abdomen, Acute↗
PubMed1991

[Laparoscopic cholecystectomy--results of the first 100 cases].

100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, choledochus injury and acute cholecystitis. There were no complications postoperatively. We feel that the indication of this method is advantageous. Independent of the size, the number and the chemical composition, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.

Adult↗
PubMed1990

[Laparoscopic cholecystectomy. Personal experiences in 20 cases].

20 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. Only in one case the laparoscopic procedure had to be converted into an open cholecystectomy due to cystic arterial bleeding. There were no complications postoperatively. We feel that in selected cases laparoscopic cholecystectomy is a real alternative to the standard operation. The main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.

Adult↗