Biomedical subjects
Publications and source records attributed to A Thiede.
The own findings about the functional behavior of the gastric substitute together with the results from the literature demand a jejunal J-pouch after gastrectomy, if it is not a palliative resection. It is an open question, whether the good experience with the Roux-en-Y-pouch-reconstruction--only 15 min. more time of operation, low rate of complications--allows a wider indication for this procedure.
Endocrine tumors of the pancreas are extremely rare (1-3%). We present two cases with functional inactive tumors--one benign and one malignant--, which were immunohistologically secreting glucagon without having clinical symptoms. Differential diagnosis, operative strategy and therapy of endocrine tumors of the pancreas are discussed.
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The development of the continent ileostoma (Kock pouch) is delineated and its results are reviewed. Leading centers achieved continence in more than 90%. High rates of complications and relaparotomies in the early phase could be significantly reduced by technical modifications. Development of ileoanal pouch procedures have, however, confined the continent ileostomy to special indications.
Since Nissen performed his first ileo-anal anastomosis for a benign large bowl disease in 1933, restorative proctocolectomy has undergone substantial developments, thus especially in the last two decades. Different pouch designs (J-, S-, W- and H-pouch) obtain normal defecation in patients treated with proctocolectomy. Many groups prefer the J-Pouch for it's technical simplicity and good results.
For the assessment of ileoanal and coloanal pouches different diagnostic tests should be applied. Apart from case history and rectal digital examination the most important methods comprise a radiologic evaluation of the pouch and its afferent loop as well as anorectal manometry for the assessment of pouch motility and sphincter function. Increasingly transanal endosonography is being used for the precise examination of size, volume, and shape of ileoanal and coloanal pouches. The afferent loop is also easily accessible to endosonography, e.g. for evaluation of bowel wall morphology and function. Furthermore, in cases of coloanal pouches following an oncologic lower anterior resection, endosonography is used in follow-up examinations for the detection of local tumor recurrence.
AIM OF THE STUDY: Clinical relevant follow up parameters were used to examine the influence of an additional pouch for reconstruction after gastrectomy in Roux-en-Y technique and jejunal interposition in rats. METHOD: 3 months old rats were gastrectomized and reconstructed as follows: Roux-en-Y (RY n = 50), jejunal interposition (JI n = 55) and each of these combined with a jejunal J-pouch (RYP n = 33; JIP n = 26). Up to 9 months postoperatively body weight, hemoglobin, iron, total protein and amylase as well as the pouch volume and esophageal mucosa were followed up. RESULTS: All gastrectomized animals show deficiencies compared to non operated controls (n = 6). The severity depends on the type of reconstruction. The RY group overall has the lowest values; hemoglobin (9 month) 4.2 g/dl, body weight (6 mon) 77% total protein (9 mon) 47 g/l. JI causes less defect: Hb (9 mon) 8.3 g/dl, BW (6 mon) 109%, TP (9 mon) 61 g/l. Animals with additional pouch have better values than those with the similar type of reconstruction but without pouch; RYP: Hb (9 mon) 12.7 g/dl, BW (6 mon) 95%, TP (9 mon) 55 g/l; JIP: Hb (9 mon) 15.1 g/dl, BW (6 mon) 107%, TP (9 mon) 64 g/l. Hemoglobin and total protein do not significantly differ between the combination of interposition and pouch and the control group (p > or = 0.05). The volume of the pouch increases 1:3 during 6 months. Animals with pouch do not show severe reflux esophagitis as do those without pouch. CONCLUSION: With global follow-up parameters the postgastrectomy deficiency can be evaluated in this experimental model. Interposition combined with the pouch is superior to the other methods as demonstrated by less deficiencies. Furthermore the pouch serves as a functional food reservoir and as reflux barrier.
In a series of experimental studies on rat behavior following reconstructive surgery after gastrectomy the effects of Roux-Y-Pouch-technique (RY-P) as compared to Roux-Y (RY) alone were observed. 12 rats with RY-P and 13 rats with RY were tested on days 100-105 post surgery using the Open-Field-test paradigm. Feeding behavior and weight were additionally controlled. Data analysis of repeated measurement design (ANOVA) revealed significant group x time-interaction between type of reconstruction and exploratory behaviors (p < .01). Moreover, RY-P rats consumed more food (p < .001), had higher weight gain (p < .01), and tended to more normal defecation. Overall, results favour the more physiological type of reconstruction.
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This prospective study investigates the technical feasibility and the potential advantage of laparoscopic operative techniques in patients following previous surgery. Data were obtained from a group of patients following previous surgery who underwent laparoscopic cholecystectomy, explorative laparoscopy, laparoscopic adhesiolysis, or laparoscopic procedures on the intestinal tract; all of these patients presented intraabdominal adhesions leading to a change of the originally intended operative procedure. 240 patients who underwent laparoscopic cholecystectomy without previous surgery or with previous surgery but without relevant adhesions represented the control group. Endpoints of investigation were duration of operation, post-operative hospitalization, intra- and postoperative complications, and postoperative quality of life. A total of 370 patients was followed after laparoscopic procedures. With an equal distribution of complications in both groups a higher percentage of calculated and emergency conversions was found in the group of patients following previous surgery; these conversions did not lead to a larger ratio of complications. The patients' postoperative quality of life, recorded by means of a complaint score, was equal in both groups. These results show that "previous abdominal surgery" does not represent a contraindication for laparoscopic surgery and that patients following previous surgery will profit from laparoscopic operations to the same extent as already proven for patients undergoing laparoscopic procedures without previous surgery.
The management of gastroduodenal ulcer disease has changed because of new evidence of its pathophysiologic background and the introduction of new medication and operative techniques. Proximal gastric vagotomy (PGV) was abandoned by some as the treatment of choice because of high recurrence rates. With the advent of minimally invasive surgery, laparoscopic vagotomy has renewed interest in vagotomy as a treatment option for gastroduodenal ulcer disease. In view of this development, a study was performed to investigate the incidence of abnormal gastric hyperacidity in a population of ulcer patients in order to select those patients for operative acid reduction who will benefit most from operation. Sixty-eight patients with gastroduodenal ulcer disease underwent 24-hour-gastric-pH monitoring, 29 of these patients subsequently underwent proximal gastric vagotomy. The study demonstrates that it is possible to identify patients with hyperacidity. It revealed a variation of intraluminal gastric acidity in patients with different ulcer locations. On the basis of the opinion that gastric hyperacidity is the main indication for PGV, it is emphasized that the choice of surgery should depend on the functional defect and that the indication for operation should be based on therapy-resistant symptoms.
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Explore the source record for details and available documents.
Mechanic or stapled anastomoses of hollow organs represent a safe and attractive alternative to the manual suture. The rate of complications for the duodenal stump closure by linear staplers is minimal with leakages below 1%; the same is true for the jejunum. In esophagogastrostomies which are often performed cervically, the stapler offers more safety compared to manual sutures, but the rate of stenoses is higher with about 15%. Stenoses have been observed especially with smaller magazines (25 mm diameter). For esophagojejunostomies safety is much greater with mechanic staplers than with manual sutures. Only most experienced surgeons would achieve the same results with the same low rate of leakages of less than 10%; stenoses do not have clinical relevance.
Practicability and indication for continuity preserving surgery increase by the use of staplers in the lower gastrointestinal tract. The mean rate of complications for the deep colorectal and colo-anal anastomosis decreased. Locoregional relapses occur as often as with other techniques, when the criteria of radicality have been observed. Stenoses are prevalently due to complications of extraperitoneal anastomoses. In higher large bowel sections, only a few surgeons favor the use of staplers, as the risk for the patient increases without offering particular advantages. The double stapling technique in deep anterior resection is possible for small tumors and a large pelvis. For colonic pouches linear staplers are completed by circular staplers for the subsequent pouchanal anastomosis. Studies are running, actually, regarding indication of the colonic pouch.