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Biomedical subjects

C Klaiber

Publications and source records attributed to C Klaiber.

At least 37 records · Page 2Linked to original sources
PubMed1995

An evaluation of laparoscopic adhesiolysis in patients with chronic abdominal pain.

The purpose of this prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-five patients with chronic abdominal pain lasting for more than 6 months but with no abnormal findings other than adhesions found at laparoscopy underwent laparoscopic adhesiolysis. Thirty-six patients (80%) were available for follow-up after a median time interval of 10 months (range: 6-36 months). Seventeen patients (47.2%) were free from abdominal pain and 13 patients (36.1%) reported significant amelioration of their pain. Six (16.6%) patients had no amelioration. Twenty-nine patients (80.6%) judged the outcome of the operation to be good or beneficial and 35 (97.2%) said that they would undergo the operation a second time if that were necessary. Laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures or ameliorates chronic abdominal pain in more than 80% of patients.

Abdominal Pain↗
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

[Does laparoscopy influence the treatment of choledocholithiasis?].

Operative common bile duct exploration, performed in conjunction with cholecystectomy, used to be considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. The advent of laparoscopic cholecystectomy (LC) has affected the management of common bile duct stones. More emphasis is placed on preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) with endoscopic papillotomy (EP) either just before or soon after laparoscopic surgery. This involves the patient in an additional procedure with its associated risks. Single-stage treatment of biliary lithiasis, i.e. LC and laparoscopic common bile duct exploration (LCDE) appears preferable to two-stage treatment, especially when the ampulla of Vater can be preserved. 550 consecutive patients with LC are reviewed. IVC with tomography was performed in 341 of these patients without complications and with a sensitivity of 75% and a specificity of 99%. The procedure failed in 5.6% due to poor quality imaging, and was contraindicated in 21 patients. With increasing laparoscopic experience, intraoperative cholangiography (IOC) was adopted and has been used routinely since November 1992. IOC was successful in 204 of 209 attempts (97.6%) with a sensitivity of 95% and a specificity of 100%. The mean operation time for IOC was 10 minutes. Unsuspected bile duct stones were found in 6% of instances. IOC demonstrated one choledochotomy (0.18% of all LC), thus preventing transsection of the duct. 47 patients (8.5%) had common duct stones. 29 (62%) were treated by ERC and EP, while 18 (38%) underwent LCDE. Successful clearance was achieved endoscopically in 94% and laparoscopically in 82% of the attempts.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiography↗
PubMed1994

[Laparoscopic suturing of a perforated gastroduodenal ulcer].

The mortality rate for perforated peptic ulcer ranges from 10 to 30%. Age above 70 years, preoperative shock, operation more than 24 hours from the time of acute onset, and poorly controlled concurrent illness are considered to be risk factors. Individuals with any of these features are deemed unfit for definitive surgery and should undergo simple omental patch suture alone. This case report details the laparoscopic management of an 86-year-old female with a ruptured duodenal peptic ulcer who was receiving corticosteroids and a non-steroidal antiinflammatory drug. Laparoscopy is of diagnostic value and permits efficient cleaning of the abdominal cavity. Provided the laparoscopic principles of management are essentially the same as those adhered to during open surgery, the minimally invasive procedure may help to reduce postoperative morbidity and mortality.

Aged↗
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

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

[Does laparoscopic lysis of adhesions make sense?].

Between May 1989 and December 1991 23 patients were operated on laparoscopically for symptomatic peritoneal adhesions. 19 were followed up by telephone using a standardized questionnaire an average of 18.3 months post-operatively (range 5-36 months). 12 patients were totally painfree, 3 complained of slight pain, 2 patients of fairly severe and 2 of severe pain. 15 patients considered the outcome of the operation to be good or fairly good and 18 said they would undergo the same operation in similar circumstances. We therefore recommend laparoscopic adhesiolysis in cases of acute or chronic abdominal pain, provided other causes of abdominal discomfort have been ruled out.

Abdominal Pain↗
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↗
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↗
PubMed1992

[Ambulatory laparoscopic cholecystectomy?].

Commonly, after laparoscopic cholecystectomy, patients will be discharged from the hospital on the second or the third postoperative day and return to full activities about a week after surgery. Some reports from the USA demonstrate that laparoscopic cholecystectomy can be done on an outpatient basis. But these as well as all operative procedures are not without risk, and we prefer a short hospitalization. Outpatient laparoscopic cholecystectomy is performed because cost containment has become a major issue in American medicine.

Ambulatory Surgical Procedures↗
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↗