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E Eypasch

Publications and source records attributed to E Eypasch.

At least 37 records · Page 2Linked to original sources
PubMed1996

Laparoscopic and conventional closure of perforated peptic ulcer. A comparison.

BACKGROUND: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. METHODS: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. RESULTS: Consumption of analgesics was lower in the laparoscopic group. CONCLUSIONS: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.

Adult↗
PubMed1996

Laparoscopic cholecystectomy for acute cholecystitis: is it really safe?

The prospectively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) for acute cholecystitis with that for routine symptomatic gallbladders. The preoperative, intraoperative, and postoperative parameters of 424 routine (noninflamed) LCs and 54 LCs for acutely inflamed gallbladders were compared under the "intention to treat" principle. Operating time was longer in the inflamed group (median 97 minutes versus 75 minutes; p < 0.0001). Significantly more adhesions (20% versus 8%), more blood loss (48% versus 19%), a higher incidence of bile spillage (28% versus 12%), and lost stones (19% versus 8%) were encountered in patients with acute cholecystitis. Common bile duct (CBD) injuries were also more frequent in that group (5.5% versus 0.2%; p = 0.005). The rate of conversion to open surgery was higher than with routine LCs (13% versus 4%). There were two deaths in the routine LC group and none in the acutely inflamed group. There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements. Patients with acute cholecystitis stayed only 1 day longer (median 4 days versus 3 days) in hospital. The quality of life scores indicate return to almost normal values by the 14th postoperative day. Long-term follow-up (1-3 years) did not reveal any delayed clinical adverse effects. In summary, LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders. If successfully performed, it has definite benefit for the patient in terms of better postoperative recovery. The trade-off is that the risk of CBD injury is significantly higher.

Acute Disease↗
PubMed1996

[Laparoscopic colon resection in carcinoma--beneficial or not?].

It was the aim of our study to investigate the role of laparoscopic colorectal cancer resection for cure. Postoperative morbidity, pain and hospital stay (n = 21) was reduced and patients' recovery accelerated compared to conventionally operated patients (n = 54). The number of resected lymph nodes and tumor distances were comparable; however, portal recurrences remain the main problem.

Colon↗
PubMed1995

Probability of adverse events that have not yet occurred: a statistical reminder.

The probability of adverse and undesirable events during and after operations that have not yet occurred in a finite number of patients (n) can be estimated with Hanley's simple formula, which gives the upper limit of the 95% confidence interval of the probability of such an event: upper limit of 95% confidence interval = maximum risk = 3/n (for n > 30). Doctors and surgeons should keep this simple rule in mind when complication rates of zero are reported in the literature and when they have not (yet) experienced a disastrous complication in a procedure.

Confidence Intervals↗
PubMed1995

Gastrointestinal Quality of Life Index: development, validation and application of a new instrument.

At present, an instrument for measuring the quality of life, specifically for patients with gastrointestinal disease, is not available. A new instrument for gastrointestinal disorders that is system-specific has been developed in three phases. In the first phase, questions were collated and then tested on 70 patients with gastrointestinal diseases and those that worked well were retained. In the second phase, the questions were modified and tested on 204 patients and the results verified by international experts. The instrument was also validated against other generic measures of quality of life. During the third phase, the instrument was validated with 168 normal individuals. Reproducibility was tested on 25 patients with stable gastrointestinal disease and responsiveness was tested on 194 patients undergoing laparoscopic cholecystectomy. The result is a bilingual (German and English) questionnaire containing 36 questions each with five response categories. The responses to questions are summed to give a numerical score. It is concluded that the Gastrointestinal Quality of Life Index (GIQLI) is ready to be used in clinical practice and research.

Adult↗
PubMed1995

The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements--September 1994. The Educational Committee of the European Association for Endoscopic Surgery.

Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.

Appendectomy↗
PubMed1995

Validation and application of a subjective knee questionnaire.

Patients' complaints on limitations in activities of daily living (ADL) and sports are possible signs for various injuries of the knee joint. These complaints can be easily assessed by the patient using a questionnaire with visual analogue scale (VAS) responses. A German translation of the English questionnaire concerning knee complaints [4] has been validated and tested for clinical use. It consists of 28 questions. For the statistical analysis, an overall score (VAS score) of the questionnaire was determined. The validation included an expert evaluation on the content of the questionnaire, a test for the reliability, a comparison with subjective knee scoring systems (Cincinnati score, Lysholm score) and a test on VAS score results in patient groups with various knee injuries (discrimination of patients). For the evaluation of operative treatment results, the responsiveness of the questionnaire was tested in patients undergoing arthroscopic meniscus surgery and anterior cruciate ligament reconstruction. The investigation was conducted prior to the operation, 2, 6, 12 and 24 weeks after surgery for both groups and also 36 weeks after surgery for the cruciate ligament patients. Interviews conducted with knee surgeons (so-called knee experts) revealed that 85% judged the questionnaire as being acceptable for clinical use. The reliability of the VAS score for healthy individuals was r = 0.86. The reliability for patients in a postoperative rehabilitation programme was r = 0.92. By means of the VAS score we were able to assess the extent of limitations in knee function in various patient groups with meniscus lesions, insufficiency ot the anterior and posterior cruciate ligaments and chondromalacia.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

[Laparoscopic surgery of ileus--miscarriage or training problem?].

The first results of laparoscopic surgery for mechanical ileus were analysed according to 3 classification systems of adverse perioperative events (complications). In our series 11 out of 14 patients were unsuitable for laparoscopic surgery mainly due to intraoperative mechanical problems. In 3 patients relevant and potentially hazardous events occurred which induced immediate conversion to laparotomy. Due to the impossibility and inability to completely explore the abdominal cavity, the laparoscopic approach cannot yet be recommended.

Adult↗
PubMed1995

Anaesthesia for laparoscopic closure of perforated peptic ulcer--any harm or benefit?

Laparoscopic closure of perforated peptic ulcer is technically feasible (1). Haemodynamic changes during laparoscopic operations are known and may have an adverse influence on outcome in patients who have peritonitis, are hypovolemic or even septic (2-4). A complete physiological understanding of CO2-inflation of an abdomen in diffuse peritonitis is still missing. The purpose of this study is to compare perioperative variables of general anaesthesia in patients undergoing open or conventional laparoscopic closure of perforated peptic ulcer.

Abdomen↗
PubMed1995

Haemodynamic changes during laparoscopic cholecystectomy in the high-risk patient.

Although laparoscopic cholecystectomy (LC) has become the standard surgical procedure for the treatment of gall stones, the question has still to be answered whether it is safe for critically ill patients with cardiac disease. 20 ASA-class III/IV patients were monitored during LC by means of a Swan-Ganz catheter. Commencement of anaesthesia led to a significant decrease of mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index. Increasing intra-abdominal pressure by insufflation of CO2 and surgical stimuli during gall bladder dissection induced an increase of pulmonary arterial occlusion pressure mean pulmonary artery pressure and central venous pressure (p = 0.05). Mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index remained below pre-induction values (p < 0.05). In 13 patients with high filling pressures the administration of nitroglycerine improved all parameters. In the post-anaesthetic care unit all parameters had returned towards baseline. In conclusion, LC may lead to temporary myocardial insufficiency. Nevertheless, LC seems to be safe provided that pathological alterations are recognised and treated.

Aged↗
PubMed1994

[Laparoscopic and conventional suture of perforated peptic ulcers--a comparison].

After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 13 consecutive patients with laparoscopic closure were compared to 8 previous patients with conventional surgery. The endpoints adverse advents (complications), pain intensity, fever, leucocytosis and hospital stay showed no clinically relevant differences. Consumption of analgesics was lower in the laparoscopy group. Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by a randomized controlled trial.

Adult↗
PubMed1993

[Value of laparoscopy in diagnosis and therapy of the acute abdomen].

While diagnostic laparoscopy is a well established tool, therapeutic laparoscopy for acute abdominal disorders has recently been made possible by video-endoscopic techniques. From July 1989 to April 1992, 243 laparoscopic interventions were carried out in patients with an acute abdomen. After a pilot phase, patients with acute appendicitis were entered into a randomized trial, those with acute cholecystitis were operated within the next day list. Among the 243 operations were 202 appendectomies, 12 closures of perforated peptic ulcers, 4 successful interventions for intestinal obstruction, 4 irrigations for intraabdominal abscesses and 35 further operations, some of which had to be finished as laparotomies. Laparoscopic appendectomy was less painful but technically more difficult. In cases which needed bowel resection for ischemic necrosis or diverticular disease, conversion to open surgery had to be performed. Laparoscopic treatment of acute abdominal disorders including peritonitis can be effective and beneficial in one out of two patients. Adequate surgical training, expertise and respect to the safety of the patient are mandatory. The application of endoscopic suture devices will further enlarge the spectrum of laparoscopic treatment options for the acute abdomen.

Abdomen, Acute↗
PubMed1993

[The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery].

Since the measurement of quality of life is a relevant endpoint of patient assessment, an international team of methodologists and surgeons have developed a new system-specific index. In different phases, items were collected, tested, rejected or retained and finally verified by international experts. The instrument was also validated against other generic measures, it was compared to 150 normals, tested for reproducibility with 50 stable patients and for responsiveness with 159 patients undergoing laparoscopic cholecystectomy. The product is a bilingual (German and English) questionnaire containing 36 items. Although further testing is in order, we conclude that the Gastrointestinal Quality-of-Life Index is ready to be used in clinical practice and research.

Activities of Daily Living↗
PubMed1992

Laparoscopic cholecystectomy: technical performance, safety and patient's benefit.

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.

Cholecystectomy↗