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Biomedical subjects

E Schippers

Publications and source records attributed to E Schippers.

At least 19 recordsLinked to original sources
PubMed2000

Myoelectric and motor activity after proctocolectomy and ileal pouch-anal anastomosis in dogs.

BACKGROUND: The aim of this study was to investigate the motor function of the ileoanal pouch and to evaluate its coordination with proximal small-intestine motility. METHODS: Proctocolectomy and ileal J pouch-anal anastomosis were performed in 12 dogs. Motility was recorded by serosal electrodes and strain gauge transducers. RESULTS: Transmission of the migrating motor complex (MMC) on the pouch appeared in only 37 of 109 measurements. On the ascending limb there was a constant irregular activity with no MMC detectable. Motility pattern of the pouch did not change postprandially. Spontaneous defecation always appeared independently from MMC transmission without an increase of electrical or mechanical activity or endoluminal pouch pressure. CONCLUSIONS: Ileal pouch motility is independent from motility patterns of the proximal intestine. Its random contractile activity might provide storage function and make the pouch act as a functional reservoir. Intrinsic pouch motility is not responsible for pouch evacuation under physiologic conditions.

Animals↗
PubMed1999

[Duodenal fistula following Port-à-cath--a rare complication of regional hepatic chemotherapy].

Arterial port systems are frequently used in the adjuvant and palliative therapy of colorectal hepatic metastasis. Specific complications are rarely documented in literature. The perforation of an arterial Port-à-cath followed by duodenal fistula is an uncommon complication of regional hepatic chemotherapy. Besides systemic disorders caused by the chemotherapeutic agents, such as vomiting, sickness, or gastritis and duodenitis, gastroduodenal ulcers can occur as a local complication of treatment. Thrombosis of the hepatic artery or occlusion of the port device are the most common reasons for withdrawal of treatment in our series. Based on our experience and the case report of a duodenal fistula we recommend angiography of the port system prior to each cycle of chemotherapy.

Angiography↗
PubMed1998

[Ulcerative colitis--late functional results of ileoanal pouch anastomosis].

Stool frequency after ileal pouch-anal anastomosis (IPAA) is about 5/day after adaptation during the first year. It depends on stool volume and pouch capacity, not on the design of the pouch. In most cases evacuation is spontaneous and as complete as in healthy rectum. 67% of patients are perfectly continent, while 19% have to wear pads due to intermittent leakage. Complete incontinence is reported in 0-4% of the patients. Preservation of the anal transitional zone by the double-stapling technique does not improve functional results when compared to endoanal mucosectomy or intersphincteric resection. Impairment of continence is caused by damage of the internal sphincter with consecutive decrease of the pouch-anal pressure gradient. Despite altered reflex activity, stool discrimination is preserved in most patients. The loss of colonic water and electrolyte absorption is compensated by decreased renal excretion. Alterations in bile acid metabolism are lower after IPAA than after ileostomy. Bacterial overgrowth may lead to deterioration of the functional results.

Anastomosis, Surgical↗
PubMed1998

[Necrotizing fasciitis after laparoscopic cholecystectomy].

Necrotizing fasciitis is a rare and potentially fatal infection of the fascia and subcutaneous tissue. We found only few reports about this disease following laparoscopic surgery. A contamination of the abdominal wall at the trocar position with pathogenic aerobic and anaerobic microorganisms in an "aerosol" is discussed. An increased incidence is associated with risk factors which lead to compromised tissue perfusion and immunosuppression. Early recognition and aggressive surgical management combined with intravenous antibiotics are crucial to a successful outcome. Various aspects of the pathophysiology, diagnosis and therapy of this severe complication following laparoscopic cholecystectomy are discusses.

Adult↗
PubMed1998

Laparoscopy versus laparotomy: comparison of adhesion-formation after bowel resection in a canine model.

AIM: The purpose of the study was to compare adhesions following laparoscopic and conventional operations. METHODS: In 14 dogs cecal resection and a deserosation of the abdominal wall were performed laparoscopically (n = 7) or by laparotomy (n = 7). After 8 days all dogs were reexamined and the adhesions were quantified by computer-aided measurements. The significance of any differences were tested using Student's t test. RESULTS: The extent of adhesions after laparoscopy (630 +/- 360 mm2) and after laparotomy (3,300 +/- 1,007 mm2) differed significantly (p < 0.0001). Extensive adhesions to the abdominal incision and interenteric adhesions were found after conventional operations. Identical manipulations, such as cecal resection or deserosation of the lateral wall, led to the same frequency and extent of adhesions in both operation groups. CONCLUSION: Laparoscopic procedures are associated with significantly less adhesions in comparison to conventional operations. Therefore the risk of adhesion-related complications should be reduced after laparoscopic operations.

Abdominal Muscles↗
PubMed1998

[Direct ileum pouch-anal anastomosis in ulcerative colitis: function and complications after stapler technique].

Stapled ileal pouch-anal anastomosis after proctocolectomy enables a continence preserving reconstruction. We assessed complications and functional outcome after ileoanal pouch-anastomosis in 86 consecutive patients with ulcerative colitis. There was no postoperative mortality. 2 patients required permanent ileostomy and pouch excision for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis (n = 2), anastomotic leakage (n = 4), bleeding (n = 1), pancreatitis (n = 3) and peritonitis (n = 1). Both frequencies of bowel movements and degree of continence improved with time. Two years after take down of the deviation ileostomy frequency of bowel movements was 5,6 [2]/die. At this time no patient complained of major incontinence. Minor incontinence was reported with 9% and 14% during day-time and night-time respectively. It is concluded that direct stapled ileal pouch-anal anastomosis is a safe procedure with excellent functional results for patients with ulcerative colitis.

Adolescent↗
PubMed1998

[Colon carcinoma after ureterosigmoidostomy--a case report].

Ureterosigmoidostomy was the method of choice for continent urinary diversion in cases of bladder exstrophy. The development of colonic cancer at the ureterocolic junction is one of the major complications in the late course of this procedure. The risk of large bowel carcinoma is increased 150-500-fold compared to the general population. Therefore regular examinations are mandatory. Based on a case report the problems associated with ureterosigmoidostomy are presented.

Adenocarcinoma↗
PubMed1997

[Streptococcal toxic shock-like syndrome" as a rare surgical disease picture].

In recent years there has been an increasing incidence of streptococcal toxic shock-like syndrome (TSLS) in otherwise healthy adults. It is characterized by fever, rash, hypotension and early shock with consecutive organ failure and a mortality rate of about 30%. This paper describes the history of two patients with severe streptococcal TSLS. Various aspects of the pathophysiology, diagnosis and therapy are discussed. Only early, aggressive and repeated surgical debridement can reduce the bacterial load and decrease circulating exotoxins and thereby, in combination with antibiotic therapy, decrease the high mortality of this entity.

Adult↗
PubMed1997

[Streptococcal toxic shock-like syndrome"--a rare complication of pyogenic skin infections].

In recent years there is an increasing incidence of streptococcal toxic shock-like syndrome in otherwise healthy adults. It is characterized by feaver, rash, hypotension and early shock with consecutive organ failure and a mortality rate of about 30%. Only early, aggressive and repeated surgical debridement can reduce the bacterial load and decrease circulating exotoxins and thereby in combination with antibiotic therapy decrease the high mortality of this entity.

Adult↗
PubMed1997

[Laparoscopic fundoplication--prevention of complications].

False indications, inadequate procedures and incorrect technique cause complications after laparoscopic antireflux procedures. Indication for operative treatment are esophagitis grade III and IV. Requirement of life-long treatment as well as persisting esophagitis after conservative treatment are indications in patients with esophagitis grade I and II. Preoperative evaluation includes endoscopy with biopsy, 24-h pH measurement and manometry. Therapy of choice is 360 degrees Nissen fundoplication analogue to the open procedure. In case of impaired esophageal contractility, a Toupet fundoplication is performed. Essential steps of the operative technique are prescribed with respect to potential peri- and postoperative complications. With crucial indication, careful preoperative evaluation and subtle technique, a fundoplication performed by an laparoscopic experienced surgeon is safe and efficient.

Follow-Up Studies↗
PubMed1996

[Minor abdominal trauma by laparoscopic surgery? Comparison of adhesion formation and intestinal motility after laparoscopic and conventional operations in the dog].

Early postoperative intestinal motility after conventional and laparoscopic cholecystectomy was registered in dogs (n = 10) by implanted serosal electrodes to compare the abdominal trauma. In addition postoperative adhesions after laparoscopic and conventional resection of the cecum were measured in dogs (n = 14). A significantly shortened postoperative atony occurred after laparoscopic cholecystectomy compared with the conventional operations. Laparoscopic operations caused significantly less adhesions. After conventional operations extensive adhesions to the abdominal wall and interenteric adhesions were found. The shortened postoperative atony and the reduced adhesions document the minor abdominal trauma of laparoscopic surgery.

Abdominal Muscles↗
PubMed1996

[Gastroesophageal reflux--surgical indications, laparoscopic surgical technique, results].

OBJECTIVE: To investigate criteria for indication to surgery and results of laparoscopic fundoplication. BACKGROUND: Gastroesophageal reflux is a common problem in well developed countries. Beside clinical symptoms of heartburn and regurgitation complications may occur like esophagitis, bleeding, ulceration, mucosal metaplasia and loss of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of the esophagogastric junction is discussed. In some patients medical treatment is complicated by relapse, persistent or progressive disease. For these patients laparoscopic antireflux surgery may be an effective alternative. PATIENTS: 22 patients with chronic gastroesophageal reflux disease. METHODS: Since 9-2-1922 patients with gastroesophageal reflux disease were prospectively evaluated and treated by laparoscopic Nissen fundoplication. RESULTS: 11 patients had frequent recurrent disease, 9 persistent reflux and 2 a stricture while on medical treatment. All had pathologic reflux on 24 hour pH monitoring and defective sphincter on standard manometry. Beside an intraoperative pneumothorax there was no intraoperative complication. Postoperative 2 patients had a temporary and 1 mild persisted dysphagia. None had recurrent reflux. 10 patients were reevaluated one year after surgery. None had an esophagitis, abnormal reflux or an insufficient or hypercontinent sphincter. CONCLUSIONS: Patients with recurrent or persistent reflux while on medical treatment with abnormal reflux on pH monitoring and defective sphincter on manometry can be treated by laparoscopic Nissen fundoplication with good results.

Adult↗
PubMed1996

[Pro-Shouldice: primary tension-free hernia repair--conditio sine qua non?].

Protagonists of laparoscopic hernia repair with mesh emphasize the tension-free repair as a main advantage. Thus, conventional techniques of hernia repair with tissue approximation and suture lines are questioned. Postulated advantages of the tension-free repair are less postoperative pain, shorter labour disability, less recurrences and less complications. The results of our own patients (primary hernia n = 2025, recurrent hernias n = 897) operated with the Shouldice technique were evaluated with regard to the postulated advantages of the tension-free repair. 95% of our patients were operated under local anesthesia. The amount of analgetic drugs/patient decreased from 45% first postoperative day to 20% second postoperative day. The individual judgement of pain with a visual analogue scale decreased to zero at the second postoperative day. Chronic groin pain persisted in 1.4% after primary hernia repair and 2.6% after repair of recurrent hernias in our patients. Mobilizing the patient from the operating table the postoperative hospital stay is 3,7 days after primary hernia and 6,7 days after recurrent hernia. The length of labour disability correlated significantly with the occupation. 90% of self-employees are back at work 3 weeks postoperatively while, in the group of employers, it lasts 8 weeks. 5-year follow-up reveals a recurrence rate of 1.3% after primary hernia and 3.1% after recurrent hernia. With the Shouldice repair the modern goals of hernia surgery are feasible. Therefore, a primary tension-free repair is not a "conditio sine qua non".

Anesthesia, Local↗
PubMed1996

Small intestinal myoelectrical activity and bacterial flora after Roux-en-Y reconstruction.

Small bowel myoelectrical activity and intestinal microflora were examined after partial gastrectomy and Roux-en-Y reconstruction in six dogs. Bacteriological analysis revealed a predominance of faecal bacteria. The basal electrical rhythm of the Roux limb was significantly decreased, while the frequency of phase III was increased (P < 0.05). In the bypassed duodenum, activity fronts occurred in only 25 per cent of experiments. Food intake led to an increase in the mean(s.e.m.) motility index in the Roux limb (from 46.1(9.4) to 75.0(21.5), P < 0.05), but not in the bypassed intestine (from 27.0(3.6) to 27.8(4.1), P not significant). Stimulation of the hypomotile bypassed intestine with cisapride induced an increase in the motility index from 27.0(3.6) to 111.2(16.5) (P < 0.001).

Anastomosis, Roux-en-Y↗
PubMed1996

[Minimal invasive surgery--impact on conventional surgery].

The impact of minimal invasive surgery on conventional surgery is diverse. The fields it involves include: (1) pathophysiology of surgical trauma; (2) instrumental technique; (3) medical-industrial interaction; (4) laparoscopic diagnostic procedures; (5) intraoperative endoscopy; (6) patients' comfort; (7) quality control; (8) changing hierarchy; (9) loss of surgical dogmas and (10) globalization.

Diffusion of Innovation↗
PubMed1996

[Synergistic effects of intracavitary and endoluminal endoscopic surgery].

The extended application of laparoscopic techniques led to complications related to the procedure (resection of wrong segments, non-curative resections, perforation, anastomotic stenosis/leakage). Main aetiology is the missing tactile sense. The combined action of laparoscopy and intraoperative endoluminal endoscopy is here an alternative. Intraoperative endoscopy is useful at the upper GI tract during total vagotomy, SPV, Taylor procedure, myotomy, fundoplication, perforated ulcer and BI/BII resections. During colorectal procedures, intraoperative endoscopy provides localisation of the tumor, determination of margins for resection, identification of anatomy (i.e. Hartmann stump) as well as inspection of the anastomoses. A consequent combination of intraabdominal and endoluminal endoscopy is helpful in prevention of the observed complications due to laparoscopic surgery.

Endoscopes↗
PubMed1995

Intraabdominal humidity and electromyographic activity of the gastrointestinal tract. Laparoscopy versus laparotomy.

The purpose of this study was to observe electromyographic activity of stomach, small bowel, and colon during and early after identical laparoscopic and conventional operations to compare the operative trauma. In nine dogs a cholecystectomy was performed laparoscopically (n = 5) or by laparotomy (n = 4). Analysis of electromyographic activity focused on rhythm, frequency, and amplitudes of slow waves. Furthermore, oxygenation of blood and tissue, intestinal impedance, intraabdominal humidity, and temperature were documented to investigate their influence on slow waves. Open cholecystectomy caused an evident decrease of frequency and amplitude of colonic slow waves in comparison to laparoscopic cholecystectomy. Arrhythmic slow waves were observed only in the stomach during conventional cholecystectomy. Stomach and small intestine showed no significant difference of frequency and amplitude of slow waves in both operation groups. Intraabdominal humidity and intestinal impedance differed significantly in laparoscopy and laparotomy. Laparoscopic cholecystectomy proceeded with a minor abdominal trauma documented by smaller alterations of slow waves. This may be caused by reduced peritoneal desiccation.

Animals↗