Biomedical subjects
Publications and source records attributed to G Buess.
A new transanal endoscopic operative technique permits microsurgery in the rectal cavity and the placing of surgical sutures. Compared with other procedures this one is non-aggressive, and there were not postoperative complications in twelve cases. A stereoscopic optical system, a new operating rectoscope and special surgical instruments, as well as a modification to an insufflation device are necessary for the endoscopic operation.
Cervical location of esophageal carcinoma is generally accepted as a contra-indication for palliative intubation. Seven patients with a cervical neoplasm were treated by placement of a tube. Four patients tolerated the tube well, 2 patients complained of a persistent sensation of pressure and had their tube removed. The 4 successfully treated patients were able to swallow normal food. We are of the opinion that cervical esophageal cancer does not represent an absolute contra-indication for palliative intubation.
A special surface coil was developed with the intention of producing optimal resolution and signal-to-noise ratio for the examination of the knee joint by MRI. Eight volunteers and 25 patients with various abnormalities of the knee have been examined. Normal anatomical structures can be differentiated and there is high diagnostic reliability for lesions of the meniscus, as confirmed by arthroscopy and surgery. Cartilage lesions are less well demonstrated. Total rupture of cruciate ligaments is clearly shown, but partial rupture can often be recognised on the basis of indirect signs only. Good diagnostic results were obtained in cases of osteochondritis dissecans and chondropathia of the patella.
93 patients with advanced carcinoma of the esophagus or cardia were treated by positioning an endoprothesis under combined endoscopic and radiological control. Before this procedure the esophagus had been dilated - in 31 cases with our new multistage bougie. 14% of patients died in the hospital, 7,5% of these as a consequence of the procedure described. If no complications occur, the patients can be discharged from the hospital 24 hours later. Swallowing is improved definitely, mean survival time of our group was 10.9 weeks. Complications occurring later are mostly due to technical problems of the endoprothesis. Endoscopic positioning of the endoprothesis is a satisfactory palliative procedure. Positioning the endoprothesis by surgery to day is outdated.
26 patients suffering from nonresectable adeno-carcinoma of the rectum have been treated since Sept. 1980. The mean age was 72 years. The temperature of the probe tip was -160 degrees C. A closed system with liquid nitrogen was used. In 12 patients there was an indication of systemic inoperability, 13 had an irremovable tumour or metastases. 1 patient refused curative operation. Cryosurgery was aimed at reducing the mass of rectal tumours and preventing colostomy. Colostomy could also be avoided in 12 of 14 patients suffering from stenosing tumours. The advantages of cryotherapy are outpatient treatment, no anaesthesia and minimal complications. Generally, this method will yield good results in palliative treatment of inoperable rectal carcinomata.
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A new endoscopic surgical method was developed for removal of large sessile adenomas of the rectum and lower sigmoid. Stereoscopic sight and magnifying glasses do allow precise surgery of these tumors. If adenomas are present they can be removed using the technique of mucosa excision; if on the other hand rectum carcinomas have to be removed the complete wall of the rectum in an appropriate extension can be excised. Hemorrhages which occur during preparation always can be stopped by diathermy. The surgical intervention is terminated by a transverse continuous suture of the defect. 33 patients were operated upon in this way from July 1983 to April 1985. Areas with an diameter of up to 10 cm could be removed, even located up to 18 cm in the colon. Suturing of the defect could always be performed without problem. In 1 patient a relapse occurred.
In the intravascular sclerotherapy of oesophageal varices, the success of the procedure depends upon the precision and rapidity of injection of the sclerosant. With the aid of a high-pressure injector, which has been tested in a total of 174 sclerotherapeutic procedures, 10 ml of the sclerosant can be injected within 7 seconds, without any particular manual effort being required.
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New instruments for dilatation of the upper gastrointestinal tract are described: 1. A hollow plastic bougie with an inside diameter of approximately 10 mm to allow a 9 mm endoscope to pass. The diameter of this tube-like bougie increases in four steps up to 16 mm. 2. A second-similar bougie employs a flexible bronchoscope for guidance of the bougie. This system permits bougienage from 4 to 11.5 mm. The system permits stepwise bougienage of stenoses using only two instruments. For the first time complete endoscopic control of bougienage is possible.
ERCP was performed in 57 patients who had undergone Billroth II resection. Cannulation of the papilla of Vater was successfully accomplished in 31 cases (55%). The success rate of ERCP was clearly dependent on the type of Billroth II resection presenting.
A new technique for dilation of the upper gastrointestinal tract permits complete endoscopic control of the whole procedure for the first time. 113 dilations have been carried out in 37 patients within a period of 15 months. The endoscopic guidance of the multiple diameter bougie positively excludes perforation resulting from the bougie's going the wrong way. With the steerable tip of the endoscope, kinking can be overcome and stenoses down to the duodenum can be dilated.
Severe dysphagia is a rare complication of proximal gastric vagotomy. Two of our patients developed severe dysphagia up to complete obstruction. They got symptom-free after 4 or 5 bouginages. It is of greatest importance to avoid operating on those patients who show signs of post-vagotomy dysphagia unless repeated bouginage has been performed. On one patient we used a newly designed bougie which allows dilation by complete endoscopic control.
Surgery of the lower third of the rectum can be done without difficulty through the anus using an endoscopical approach. Polyps or tumors located in the upper two thirds of the rectum can be removed using the Mason or Kraske procedure, or by the transabdominal approach. A new endoscopic technique has been developed with the aim, to allow surgery in the whole rectum through the anus. The rectum is being dilated by mechanical means and air insufflation. An oblique angle stereoscopic endoscope as well as modified surgical instruments are used. In animals 47 excisions of mucosa were done, and the incisions were closed by continuous suture. Application of this technique in a clinical setting is planned.
The reported cases of Latex material dissolution after longterm placement of Celestin oesophageal tubes, and the ensuing complications are discussed. Also discussed is a case of ours with adenocarcinoma of the distal oesophagus in which dissolution of the Celestin tube was found 8 months after placement. What is needed is a stable substance to replace Latex. So far, no problems have been reported with the Latex-Silicone Haering tube.
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During the past 2 years we have treated 30 patients with an endotubus positioned by endoscopical and radiological control. In contrast to many other authors we have also used this method in proximal stenosing tumors. Our mortality rate lies at 16% with a mean post-operative survival time of 9 weeks. There were no deaths due to this procedure in patients (n = 18) with distally situated tumors. The hospital stay of patients treated using this method is much shorter than when surgery is employed, and the complication rate is much lower. If no problems are encountered, patients can be discharged after 2 days.