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H G Rau

Publications and source records attributed to H G Rau.

At least 37 records · Page 2Linked to original sources
PubMed1998

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. A 1-year follow-up study.

BACKGROUND: Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. METHODS: Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n = 14) to determine the short- and long-term results of the procedure. RESULTS: Mean operation time was 123.4 +/- 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 +/- 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 +/- 47.3 g. Mean postoperative hospital stay was 4.6 +/- 0. 4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). CONCLUSIONS: Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.

Adolescent↗
PubMed1998

Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases (Arbeitsgruppe Lebermetastasen)

OBJECTIVE: To determine the impact of adjuvant hepatic arterial infusion (HAI) on survival relative to resection alone in patients with radical resection of colorectal liver metastases. SUMMARY BACKGROUND DATA: Nearly 40% to 50% of all patients with colorectal carcinoma develop liver metastases. Curative resection results in a 5-year survival rate of 25% to 30%. Intrahepatic recurrence occurs after a median of 9 to 12 months in up to 60% of patients. The authors hypothesized that adjuvant intraarterial infusion of 5-fluorouracil (5-FU) might decrease the rate of intrahepatic recurrence and improve survival in patients with radical resection of colorectal liver metastases. METHODS: Between April 5, 1991, and December 31, 1996, patients with colorectal liver metastases from 26 hospitals were stratified by the number of metastases and the site of the primary tumor and randomized to resection of the liver metastases followed by adjuvant HAI of 5-FU (1000 mg/m2 per day for 5 days as a continuous 24-hour infusion) plus folinic acid (200 mg/m2 per day for 5 days as a short infusion), or liver resection only. RESULTS: The first planned intention-to-treat interim analysis after inclusion of 226 patients and 91 events (deaths) showed a median survival of 34.5 months for patients with adjuvant therapy versus 40.8 months for control patients. The median time to progression was 14.2 months for the chemotherapy group versus 13.7 months for the control group. Grade 3 and 4 toxicities (World Health Organization), mainly stomatitis (57.6%) and nausea (55.4%), occurred in 25.6% of cycles and 62.9% of patients. CONCLUSION: According to this planned interim analysis, adjuvant HAI, when used in this dose and schedule in patients with resection of colorectal liver metastases, reduced the risk of death at best by 15%, but at worst the risk of death was doubled. Thus, the chance of detecting an expected 50% improvement in survival by the use of HAI was only 5%. Patient accrual was therefore terminated.

Adult↗
PubMed1998

[The Janeway laparoscopic gastrostomy in palliative surgery].

For the creation of a gastrostomy percutaneous endoscopic technique should be the method of first choice. If impossible a laparoscopic procedure should be preferred to a conventional one. Laparoscopic Janeway-gastrostomy might have some advantages compared to Kader-Stamm-Fistulas. We present the results with this method which we have used since 1993 in 12 patients. The postoperative course of these patients with mainly malignant diseases of ENT (n = 4), esophagus (n = 3) and thyroid gland (n = 3) as well as two non-malignant underlying diseases is presented and discussed in the light of recent publications. The Janeway-gastrostomy is an effective, easily feasable and safe procedure that ensures a good palliation also due to easy handling and care.

Aged↗
PubMed1998

[Operation or intervention in advanced gallbladder carcinoma?].

In a retrospective study of patients with locally advanced or metastatic gallbladder cancer, we tried to define patient groups, that profit either from extended resection, palliative surgery or intervention. 102 out of 160 operative treated patients (73.8%) had UICC-tumor stages III and IV. Depending on the T-stage, resection rates were 31% for T3-stage and 12.5% for T4-stage tumors. Corresponding median survival times were 20.2 and 18.1 month, respectively. Patients with T3/T4-tumor stages, where only palliative surgery was possible, had median survival times of 2.5 to 4.5 month. So, only radical tumor resection can result in better survival times and should be performed even in elderly patients in good condition. Palliative surgery does not improve survival and, moreover, often not life quality.

Adult↗
PubMed1997

Preoperative risk assessment of hepatic resection for malignant disease.

Clinical, laboratory, functional, and volumetric data of 340 consecutive patients undergoing hepatic resection for malignant disease between November 1990 and June 1995 were analyzed. The operative mortality was 3.3% (8/244 patients). Among 178 patients with liver metastases and 66 with primary hepatobiliary tumors the hospital mortality was 4.1% (10/244 patients) and morbidity 22.0% (54/244 patients). Survival after hepatectomy was strongly influenced by the extent of resection quantified by the parenchymal hepatic resection rate. The prediction of fatal postoperative complications can be improved for patients with hepatic metastases by calculating the liver resection index (sensitivity 75%, specificity 83%).

Adult↗
PubMed1997

The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial.

OBJECTIVE: A prospective, randomized, double-blind, placebo controlled multicenter trial was undertaken in 205 patients treated with total gastrectomy for gastric malignancies to evaluate whether local antimicrobial measures reduce the incidence of esophagojejunal anastomotic leakage. SUMMARY BACKGROUND DATA: Anastomotic leakage of the esophagojejunostomy is always a septic complication of total gastrectomy for gastric malignancies, but it never has been attempted to prevent this complication with the administration of topical antimicrobial agents during the critical phase of anastomotic wound healing. METHODS: To evaluate the efficacy and safety of topical decontamination, the study was carried out as a prospective, randomized, double-blind and placebo-controlled clinical multicenter trial in patients with total gastrectomy for gastric cancer. Patients received either placebo or decontamination with polymyxin B (100 mg), tobramycin (80 mg), vancomycin (125 mg), and amphotericin B (500 mg) four times per day orally from the day before the operation until the seventh postoperative day. All patients received a perioperative intravenous prophylaxis with cefotaxime 2 x 2 g. Other interventions including the administration of antibiotics and fluids, were not affected by the study protocol. RESULTS: Of 260 patients who were randomized, total gastrectomy was not carried out in 55 patients. They dropped out of the study. Patients receiving an esophagojejunostomy were observed until day 42, when they were discharged from the clinic or died. An intention-to-treat analysis of the data was carried out. Among the 103 recipients of placebo, there were 11 (10.6%) with an anastomotic leakage of the esophagojejunostomy, and among the 102 recipients of decontamination, there were 3 (2.9%) with an anastomotic leakage of the esophagojejunostomy (p = 0.0492). Pulmonary infections were observed in 23 patients (22.3%) receiving placebo and in 9 patients (8.8%) who were decontaminated (p = 0.02). There were 11 deaths (10.6%) among the recipients of placebo and 5 deaths (4.9%) among the recipients of decontamination (p = 0.1). CONCLUSIONS: Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy.

Aged↗
PubMed1996

Subclavian carotid transposition: an analysis of a clinical series and a review of the literature.

OBJECTIVE: To analyse the clinical results and long-term patency rates of 108 patients with subclavian carotid transposition (SCT) and compare the outcomes to other clinical series using the same technique, as well as to those reported for other surgical procedures and PTA in the treatment of proximal subclavian artery disease. METHODS: The hospital records of 108 patients with carotid subclavian transposition were retrospectively reviewed for preoperative symptoms, Doppler examination, arteriography, blood pressure differentials and postoperative complications. Long-term patency and symptoms were determined during a follow-up examination including a history, physical examination, blood pressure differentials, Doppler examinations and arteriography in selected cases. RESULTS: The indication for SCT were subclavian steal (78%), upper extremity ischaemia (59%), rest pain or acral necrosis (5%), vertigo (6%). There was no mortality, blood pressure differentials were equalised in all patients without any early reocclusions. The complication rate was 15% with a permanent morbidity of 3%. Eighty-four patients (77%) could be re-examined during follow-up. For them the overall patency after a mean observation period of 70 months (1-144 months) was 100%. CONCLUSIONS: Subclavian carotid transposition is an excellent method for the treatment of proximal subclavian occlusive disease because of its exceptional long-term patency and low morbidity.

Anastomosis, Surgical↗
PubMed1996

[Liver resection with the water jet: conventional and laparoscopic surgery].

In a prospective study 60 patients underwent liver resection. Two different resection techniques, ultrasonic aspirator (CUSA, n = 30) and Jet-Cutter (n = 30), were compared, Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of the area of transsected liver. Liver resection with the Jet-Cutter was significantly faster with a resection time of 0.35 min/cm2 in comparison to the CUSA (0.77 min/cm2, p < 0.001) and associated with less blood loss of 18.4 ml/cm2 (p < 0.05) than the CUSA technique (34.4 ml/cm2). Tissue damage in respect to levels of transaminases SGOT and SGPT was comparable with both techniques. The Jet-Cutter is a promising new instrument in liver surgery, and challenged by these results we used the Jet-Cutter in 7 patients performing laparoscopic liver resections.

Adult↗
PubMed1995

Laparoscopic liver resection with the water-jet dissector.

Laparoscopic liver resection requires careful patient selection. Tumor size and location have a major influence on the feasibility of a laparoscopic operation. Isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques are important for visual control of the operating field. Since the Jet-Cutter has proven to give excellent clinical results in conventional liver surgery, we carried out laparoscopic liver resections with the Jet-Cutter in six patients. Five tumors were located in the left liver lobe; the fifth was in segment 6. There were no intra- or postoperative complications. The patients were discharged from the hospital after a mean of 5.4 +/- 2.1 days.

Adult↗
PubMed1995

A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter.

In a prospective study 116 patients underwent liver resection. Three different resection techniques, blunt dissection (n = 61), ultrasonic aspirator (CUSA) (n = 27) and jet-cutter (n = 28) were compared. Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of area of transected liver surface. Liver resection with the jet-cutter was significantly faster with a resection time of 0.33 min/cm2 in comparison to blunt dissection (0.57 min/cm2) and CUSA (0.50 min/cm2) (P < 0.01) and associated with lower blood loss of 17.7 ml/cm2 (P < 0.01) than the other techniques (blunt dissection 32.5 ml/cm2, CUSA 24.3 ml/cm2). Tissue damage with respect to transaminases SGOT and SGPT was comparable to the other techniques. The jet-cutter is a promising new instrument in liver surgery.

Adult↗
PubMed1994

Laparoscopic repair of a Morgagni hernia.

Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.

Adult↗
PubMed1994

Bacteria: a major pathogenic factor for anastomotic insufficiency.

The aim of this study was to determine the influence of bacteria on the development of anastomotic insufficiency following gastrectomy in the rat. Fifty-seven male Wistar rats were randomly assigned to three groups and subjected to gastrectomy. Group I (n = 20) was orally inoculated with 10(9) Pseudomonas aeroginosa organisms on postoperative day 1. Group II (n = 20) served as the control group. Group III (n = 17) was decontaminated with 320 mg of tobramycin, 400 mg of polymyxin B, and 500 mg of vancomycin per liter of fluid administered from preoperative day 7 to postoperative day 10. Swabs from the oropharynx and rectum were cultured and analyzed daily for gram-positive and gram-negative bacteria. Surviving animals were sacrificed on postoperative day 10. All animals were autopsied immediately following death. Anastomotic insufficiency was defined as a histologically proven transmural defect at the suture line. Along with an effective reduction of pathogenic bacteria colonizing the oropharynx, the rate of anastomotic insufficiency could be reduced significantly, to 6% in decontaminated animals compared with 80% in controls (P < 0.001 by Fisher's exact test). Inoculation of group I animals with P. aeruginosa led to an increase of anastomotic insufficiency up to 95% and a significant increase in mortality (P < 0.05). We conclude that bacteria play a major role in the pathogenesis of anastomotic insufficiency following gastrectomy in the rat.

Anastomosis, Surgical↗
PubMed1994

[Conventional or laparoscopic cholecystectomy in treatment of acute cholecystitis?].

Elective laparoscopic cholecystectomy has become established as the procedure of choice for the treatment of symptomatic cholecystolithiasis while the application of this method for acute cholecystitis has been propagated with restrainment. In a prospective study 114 conventional (right subcostal incision) and 102 laparoscopic cholecystectomies for this indication were compared. The overall complication rate amounted 10.7% for conventional cholecystectomy and 8.9% for laparoscopic cholecystectomy. The rate of conversion was 9.2%. Due to the fact that intraoperative cholangiography was carried out in 60% of conventional cholecystectomies and in only one of laparoscopic procedures the arithmetic advantage of minimally invasive technique with respect to blood loss and operating time does not allow final conclusions. These patients however recovered clearly faster and could be discharged after an average of 5.2 +/- 4.2 postoperative days, while the hospitalisation after conventional operations amounted to 7.6 +/- 3.8 days (p < 0.001).

Acute Disease↗
PubMed1994

[Leiomyosarcoma of the inferior vena cava--diagnosis and therapy].

We report four patients with primary vascular leiomyosarcoma of the inferior vena cava. Even after radical surgery the prognosis is serious because of local tumor recurrence and distant metastases. Although controlled studies are difficult because of the small number of patients, a multimodal therapeutic approach needs to be developed.

Adult↗
PubMed1994

[Laparoscopic single staple suture--initial clinical experiences].

Based on the results of our own animal experimental investigations, the first clinical employment of single titanium staples in the creation of suture lines on the gastrointestinal tract was carried out. These staple lines are most favorably adapted for laparoscopic use. First experiences with 10 staple lines, 6 of which were anastomoses, are reported. Neither insufficiencies nor stenoses were detected. Until now there are no long-term observations. The technique seems to allow open or laparoscopically the creation of standardized suture lines in any segment of the gastrointestinal tract.

Anastomosis, Surgical↗
PubMed1993

Laparoscopic stenting for protection of common bile duct sutures.

Laparoscopic common bile duct exploration is comparable with the open operation and it is usually finished with the insertion of external bile drainage such as a T-tube. We performed an antegrade placement of a biliary stent with primary suture of the common bile duct following common bile duct exploration. We thereby avoided the acquisition of the additional expensive equipment required for the transcystic approach and the placement of a T-tube, which in our eyes contradicts the idea of minimized discomfort in minimally invasive surgery.

Adult↗