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Biomedical subjects

H Obertop

Publications and source records attributed to H Obertop.

At least 163 records · Page 9Linked to original sources
PubMed1995

Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute.

BACKGROUND: Delayed emptying of the gastric substitute is a common problem after resection and reconstruction of the esophagus. The occurrence of postoperative delayed gastric emptying in patients undergoing resection and reconstruction of the esophagus was studied with regard to the type and size of gastric substitute and the execution of a pyloroplasty. STUDY DESIGN: From 1983 to 1994, one hundred fifty-five patients underwent resection of the esophagus, with a hospital mortality rate of 7 percent. The inability to resume a diet of solid food within one week after a normal esophagography was defined as delayed gastric emptying. One hundred forty patients were studied; group 1, substitution with whole stomach with (1a, n = 9) and without (1b, n = 31) pyloroplasty; group 2, substitution with distal two-thirds stomach with (2a, n = 20) or without (2b, n = 45) pyloroplasty; and group 3, tubulized stomach without pyloroplasty (n = 35). RESULTS: Delayed gastric emptying was seen in 38 percent (15 of 40) of patients in group 1 (1a, 44 percent; 1b, 37 percent), in 14 percent (nine of 65) of patients in group 2 (1a, 10 percent; 2b, 15 percent), and in 3 percent (one of 35) of patients in group 3. The differences between patients in group 1 and group 2, and between patients in group 1 and group 3 were significantly different (p < 0.05). CONCLUSIONS: The type of gastric remnant used for reconstruction is an important determinant of postoperative gastric emptying. Pyloroplasty does not prevent delayed gastric emptying after esophageal substitution.

Esophagectomy↗
PubMed1995

End-to-side and end-to-end anastomoses give similar results in cervical oesophagogastrostomy.

OBJECTIVE: To find out if there were any differences in healing between end-to-end and end-to-side anastomoses for oesophagogastrostomy. DESIGN: Open study with historical controls. SETTING: University hospital, The Netherlands. SUBJECTS: 28 patients with end-to-end and 90 patients with end-to-side anastomoses after transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical anastomosis. MAIN OUTCOME MEASURES: Leak and stricture rates, and the number of dilatations needed to relieve dysphagia. RESULTS: There were no significant differences in leak rates (end-to-end 4/28, 14%, and end-to-side 13/90, 14%) or anastomotic strictures (end-to-end 9/28, 32%, and end-to-side 26/90, 29%). The median number of dilatations needed to relieve dysphagia was 7 (1-33) after end-to-end and 9 (1-113) after end-to-side oesophagogastrostomy. CONCLUSION: There were no differences between the two methods of suture of cervical oesophagogastrostomy when leakage, stricture, and number of dilatations were used as criteria of good healing.

Adult↗
PubMed1994

Impaired healing of cervical oesophagogastrostomies can be predicted by estimation of gastric serosal blood perfusion by laser Doppler flowmetry.

OBJECTIVE: To assess the value of relative blood perfusion of the gastric tube in prediction of impaired healing of cervical oesophagogastrostomies. DESIGN: Prospective study. SETTING: University hospital, The Netherlands. SUBJECTS: Thirty patients undergoing transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical oesophagogastrostomy. MAIN OUTCOME MEASURES: Operative measurement of gastric blood perfusion at four sites by laser Doppler flowmetry and perfusion of the same sites after construction of the gastric tube expressed as a percentage of preconstruction values. RESULTS: The relative perfusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, compared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage. CONCLUSION: Impaired anastomotic healing is unlikely if relative perfusion is 70% or more of preconstruction values. Perfusion of less than 70% partly predicts the occurrence of anastomotic stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.

Adult↗
PubMed1993

Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy.

Benign anastomotic stricture after transhiatal oesophagectomy and gastric tube reconstruction constitutes a major problem. From August 1988 to April 1991, 81 patients were followed after cervical oesophagogastrostomy. Twenty-four patients (30 per cent) developed a benign anastomotic stricture 3-23 (median 8) weeks after operation. Poor vascularization of the gastric tube, determined during operation, and postoperative anastomotic leakage were statistically significant risk factors for stricture formation. Symptoms related to stricture were often typical and were confirmed by endoscopy and/or radiography. Radiography did not yield information additional to that obtained from endoscopy. Strictures were treated in the outpatient clinic by dilatation with Savary dilators. Repeated dilatation completely alleviated dysphagia in 20 of the 24 patients (83 per cent). In ten patients dilatations could be discontinued after a median of 8 (range 1-17) sessions. Dilatation was continued until the end of follow-up in nine patients or until death from recurrent disease in five. No complications of dilatation were seen.

Adult↗
PubMed1993

Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease.

Teres cardiopexy was compared with Nissen fundoplication in a prospective randomized study of surgery for gastro-oesophageal reflux disease refractory to medical treatment. Follow-up at 3 months of ten patients undergoing each procedure showed good clinical results and improvement of the mean symptom score in both groups, for cardiopexy from 7.8 to 1.1 (P < 0.01) and for fundoplication from 5.7 to 0.2 (P < 0.01). After 1 year, six of the ten patients undergoing cardiopexy required a second antireflux procedure because of recurrent disease, whereas one reoperation was performed after fundoplication. The mean symptom score after 1 year was higher in patients submitted to cardiopexy than in those receiving fundoplication (3.9 versus 0.3, P < 0.01). The mean endoscopic oesophagitis score after 1 year was no different from preoperative values after cardiopexy (1.9 versus 1.9) but was significantly lower after fundoplication (1.5 versus 0.3, P = 0.01). Ambulatory 24-h pH monitoring showed a significantly higher proportion of total time at pH < 4 after cardiopexy than fundoplication (24.0 versus 3.8 per cent, P < 0.05). Cardiopexy is significantly less effective than fundoplication for the treatment of gastro-oesophageal reflux disease assessed at 1-year follow-up. This study does not support the use of cardiopexy either in conventional or laparoscopic antireflux surgery.

Adult↗
PubMed1993

Advantages of magnetic resonance imaging in breast surgery treatment planning.

Preoperative magnetic resonance imaging (MRI) was performed in 40 patients with malignant and benign breast tumors. Images were qualitatively evaluated to determine features of MRI that would benefit breast surgery treatment planning. MRI was found to be exceptional in demonstrating the relationship of tumors with respect to structures such as the chest wall, nipple, and skin. Tumor size was estimated by MRI, mammography, and gross pathological measurement in the 32 patients confirmed to have a malignant tumor of the breast. MRI estimated the tumor size to be larger than mammography in 71% of the cases and larger than pathological measurement in 84% of the cases. Compared with the standard method for determining tumor size (pathological measurement), MRI would have upstaged 22% of the evaluated cases from T1 to T2 and 10% of the cases from T2 to T3. MRI may prove useful in selecting patients for breast conserving therapy.

Adult↗
PubMed1992

[Value and risks of percutaneous cytological puncture in the preoperative assessment of pancreas tumors].

In a period of a little over two years 34 preoperative fine needle aspiration biopsies were performed in 32 patients with a possible malignant lesion of the pancreas. A cytological diagnosis of cancer was obtained in 22 patients. On follow-up 27 patients, in whom 28 biopsies were performed, proved to have a malignant tumour. The overall sensitivity of fine needle aspiration cytology in diagnosing a malignancy was 77.8%. There were no false positive results (specificity: 100%). Three patients developed serious biopsy-related complications. This relatively low sensitivity and the fact that a biopsy is not without risk leads to the advice not to perform preoperative fine needle aspiration biopsies as a routine in patients in whom curative or palliative surgery is indicated. Percutaneous biopsy is advised and can be useful if no indication for surgery is present because of the patient's condition or the extent of the disease and non-surgical palliation is the treatment of choice.

Adenocarcinoma↗
PubMed1992

Hepatic resections for colorectal metastases in The Netherlands. A multiinstitutional 10-year study.

BACKGROUND AND METHODS: The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively. RESULTS: The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial disease-free survival rate of 19%. The postoperative mortality rate was 7.6%. In the remaining group, the morbidity rate was 34.7%. A number of factors were examined that were reported to be of prospective significance in other studies. In the multivariate proportional hazard model of Cox, the number of metastases (P = 0.001) and the amount of perioperative blood loss (P = 0.002) were related significantly to disease-free survival. A factor that may be considered a contraindication to resection is the presence of extrahepatic disease (whether nodal or visceral), even if resectable. CONCLUSIONS: Although the actual benefit of resection is limited, and it is associated with considerable morbidity, surgical therapy offers some patients a chance for cure. It is a valid expectation that improvement in techniques and a proper understanding of hepatic anatomy will improve the safety and efficacy of hepatic resections in the future. Future research should focus on defining better selection criteria and on study of the value of adjuvant treatment modalities.

Adult↗