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H Scheuerlein

Publications and source records attributed to H Scheuerlein.

14 recordsLinked to original sources
PubMed2003

Totally extraperitoneal repair of recurrent inguinal hernia.

BACKGROUND: A variety of procedures with substantial differences in results are employed to treat recurrent inguinal hernia. The advantages of totally extraperitoneal patch repair (TEP) are even more evident when it is applied to recurrent compared to primary hernias. To investigate the superiority of this method more closely, we reviewed our results obtained for recurrent inguinal hernias over a period of 2 years. METHODS: We performed a prospective single-center study using data obtained in consecutive patients with recurrent inguinal hernia who were operated on in 1997 and 1998. RESULTS: A total of 179 patients with recurrent inguinal hernia were recruited. Overall, 1329 patients with inguinal hernia were treated in the 2-year period, of whom 1270 underwent TEP. The percentage of recurrent hernias was 14%. The average age of the patients was 56 years. The follow-up rate was 87.5%, and the mean follow-up period was 2.3 years. The 154 patients who were followed up underwent a total of 225 hernia repairs, of which 181 were for recurrent hernias. The average operating time was 57 min. In 68% (104/154) of the patients, adhesions, adherent epigastric vessels, or cicatricial changes were found, which resulted in the inadvertant opening of the peritoneum in 26.3% of the patients. All the openings in the peritoneum were closed by endoscopic suturing. Intraoperative complications developed in 4 patients (2.3%), including one injury to the bladder and three cases of bleeding from side branches of the epigastric vessels. The conversion rate was 0%. The sole postoperative complication was treatment requiring hematomas in 7 patients, in 2 of whom reoperation became necessary. In both cases, a diffuse hemorrhage due to a preoperatively undiagnosed coagulation disorder was found. No cases of wound or patch infection were observed. In a patient undergoing both primary and recurrent hernia repair, displacement of a mesh led to a recurrence on the primary hernia side (recurrence rate, 0.4%; re-recurrence rate, 0%). CONCLUSIONS: Although for its definitive management, recurrent hernia requires a reliable operative technique, current data do not support the recommendation of any of the currently available procedures as the gold standard. In a representative patient population with recurrent hernia, we were able to demonstrate that TEP achieves very good results in terms of re-recurrence rate, intraoperative and postoperative complications, and rehabilitation. Prerequisites for the reliable and low-complication application of the method are a high level of standardization of the procedure and an advanced learning curve.

Adolescent↗
PubMed2003

Oncological quality and preliminary long-term results in laparoscopic colorectal surgery.

BACKGROUND: Our aim here was interpret data on the perioperative course, oncological quality, and preliminary long-term results of laparoscopic colorectal surgery carried out with a curative intent. METHODS: The data were collected within the framework of a prospective multicenter observational study that has been ongoing since 1 Aug 1995 and includes 46 hospitals. Of a total of 3133 patients, 826 (26.4%) underwent a curative resection for colorectal carcinoma. RESULTS: The average age of the patients was 67.9 years; the sex distribution was almost 1:1. UICC staging of tumors (stages I, II, and III) showed the following figures: 301/36.4%, 265/32.1%, and 260/31.5%. In the majority of cases, an oncologically radical resection with high transection of the supplying vessels was performed. Intraoperative seeding of tumor cells was reported in 1.8% of the patients. In eight cases, the seeding was due to spontaneous rupture of the tumor. A mean of 13.5 lymph nodes in the resected specimen were investigated histopathologically (10.9 lymph nodes in stage I, 15 each in stages II and III). Depending on the individual hospital, we found a remarkable variation in the number of lymph nodes investigated. With a mean follow-up period of 2.1 years, Kaplan-Meier survival function showed acceptable results, both for rectal and colonic carcinoma, in comparison with conventional colorectal surgery. A stage-related consideration of the survival data yielded similar results. CONCLUSION: All in all, the results show that a laparoscopic colorectal procedure can meet oncological radicality criteria, even though certain reservations-in particular, in the case of procedures done with a curative intent-have not been completely eliminated.

Aged↗
PubMed2000

Effects of partial and total colectomy on mineral and acid-base homoeostasis in the rat: magnesium deficiency, hyperphosphaturia and osteopathy, in the presence of high serum 1,25-dihydroxyvitamin D but normal parathyroid hormone.

The effects of colectomy on acid-base status, extra-osseous and bone minerals, calciotropic hormones and bone morphology have not yet been studied. To rectify this, groups of normally fed male rats were subjected to distal (n=11), proximal (n=12) or total (n=12) colectomy. Sham-operated rats (n=12) served as controls. At 112 (+/-2) days after colectomy the following changes were noted: (1) weight gain was delayed; (2) faecal excretion of calcium and phosphorus was normal, whereas that of magnesium was increased; (3) intestinal calcium secretion and absorption of calcium and phosphorus were normal, but magnesium absorption was decreased; (4) urinary excretion of magnesium was also decreased, that of phosphorus was increased, and that of pyridinium and deoxypyridinium tended to be high; (5) the serum levels of ionized magnesium, total calcium, 25-hydroxyvitamin D and parathyroid hormone were normal, while that of 1,25-dihydroxyvitamin D was markedly elevated; and (6) bone magnesium and phosphorus content were decreased, but bone calcium was normal, and thus the bone calcium/phosphorus ratio was high. These abnormalities were associated with moderate metabolic acidosis, as reflected by high urinary ammonium, low citrate and low total CO(2), but normal blood gases. Significant structural abnormalities of bone were not detectable, but trabecular bone tended to show rarefication. Distal colectomy had the least effect, whereas proximal and total colectomies had a distinct effect, on these parameters. It is concluded that colectomy in the rat causes: (1) a syndrome of magnesium deficiency of intestinal origin, compensated metabolic acidosis, urinary phosphorus loss, and high circulating 1,25-dihydroxyvitamin D levels, with the degree depending on the extent of surgical resection; and (2) brittle bones, a feature characteristic of low bone magnesium and more generalized magnesium deficiency. The mechanisms leading to this syndrome are unknown, but altered tissue levels of magnesium and phosphorus may play a key role.

Acid-Base Equilibrium↗
PubMed2000

[Anatomy of the liver].

Over the past decades, great progress has been made in surgery on the liver. Technical achievements and the strict application of anatomical knowledge to surgical practice have added a new dimension to the field of liver surgery. In some cases, new facts about the anatomy of the liver needed considerable time before being implemented. Surgery of liver metastases, primary tumours of the liver and not least liver transplantation have focussed the interest of visceral surgeons more and more on this organ. Segment-orientated liver anatomy, a knowledge and consideration of vascular structures, and the observance of anatomical landmarks are the prerequisites for successful surgery on the liver.

Bile Ducts, Intrahepatic↗
PubMed2000

[Prospective multicenter study of laparoscopic colorectal surgery. Quality assurance during introduction of new methods].

During the course of development of laparoscopic surgery, the first successful procedures involving the colorectum were reported already in 1991 and 1992. This having demonstrated the principal feasibility of such operations, a study was initiated in German speaking countries in 1995, with the aim of investigating the efficacy and quality of laparoscopic surgery and involving the collection of all the interventions on the colorectum carried out in the departments participating. In an initial step, and when the first 500 patients had been treated, an indication spectrum was identified, which differed from the typical spectra of open colorectal surgery in showing a clear preponderance of benign diseases. In terms of the intra-operative and post-operative complications developing after laparoscopic procedures, however, no differences were to be seen vis-a-vis open surgery. In 167 of the first 500 recorded patients, an intervention for carcinoma was done in curative intent. On the basis of a detailed analysis, no trend towards a restriction of the scope of the procedures was to be seen in the laparoscopically treated patients. Furthermore, the number of dissected lymph nodes, the number of injuries to the tumor and the distal margins of clearance in the case of rectal resections were comparable with those seen in studies on open surgery. In the next step of the analysis, now based on larger numbers of patients, an evaluation of the sigmoid diverticulitis subgroup was carried out. A distinct selection of the uncomplicated forms of diverticulitis was found, the rate of intra-operative and post-operative complications remained satisfactory and comparable with the figures known for open procedures. The anastomosis was created almost exclusively either transanal with the stapler, or handsewn after exteriorization. In comparison with open surgery, the rate of anastomotic insufficiencies in the laparoscopic study was no higher than seen in open surgery. The last remaining, an as yet unanswered question is that of the long-term oncological results. Only in a few years time, when a mean follow-up period of more than 5 years has been achieved and the unselected data of all patients are available will it be possible to make a statement on the local recurrence rate as a sign of surgical quality, and on disease-free survival and 5-year survival rates. Only then we will be able to make a definitive assessment of the place of laparoscopic surgical in oncological interventions done in curative intent in a comparison with a historical group of open surgical patients. Until then, all laparoscopic procedures on the colorectum carried out in curative intent should be limited to prospective studies.

Colorectal Neoplasms↗
PubMed2000

[Prospective multicenter comparative study of the management of peritonitis. Quality assurance in severe intra-abdominal infection].

Despite all the efforts made in the areas of intensive care and surgery, severe peritonitis remains a feared condition that is associated with a high mortality rate. Severe abdominal infections are accompanied by a high level of endotoxin production, resulting in the so-called systemic inflammatory response syndrome (SIRS), which is often complicated by multiple organ failure. In addition to the surgical elimination of the source of the infection, the removal of the endotoxin is of prime importance. The aim of surgical treatment of peritonitis is, in the first instance, the elimination of the bacterial contamination and prevention or reduction--if possible--of fibrin formation. Attempts to block the cascade of mediators by pharmacological means have so far proved ineffective. For more than 10 years, therefor, various forms of abdominal lavage have been of vital importance in reducing bacterial contamination and aiding the healing process after successful surgical elimination of the focus of infection. A watertight temporary closure for the abdominal wall (TAC) was developed, which makes possible the continuous irrigation of the abdominal cavity. At the same time, it also gives the oedematous abdominal organs room to expand without the constraints otherwise imposed by the abdominal wall. This concept has extended the spectrum of surgical options, and we believe that, as a result, a reduction in the mortality rate associated with severe peritonitis with sepsis (MPI > 26) can be achieved. To investigate this hypothesis, a multi-centre study is presently being conducted. In a prospective parallel-group study, patients are randomized to either programmed etappenlavage with the Ethizip or to open dorsoventral interval therapy using the TAC. The patients are stratified on the basis of APACHE II and MPI, and the post-operative course is documented in a standardized manner. As secondary objectives, the study also aims to clarify the question as to whether the new therapeutic concept is also capable of reducing the number of revisions necessary, the duration of intensive care treatment, and the lenght of hospitalization, as also of abbreviating antibiotic treatment. Since it is being done under controlled conditions, and a uniform documentation is being used, the study represents a major contribution to quality control in the field of surgical treatment of peritonitis.

APACHE↗
PubMed1999

Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group.

BACKGROUND: In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or the results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic resection of the sigmoid colon for diverticulitis in various stages of severity. RESULTS: Between January 8, 1995 and January 1, 1998, the Laparoscopic Colorectal Surgery Study Group recruited 1,118 patients to the prospective multicenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In most of these patients undergoing laparoscopic surgery (81.9%), the diverticulitis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinchey stages I to IV and late complications of chronic diverticular disease with fistula formation and bleeding accounted for only 18.1% of the cases. For the overall group, the conversion rate was 7.2%. Patients with less severe diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and the rate for complicated cases was 18.2%. Regarding laparoscopically completed interventions, 3 of 282 patients died (1.1%). In the group of patients with peridiverticulitis, stenosis, or recurrent attacks of inflammation the overall complication rate was 14.8%. The group with perforated diverticulitis in Hinchey stages I to IV or those with fistula and bleeding, the corresponding rate was 28.9%, and after conversion it was 31.8%. CONCLUSIONS: Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.

Diverticulitis, Colonic↗
PubMed1999

Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG).

BACKGROUND: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open colorectal surgery. METHODS: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics, surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were rendered anonymous. RESULTS: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%), and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%, and the 30-day mortality rate was 1.57%. CONCLUSIONS: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.

Adult↗
PubMed1998

[Surgical therapy of liver metastases in breast carcinoma].

The literature contains little information on the surgical treatment of metastases from carcinoma of the breast. Advanced stages of mammary cancer with generalised metastatic spread are considered to be the therapeutic domain of systemic chemotherapy. Patients with isolated liver metastases may, under certain circumstances, be considered candidates for partial resection of the liver. Another therapeutic option in this group of patients is intraarterial chemotherapy via a port catheter system implanted in the hepatic artery. A number of institutions employ a combination of both treatment modalities. Overall 5-year survival rates are low for both the regional and the systemic form of treatment. A carefully selected group of patients may be expected to benefit from partial resection of the liver, intraarterial chemotherapy or a combination of the two by having their survival time prolonged--provided that due consideration is given to all contraindications, and there are no extrahepatic manifestations. Wherever possible, resections should be carried out in curative intent. However, palliative resection may be justified in individual cases where alleviation of symptoms and an improvement in the patient's quality of life is to be expected. The present paper discusses the results achieved in 21 women who underwent liver resection at the surgical department of the University of Erlangen between 1980 and 1997, and compares these results with those reported in the literature. The average age of the patients was 54 years, and 9 had a solitary metastasis. As was to be expected, the R classification had a decisive influence on survival. The 2-year survival rate was 60% for R0 resections as compared with 16.7% for R1 or R2 resections.

Adult↗
PubMed1998

[Laparoscopic splenectomy].

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail.

Humans↗
PubMed1998

[Surgical therapy of choledocholithiasis].

Following the introduction of endoscopic papillotomy and stone extraction, surgical bile duct revision has decreased considerably in importance during the past two decades. Surgical bile duct revision is associated with an appreciably higher rate of complications than endoscopic stone extraction. The result has been that most working groups now favour a "therapeutic splitting" approach. This means that, wherever possible, endoscopic revision of the bile duct is first attempted. If, during laparoscopic cholecystectomy, intraoperative cholangiography reveals the presence of bile duct stones, they may, after consultation with the endoscopist, be left in place for removal by endoscopic papillotomy at some later date. Only in the case of very young patients and exceptionally, a highly experienced laparoscopic surgeon may attempt a transcystic extraction of such stones. Continuing indications for conventional surgical treatment of choledocholithiasis are local factors obstructing access to the papilla (gastrectomy, stenosis of the pylorus) and other bile duct changes requiring correction (choledochocele, strictures, stenoses, Mirizzi's syndrome, over-looked impacted stone obstructing an over-long cystic duct stump, intrahepatic lithiasis).

Adult↗
PubMed1998

[Thoracoscopic resection of epiphrenic esophageal diverticula by an intracavitary/endoluminal combined intervention].

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.

Dilatation↗
PubMed1997

[Laparoscopic fenestration of non-parasitic liver cysts].

Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.

Cysts↗