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Biomedical subjects

J F Lange

Publications and source records attributed to J F Lange.

At least 19 recordsLinked to original sources
PubMed2000

Successful laparoscopic removal of a migrated Angelchik prosthesis.

Implantation of an Angelchik prosthesis has been considered a quick and safe procedure for the surgical treatment of gastroesophageal reflux disease. Since its introduction in 1979 more than 25,000 have been inserted worldwide. However, the use of this device has been largely abandoned because of frequent complications and high costs. One of the more serious complications is migration of the prosthesis, which usually requires open correction. We recently operated on a 49-year-old man with a migrated Angelchik prosthesis. The device, placed 17 years earlier, had now migrated to the free abdominal cavity causing recurrent urinary tract infections and fecal incontinence. The prosthesis was removed laparoscopically via three ports in a simple procedure without any blood loss. Recovery was uneventful. At this writing, complaints have resolved, and reflux is being controlled medically. This case supports the suggestion that Angelchik prosthesis-related problems may be solved laparoscopically, even if the device was inserted via an open procedure.

Adult↗
PubMed2000

Is it necessary to lift the abdominal wall when preparing a pneumoperitoneum? A randomized study.

BACKGROUND: In order to create a pneumoperitoneum with the Veress needle, it is generally advocated that the abdominal wall should be lifted. Lifting is aimed at increasing the distance between the abdominal wall and the intraabdominal structures. This study was conducted to compare lifting (L) and nonlifting (NL) of the abdominal wall. METHODS: All patients scheduled for laparoscopic surgery without previous abdominal surgery or morbid obesity were included in the study group. The number of attempts needed for proper positioning of the needle was assessed. RESULTS: A total of 150 patients were randomized. There were no complications. The number of attempts needed for correct positioning of the Veress needle was significantly higher in the L group than in the NL group (31 of 75 vs nine of 75, p < 0.001). The body mass index (BMI) of patients in whom peritoneal entry needed more than one puncture was significantly higher than the BMI of patients with immediate proper placement (28.3 vs 24.7 kg/m(2), p < 0.05). CONCLUSION: Abdominal wall lifting is not necessary.

Abdominal Muscles↗
PubMed2000

The gastrocolic trunk of Henle in pancreatic surgery: an anatomo-clinical study.

From 37 peroperative and cadaver anatomical investigations, it was concluded that, in contrast to the information in common texts on anatomy and surgery, a venous gastrocolic trunk was observed in only 46% of subjects; a true bipod gastrocolic trunk of Henle was a rare (8%) phenomenon. In this respect, a variate venous anatomy at the inferior border of the neck of the pancreas, as observed in this study, must be taken into account during pancreatic surgery and radiological procedures in the pancreas.

Humans↗
PubMed2000

Cutaneous nephrocolonic fistula as a consequence of a kidney stone.

We report an unusual case of cutaneous nephrocolonic fistula caused by a renal calculus with perirenal infection. The diagnosis was made by fistulography and computed tomography, after which nephrectomy and resection of the descending colon were successful. We also review the literature on cutaneous nephrocolonic fistulas.

Aged↗
PubMed1997

[Abdominal wall metastasis following surgical removal of colorectal carcinomas].

Abdominal wall metastases after laparoscopic resection of colorectal cancer have been reported by various authors. It appeared that abdominal wall metastases occur more frequently after laparoscopic than after conventional, open resection of colorectal cancer. However, the frequency of abdominal wall metastases after laparoscopic surgery varies from only 0 to 1.9% in centres with sufficient relevant experience, whereas after conventional resections the frequency is 0.8-3.3%. A randomized clinical study comparing laparoscopic with conventional resection of colon cancer is necessary to assess the optimal surgical approach to colon cancer. Such a trial has been set up.

Abdominal Muscles↗
PubMed1997

[The 'Colon cancer laparoscopic or open resection' (COLOR) trial].

The value of laparoscopic surgery for colorectal malignancy as compared with open surgery will be determined in the COLOR-trial. The disease-free survival time is the primary end point. Twenty-one hospitals in the Netherlands and Scandinavia will participate in the trial. In the COLOR trial 1500 patients with colon carcinoma will be randomised for either a laparoscopic or open colon resection.

Colonic Neoplasms↗
PubMed1997

[Endoscopic retroperitoneal adrenalectomy: a surgical improvement].

OBJECTIVE: Evaluation of endoscopic retroperitoneal adrenalectomy in patients with adrenal tumours less than 6 cm in diameter. DESIGN: Retrospective analysis. SETTING: University Hospital Rotterdam-Dijkzigt, Department of General Surgery, Rotterdam, the Netherlands. METHOD: Analysis of per- and postoperative data on 19 patients subjected to endoscopic retroperitoneal adrenalectomy; 3 patients had bilateral surgery. RESULTS: Twenty adrenal tumours in 17 patients were successfully removed endoscopically. Conversion to lumbotomy was necessary in the two other cases. Median operative time was 85 min (range: 50-120). Median blood loss was 50 ml (10-400). Median postoperative hospital stay was 4 days (2-14). CONCLUSION: Endoscopic retroperitoneal adrenalectomy is associated with minimal morbidity and therefore valuable in patients with adrenal tumours smaller than 6 cm in diameter.

Adrenal Gland Neoplasms↗
PubMed1997

Laparoscopic vs open appendectomy. A randomized clinical trial.

BACKGROUND: A randomized clinical trial was performed to compare open appendectomy (OA) and laparoscopic appendectomy (LA). METHODS: 201 patients with similar characteristics of appendicitis were randomized to either OA or LA. Operative time and technique, reintroduction of diet, postoperative pain, use of analgesia, hospital stay, and complications were documented. RESULTS: 104 patients were allocated to the OA group and 97 to the LA group. Postoperative pain was significantly less in the LA group on the 1st (p < 0.001) and 2nd (p < 0.001) postoperative day, resulting in less use of analgesics on both days (p < 0.001). Restoration of diet was similar in both groups. Mean operative time was longer in the LA group: 61 vs 41 min (p < 0.001). Postoperative complications did not differ in either group, except for wound infections (six OA group vs zero LA group, p < 0.05). Mean hospital stay was similar in both groups. CONCLUSIONS: LA results in less postoperative pain and fewer wound infections. The laparoscopic procedure is technically more demanding to perform, resulting in longer operative time.

Acute Disease↗
PubMed1997

Differential prognosis of gram-negative versus gram-positive infected and sterile pancreatic necrosis: results of a randomized trial in patients with severe acute pancreatitis treated with adjuvant selective decontamination.

Results of a previous randomized multicenter trial involving 102 patients with severe acute pancreatitis treated with or without adjuvant selective decontamination (SD) were analyzed additionally with regard to the bacteriologic status of (peri)pancreatic necrosis. The incidence of gram-negative pancreatic infection was significantly reduced in patients treated with SD (P = .004). Once such an infection develops, mortality increases 15-fold (P < .001) in comparison with that for patients with sterile necrosis. Among patients in whom only gram-positive infection of pancreatic necrosis was found, there was no significant increase in mortality. These results were similar in both treatment groups. In addition, the hospital stay was significantly longer in cases of gram-negative infected necrosis. The incidence of gram-positive infected necrosis in patients treated with SD did not increase. Gram-negative pancreatic infection can be prevented with adjuvant SD, thereby reducing mortality among patients with severe acute pancreatitis.

Acute Disease↗
PubMed1997

Open versus closed establishment of pneumoperitoneum in laparoscopic surgery.

BACKGROUND: Closed laparoscopy, employing a Veress needle and blind insertion of the first trocar, is favoured by most laparoscopic surgeons. The potential danger of this technique is the occurrence of visceral or vascular injury. Establishment of pneumoperitoneum by an open technique using a blunt-tipped trocar may be a safer alternative. METHODS AND RESULTS: Retrospective review of the literature and the authors' experience was used to compare closed and open laparoscopy. Data on closed laparoscopy in 489335 patients and on open laparoscopy in 12444 patients were culled. Rates of visceral and vascular injury were respectively 0.083 and 0.075 per cent after closed laparoscopy, and 0.048 per cent and zero after open laparoscopy. Mortality rates after closed and open laparoscopy were respectively 0.003 per cent and zero. Pearson chi 2 analysis demonstrated a statistically significant difference in terms of visceral and vascular injury between closed and open laparoscopy (P = 0.002); there was no such difference for mortality rates. CONCLUSION: Open establishment of pneumoperitoneum is advocated in laparoscopic surgery because it is safer than the closed method.

Humans↗
PubMed1997

Comparison of three techniques for adrenalectomy.

BACKGROUND: Conventional open adrenal surgery requires relatively large incisions and is associated with postoperative wound pain, intercostal neuralgia and pulmonary complications. Introduction of laparoscopic techniques has enabled development of minimally invasive adrenalectomy. METHODS: A case-control study of nine open, nine transperitoneal laparoscopic and 12 retroperitoneal endoscopic adrenalectomies was done in patients who were matched for Quetelet index, adrenal disorder and size of adrenal lesion; all tumours were less than 6 cm in diameter. RESULTS: Conversion to open adrenalectomy was necessary in two patients having transperitoneal laparoscopic adrenalectomy and in one having retroperitoneal endoscopic adrenalectomy. Operative time was longest in transperitoneal laparoscopic adrenalectomy (P = 0.004 and P = 0.005 versus open and retroperitoneal endoscopic adrenalectomy respectively). Blood loss was least in retroperitoneal endoscopic adrenalectomy (P = 0.01 versus both other groups). End-tidal carbon dioxide increase was greater in transperitoneal laparoscopic and retroperitoneal endoscopic than in open adrenalectomy (P = 0.014 and P = 0.01 respectively). After retroperitoneal endoscopic adrenalectomy, use of analgesia was least (P = 0.0003 versus other groups). Postoperative hospital stay was shortest after retroperitoneal endoscopic adrenalectomy (P = 0.024 and P = 0.027 versus open and transperitoneal laparoscopic procedures respectively). CONCLUSION: Retroperitoneal endoscopic adrenalectomy was optimal in patients with small adrenal tumours.

Adrenal Gland Neoplasms↗
PubMed1995

Inferior brachial plexus injury during thoracoscopic sympathectomy.

A case of inferior brachial plexus injury during thoracoscopic sympathectomy is presented. As this complication occurred during the first operation of the kind in our department in 1991, it is believed that it can be prevented now by supervision of thoracoscopic sympathectomy by experienced surgeons.

Adult↗
PubMed1995

Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.

OBJECTIVE: A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA: Secondary pancreatic infection is the major cause of death in patients with acute necrotizing pancreatitis. Controlled clinical trials to study the effect of selective decontamination in such patients are not available. METHODS: Between April 22, 1990 and April 19, 1993, 102 patients with severe acute pancreatitis were admitted to 16 participating hospitals. Patients were entered into the study if severe acute pancreatitis was indicated, on admission, by multiple laboratory criteria (Imrie score > or = 3) and/or computed tomography criteria (Balthazar grade D or E). Patients were randomly assigned to receive standard treatment (control group) or standard treatment plus selective decontamination (norfloxacin, colistin, amphotericin; selective decontamination group). All patients received full supportive treatment, and surveillance cultures were taken in both groups. RESULTS: Fifty patients were assigned to the selective decontamination group and 52 were assigned to the control group. There were 18 deaths in the control group (35%), compared with 11 deaths (22%) in the selective decontamination group (adjusted for Imrie score and Balthazar grade: p = 0.048). This difference was mainly caused by a reduction of late mortality (> 2 weeks) due to significant reduction of gram-negative pancreatic infection (p = 0.003). The average number of laparotomies per patient was reduced in patients treated with selective decontamination (p < 0.05). Failure of selective decontamination to prevent secondary gram-negative pancreatic infection with subsequent death was seen in only three patients (6%) and transient gram-negative pancreatic infection was seen in one (2%). In both groups of patients, all gram-negative aerobic pancreatic infection was preceded by colonization of the digestive tract by the same bacteria. CONCLUSION: Reduction of gram-negative colonization of the digestive tract, preventing subsequent pancreatic infection by means of selective decontamination, significantly reduces morbidity and mortality in patients with severe acute necrotizing pancreatitis.

Acute Disease↗