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Biomedical subjects

J Heimbucher

Publications and source records attributed to J Heimbucher.

34 records · Page 2Linked to original sources
PubMed1995

A tailored approach to antireflux surgery.

Tailored surgical antireflux procedures were done in 104 patients during a 7-year period. Presenting symptoms included heartburn in 95 patients (91%), regurgitation in 83 patients (80%), and dysphagia in 61 patients (60%). Evaluation before operation included video barium esophagography, endoscopy, 24-hour esophageal pH monitoring, and esophageal motility studies. On the basis of anatomic and functional findings, the following procedures were performed: 15 laparoscopic and 49 open transabdominal Nissen fundoplications, 23 transthoracic Nissen fundoplications, seven Belsey partial fundoplications, and 10 Collis gastroplasty and Belsey partial fundoplications. The severity of symptoms was assessed before and after operation according to a previously published grading score. Eighty-five of the 104 patients (82%) were able to be contacted for a follow-up evaluation by means of a standardized questionnaire. Median length of follow-up was 4 years, with 40 patients having follow-up beyond 5 years. The tailored operation cured the symptoms of heartburn in 97%, regurgitation in 91%, and dysphagia in 92%. Ninety-eight percent of the patients reported that operation had cured their preoperative symptoms and 93% were satisfied with the outcome of the operation. To obtain optimal results, surgical treatment of gastroesophageal reflux disease should be tailored to the patient's anatomic and functional assessments. For early, uncomplicated disease a transabdominal Nissen fundoplication is done, laparoscopically when expertise exists. Patients with complicated disease should undergo an open antireflux procedure tailored to specific anatomic or functional abnormalities.

Adolescent↗
PubMed1995

Teaching upper gastrointestinal endoscopy: the pig stomach.

An easily applicable teaching and training technique for flexible endoscopy in the upper gastrointestinal tract is presented. Using a fresh, flushed-out pig stomach with adherent esophagus and duodenum, the trainee endoscopist can practice all the essential endoscopic diagnostic and interventional techniques. The teaching model proposed requires little preparation, represents a cheap and easy technique with widespread applicability, offers a high degree of learning efficiency, and is appropriate for specialized teaching courses.

Animals↗
PubMed1995

Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication.

BACKGROUND: Although recent reports have documented the safety and efficacy of laparoscopic fundoplication, none have compared outcomes to that of open Nissen fundoplication. STUDY DESIGN: Eighty-one patients had either open (n = 47) or laparoscopic (n = 34) Nissen fundoplication. Relief of symptoms was measured by a standardized questionnaire and scored by a modified Visick-Index. Physiologic outcome was assessed by postoperative pH monitoring and manometry in a subset of both groups. RESULTS: Primary symptoms were heartburn in 55 percent of the patients, regurgitation in 9 percent, dysphagia in 11 percent, and atypical in 25 percent of patients. Twenty-seven (84 percent) of 32 patients in the laparoscopic group and 31 (84 percent) of 37 patients in the open group were cured or improved. Operative time was significantly longer in the laparoscopic group (218 compared to 168 minutes). The period of hospitalization was shorter for the laparoscopic group (4.7 compared to 9.2 days, p < 0.0001). Postoperative pressures in the lower esophageal sphincter (LES) were significantly higher in the laparoscopic group (20.9 compared to 12.1, p = 0.006). Augmentation of sphincter length was similar for both groups. More patients in the laparoscopic group failed to relax their LES completely after fundoplication (32 compared to 71 percent, p = 0.1). CONCLUSIONS: Symptomatic outcome after laparoscopic fundoplication is similar to that of open surgery. Physiologic studies reveal a greater augmentation of LES pressure and a low prevalence of sphincter relaxation after laparoscopic fundoplication.

Adolescent↗
PubMed1994

Selection of patients for curative or palliative resection of esophageal cancer based on preoperative endoscopic ultrasonography.

OBJECTIVE: To assess the accuracy of pretreatment staging and the potential of using endosonographic findings to select patients for curative or palliative resection by comparing the preoperative endosonographic and computed tomographic (CT) findings with the histology of the surgical specimen. METHODS: Forty-two patients referred to our clinic with esophageal carcinoma underwent preoperative upper endoscopy with biopsy, endosonography, thoracic CT, and abdominal CT. Based on endoscopic ultrasonographic findings, patients with early-stage disease underwent en-bloc esophagogastrectomy, whereas those with advanced disease had a palliative transhiatal esophagectomy. Exceptions included patients with poor physiologic reserve who were treated by the transhiatal route. RESULTS: In eight patients, we were unable to pass the ultrasonographic endoscope. Seven of these eight had transmural tumors with nodal involvement on histologic study. Tumor length, based on endosonographic measurements, was correctly predicted in 34 patients (85%). Extent of wall penetration was accurately predicted in 26 (76%) of the 34, and regional lymph node status was accurately predicted in 28 (82%) of the 34. Of the patients with sonographic wall penetration, 80% had histologic evidence of one or more positive nodes. Using the WNM staging system, endoscopic ultrasonography correctly staged the cancer in 68% of the patients. Three patients were treated with an inappropriate procedure. CONCLUSION: Endosonography is a reliable method for the preoperative staging and selection of patients for curative or palliative resection. Endosonographic wall penetration appears to be a critical factor in determining tumor spread.

Adult↗
PubMed1994

Laparoscopic adhesiolysis.

The aim of this study was the detection of criteria that support the indication for laparoscopic adhesiolysis in patients presenting with unspecific symptoms. A prospective analysis investigates the value of laparoscopic adhesiolysis in patients with chronic abdominal pain after exclusion of other pathologic findings; 58 consecutive patients were followed after laparoscopic adhesiolysis. Endpoints of investigation were extent of adhesions, complications, postoperative hospitalization, and postoperative quality of life. A comparison was drawn to patients following laparoscopic cholecystectomy, laparoscopic cholecystectomy plus adhesiolysis, and conventional cholecystectomy. The results showed that major complications occurred in 10% of cases. In 45% of patients we found a complete remission, in 35% a substantial improvement, and in 20% a persistence of complaints. In a correlation between the preoperative complaints and the extent of adhesions we found small adhesions to cause recurrent abdominal pain without other symptoms while large adhesions produce recurrent abdominal pain in combination with symptoms indicative of intermittent bowel obstruction. Finally, the results of this study indicate a certain "ideal constellation" for an enduring successful adhesiolysis per laparoscopy: it is the subjective complaint of recurrent abdominal pain with a localized and reproducible punctum maximum in combination with a circumscribed area of adhesions at that site.

Abdominal Pain↗
PubMed1994

Motility in the Hunt-Lawrence pouch after total gastrectomy.

PURPOSE: The aim of this study was to evaluate motility patterns of the Hunt-Lawrence pouch and the jejunal limb of patients reconstructed with a pouch after total gastrectomy, and to compare the findings in symptomatic patients to those without symptoms after the operation. PATIENTS AND METHODS: Thirty-three patients who had undergone post-gastrectomy pouch reconstruction were studied using a water-perfused motility system. In 21, the pouch was connected by a Roux-en-Y, and, in 12, by a jejunal interposition. Twenty-eight patients were asymptomatic, including 17 connected by a Roux-en-Y and 11 by a jejunal interposition. Five patients were by a jejunal interposition. Five patients were symptomatic, including 4 connected by Roux-en-Y Y and 1 by jejunal interposition. A control group consisted of 5 healthy volunteers who had not undergone operation. RESULTS: The motility phases in the pouch and jejunal limb of asymptomatic patients were of shorter duration than those of controls, and they followed a random sequence instead of a normal progression from phase I to II to III. Motility features were similar in the pouch and the jejunal limb. Orthograde propagation of phase III-like activity was reduced and may contribute to the pouch storage function. Four of the 5 symptomatic patients showed highly abnormal motility with hypomotile or obstructive patterns. The technique of connecting the pouch--jejunal interposition of Roux-en-Y--did not affect the motility findings. CONCLUSIONS: The altered motility occurs after a Hunt-Lawrence pouch reconstruction in asymptomatic patients. Symptoms after gastrectomy are associated with further disturbed motility that can be differentiated from the motility changes in asymptomatic patients.

Adult↗
PubMed1994

Laparoscopic Posterior Truncal Vagotomy and Anterior Seromyotomy.

For patients with peptic ulcer disease who only require acid reduction, laparoscopic procedures such as posterior truncal vagotomy and anterior seromyotomy can be offered. Elective surgery after a complete physiological workup can improve the results for a certain group of patients. The experiences with the Taylor procedure in open surgery promise the interest of gastroenterologists to include elective surgery among the therapeutic options. As experienced with other procedures, a minimally invasive approach will increase patients' acceptance of surgical treatment.

Journal Article↗
PubMed1994

[Laparoscopic interventions in previously operated patients].

This prospective study investigates the technical feasibility and the potential advantage of laparoscopic operative techniques in patients following previous surgery. Data were obtained from a group of patients following previous surgery who underwent laparoscopic cholecystectomy, explorative laparoscopy, laparoscopic adhesiolysis, or laparoscopic procedures on the intestinal tract; all of these patients presented intraabdominal adhesions leading to a change of the originally intended operative procedure. 240 patients who underwent laparoscopic cholecystectomy without previous surgery or with previous surgery but without relevant adhesions represented the control group. Endpoints of investigation were duration of operation, post-operative hospitalization, intra- and postoperative complications, and postoperative quality of life. A total of 370 patients was followed after laparoscopic procedures. With an equal distribution of complications in both groups a higher percentage of calculated and emergency conversions was found in the group of patients following previous surgery; these conversions did not lead to a larger ratio of complications. The patients' postoperative quality of life, recorded by means of a complaint score, was equal in both groups. These results show that "previous abdominal surgery" does not represent a contraindication for laparoscopic surgery and that patients following previous surgery will profit from laparoscopic operations to the same extent as already proven for patients undergoing laparoscopic procedures without previous surgery.

Abdomen↗
PubMed1994

Laparoscopic posterior vagotomy and anterior seromyotomy.

Laparoscopic truncal vagotomy with anterior seromyotomy, as described by Taylor, is our operation of choice in open surgery for elective treatment of chronic duodenal ulcer because it is a rapid, reliable and efficacious procedure. This procedure also does not have the variability of highly selective vagotomy in relation to the surgeon who is performing the operation. The technique is standardised and the results on 90 patients showed minimal morbidity and no mortality with a recurrence rate of 4.2% after a follow-up of 2-41 months. These results are very similar to those obtained in open surgery and compare favorably with the recurrence results after medical treatment. The procedure is therefore effective and safe and should be included in the armamentarium of treatment of chronic duodenal ulcer resistant to a thorough medical treatment.

Adult↗
PubMed1993

[Experiences with laparoscopic technique in anti-reflux surgery].

The introduction of the laparoscopic techniques in antireflux surgery has created hopes for an improvement in the patients' outcome. Initial experience with minimally invasive procedures show that the application in antireflux surgery is possible without major problems. However, the functional result of antireflux surgery rather depends more on a differentiated indication for operation and an operative procedure designed to remove or compensate the underlying pathophysiologic functional defect. The method of access is of lesser priority. The promising results of this series may encourage to continue the demonstrated protocol and operative technique. However, generalized application of laparoscopic antireflux surgery should not be performed until further data of its advantages are available.

Adult↗
PubMed1992

[Laparoscopic cholecystectomy--what is the value of laparoscopic technique in "difficult" cases?].

This prospective study with an external control group of patients investigates the technical aspects of laparoscopic cholecystectomy in patients with difficult intraabdominal situations as well as the postoperative quality of life of these persons. Difficult concomitant circumstances were defined when those patients had multiple adhesions after previous abdominal surgery in the middle and upper quadrants, acute cholecystitis, and severe obesity. 100 patients after classic cholecystectomy represented the external control group. 170 patients were followed after laparoscopic cholecystectomy. Endpoints of investigation were duration of operation, complications, postoperative hospitalization, and postoperative quality of life. Major complications occurred in 1.2%. Although in patients after laparoscopy minor complications were registered at a higher incidence than in classic cholecystectomy, the patients' postoperative quality of life improved significantly faster after laparoscopy in all patients groups. These results show that even patients with severe adhesions, with acute cholecystitis and with prolonged duration of operation still profit from the laparoscopic technique in comparison to laparotomy.

Adolescent↗
PubMed1981

[Subcutaneous Dirofilaria (Nochtiella) repens infection in man--report of the first case in Austria and review of the literature (author's transl)].

A 39-year-old female patient developed migratory skin nodules 4 months after a vacation in Greece. The patient observed a total of 17 nodules moving over the trunk to the left thigh, where a subcutaneous lesion was excised, yielding a parasite measuring 0.5 mm X 7 cm. It was classified as Dirofilaria (Nochtiella) repens. Since this is the first case observed in Austria, an exact description of subcutaneous dirofilariasis, its geographical distribution and a review of the literature is presented.

Adult↗
PubMedDate not supplied

Quality of life following laparoscopic gastric banding in patients with morbid obesity.

In a prospective study of 188 patients with morbid obesity, the time-dependent changes in the quality of life of individual patients were analyzed following laparoscopic gastric banding (LGB). These 188 patients (148 females and 40 males; age 19 to 59 years; body mass index 33 to 72 kg/m(2)) underwent evaluation of the LGB according to a strict protocol that included psychological testing using standardized instruments, detailed medical evaluation, upper gastrointestinal function studies, and evaluation of quality of life using the Gastrointestinal Quality of Life Index (GIQLI). Following this evaluation, 73 patients (57 females and 16 males; age 37 years [range 19 to 59 years]; body mass index 48 kg/m(2) [range 37 to 72 kg/m(2)]) underwent LGB and were followed up for 2 years focusing on weight loss, postoperative morbidity, weight-related comorbidity, and quality of life. The results demonstrate that LGB is well able to allow for a significant loss of excess weight and a significant improvement in patients' quality of life, both after a rather short period of time after surgery and at a continuous rate throughout the follow-up. The price for this success that was found in approximately 90% of patients is a complication rate of 38%; 85% of these patients, almost one third of all patients, must undergo some type of revision surgery. However, once the complications are resolved, these patients achieve the same level of weight loss and improvement in quality of life as patients with an uncomplicated postoperative course.

Adult↗
PubMedDate not supplied

Variability in the composition of physiologic duodenogastric reflux.

Duodenogastric reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, duodenogastric reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of duodenogastric reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of duodenogastric reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic duodenogastric reflux. A total of 70 episodes of duodenogastric reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile reflux occurred separately from pancreatic enzyme reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile reflux (P <0.01). Duodenogastric reflux is a physiologic event with varying composition. Both bile and pancreatic enzyme reflux frequently occur separately. These findings could explain the disagreement regarding assessment and interpretation of duodenogastric reflux in the past. Thus monitoring of duodenogastric reflux requires more than the detection of just one component.

Adult↗
PubMedDate not supplied

The role of 24-hr gastric pH-monitoring in the interpretation of 24-hr gastric bile monitoring for duodenogastric reflux.

BACKGROUND/AIMS: Duodenogastric reflux is a physiologic phenomenon. For a number of years, alkalinization of the acidic intragastric pH environment, as assessed by 24-hour gastric pH-monitoring, was thought to be caused by duodenogastric reflux. The recent introduction of the fotooptic Bilitec system for intraluminal bilirubin measurement has created the possibility to directly quantify a component of duodenal juice. METHODOLOGY: In this study, 24-hour gastric pH-monitoring and 24-hour bilirubin monitoring were performed in healthy subjects. The upper limits for physiologic bile reflux are the percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). RESULTS: Comparing bile with pH-monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (43%) or an increase of pH with constant bilirubin (37%). CONCLUSIONS: The hypothesis was drawn that the composition of duodenogastric refluxate can vary. Bile and pancreatic juice may separately contribute to duodenogastric reflux.

Bile↗