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Biomedical subjects

J Waninger

Publications and source records attributed to J Waninger.

At least 19 recordsLinked to original sources
PubMed2001

[Acute cholecystitis. Do you send the patient to the operating room or to bed?].

Acute cholecystitis is increasingly becoming a disease of the elderly. The condition begins with colic-like pain in the upper abdomen radiating to the right shoulder, and is accompanied by fever, nausea and vomiting. The diagnosis is confirmed by tenderness and palpable resistance in the right upper abdomen. Ultrasound detects the stone in 95% of cases, and confirms the diagnosis. Differential diagnostic considerations include appendicitis, duodenal or gastric ulcer, and myocardial infarction. Early cholecystectomy is associated with a low complication rate which, however, increases, the longer the intervention is delayed. Laparoscopic cholecystectomy has a lower complication rate and a reduced hospital stay; the reported mortality rate is between 0% and 3.5%. Conventional cholecystectomy is recommended when there is concomitant choledocholithiasis and no possibility of carrying out ERCP, and in patients with previous upper abdominal surgery. Conservative treatment is applied when the patient refuses surgery or is at high risk from anaesthesia.

Acute Disease↗
PubMed2000

[A retaining dam against reflux. Laparoscopic fundoplication helps even in stubborn cases].

The introduction of proton pump inhibitors (PPI) and laparoscopic fundoplication in the treatment of gastroesophageal reflux disease offered an opportunity for definitive healing. The indication for surgery is the failure of medical treatment, recurrence of symptoms following conservative treatment, severe side effects of the medication, and the patient's wish to stop taking drugs. The laparoscopic treatment has a low rate of complications. Apart from temporary dysphagia (30%), rapid satiety, increased flatulence and suppressed eructation are possible undesirable sequelae. Intra-operative bleeding and organ perforation (1%) are major feared occurrences. The rate of conversion to open surgery is 5.8%, and the mortality rate is 0.1%. Persistent dysphagia in 3.4% may be caused by a slipped cuff. A revision procedure is necessary in 0.7% of the patients. Patient satisfaction with the results of the operation ranges between 87 and 100%.

Esophagitis, Peptic↗
PubMed1997

[Inguinal hernia--which method leads to the goal? Endoscopic and open surgical procedures are available].

In recent years, the methods available for repair of inguinal hernia have greatly expanding, resulting in confusion as to what constitutes a suitable choice. Is it to be laparoscopy or open surgery, plastic mesh yes or no, general anesthesia or local anesthesia? Bassini's operation has now been ousted by the Shouldice procedure, which is suitable for all primary forms of hernia. The Lichtenstein procedure is readily and rapidly carried out under local anesthesia, making it suitable for use in multimorbid and old patients; the recurrence rate is low. The laparoscopic approach can be recommended for patients who, for private or occupational reasons need to be up and about again as soon as possible. It is also particularly suitable for the treatment of recurrent hernias or for the simultaneous repair of bilateral hernias. Disadvantages are the high costs, a lack of long-term results and unusual complications that are not seen in open surgery.

Endoscopy↗
PubMed1997

[Cost data of standard surgical interventions].

Personnel and nonpersonnel costs of seven surgical standard procedures were calculated related to the patient. Nonpersonnel costs were up to 57% below to the figures of the Ministry of Health. Personnel costs ranged from 3.2% to 30% less. The result of a patient related calculation will lead to more efficiency by changing a faulty organisation, the management of the personnel, the indication for surgical procedures and the surgical technique.

Cost-Benefit Analysis↗
PubMed1996

Effects of the Pringle maneuver on hemodynamics during laparoscopic liver resection in the pig.

The Pringle maneuver (PM) is recognized in conventional liver surgery as a method of controlling bleeding. To determine the hemodynamic effects of the PM during pneumoperitoneum (PP) for laparoscopic liver resection, we measure hemodynamic and blood gas changes in 7 healthy pigs. All variables were recorded 5 min before and 10 and 30 min after employing PP or PM and 10 min after discontinuation of PM. After the induction of PP, cardiac index and arterial carbon dioxide tension significantly increased, accompanied by a significant decrease in pH. After the beginning of PM, cardiac index and mean arterial and central venous pressures decreased significantly, whereas the heart rate rose markedly. After discontinuation of the PM, the systemic vascular resistance index decreased, and the heart rate remained elevated. These results demonstrate severe hemodynamic deterioration with PP and a subsequent PM. The latter should, therefore, be considered only as a last resort for the control of bleeding during laparoscopic liver surgery.

Animals↗
PubMed1996

Comparison of laparoscopic handsewn suture techniques for experimental small-bowel anastomoses.

Laparoscopic techniques have only rarely been applied to procedures on the small bowel. A comparison of three handsewn intracorporeal anastomoses was carried out. Thirty pigs were divided into three groups, and a different technique was used in each group (SK, single knot; RS, running suture; CL, clip suture). Half of the animals had a relaparoscopy on day 4. The duration of the procedure was recorded, and the quality of anastomotic healing was assessed by morphological, radiological, mechanical, and biochemical examinations. The animals were sacrificed on postoperative day 14. The anastomoses in the SK group took significantly longer than in the RS or CL groups. The mean duration of relaparoscopy was 28 min. Bursting pressure values and hydroxyproline concentrations were without any significant difference. The SK and CL groups showed a good alignment of the layers and the RS showed necrosis and overlying mucosa. Most complications were noted in RS. The results demonstrate that manual small-bowel anastomoses can be performed laparoscopically. Single-knot and clip sutures are reliable techniques. The ongoing development of new instruments and the three-dimensional technique will basically improve the construction of intracorporeal anastomoses.

Anastomosis, Surgical↗
PubMed1994

[Laparoscopic techniques in therapy of choledocholithiasis].

Several methods for therapy of common bile duct stones (CBDS) during laparoscopic cholecystectomy are available. After intraoperative cholangiography laparoscopic removal of CBDS can be achieved via the cystic duct or a choledochotomy using a thin cholangioscope, balloon catheters and Dormia baskets. Lithotripsy (electrohydraulic or laser) is necessary in presence of larger stones. Also combined procedures with intraoperative antegrade or retrograde papillotomy have been described. Published studies show that laparoscopic common bile duct exploration can be performed successfully by experienced surgeons. However, these procedures are demanding and time-consuming. Further evaluation is essential.

Cholangiography↗
PubMed1994

[The value of CEA immunoscintigraphy for diagnosis of colorectal cancer and its metastases: results of a prospective study].

The importance of the CEA-immunoscintigraphy (IS; BW 431/26 Fa Behring) for the diagnosis of colorectal carcinoma and its metastases was determined in a prospective trial including 60 patients. The results were compared with results of the ultrasound, the CT-Scan and the Angio-CT. Patients suffered from a colorectal carcinoma (15), from a local tumor recurrence after bowel resection (10), from hepatic (39) and/or extrahepatic metastases (16). In 40 patients the diagnosis was confirmed by laparotomy. Regarding the detection of hepatic metastases the sensitivity and specificity of the Angio-CT were superior to the IS (0.86 and 0.63 vs. 0.78 and 0.45). Ultrasound and Angio-CT together revealed true positive results in 89.2%. The IS did not improve this rate. Regarding the detection of extrahepatic metastases the sensitivity and the specificity of the CT were slightly superior to the IS (0.59 and 0.87 vs. 0.47 and 0.28). However, the IS increased the rate of true positive results by 18.8% (US + CT 43.7%; +IS 62.5% true positive results). Due to these results the IS is not recommended as the method of choice to detect liver metastases. But in patients unfit for diagnostic laparotomy the IS may give additional information of the extrahepatic tumor stage.

Adult↗
PubMed1994

[Duplex ultrasound studies after organ saving intervention in traumatic splenic rupture].

The increased risk of overwhelming postsplenectomy sepsis (OPSI) led to the development of organ preserving procedures. However, little is known about the long-term results of organ preserving. A reduced blood flow has been suspected. In the period from 1982 till 1990 144 patients were operated on for a ruptured spleen. Thirty patients had organ preserving procedures. These failed to stop the bleeding in eight patients. Two patients died. Nineteen patients (group A) out of twenty were reexamined clinically, by ultrasound and by Duplex sonography. They were compared with matched test persons. Three patients in group A complained of recurrent minor infections. Changes in the shape and the location of the spleen were a common sonographic finding. The diameter of the hilus was 3.8 +/- 0.5 cm and the blood flow was 221 +/- 75 ml/min in group A. There was no difference to group B with 3.8 +/- 0.6 cm and 224 +/- 76 ml/min, respectively. The hemodynamic preconditions necessary for a functioning spleen could be preserved in all patients.

Adolescent↗
PubMed1993

[Abdominal surgery in advanced age. Indications and prognosis exemplified by stomach, bile duct, colon and hernia surgery].

The increased risk of morbidity and mortality associated with abdominal surgery in the aged is determined by the number and severity of accompanying diseases and the emergency situation. Age per se is not a risk factor. Limitation of the risk requires an age-oriented treatment plan, which must take account of the specific problems of the geriatric patient in the pre-, intra-, and postoperative phases. Emergency operations should be avoided as far as possible. The aim of geriatric surgery is not merely to prolong life, but also to secure adequate quality of life. To accomplish this, it may occasionally be necessary to forgo surgical radicality in favor of a palliative procedure. The results of abdominal surgery in the elderly are presented on the basis of exemplary cases of stomach, biliary, colonic and hernial surgery.

Abdomen↗
PubMed1993

[Microbiological and economic studies of abbreviated procedures for surgical hand disinfection].

An investigation was performed of whether shortened procedures for surgical hand disinfection (2 and 3 min, respectively) are equally effective as the usual German standard procedure of 5 min duration and, in addition, which saving of working time and costs would be achievable if shorter procedures were employed. The shortened procedures were: 1) 3 min alcoholic disinfectant (1 min prior handwashing) and 2) 1 min chlorhexidine detergent (Hibiscrub), 2 min 0.5% chlorhexidine in 70% isopropanol (Hibisol). The two shortened procedures were equally effective as the standard procedure (test of equivalence, p < 0.05). The savings of working time and costs calculated for 17708 operations were 1) 2360 h or 79768 German marks and 2) 3540 h or 119652 German marks, respectively.

Bacteria↗
PubMed1993

[Sequelae of cholecystectomy--a prospective study].

In a prospective study designed to assess the situation following cholecystectomy carried out at the Department of Surgery of the University of Freiburg, 105 patients were examined between August, 1988 and December, 1989. Out of 80 patients who were followed up, 64 had undergone cholecystectomy alone and the remaining 16 had been additionally subjected to exploration of the common bile duct. 80% of the patients reported that their preoperative symptoms had disappeared altogether, 8% admitted some improvement and 10% complained that their condition was unchanged. Specific questioning resulted in the reporting of persistent symptoms in 54%, and these consisted mostly of general complaints such as dyspepsia, flatulence, food intolerance and dull upper abdominal pain. These complaints were vanished or appeared with equal frequency following operation. Objective clinical findings could not be confirmed. Comparison between the pre- and postoperative signs in these patients established a statistically significant correlation (p < 0.05) between the patient's age and the severity of the preoperative symptoms on the one hand and a satisfactory postoperative outcome on the other. This also applied to patients for whom an examination of the bile duct was necessary.

Adult↗
PubMed1992

[Ambulatory follow-up care in laparoscopic cholecystectomy].

UNLABELLED: FUNDAMENTAL CONSIDERATIONS: With increasing frequency, laparoscopic procedures are now replacing conventional cholecystectomy. Given the choice, patients with cholecystolithiasis almost always opt for the former procedure. MAJOR POINTS: Because the laparoscopic procedure offers considerable advantages as compared with open surgery, the increased risk of local complications associated with it tends to be ignored. For example, injuries to the biliary ducts are about ten times as common as in the case of conventional cholecystectomy. Injuries to the bowel, previously unknown, are increasingly being observed. Symptoms associated with undetected injuries usually do not occur until the patient has been discharged. CONCLUSIONS: Ambulatory aftercare is particularly important following laparoscopic cholecystectomy. Complications need to be detected in good time in order to be able to institute appropriate counter-measures.

Ambulatory Care↗