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K H Fuchs

Publications and source records attributed to K H Fuchs.

At least 19 recordsLinked to original sources
PubMed2004

Laparoscopic Nissen repair: indications, techniques and long-term benefits.

BACKGROUND: The Nissen fundoplication or total 360 degrees fundoplication is probably the most frequently used anti-reflux procedure throughout the world. With the advent of laparoscopic surgery the popularity among surgeons to perform a laparoscopic Nissen fundoplication has even increased. AIM: The purpose of this paper is to provide an overview of the experience of laparoscopic Nissen fundoplication over the past 15 years. METHOD: We performed an extensive review of the literature in order to ascertain the representative papers. In addition, available consensus papers, especially with regard to indication and technique, were assessed. Indication for a laparoscopic Nissen fundoplication should depend on documentation of the presence of disease as well as objective testing of the functional disorders and the complications. The technique of Nissen fundoplication is discussed controversially. Consensus exists with regard to floppiness of the wrap, necessary closure of the crurae and the use of a calibration method during the performance of the wrap. RESULTS: The laparoscopic technique creates a learning curve, which needs to be respected. Large prospective series in recent years have shown a complication rate between 5% and 10%, depending on the definition of the complication. In these last prospective series good and excellent results have been reported, of between 85% and 95%. Reflux recurrence is reported as between 1% and 8.5%, with a concomitant dysphagia rate of 0%-10%. CONCLUSIONS: The Nissen fundoplication is currently performed throughout the world, most frequently in a minimally invasive technique. Several randomized trials that have been performed in the past years document that the Nissen fundoplication is an effective procedure for the treatment of pathological gastro-oesophageal reflux disease when a critical indication is used for well-defined patients.

Fundoplication↗
PubMed2004

A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors.

For determination of histology of small solid and microbiology of liquid pararectal tumors there is no other method than endorectal ultrasound-guided biopsy. Also for therapy of abscesses or seromas drainage application is possible. With this technique an operation may be prevented. In awareness of possible complications such as major injury of rectal wall, bleeding, persistent fistula and sepsis, teaching and training in this method is consequently necessary. For a training program a lifelike model of the rectum was developed. It has been used by 780 participants in 20 training courses organized by the Surgical Department of University Hospital Würzburg.

Abscess↗
PubMed2003

[Laparoscopic anti-reflux surgery].

The indication for antireflux surgery despite consequent PPI medication includes: persisting disease with non-acid associated symptoms, such as volume reflux, recurrent hoarseness bronchiopulmonal reflux symptoms, in compliance with PPI, recurrent or persisting esophagitis. Our standard procedure is the short full Nissen wrap. Only in a 70% esophageal pump disturbance we actually apply a partial Toupet wrap. In 412 operations (Nissen 82%, Toupet 18%) during one year we observed 1.9% persisting postoperative dysphagia, 5% reflux relapses and 2% gas bloat syndrome of which 1 patient (0.2%) was re-operated. Significant differences between both procedures regarding the rate of function and complication have not been seen. Quality of life nearly came up to that of non-operated healthy patients and was much better than before surgery. The high acceptance of laparoscopic antireflux surgery in a highly selected collective caused a revival of antireflux surgery by minimal invasive methods.

Fundoplication↗
PubMed2002

Minimally invasive surgery.

During the last 10 years, minimally invasive surgery has influenced the techniques used in every specialty of surgical medicine. This development has not only led to the replacement of conventional procedures with minimally invasive ones, but has also stimulated surgeons to reevaluate conventional approaches with regard to perioperative parameters such as pain medication. However, two major drawbacks have emerged with the introduction of this new technique: firstly, the prolonged learning curve for most surgeons, in comparison with the learning process in open surgery; and secondly, increased costs due to investment in the equipment required and the use of disposable instruments, as well as longer operating times. In the various health-care systems around the world, these increased costs are not always compensated for by shorter hospital stays. This review focuses on major areas of indication for minimally invasive surgery in the gastrointestinal tract. These include functional disorders of the upper and lower gastrointestinal tract, obesity surgery, minimally invasive techniques in gastric and hepatobiliary surgery and in other solid organs, and laparoscopic colorectal surgery. The shortening of the hospitalization period has led to increasing use of outpatient laparoscopic surgery, and many centers specializing in day-care surgery are using these techniques. The frontiers are being pushed even further, as the size of the instruments is reduced to achieve better cosmetic results. Clinical research has also focused on the topic of expanding the indications for minimally invasive approaches in the elderly and in high-risk patients, to take advantage of the shorter hospital stays and reduced surgical trauma that are possible. A considerable amount of basic research has been carried out on the stress response during and after minimally invasive procedures, and an improved immune response with the minimally invasive approach has been observed, leading to better results after extensive oncological procedures. Robotic surgery and telesurgery involve new computer-aided methods that allow greater precision in surgical technique, as well as offering an opportunity to supply surgical skill and expertise remotely, over long distances. Minimally invasive surgical techniques are thus now fully established in routine use, and the indications are continuing to expand.

Ambulatory Surgical Procedures↗
PubMed2002

[Laparoscopic Collis-Nissen operation for shortened esophagus].

Esophageal shortening as a complication of advanced gastroesophageal reflux disease is seen in 2-4 % of patients with GERD. The Collis gastroplasty with Nissen fundoplication creates an intraabdominal neoesophagus with a fundic wrap and is an effective procedure in the difficult intraoperative situation of esophageal shortening. After own experience with the open Collis gastroplasty and after reports on successful laparoscopic Collis-Nissen operation we performed 2 laparoscopic Collis-Nissen operations. The technique we used is a new modification of the laparoscopic technique described by Johnson and Hunter in 1998. The postoperative course was uncomplicated in both patients. The follow up included endoscopy and barium meal. The patients showed relief from reflux symptoms except a mild dysphagia. There was no persisting esophagitis. The laparoscopic Collis-Nissen gastroplasty is an effective minimal-invasive procedure in patients with shortened esophagus diagnosed intraoperatively.

Aged↗
PubMed2002

[Is duodeno-gastro-esophageal reflux just a bystander of acid reflux?].

BACKGROUND & AIM: Duodeno-gastro-esophageal reflux (DGER) as measured with bilirubin monitoring is observed in many patients with reflux disease especially in Barrett's esophagus. As acid suppression is an effective therapy of reflux disease, DGER is frequently just considered as a bystander of acid reflux. To define the importance of DGER, reflux of duodenal contents was evaluated by bilirubin monitoring in the stomach. METHODS: 100 patients with reflux disease were evaluated (62 m, 38 f, 50 (12) years). 26 patients had Barrett's esophagus, 57 had esophagitis and 17 non- erosive reflux disease (pH pos.). All patients were evaluated with simultaneous 24-hour bilirubin monitoring in the esophagus and stomach. Results were compared to 35 measurements of healthy volunteers in the esophagus and 41 measurements in the stomach. RESULTS: Normal values: DGER - Exposure time esophagus > 11.8 % using an absorbance value > 0.14, duodenogastric reflux (DGR) - Exposure time stomach >24.8 % using an absorbance value > 0.25. 56 % of the patients had DGER, 41 % had DGR. 29 of the 41 patients with DGR had DGER (71 %), while 27 of the 56 patients with DGER had physiologic duodenogastric reflux (48 %). DISCUSSION: About 30 % of the patients with reflux disease show DGER combined with excessive DGR. Therefore, DGER is not just a bystander of acid reflux. The excessive DGR in some patients adds additional potentially dangerous substances to the esophageal reflux.

Barrett Esophagus↗
PubMed2001

Alternative shift models and the quality of patient care. An empirical study in surgical intensive care units.

UNLABELLED: On 1 January 1996, the German Arbeitszeitgesetz (working-time regulation) came into effect for hospital physicians. It states that working hours must not exceed 8 h per day, even for physician in hospitals. As a consequence, the prevalent two-shift model is legally inadmissible. The intention of this law is to protect the physician and to create better conditions for the patients. However, a systematic evaluation of the postulated benefits is still lacking. AIM: The aim of our study was to analyze the influence of the length of daily working hours on the quality of patient care by measuring the outcome of patients in intensive care units (ICUs), comparing the two-shift model (2-SM)--two 12-h shifts--with the three-shift model (3-SM)--three 8-h shifts. MATERIALS AND METHODS: In a prospective multicenter study, we compared the outcome of patients in six ICUs (organized by surgeons) with different models of working hours. The health status of each patient and the course on ICU [described by hospital mortality, number of complications, readmission to the ICU, reinterventions, duration of the stay in an ICU and hospital, the course of the Acute Physiology and Chronic Health Evaluation (APACHE) II score] were uni- and multivariately analyzed. In addition, the technical and personnel resources of the ICUs and the hospitals were documented. RESULTS: Three hundred and forty seven patients (103 2-SM, 244 3-SM) were included. The epidemiological and the health status on admission to the ICU were comparable. Patients in the 3-SM stayed 1.6 days longer on ICU and 2.3 days longer in the hospital than the 2-SM patients. The frequency of complications, reinterventions, and readmissions to ICU was higher in the 3-SM. The median of the APACHE-II score decreased more for 2-SM than for 3-SM patients. This means a significantly quicker recovery of the patients in 2-SM (P < 0.05). The multivariate analysis with individual outcome measures as dependent variables revealed a significant positive effect of the 2-SM on the physicians' assessment of postoperative course, on the relative frequency of therapeutic procedures, and to a lesser extent on the duration of stay in the ICU.

APACHE↗
PubMed2001

Morphologic changes of the anal sphincter musculature during and after temporary stool deviation.

BACKGROUND AND AIMS: Temporary stool deviation, using a stoma, is a well-known surgical principle to protect low colorectal or coloanal anastomoses. The purpose of this study was to evaluate any morphologic changes with regard to the anal sphincter muscles during and after temporary ileostomy. PATIENTS AND METHODS: Forty-four patients with rectal carcinomas were studied prospectively. All patients underwent low anterior resection. Reconstruction was performed using either a coloanal pouch or a straight end-to-end anastomosis. A protective stoma was fashioned in all 44 patients (ileostomy n=41; colostomy n=3). Stoma closure was carried out after a median of 85 days (41-330 days). Using a standard protocol, anal-sphincter thickness [m. puborectalis, external anal sphincter (EAS) and internal anal (IAS) sphincter] was assessed by means of endoanal ultrasonography preoperatively, at the time of stoma closure, and every 3 months thereafter for 1 year. RESULTS: The diameter of the puborectal muscle decreased from a median preoperative value of 6.3 mm to 5.7 mm at the time of stoma closure (P=0.03). After 3 months, 6.2 mm was measured. This value remained stable for the complete follow-up period. Similar results were recorded for the EAS. The IAS thickness remained stable throughout the study period, measuring between 2.1 mm and 2.4 mm. CONCLUSION: Temporary stool deviation does lead to morphologic changes of the anal sphincter. While the smooth muscle remains unchanged, the striated counterpart undergoes atrophic transformation. However, after passage reconstruction, i.e., stoma closure, a rapid regeneration of the voluntary muscles is observed.

Aged↗
PubMed2001

How long should a long-term esophageal motility study be?

It was the aim of this study to analyze whether a shorter measuring period would render the same diagnostic information on esophageal motility as a circadian measuring period in ambulatory esophageal manometry. In an investigation on normal volunteers (n = 10), patients with gastroesophageal reflux disease without esophageal motility disorders (n = 13), and patients with esophageal motility disorders (n = 14), a comparison was performed between a 5-hr and a 24-hr motility study. An analysis was performed on inter- and intraindividual reproducibility of time periods, prandial phases, and motility sequences (Wilcoxon and Spearman test). There was no significant difference between the two analyzed measuring periods in all three groups with regard to the diagnostic information on esophageal motility in 44 of 45 comparisons for intraindividual variability. A measuring period restricted to 5 hr offers the same diagnostic information on esophageal peristaltic activity as a 24-hr motility study.

Adult↗
PubMed2001

[Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials].

Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials. In animal experiments four reconstruction methods following gastrectomy were compared: Roux-en Y reconstruction with (n = 33) and without pouch (n = 50) and isoperistaltic jejunum interposition with (n = 26) and without pouch (n = 55). The results were mostly influenced by the extent of esophagitis, documenting the reflux reduction by a pouch. Weight gain was slightly higher following jejunum interposition.Roux-en Y pouch reconstruction with jejunum interposition with pouch was compared in a randomized controlled trial. The additional operative effort of jejunum interposition did not achieve benefits in outcome. Therefore, Roux-en Y reconstruction should be advocated as standard reconstruction. The second randomized controlled trial compared Roux-en Y reconstruction with and without pouch. After more than three years, there was an advantage in life quality for patients with pouch indicating that patients with a favorable prognosis following gastrectomy should be reconstructed with a pouch.

Anastomosis, Roux-en-Y↗
PubMed2001

[Pouch reconstruction after resection of the rectum].

Pouch reconstruction after resection of the rectum. Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called "anterior resection syndrome" which comprises faecal incontinence, urge, frequency and fragmentation. To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 55 patients [29 men; median age 66,4 (30-85)] underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5-7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer: n = 51, 2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which two patients required reoperation. A pelvic abscess was encountered in three patients as well as one pelvic haematoma. Micturition was impaired in five patients. To date 47 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at three-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.6 after 12 months. After 3 months 38 patients (69 %) reported complete continence which increased to 83 % at 1 year. 18 Patients (33 %) complained of urge defaecation initially, which decreased to 14.5 % after 1 year. Fragmentation was observed in 40 % at 3 and and 22 % at 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.

Adult↗
PubMed2000

[Aorto-mesenteric artery compression syndrome].

INTRODUCTION: The aim of this paper was to describe a rare gastrointestinal motility disorder caused by vascular compression of the duodenum. PATIENTS: The authors present two patients with vomiting and severe weight loss. Diagnostic evaluation revealed superior mesenteric artery syndrome. METHODS: After frustrane treatment with i.v. infusions, surgical intervention with laterolateral duodenojejunostomy or Roux-en-y reconstruction for restoration of the intestinal passage was performed. RESULTS: Following initial recovery, the first patient showed permanent anorexia. Psychosocial evaluation revealed a severe pathological mother-child relationship. Intensive psychological treatment finally achieved definite weight gain and complete recovery in this patient. The second case subsequently gained weight without psychological evaluation. CONCLUSION: The authors review the literature, pointing out the anatomy of the duodenojejunal angle, the etiology, and the predisposing factors, as well as diagnostic and therapeutic strategies.

Adolescent↗