[Therapy of chronic constipation].
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Chronic Disease↗
Biomedical subjects
K H Fuchs
Publications and source records attributed to K H Fuchs.
[Diagnosis of chronic constipation].
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Aged↗
Peritoneal seeding of gallbladder cancer after laparoscopic cholecystectomy.
We report a case of peritoneal seeding of an unsuspected adenocarcinoma of the gallbladder following laparoscopic cholecystectomy despite the use of a retrieval bag. The metastasis developed at the umbilical trocar site, which was also used to extract the resected gallbladder. There was no evidence foe a leak of the retrieval bag. Most likely malignant cells became desquamated during the operation, implanting themselves in the tissue during the removal of the bag. Taking into consideration previous reports and the dismal prognosis of the disease, we discuss the management in the case of an incidental carcinoma.
Adenocarcinoma↗
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↗
[Endorectal ultrasound for evaluating perirectal processes].
Between July 1992 and December 1993 we examined 258 patients by endorectal ultrasound at the Surgical Department of the University of Würzburg. In 24 (9.3%) patients we found 27 perirectal lesions. These comprised abscesses, cysts, primary and secondary malignancies, as well as various benign tumours. All lesions but one underwent histological and/or microbiological examination. Endosonographic assessment with regard to size, location and anatomical structure was correct in 24 (89%) cases. We performed ultrasound-guided, transrectal aspiration in six patients. Endorectal ultrasound is a useful complementary imaging device in the assessment of pararectal disease. Owing to its high resolution it may be superior to other methods (e.g. CT or MRI). Another advantage is the possibility of ultrasound-guided aspiration biopsy. Precise knowledge of the topographic anatomy and its endosonographic appearance is of great importance.
Adult↗
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↗
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↗
[Pouches of the upper gastrointestinal tract].
The own findings about the functional behavior of the gastric substitute together with the results from the literature demand a jejunal J-pouch after gastrectomy, if it is not a palliative resection. It is an open question, whether the good experience with the Roux-en-Y-pouch-reconstruction--only 15 min. more time of operation, low rate of complications--allows a wider indication for this procedure.
Anastomosis, Roux-en-Y↗
[Techniques of follow-up examination of the ileoanal and colo-anal pouch].
For the assessment of ileoanal and coloanal pouches different diagnostic tests should be applied. Apart from case history and rectal digital examination the most important methods comprise a radiologic evaluation of the pouch and its afferent loop as well as anorectal manometry for the assessment of pouch motility and sphincter function. Increasingly transanal endosonography is being used for the precise examination of size, volume, and shape of ileoanal and coloanal pouches. The afferent loop is also easily accessible to endosonography, e.g. for evaluation of bowel wall morphology and function. Furthermore, in cases of coloanal pouches following an oncologic lower anterior resection, endosonography is used in follow-up examinations for the detection of local tumor recurrence.
Adenomatous Polyposis Coli↗
[Experimental studies of the value of the pouch after gastrectomy].
AIM OF THE STUDY: Clinical relevant follow up parameters were used to examine the influence of an additional pouch for reconstruction after gastrectomy in Roux-en-Y technique and jejunal interposition in rats. METHOD: 3 months old rats were gastrectomized and reconstructed as follows: Roux-en-Y (RY n = 50), jejunal interposition (JI n = 55) and each of these combined with a jejunal J-pouch (RYP n = 33; JIP n = 26). Up to 9 months postoperatively body weight, hemoglobin, iron, total protein and amylase as well as the pouch volume and esophageal mucosa were followed up. RESULTS: All gastrectomized animals show deficiencies compared to non operated controls (n = 6). The severity depends on the type of reconstruction. The RY group overall has the lowest values; hemoglobin (9 month) 4.2 g/dl, body weight (6 mon) 77% total protein (9 mon) 47 g/l. JI causes less defect: Hb (9 mon) 8.3 g/dl, BW (6 mon) 109%, TP (9 mon) 61 g/l. Animals with additional pouch have better values than those with the similar type of reconstruction but without pouch; RYP: Hb (9 mon) 12.7 g/dl, BW (6 mon) 95%, TP (9 mon) 55 g/l; JIP: Hb (9 mon) 15.1 g/dl, BW (6 mon) 107%, TP (9 mon) 64 g/l. Hemoglobin and total protein do not significantly differ between the combination of interposition and pouch and the control group (p > or = 0.05). The volume of the pouch increases 1:3 during 6 months. Animals with pouch do not show severe reflux esophagitis as do those without pouch. CONCLUSION: With global follow-up parameters the postgastrectomy deficiency can be evaluated in this experimental model. Interposition combined with the pouch is superior to the other methods as demonstrated by less deficiencies. Furthermore the pouch serves as a functional food reservoir and as reflux barrier.
Anastomosis, Roux-en-Y↗
[Surgical or conservative therapy of Barrett esophagus?].
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Antacids↗
[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↗
Technique, indications, and clinical use of ambulatory 24-hour gastric pH monitoring in a surgical practice.
BACKGROUND: Prolonged pH monitoring is used increasingly to assess alterations of gastric luminal pH caused by gastroduodenal secretory and motor abnormalities. The clinical value of gastric pH monitoring, however, has been debated. METHODS: We obtained normal values for 24-hour ambulatory gastric pH monitoring in 50 healthy volunteers and evaluated its clinical use by monitoring pH in 285 consecutive patients with nonspecific foregut symptoms and duodenal ulcers (n = 33), gastric ulcers (n = 21), antral gastritis (n = 123), or no mucosal injury (n = 108). RESULTS: Patients with duodenal ulcer had a shift of their recorded pH values to a more acidic range, particularly during the night (p < 0.01). Multiple regression analysis showed that an increased percentage of time pH was less than 1.2 during the night indicates gastric acid hypersecretion. In contrast, patients with gastric ulcer or antral gastritis had an increased frequency of alkaline peaks and percentage of time spent at a pH greater than 3 (p < 0.01). The presence of excessive duodenogastric reflux was identified in 39% of these patients as compared with 7% with no gastric mucosal injury (p < 0.01). Delayed gastric emptying was suggested by prolonged postprandial alkalinization of the gastric pH record in 25% of the patients. Radionuclide gastric emptying studies confirmed this in 85% of these patients. CONCLUSIONS: Gastric pH monitoring allows evaluation of gastric secretory state fluctuation in gastric pH environment, duodenogastric reflux, and gastric emptying under physiologic conditions during a complete circadian cycle and has potential to be one of the most inclusive initial tests of gastroduodenal function.
Adolescent↗
Current aspects of gastroduodenal ulcer disease: diagnosis of pathophysiologic background and indications for operative therapy.
The management of gastroduodenal ulcer disease has changed because of new evidence of its pathophysiologic background and the introduction of new medication and operative techniques. Proximal gastric vagotomy (PGV) was abandoned by some as the treatment of choice because of high recurrence rates. With the advent of minimally invasive surgery, laparoscopic vagotomy has renewed interest in vagotomy as a treatment option for gastroduodenal ulcer disease. In view of this development, a study was performed to investigate the incidence of abnormal gastric hyperacidity in a population of ulcer patients in order to select those patients for operative acid reduction who will benefit most from operation. Sixty-eight patients with gastroduodenal ulcer disease underwent 24-hour-gastric-pH monitoring, 29 of these patients subsequently underwent proximal gastric vagotomy. The study demonstrates that it is possible to identify patients with hyperacidity. It revealed a variation of intraluminal gastric acidity in patients with different ulcer locations. On the basis of the opinion that gastric hyperacidity is the main indication for PGV, it is emphasized that the choice of surgery should depend on the functional defect and that the indication for operation should be based on therapy-resistant symptoms.
Duodenogastric Reflux↗
Operative procedures in antireflux surgery.
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Cardia↗
[Use of surgical staplers on the upper gastrointestinal tract].
Mechanic or stapled anastomoses of hollow organs represent a safe and attractive alternative to the manual suture. The rate of complications for the duodenal stump closure by linear staplers is minimal with leakages below 1%; the same is true for the jejunum. In esophagogastrostomies which are often performed cervically, the stapler offers more safety compared to manual sutures, but the rate of stenoses is higher with about 15%. Stenoses have been observed especially with smaller magazines (25 mm diameter). For esophagojejunostomies safety is much greater with mechanic staplers than with manual sutures. Only most experienced surgeons would achieve the same results with the same low rate of leakages of less than 10%; stenoses do not have clinical relevance.
Anastomosis, Surgical↗
[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↗
[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↗