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Biomedical subjects

K W Ecker

Publications and source records attributed to K W Ecker.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Laparoscopically assisted surgery in Crohn disease].

UNLABELLED: From Jan. 1993 to Apr. 1997 intestinal resections in Crohn's disease have been performed in 275 patients. 89 patients have been operated on laparoscopic assisted. The following parameters were analyzed: previous laparotomies, extent of resection, steroid medication, conversionrate, complications, operative time and postoperative stay. Endpoints were: conversionrate, complications, reconvalescence and overall satisfaction with the laparoscopic technique. RESULTS: The duration of the disease ranged from 1 to 16 years (x = 6). 47 patients were under steroid medication at the time of surgery. 30 patients had undergone previous laparotomies. In 10 patients the operation had to be converted into open surgery. The following procedures have been performed: ileocaecal resections (45), anastomotic resections (14), small bowel resections (4), hemicolectomies (12), colectomies (9), loopileostomies (4), adhesiolysis (1). Minor complications occurred in 6.7% of patients, major complications in 5.6%. Operative time ranged from 70 to 420 minutes (x = 173.7). The postoperative hospital stay was 13.3 days in the average. CONCLUSION: The morbidity of 12.3% is not higher than in open surgery. When complications do not occur the patients benefit from early convalescence, better cosmetics and shorter hospital stay.

Adolescent↗
PubMed1998

[Surgical options in ulcerative colitis].

Surgery is needed in every second patient with pancolitis. Historically four surgical options have been developed: conventional ileostomy, ileorectostomy, continent ileostomy (Kock's pouch) and ileo-anal pouch. However, in emergent or unclear situations subtotal colectomy, ileostomy and preservation of the rectum is the most suitable operation. After recovery and in elective indications proctectomy and proctocolectomy establish the general surgical standard. Today, in most cases ileo-pouch-anal anastomosis is performed instead of creation of an ileostomy. Both lowered frequency of defecation and acceptable continence contribute to a better quality of life. However, functional disturbances are not uncommon and result in most cases from complications of the demanding technique. Definitive cure of the colitis is in interference with the risk of pouchitis in about 30%. The cumulative probability to loose the pouch may rise to 15-20% in the long-term course. Thus, ileorectostomy may be considered as a first step of surgical treatment, since pelvic nerve damage is excluded, function is much better and persistent proctitis can be treated topically. The attractively is that ileo-anal pouch can be performed later on, when decreasing function and increasing risk of malignant change will eventually require proctectomy. A Kock-pouch is seldom considered, especially in patients with ileostomy wishing sure fecal control. But the continent reservoir becomes more and more interesting again since it can be reconstructed from a failed ileo-anal pouch without loss of bowel. Conventional ileostomy should be reserved for patients not suitable for reconstructive methods or those who consider pough operations risk. However, it is the safest procedure with absolute cure of disease. The optimal choice of method considers medical and surgical aspects as well as patients conception and desire.

Colectomy↗
PubMed1998

[Changes in colitis surgery. I: Is there a standard in primary surgical treatment?].

In a 15 years period surgery of ulcerative colitis expanded from ileostomy (IS) via Kock's pouch (KP) and ileoanal pouch (IAP) to ileorectal anastomosis (IRA). Interactions between availability of methods and frequency of operations are investigated retrospectively in order to establish an optimal primary procedure. With an overall amount of 80 operations the yearly operative frequency raised in correlation to the introduction of continence reconstructive procedures. As a consequence of this fact history of disease was shortened to less than 8 year and global colitis-associated morbidity markedly decreased. For patients readiness to undergo operation Kock's pouch was only important at the beginning (n = 9/11.3%). Most decisive was IAP (n = 49/61.3%) which could be realized last even in an one-stage-procedure with better early results due to improved patients conditions and simplified technical modifications. IRA (n = 7/8.8%) played only a limited role in the last years for selected patients, whereas IS (n = 15/18.8%) kept reserved for contraindications to reconstructive surgery. For all procedures operative complications decreased from 46.1% (12/26) to 11.0% (6/54) and lethality to 0%. Late complications were related to proctectomy (nerve damage) and construction of IAP (pouchitis in 34.8% and defunctioning of the pouch in 10.4%), whereas IRA was free of specific morbidity so far. Surgery of ulcerative colitis is characterized today by restoration of anal continence. The advantage of the changed surgical concept lies within the ability to perform colectomy at an earlier stage of the disease. Safe construction of IAP is the most important technical progress. Early operation of colitis and late morbidity of pouch justify (preliminary) IRA. Thus, surgical standard in colitis-surgery is defined more individually.

Adolescent↗
PubMed1998

[Changes in colitis surgery. II: Corrective interventions and conversion operations].

Over a period of 9 years in 48 patients already operated on for ulcerative colitis secondary surgical interventions had to be planned. 25 patients had an ileostomy (IS), 10 a Kock-pouch (KP), 11 an ileoanal pouch (IAP) and 2 an ileorectal anastomosis (IRA). Whereas in 4 patients only the subjective wish for another procedure with better quality of life predominated, in 44 patients (91.7%) also objective, sometimes multiple indications for reoperation existed. In 37 patients main indications were complications or dysfunctions of the preexisting procedures, combined with the need for further resection of the colitis in 6 of them. Resection of the residual colitis was the main indication in the remaining 7 patients. The aim of the reoperation in all patients was both complete elimination of the eventually persisting colitis and restoration of quality of life in the best way wished or possible. Our of 25 IS 3 remained, 3 were reconstructed, 17 were converted to KP and 2 to IAP. Out of 10 KP one remained and in 9 corrective surgery of the nipple valve was performed. Out of 11 IAP 2 had to be resected with construction of IS, 5 were converted to KP and 4 were corrected. Two IRA were converted to IAP. The rate of early complications was 8.3% (n = 4), lethality was zero. Late complications occurred in 13 cases (27.1%) and were associated ten times with KP. Complications of KP decreased with time to zero due to technical modifications. They could always be corrected restoring function. Since only one KP had to be resected due to severe pouchitis, KP was an important secondary procedure for 31 out of 48 patients also in the long-term course ensuring both complete elimination of colitis and good quality of life owing to voluntary fecal control.

Adolescent↗
PubMed1998

[Laparoscopically-assisted proctocolectomy with ileoanal pouch in ulcerative colitis].

Laparoscopic assisted proctocolectomy with ileoanal pouch is a technical alternative to the conventional open procedure. The aim of this technique are better cosmetics. Mobilisation of the colon is achieved laparoscopically. Rectal resection, J-pouch creation, and pouchanal anastomosis are performed via a Pfannenstiel incision. Laparoscopic assisted proctocolectomy has been performed in five selected patients, three female and two male aged 17 to 36 years. Operative time ranged from 305 to 420 minutes. Intra- and postoperative complications were not encountered. Postoperative hospital stay ranged from 13 to 16 days. On a scale from 1 to 10 the average quality of life was graded 9 and the overall satisfaction level with the results of surgery scored 10. Function was identical to open surgery in not selected patients.

Adolescent↗
PubMed1997

Long-term function of experimental substitutes of the ileocecal valve.

The bacteriological barrier function of the ileocecal valve (ICV) can be replaced according to the principle of the nipple-valve anastomosis. Since late complications due to technical measures for stabilizing the ileal nipple have been hitherto unknown, 12 adult beagle dogs were operated on by three technical modifications of a nipple-valve anastomosis and were followed up for 1 year: In three cases the ileal nipple was stabilized by longitudinal staples (NVA), in three cases an intestinal neosphincter (INS) was produced by healing of the muscular layers between the ileal nipple and colon, and in six cases an oral zone of stabilization, preserving an aboral valve zone (S-NVA) was constructed. Measures for valve function at the end of the study period were the weight course of the animals and the intestinal bacterial profile, considering morphological complications of the substituted valves. As reference the respective bacterial counts in ICV and end-to-end anastomosis (EEA) were used, which had been determined in the same animals in earlier experiments. Following an initial increase in weight the 3 animals with NVA and the three animals with INS continuously lost weight from the 4th postoperative month onward. The 6 animals with S-NVA, however, showed from the 4th postoperative month onward a significantly higher weight level (p < 0.05), which remained constant up to the end of the 1-year observation period. Because of a morphologically intact structure of the substituted valve a significantly (p < 0.05) better bacteriological clearance of the ileum was confirmed in these animals after 12 months when compared with the EEA group. In contrast, in the NVA and INS animals a severe bacterial overgrowth of the entire small intestine was observed. This was caused by an intestinal stagnation due to partial prolapse of the nipple in NVA and due to fibrotic stenosis in INS. The results of our study suggest that technical measures to relieve the tendency to devaginate are only successful, if they do not lead to obstruction of the orthograde intestinal passage in the long term. Thus, only the clinical introduction of the S-NVA model may be justified.

Animals↗
PubMed1996

Biomechanical stabilization of the nipple valve in continent ileostomy.

Despite stapler stabilization, sliding complication of nipple valve function occur in 19 per cent of continent ileostomies. Because the tendency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of contacting intestinal walls was removed by selective ultrasonic fragmentation. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a median time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch. All are functioning well after a median of 4.6 (range 3.0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm2 was shown by endosonography. This procedure may provide long-term prevention of sliding complications in continent ileostomies.

Adenomatous Polyposis Coli↗
PubMed1996

Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone.

PURPOSE: We report the indications, technique, and results of conversion of the ileoanal pouch to the Kock's pouch in five patients. The indication was functional disturbance that could not be corrected by operation. Aim of the conversion operation was re-establishment of fecal control and complete preservation of existing ileal surface. METHODS: The ileal pouch was used again, and in one case an augmentation was made. The continence valve was made three times from the afferent loop and in two cases from a higher ileal segment. RESULTS: Following conversion, function was excellent in three patients with ulcerative colitis and in one patient with familial adenomatous polyposis. One woman who underwent proctocolectomy for slow-transit constipation needed a Brooke ileostomy for continuous abdominal distention pain. CONCLUSION: We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.

Adenomatous Polyposis Coli↗
PubMed1996

[Current proctology--modern functional diagnosis].

The large majority of pathological conditions in proctology can be recognized and distinguished from each other by clinical and endoscopic means of diagnosis. Manometric and neurophysiological investigations are especially useful for understanding pathophysiology; these methods are of great clinical value whenever their results contribute to a specific concept of therapy. Functional tests are able to distinguish among the various causes of sphincteric dysfunction. Defaecography might provide the decisive hint for operative treatment for manometric investigations of the ano-rectum, balloons, perfusion tubes and microtransducers are available. In cases of incontinence, especially in females, endosonography is the investigation of choice, providing most relevant information with regard to possible surgical reconstruction of the sphincter muscle.

Anal Canal↗
PubMed1996

[Surgical treatment concept in traumatic sphincter lesions].

The surgical problems of traumatic sphincter lesions are reported comparing early and late repair. In 11 acute injuries the surgical concept consisted generally of proximal fecal deviation, distal washout, reconstruction of the muscular defects and presacral drainage. In soft tissue injuries (grade I, n = 2) complete healing without functional deficiencies was obtained inspite of renouncing fecal diversion. In isolated ruptures of the rectum or the sphincter (grade II, n = 3) and in complete disruption of both components (grade III, n = 4) after healing and closure of the temporary colostomy continence was estimated subjectively as being sufficient. Patients' overall-appraisal was not correlated to the preoperative degree of destruction not the postoperative measurement of continence. Only when devascularisation of the anorectum with severe bleeding had occurred (grade IV, n = 2) proctectomy was necessitated resulting in one death. In none of 5 patients operated on elsewhere there was a chance of secondary sphincteric reconstruction. During operation or endosonographically and electromyographically the sphincter musculature could not be detected. Obviously renouncing of anatomical reconstruction leads not only to retraction but also to secondary degeneration of the sphincter muscles.

Adolescent↗
PubMed1995

[Laparoscopic resections in Crohn disease].

39 patients with Crohn's disease underwent laparoscopic bowel resections during January 1993 to May 1995 (16 female, 23 male, with an average age of 33 years). The duration of the disease ranged from one to 18 years. 21 of the 39 patients were under steroid therapy at the time of operation. Seven patients have had ileocaecal resection for Crohn's disease. The operative technique is laparoscopically assisted. We performed: small bowel resections (8), ileocaecal resections (16), hemicolectomies (11), subtotal colectomies (2), colectomies (2). Operative time ranged from 90 to 280 min for ileocaecal resections and from 330 to 420 min for colectomies. Intraoperative complications were not encountered. Postoperatively one patient developed a subhepatic abscess which was drained under sonographic guidance on day 6. One patient was reoperated for a different disease on postoperative day 2. Two patients had fever till day 9 and 13 without clinical relevance. Two patients had delayed incision site healing. Postoperative clinical stay was 11 days. The main benefit for the patients was early mobilisation due to reduced pain. Patients experienced the small abdominal incision as a ray of hope in their chronic disease.

Adolescent↗
PubMed1995

[Bacterial clearance of the terminal ileum in relation to the ileocolic connection].

The ecology of the (neo-)terminal ileum was investigated in three groups of mongrel dogs (group 1 to 3; 6 animals per each group) depending on the ileocolic connection and the resection of the terminal ileum. The efficacy of a stabilized nipple-valve-anastomosis (SNVA) was evaluated comparing the physiological ileocecal valve and the conventional end-end-anastomosis. The relations of the aerobic and anaerobic bacterial counts of all 18 dogs (group 0) preoperatively served as reference-values. Under this physiological condition the median counts were found to be lower in the ileum than in the colon, two logs for the aerobic bacteria and three logs for the anaerobic bacteria, confirming statistical significance (p < or = 0.05). The resection of the terminal ileum conserving the ileocecal valve (group 1) had no influence on the bacterial flora of the neoterminal ileum, whereas the limited resection of the ileocecal valve with ileocolic end-end-anastomosis (group 2) induced a bacterial colonisation of the terminal ileum. In contrast, following wide ileocoecal resection and replacement of the ileocecal valve by the SNVA (group 3) the bacterial counts were lower in the terminal ileum than in the colon: five logs for aerobic and seven logs for anaerobic bacteria. This difference was statistically significant within this group between ileum and colon and between ileum preoperatively and postoperatively (p < or = 0.05). In conclusion, the bacterial clearance of the (neo-)terminal ileum depends more on the retrograde barrier-function of the ileocecal valve or an appropriate mechanical substitute than on the propulsive motility of the ileum.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1994

Familial adenomatous polyposis: mutation at codon 1309 and early onset of colon cancer.

The clinical course of familial adenomatous polyposis (FAP) varies considerably between patients. Prediction of the severity of the disease is important in the interest of effective cancer prevention. We examined whether age at diagnosis of FAP due to gastrointestinal symptoms and age at death due to colorectal cancer are related to the site of mutation in the responsible gene. 225 families with FAP were screened for mutations. The deletion of 5 base pairs at codon 1309 within exon 15 (known to be the most common mutation) was identified in 20 families; other mutations within exons 7-15 were found in 49 families. In patients with the 5 base-pair deletion at codon 1309, gastrointestinal symptoms and death from colorectal cancer occurred about 10 years earlier than in patients with other mutations. The 1309 mutation leads to development of colonic polyps at a younger age, thus giving rise to an earlier malignant transformation. This relationship should be taken into account in strategies for preventing cancer in patients with FAP.

Adenomatous Polyposis Coli↗
PubMed1994

[An intestinal neosphincter attained by circumscribed muscle proliferation. Technical development and functional evaluation in the dog].

In an experimental study an intestinal neosphincter (INS) was constructed by modifying the principle of the ileocolic nipple-valve anastomosis by means of ultrasonic tissue fragmentation of the contacting serosa of the ileum and the corresponding mucosa of the ileum and colon. The healing of the muscle layers was studied histologically. The function of the INS was investigated in six dogs and compared intraindividually with that of the ileocecal valve and conventional end-to-end anastomosis. Morphologically the neospincters healed within 3 months without major fibrosis. The reference values of the aerobic and anaerobic bacterial counts in the terminal ileum were more than 2 logs lower than in the colon with the normal ileocecal valve, and after ileo-colonic end-to-end-anastomosis bacterial colonization of the terminal ileum was found both qualitatively and quantitatively. Subsequent interposition of the INS led to bacterial clearance of the terminal ileum. The median aerobic bacterial counts were lower by six logs and the an aerobic bacterial counts by 3 logs than in the colon. However, differences were not statistically significant owing to the wide variation in the individual values. Nevertheless, the demonstrable clearance of the terminal ileum could be explained by the orthograde passage with absolutely no stagnation and the relative competence of the INS in resisting retrograde pressure competence. In conclusion, ultrasonic fragmentation of the serosa and mucosa of the bowel allows construction of an INS from three muscle layers, which acts as a bacteriological barrier. Before it is introduced into the clinical setting its integration into the intestinal motility should be evaluated by further studies.

Anastomosis, Surgical↗
PubMed1994

Surface versus needle electrodes in determination of motor conduction time to the external anal sphincter.

Patients were referred to our neurophysiological department in order to investigate anorectal function. By the means of magnetic stimulation the total motor conduction can be determined. Only patients with normal latency of the pudendal nerve and normal EMG of the external anal sphincter were examined. Stimulation was carried out above the motor cortex with a MO between 80 and 100%. The recording was carried out in 22 patients with concentric needle electrodes and in the other 18 patients with surface electrodes. The mean latency in the group with surface electrodes was 19.4 ms (SD 1.7), and in the group with needle electrodes 23.4 ms (SD 4). Our results suggest, that in magnetic stimulation above the motor cortex and recording with a concentric needle electrode, the range and the mean was higher than with surface electrodes. In our opinion surface electrodes are preferable to needle electrodes in determining motor conduction time to the external anal sphincter.

Adult↗
PubMed1994

[Experiences with the Kock continent ileostomy].

First experiences with Kock-pouches (KP) in 34 patients operated on between 1987 and 1992 with stapler-stabilization of the nipple-valve are reported. 18 patients (52.9%) suffered from ulcerative colitis (CU), 7 patients (20.6%) from familiar adenomatous polyposis (FAP) and 9 patients (26.5%) from Crohn's colitis (CC). Each patient was inappropriate for ileo-anal pouch-procedure (IAP) and desired fecal control. Special indications for KP were identic with medical contraindications for IAP in 52.9%, refusal of IAP in 17.6% and loss of sphincter in 29.4%. In 25 patients with CU and FAP the rate of specific early complications was 24%. In 5 of 6 cases operative correction was successful. The rate of success was 96%, which could be maintained over time with a rate of 8.3% of late complications, that had to be corrected. In 9 patients with CC the rate of success was 77.8% due to two pouch resections in the early postoperative course. It decreased to 66.6% in the further course due to another resection later on. In CC, 3 out of 7 patients had repeated reoperations due to inflammatory complications of the disease not impairing pouch-function. A severe pouchitis was only observed in 2/18 patients with CU (11.1%). Thus, high rates of success in KP-surgery can be achieved for CU and FAP-patients. But it has to be kept in mind, that KP is not in concurrence with IAP, it is also an alternative to Brooke-ileostomy. Patients with CC are less appropriate, because the necessity for repeated reoperations due to recurrent disease reduces significantly the overall benefit of the patients, even if continence is preserved.

Adenomatous Polyposis Coli↗
PubMed1994

[The colo-anal pouch: indications, function and results].

Low anterior resection of rectal cancer with preservation of the anal sphincter has comparable recurrence and survival rates when compared to abdominoperineal excision. Stool frequency and leakage rates are high after coloanal anastomosis. The colonic J-pouch improves function. Endosonographic tumor stages ES T1 and ES T2 for cancer in the distal third rectum and ES T3 tumors in die middle third rectum are indications for rectal resection with preservation of the sphincter and reconstruction with the colonic pouch. In 33 patients the technique was safe, with no deaths and no reoperation. Three diverting colostomies are not yet closed. 25 patients are perfect continent, two are incontinent for gas, three have minor and one patient major incontinence. Only one patient has more than three bowel movements in 24 hrs. For selected cancers of the distal half of the rectum total resection with preservation of the anal sphincter is a safe operation. Good function is provided by the colon J-pouch.

Adult↗