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Biomedical subjects

Lars Lundell

Publications and source records attributed to Lars Lundell.

27 records · Page 2Linked to original sources
PubMed2003

Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial.

OBJECTIVE: The aim of the study was to compare the efficacy and mechanical consequences of 2 partial fundoplications performed laparoscopically under the framework of a randomized, controlled clinical trial. SUMMARY BACKGROUND DATA: Although laparoscopic total fundoplication procedures have proven their effectiveness in the control of gastroesophageal reflux, problems remain with the functional consequences after a supra-competent gastric cardia high-pressure zone. Partial fundoplications have been found to be associated with fewer mechanical side effects. PATIENTS AND METHODS: During a 2-year period, 95 patients with gastroesophageal reflux disease were enrolled into a randomized, controlled single-institution clinical trial comparing a partial posterior (Toupét, n = 48) fundoplication and an anterior partial wrap (Watson, n = 47). All patients were assessed postoperatively at predefined time points, and the 12-month follow-up data are presented in terms of clinical results and 24-hour pH monitoring variables. RESULTS: Both patient groups were strictly comparable at the time of randomization. All operations were completed laparoscopically, and no serious complications were encountered. During the first postoperative year, a difference regarding the control of reflux symptoms was observed in favor of the posterior fundoplication. Esophageal acid exposure (% time pH <4) was substantially reduced by both operations but to a significantly lower level after a Toupét compared with the Watson partial fundoplication (1.0 +/- 0.3 vs. 5.6 +/- 1.1 mean +/- SEM; p < 0.001). Postfundoplication symptoms were infrequently recorded with no difference between the groups. CONCLUSIONS: When performing a laparoscopic partial fundoplication, the posterior modification (Toupét) offers advantages in terms of better reflux control compared with an anterior type (Watson).

Adult↗
PubMed2003

Upper gastrointestinal hemorrhage--surgical aspects.

During the last decades, significant advantages have been achieved with the use of emergency endoscopy and respective hemostatic interventions. Rebleeding, however, remains a significant clinical problem, and currently re-endoscopy or surgical intervention offers advantages and disadvantages. With the discovery of Helicobacter pylori as a main causative factor behind peptic ulcer disease, a more conservative surgical approach is mandated even in situations with significant rebleeding. In case of large gastric ulcer, however, resection is a wise strategy depending on the risk of malignancy. Liver transplantation has immensely improved the prognoses for variceal bleeding in end-stage liver disease in carefully selected patients.

Duodenal Ulcer↗
PubMed2003

Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is the preferred operation for the treatment of morbid obesity by many surgeons. Hereby we present the process by which laparoscopic RYGBP (LRYGBP) developed at our institution. METHODS: Perioperative morbidity was recorded from 150 consecutive morbidly obese patients operated upon by RYGBP from August 1994 to March 2002. The first 76 consecutive patients have been followed up to 5 years postoperatively. A subgroup of 40 patients was recruited to evaluate the postoperative lung function in a randomized study between receiving and not receiving prophylactic chest physiotherapy. RESULTS: In the whole series, there were 4 conversions to open surgery, 5 leaks, 12 postoperative bleedings and 1 intestinal obstruction. 1 patient succumbed after developing acute dilatation of the bypassed stomach. Respiratory function deteriorated significantly in all patients in the early postoperative period, irrespective if given physiotherapy. During the follow-up period, 3 patients developed mechanical obstruction of the Roux limb. Another patient had a perforated ulcer at the proximal pouch. Weight reduction averaged 70% of excess body weight at 2 years after surgery. CONCLUSIONS: LRYGBP is an effective treatment for morbid obesity. During the initial development, we experienced a number of serious complications. The complication rate decreased over time. Postoperative lung function was markedly impaired, but there were no beneficial effects of chest physiotherapy. Long-term weight loss after LRYGBP seems to be comparable to what has been reported after open RYGBP.

Adult↗
PubMed2002

Repeat antireflux surgery: effectiveness of a toupet partial posterior fundoplication.

OBJECTIVE: To report the feasibility and efficacy of posterior partial fundoplication for patients with recurrent reflux after previous antireflux operations. DESIGN: Prospective non-randomised single hospital study. SETTING: University hospital, Sweden. PATIENTS: 32 consecutive patients who required reoperation after failure of previous operations for gastro-oesophageal reflux disease. MAIN OUTCOME MEASURES: Control of symptoms, oesophageal acid reflux. RESULTS: Most patients were referred for reoperation because of recurrent reflux, but six patients had a symptomatic intrahoracic herniation of the wrap with a life-threatening perforation in one patient. Three patients had recurrent reflux within 6 months of the operation and another two were classified as failures. The remaining 27 (84%) were classified as having a successful outcome during a mean follow-up period of 20 months. CONCLUSION: A posterior partial fundoplication can be done safely in a repeat operation for patients whose antireflux operation has failed.

Adult↗
PubMed2002

The effect of cisapride on oesophageal motility and lower sphincter function in patients with gastro-oesophageal reflux disease.

OBJECTIVES: To evaluate the efficiency by which the 5-HT4 agonist cisapride affects important motor functions involved in the control of gastro-oesophageal reflux. METHOD: Thirty patients with proven gastro-oesophageal reflux disease (endoscopy and 24 h pH-metry) were included in a randomized, double-blind, placebo controlled study with a cross-over design. Cisapride, 20 mg b.i.d., during 4 weeks was compared with placebo. At baseline, as well as after 4 and 8 weeks all patients underwent symptom assessments, sleeve manometry with concomitant oesophageal pH-monitoring and an acid clearance test. RESULTS: Despite adequate plasma levels cisapride had no significant effect on swallow induced peristaltic amplitude, duration, propagation speed, the elicitation of secondary peristalsis nor on acid clearance. Neither the basal tone of the lower oesophageal sphincter nor the number of transient lower oesophageal sphincter relaxations induced by gas distension of the stomach was affected by the administered dose of cisapride. CONCLUSION: Although cisapride has been alleged to improve symptoms as well as the oesophagitis in patients with gastro-oesophageal reflux disease, we found the compound (20 mg b.i.d.) devoid of effects on important motor mechanisms involved in the pathogenesis of the disease.

Adult↗
PubMedDate not supplied

Mechanical consequences of short gastric vessel division at the time of laparoscopic total fundoplication.

Laparoscopic Nissen fundoplication is currently the most commonly practiced antireflux operation. Some adverse consequences of the operation remain in the form of mechanical side effects, labeled postfundoplication complaints, of which dysphagia and gas bloat seem to predominate. Measures have been suggested to counteract some of these and one frequently advocated has been division of the short gastric vessels to create a short-floppy wrap. The advantages of this are still debated, particularly in the long-term perspective. The aim of the present study was to evaluate the mechanical consequences of dividing all short gastric vessels at the time of a laparoscopic total fundoplication. Ninety-nine patients with chronic gastroesophageal reflux disease (GERD) were originally allocated on a random basis to have either all short gastric vessels divided or left intact at the time of a laparoscopic total fundoplication. A subsample of these patients, again selected at random, were recruited for a comprehensive manometric investigation 1 year after the operation. In this cohort, 12 patients had all short gastrics divided and in 12 patients, the wrap was done with intact vessels by use of the anterior portion of the fundus. Manometry was carried out by the use of a sleeve sensor to straddle the lower esophageal sphincter (LES), and gastric distension (750 ml air) was used to trigger transient LES relaxations (TLESR). The basal LES tone was similar in the two groups (14.2 +/- 2.4 and 18.8 +/- 4.3, mean +/- SE), respectively. Accordingly, all other relevant manometric variables were equal when the two groups were compared, except for the total number of TLESRs (triggered by gastric distension by air) that were significantly higher (p < 0.02) in patients having their short gastric vessels intact. Consequently, numerically more common cavities were recorded in the latter group. Very similar outcomes in terms of motor function of the LES and esophageal body were observed after a total fundoplication irrespective of whether a complete division of all gastric vessels had been carried out or not. However, after gastric distension with air, more TLESRs were recorded in the latter group suggesting a better maintained ability to vent air from the stomach.

Adult↗
PubMedDate not supplied

Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: results of a randomized clinical trial.

The efficacy of fundoplication operations in the long-term management of gastroesophageal reflux disease (GERD) has been documented. However, only a few prospective controlled series support the long-term (>10 years) efficacy of these procedures, and further data are required to also determine whether the type of fundoplication affects the frequency of postfundoplication complaints. The aim of this study was to conduct a randomized, controlled clinical trial to assess the long-term symptomatic outcome of a partial posterior fundoplication as compared to a total fundic wrap. During the years 1983 to 1991, a total of 137 patients with chronic gastroesophageal reflux disease were enrolled in the study; 72 were randomized to semifundoplication (Toupet) and 65 to total fundoplication (Nissen-Rossetti). A standardized symptom questionnaire was used for follow-up of these patients. A total of 110 patients completed a median follow-up of 11.5 years; 54 had a total wrap and 56 underwent a partial posterior fundoplication. During this period, seven patients required reoperation (Nissen-Rossetti in 5 and Toupet in 2), 11 patients died, and nine patients were lost to follow-up or did not comply with the follow-up program. Control of heartburn (no symptoms or mild, intermittent symptoms) was achieved in 88% and 92% in the total and partial fundoplication groups, respectively, and the corresponding figures for control of acid regurgitation were 90% and 94%. We observed no difference in dysphagia scoring between the two groups, although odynophagia was somewhat more frequently reported in those undergoing a total fundoplication. On the other hand, a significant difference was observed in the prevalence of rectal flatus and postprandial fullness, which were recorded significantly more often in those undergoing a total fundoplication (P < 0.001 and P < 0.03, respectively). Posterior partial fundoplication seems to maintain the same high level of reflux control as total fundoplication. Earlier observations demonstrating the advantages of a partial fundoplication, which included fewer complaints associated with gas-bloat, continue to be valid after more than 10 years of follow-up.

Follow-Up Studies↗
PubMedDate not supplied

Relationship of tumor burden and patients' minimization of distress in facing surgery for gastric cancer.

Patients with gastric cancer considered amenable to a curative surgical procedure on the basis of a conventional preoperative workup (N=98) answered health-related quality-of-life questionnaires and completed a psychiatrist's interview before the intervention. All patients were blinded to the type of surgical procedure that would ultimately be performed; 64 patients eventually received a potentially curative resection, and 34 had palliative surgery. The curative resection group reported significantly more hopelessness before the operation than the palliative surgery group. The latter group had more eating dysfunction but minimized their distress to a greater degree than those with a more limited tumor burden. Eating dysfunction, hopelessness, and the tendency to minimize distress were independent predictors of prognosis. The findings highlight the need for careful medical interviewing to enhance patient-physician communication about symptoms and signs of malignant diseases.

Aged↗