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O Schöb

Publications and source records attributed to O Schöb.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic wedge resection for benign gastric tumors.

BACKGROUND: Both laparoscopic wedge resection and formal laparoscopic resection are used in the treatment of benign and malignant gastric diseases. METHODS: We performed totally laparoscopic wedge resection using stapling devices and three or four trocars. PATIENTS: Four patients were treated with this technique. All four suffered from gastrointestinal stromal tumors (GIST), and one presented with an additional gastric adenoma. Two were morbidly obese, and two had additional operations performed at the same time. Two patients were admitted for acute upper GI bleeding. RESULTS: All of the tumors were removed successfully. Operating time ranged from 135 to 215 min. Oral feeding commenced on days 2-4. Postoperative hospital stay ranged from 5 to 11 days. CONCLUSION: Laparoscopic wedge resection of benign gastric tumors is a safe, reliable method that should be further investigated and used on a broader scale.

Adenoma↗
PubMed2001

Spontaneous volume changes in gastric banding devices: complications of a semipermeable membrane.

The goal of this study was to prove that adjustable laparoscopic gastric banding (LAP-BAND) is semipermeable and that luminal adjustment with saline leads to spontaneous fluid loss, luminal widening, and effect loss which makes repeated readjustments necessary. In 64 patients stoma adjustment was performed with saline according to the guidelines of the manufacturer (group 1). In 32 patients hyperosmolar contrast material was used for stoma readjustments with the intention to detect a system leakage after spontaneous fluid loss and spontaneous luminal widening was observed (group 2). After spontaneous luminal narrowing had occurred in group 2, all patients from group 2 and all additional patients (n = 148) underwent stoma (re-) adjustment with iso-osmolar contrast material (group 3). Spontaneous fluid changes which led to spontaneous changes of the luminal width were then analyzed for the different filling substances in each group. Fifty-two patients from group 1 presented with effect loss because a spontaneous luminal widening had occurred secondary to a fluid loss of 0.1-0.2 ml/month. All 32 patients from group 2 presented with increasing obstruction and food intolerance because a spontaneous luminal narrowing had occurred secondary to a spontaneous fluid gain of 0.1-0.3 ml/month. In our patients from group 3, where stoma adjustment was performed with iso-osmolar contrast material, no spontaneous fluid changes were observed and luminal width/degree of obstruction did not change. The LAP-BAND is semipermeable. Stoma adjustment should not be performed with saline in order to avoid spontaneous luminal widening and the need for repeated readjustments. Stoma adjustments with hyperosmolar contrast material are clearly contraindicated since osmotic fluid gain leads to increasing obstruction. Stoma adjustments should be performed using iso-osmolar filling media which provide a stable luminal obstruction.

Contrast Media↗
PubMed2001

Pseudo-achalasia following laparoscopically placed adjustable gastric banding.

BACKGROUND: The complication of pseudo-achalasia may occur after laparoscopic adjustable gastric banding (LAGB) in patients with normal band position and normal stomal width. We hypothesized that this complication occurs especially in patients with preexisting insufficiency of the lower esophageal sphincter (LES), who show poor compliance secondary to lacking the sensation of satiety and who therefore also have insufficient weight loss at follow-up. METHODS: Early and late postoperative barium meal studies of 120 LAGB patients were retrospectively analyzed to identify patients who developed esophageal widening and dysmotility despite normal band position and normal stomal width. Results were compared with preoperative endoscopies, clinical findings, each patient's compliance with dietary instructions and postoperative weight loss. RESULTS: 9/120 patients developed pouch dilatation, esophageal widening and esophageal dysmotility as a late complication, despite normal band position and normal stomal width. All these patients had shown preexisting insufficiency of their LES endoscopically. They all showed bad compliance with dietary instruction, and they all abused their distal esophagus as an additional pouch. 7 of these patients presented with insufficient weight loss at follow-up, whereas of 3 other patients with pre-existing LES insufficiency who had shown good compliance, only 1 showed insufficient weight loss. Insufficient weight loss after 1 year was significantly more common in patients with pre-existing LES insufficiency (8/12 patients, 67%) than in patients with a competent LES (26/108 patients, 24%). CONCLUSION: Patients with pre-existing LES insufficiency appear to be at risk for pouch dilatation and esophageal decompensation despite normal band position and normal stomal width. These patients are prone to show lack of satiety and poor compliance with dietary instruction, use of their lower esophagus as additional space for food, and tend to have insufficient weight loss. Preoperative manometry should be used to identify such patients, where the indication for gastric banding should be discussed very critically.

Adult↗
PubMed2001

The effects of laparoscopic adjustable gastric banding on the proximal pouch and the esophagus.

BACKGROUND: Pouch development is a potentially serious problem following gastric banding, and reoperation is often demanded to maintain long-term function of the lap band. Laparoscopic gastric banding was performed with two different calibrations of the pouch. Within a period of 12 months, postoperative pouch behavior with regard to volume and shape was evaluated retrospectively, as were changes in the distal esophagus. METHODS: The pouches of 14 patients with intraperitoneal band positioning were calibrated at 25 ml. The volumes of 54 patients operated by a suprabursal technique were set at 15 ml. We performed three radiological examinations and calculated the volumes using the ellipsoid formula d1 x d2 x d3 x pi/6. Four morphologically different pouch types have been observed: regular, concentric, eccentric-medial and eccentric-lateral. The phi-angle corresponds to the angle between the spinal column and the gastric band. RESULTS: In the first group, the pouch volume increased from 21.2 ml +/- 21.2 to 87.9 ml +/- 64.6 (p=0.006) and the BMI fell from 47.1 kg/m2 +/- 8.4 to 38.1 kg/m2 +/- 7.0 (p=0.001). The pouch volume of the second group increased from 10.4 ml +/- 5.8 to 38.8 ml +/- 29.1 (p<0.001), and the BMI reduced from 48.4 kg/m2 +/- 6.9 to 39.3 kg/m2 +/- 6.7 (p<0.001). If the phi-angle is smaller than 4 degrees, the pouch is of the eccentric-medial type. CONCLUSIONS: The transbursal operative technique is responsible for the development of the eccentric-medial pouch. If the anterior sero-muscular fixative sutures tear, an eccentric-lateral pouch results. All pouch types are affected by changes at the pouch-esophageal junction and by pathological developments in the distal and middle oesophagus.

Analysis of Variance↗
PubMed2000

Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications.

PURPOSE: To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications. MATERIALS AND METHODS: From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22-62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m(2)) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6-8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions. RESULTS: Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection. CONCLUSION: ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.

Adult↗
PubMed1999

[Laparoscopic palliation of pancreatic carcinoma: initial experiences].

The greater part of patients presenting with pancreatic cancer is irresectable at the time of diagnosis. They are in need of palliative treatment. We report our first experience with a new concept of laparoscopic palliation based on the findings of preoperative imaging and diagnostic laparoscopy. Between 1995 and 1998, 10 patients underwent laparoscopic palliation. In 3 cases laparoscopic double bypass and 7 patients gastroenterostomy was performed, in some instances combined with endoscopic stenting. Postoperative morbidity was 10% for laparoscopic palliation. There was no mortality in laparoscopic bypass surgery. Postoperative hospital stay averaged 11 days. Our preliminary experience strongly suggests that laparoscopic palliation may greatly reduce the three major drawbacks of open bypass surgery, i.e. high morbidity and mortality, and long postoperative hospital stay. Prospective trials in larger study populations will be needed to define the place of this technique in the palliation of pancreatic cancer.

Aged↗
PubMed1999

Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: a case controlled study.

BACKGROUND: Most patients presenting with pancreatic cancer are irresectable at the time the diagnosis is made. Therefore, they are in need of palliative treatment that can guarantee minimal morbidity, mortality, and hospital stay. To address this need, we designed a study to test the feasibility of laparoscopic gastroenterostomy and hepaticojejunostomy and to compare their results with those achieved with open techniques. METHODS: We performed a case control study of a new concept in laparoscopic palliation based on the findings of preoperative imaging and diagnostic laparoscopy. Laparoscopic side-to-side gastroenterostomy and end-to-side hepaticojejunostomy (Roux-en-Y) were done in irresectable cases. Of 14 patients who underwent laparoscopic palliation, three had a laparoscopic double bypass, seven had a gastroenterostomy, and four underwent staging laparoscopy only. The results were compared with a population of 14 matched patients who had conventional palliative procedures. RESULTS: Postoperative morbidity was 7% vs 43% for laparoscopic and open palliation, respectively (p < 0.05). There were no mortalities in the laparoscopic group, as compared to 29% in the group who had open bypass surgery (p < 0.05). Postoperative hospital stay averaged 9 days in the laparoscopic group and 21 days in the open group (p < 0.06). Operating time tended to be shorter in the laparoscopic group (p < 0.25). Morphine derivatives were necessary for a significantly shorter period after laparoscopic surgery (p < 0.03). CONCLUSIONS: Our preliminary experience strongly suggests that laparoscopic palliation can reduce the three major drawbacks of open bypass surgery-i.e., high morbidity, high mortality, and long hospital stay.

Adult↗
PubMed1999

[The "buried bumper syndrome"--a rare complication of percutaneous endoscopic gastrostomy].

The buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy (PEG). Hereby the PEG bumper is overgrown by hypertrophic gastric mucosa and embedded into the gastric wall. This is probably a consequence of enforced tightening of the PEG tube causing an ulcer in the gastric mucosa. Endoscopically the bumper is not visible anymore. The symptoms of the buried bumper-syndrome are a poorly transporting PEG tube, a PEG tube that cannot be mobilised, secretion along the tube and upper abdominal pain. Most often an endoscopic approach to remove the bumper is successful. If not, the operative removal of the plate is necessary. After endoscopic removal of the tube an endoscopic replacement of a PEG tube is technically possible.

Aged↗
PubMed1999

[Role of laparoscopy in the management of acute appendicitis].

Minimal invasive surgery had a considerable impact on common surgical techniques and has almost replaced established operative procedures such as cholecystectomy. However, the laparoscopic approach for the treatment of acute appendicitis is still not very popular. We discuss the role of laparoscopy for appendectomy and include three studies from our institution (University Hospital Zürich, Switzerland) and prospective studies reported in the literature. We conclude that laparoscopic appendectomy, when compared with the open approach, has the following advantages for the diagnosis and treatment of acute appendicitis. (1) Diagnostic laparoscopy is an effective and relatively atraumatic tool to investigate the abdominal cavity, which results in a sensitivity of almost 100%. This allows for accurate decision making, which is especially advantageous in young women and obese patients. (2) Prospective studies demonstrate that laparoscopic appendectomy is at least as good as open appendectomy and that the laparoscopic approach results in a reduced postoperative infection rate. (3) The similar complication rate after laparoscopic appendectomy, when performed by residents rather than staff surgeons, underlines the feasibility and teaching potential of this minimal invasive procedure.

Acute Disease↗
PubMed1998

[Surgical pain therapy in inoperable metastatic epigastric tumor by bilateral thoracoscopic splanchnicectomy].

Patients with unresectable supramesenteric malignancies often suffer from intractable pain. The supramesenteric viscera are supplied by the greater splanchnic nerve. Surgical options to effectively denervate the supramesenteric area are coeliac ganglionectomy, open or percutaneous coeliac ganglion block or transhiatal bilateral splanchnicotomy. The surgical minimally invasive alternative is thoracoscopic splanchnicectomy. In 7 patients pain was scored on a scale from 1 (no pain) to 10 (maximal pain) before and after surgery and weekly thereafter. Five bilateral and 2 left-sided thoracoscopic splanchnicectomies were performed. Operation time was 17 +/- 3 min for each side. The mean pain score dropped from preoperatively (under morphine sulphate medication) 7.4 +/- 0.6 to 4.9 (2.5-8.25) 1 week postoperatively (p = 0.02) and to 4.9 (2.5-6.75) 7 weeks postoperatively (p = 0.02). The relief from back pain was immediate and complete, but abdominal pain tended to recur. Six of our 7 patients and their general practitioners rated the intervention as a success. Thoracoscopic splanchnicectomy affords excellent palliation in patients with unresectable supramesenteric tumour, offering reliable pain control.

Abdominal Neoplasms↗
PubMed1998

[Gastric pouch dilatation: complications after laparoscopic implantation of a silicone gastric band in pathologic obesity].

In 20 patients with morbid obesity a laparoscopic silicon gastric banding was installed using a LAP-BAND. All patients were examined postoperatively with water-soluble oral contrast material according to the usual protocol. 8 weeks after the operation a second control with thickened barium sulfate was added to measure and adjust the width of the silicon band. There were no early postoperative complications. But in the follow-up three patients presented with a pathologic gastric pouch-dilatation. This severe complication, which can have different etiologies, requires early detection and specific therapy.

Administration, Oral↗
PubMed1998

Percutaneous drainage of abdominal abscesses: are large-bore catheters necessary?

OBJECTIVE: To find out whether small-bore catheters (7 F) are as effective as the 14F sump drains generally used for drainage of abdominal abscesses. DESIGN: Retrospective review. SETTING: University hospital, Switzerland. SUBJECTS: 64 patients with intra-abdominal abscesses. INTERVENTIONS: 40 were drained with 7F pigtail catheters and 24 by 14F sump drains. RESULTS: Drainage was successful in 34/40 (85%) and 20/24 (83%), respectively. There were 3 recurrences in the small-bore and 1 in the large-bore group (p=0.4). Mean drainage time was 8 (SD 5) days and 11 (SD 11) days, respectively (p=0.29). One patient (3%) developed a complication in the small-bore group and 2 (8%) in the large-bore group. 4/6 failures in the small-bore group and 1/4 failures in the large-bore group were pancreatic abscesses. CONCLUSIONS: We conclude that percutaneous drainage with small-bore catheters is as effective as drainage with bigger tubes.

Abdominal Abscess↗
PubMed1998

Laparoscopic sigmoid resection: a comparative experimental study between double-stapling and foreign material free-biostent technique (TESA). Transient endoluminally stented anastomosis.

In current clinical practice the "double-stapling technique" is the standard for reanastomosis following minimally invasive sigmoid resection. In the present study, we compared the TESA technique (transient endoluminally stented anastomosis) with conventional stapled anastomosis and evaluated the effect of remnant foreign material on follow-up examination with endosonography. Laparoscopic sigmoid resection was performed in 12 pigs (mean weight 63+/-5.9 kg). Animals were randomly divided into two groups: In Group A, reanastomosis was performed following a standard technique using a 29-mm circular stapler. In Group B, the TESA technique using a resorbable radiopaque stent of polyglycolic acid was applied. The anastomosis was examined by plain x-ray on days 1, 7, and 14, and by contrast enema on day 42, respectively. Endosonography, macroscopic inspection, and histological evaluation of the anastomosis were performed on day 42. All anastomoses in group A were patent. In one animal in Group B stent displacement with subsequent leak of the anastomosis was observed. Circumferential length of the anastomosis on day 42 did not differ between the groups (Group A: 8.00+/-0.45 cm vs. Group B: 7.8+/-2.0 cm, p = 0.82). The duration of the operation was 130+/-27 minutes in Group A and 100+/-18 minutes in Group B (p = 0.06). Weight gain was equal: Group A: 24+/-9.6 kg vs. Group B: 24+/-5.0 kg, p = 0.74. Endosonography on day 42 postoperatively in the area of the anastomosis in group A was impaired due to metallic staples. TESA is a competitive method for reanastomosis following laparoscopic sigmoid resection. In contrast to the conventional technique, the anastomosis is free of foreign material 1 month after the operation, which facilitates follow-up examinations with endosonography as well as other imaging diagnostics.

Anastomosis, Surgical↗
PubMed1997

[Surgery in malignant obstructive jaundice: laparoscopic surgery--the future?].

The systematic staging of pancreatic cancer has facilitated exact evaluation of a patient's prognosis in recent years. Minimally invasive surgery, on the other hand, has produced new procedures which necessitate a distinct dichotomy between open, curative surgery and minimally invasive, palliative procedures. Diagnostic modalities facilitating an accurate assessment of resectability have to be found. Preoperative imaging and endoscopic techniques are only successful in about 50% of cases. Diagnostic laparoscopy is the only method for visualization of peritoneal metastases. The use of diagnostic laparoscopy and laparoscopic sonography raise the accuracy concerning resectability from 20% to between 75% and 100%. 33% up to 67% of patients deemed resectable by preoperative imaging show signs of unresectable cancer at laparoscopy and can be spared an unnecessary laparotomy. For these patients a choice of laparoscopic or endoscopic bypass techniques is available. The laparoscopic hepaticojejunostomy without sutures developed in Zurich has proven to be efficient in animal trials and will soon be implemented in clinical trials. A differentiated indication for laparoscopic bypass techniques and endoscopic stenting is necessary. The laparoscopic procedures should be employed in patients with a risk of duodenal obstruction or a projected mean survival of more than 6 months (stage III), while endoscopic stenting has already been established in the treatment of patients with a survival of less than 6 months (stage IV).

Algorithms↗
PubMed1997

Laparoscopic anterior extended seromyotomy with posterior truncal vagotomy: an experimental study.

We describe a new laparoscopic modification of parietal cell vagotomy. The laparoscopic anterior extended seromyotomy with posterior truncal vagotomy was performed in five pigs weighing 21 to 25 kg each. Congo-red and pH tests were undertaken 2 weeks later by open gastrotomy. The photographs of the stained gastric mucosa made at the 5-min interval after Congo-red administration were analyzed with a computer-driven area calculation program. Preoperative and postoperative weights were taken for all animals. The experimental parietal cell vagotomy group was compared with the sham group and showed a minimal amount of nondenervated parietal cell mass (0.9 +/- 0.4% versus 28.2 +/- 3.9%, p < 0.05). The pH values showed an inhibition of gastric acid secretion (7.8 +/- 0.7 versus 2.2 +/- 0.4, p < 0.05). During postoperative follow-up, no significant difference in the weight increase of the experimental and the sham control group was noticed (1.6 +/- 0.6 kg versus 2.0 +/- 0.1 kg, p < 0.27). The laparoscopic anterior extended seromyotomy with posterior truncal vagotomy efficiently suppresses gastric acid secretion, preserving the motility of the antrum and pylorus and diminishing the risk of residual areas of innervation. This procedure avoids dissection of the esophagus and can provide an easier but equally effective operative treatment of ulcer disease compared with other types of parietal cell vagotomy.

Animals↗
PubMed1997

Experimental technique for (laparoscopic) bowel anastomosis: transient endoluminally stented anastomosis (TESA).

A new technique for bowel anastomosis is presented. The principle of transient endoluminally stented anastomosis (TESA) is based on anastomosing the two bowel ends around a resorbable stent of polyglycolic acid (PGA) in seroserosal contact. To evaluate the feasibility of TESA for bowel anastomosis, laparoscopic colon anastomosis following sigma resection was performed in five juvenile pigs. Three animals were sacrificed 2 months postoperatively, and the anastomoses were examined radiologically and histologically. One animal was sacrificed at day 2, suffering from acute peritonitis due to small bowel leak but with regular colon anastomosis. One trial was terminated at the fourth postoperative day because of insufficiency of the colon anastomosis. Three animals did not have any complications during the 2-month follow-up. In these animals the colon anastomoses were not detectable radiologically at the time of death. The microscopic examination showed intact mucosal and muscular layers without foreign material. Our study demonstrates that laparoscopic application of TESA to colon anastomosis is a feasible method. These results will further stimulate our future research for an anastomosis technique avoiding remnant foreign material.

Anastomosis, Surgical↗
PubMed1997

Stones spilled during cholecystectomy: a long-term liability for the patient.

Within the last 2 years, an increasing number of case reports concerning stone spillage during laparoscopic cholecystectomy and its long-term consequences have been published. Recently three patients were treated for abscesses caused by spilled stones at our institution. One of them had the longest interval between cholecystectomy and abscess formation on record. Her abscess developed 20 years after open cholecystectomy. The second patient had been admitted with one of the few cases of cholelithopthysis reported after laparoscopic cholecystectomy. All three cases and their long history of recurrences clearly underline the necessity for open debridement and drainage with stone removal for definitive treatment of these patients.

Abscess↗