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P Buchmann

Publications and source records attributed to P Buchmann.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Technique and results of laparoscopic rectum resection].

The general principles of oncologic operations for colorectal cancer are the same for both open and laparoscopic surgery. Isolation of the tumor by occlusion of the intestinal lumen, early blockage of venous outflow, complete resection of the lymph node bearing mesenterium, high ligation of the artery and prevention of tumor cell dissemination during extirpation of the specimen are the most important factors. We present our technique for laparoscopic abdominoperineal resection, which fulfills the above mentioned criteria. From June 1993 to October 1994 we operated on 19 patients (median age 68 [47-91] years; male/female ratio 10/9). Laparoscopic abdominoperineal resection of the rectum was palliative in 3 patients and curative in 16. Tumors were located 3 (1-8) cm from the anal verge. In 3 patients the operation was converted to open surgery. Intraoperative complications were encountered in 3 patients. Median operation time was 300 (200-400) minutes and postoperative morbidity 8/19 (42%) leading to reoperation in one patient. 30-day mortality was nil. Three patients died 5, 8, and 14 months postoperatively due to metastatic disease (all 3 after initial palliation). One patient had local recurrence and liver metastasis and died 14 months after operation. Another patient died from liver metastases. In one patient a single liver metastasis was successfully removed. 14 patients were tumor-free after a median follow-up of 10 (3-14) months. There was no implantation metastasis on a trocar site. Laparoscopic abdominoperineal resection of the rectum is feasible and the results are comparable with those of open surgery. Local recurrence rate and incidence of liver metastases are comparable with open surgery after this short follow-up. However, 5-year survival is needed to judge the oncological radicality of laparoscopic abdominoperineal resection of the rectum.

Adenocarcinoma↗
PubMed1996

[Reinterventions in secondary incontinence].

Overlapping sphincter reconstruction for fecal incontinence due to perineal tears, trauma or iatrogenic injuries is the therapy of choice. If this technique fails repeatedly or more than half of the sphincter is destroyed, a gracilis muscle plasty is indicated. Incontinence caused by an ectropion must be treated by a skin flap procedure (Ferguson or VY-plasty). These techniques are described in detail. Results of 54 overlapping procedures carried out in 47 patients (30 females, 17 males, age 15-84, median 47 years) during the last 3.5 years are presented. The most frequent cause of incontinence was fistulectomy followed by perineal tears. Thirty-day success rate with excellent or good results (difficulty in controlling flatus) was 82%, decreasing to 70% at the end of follow-up. Complications were rare (7/54) and did not influence outcome except for wound healing by second intention, which resulted in a high failure rate. Superior results were achieved when the reason for incontinence was a perineal tear (81%, compared with fistulectomy (64%). In conclusion, overlapping sphincter reconstruction results in a high success rate, especially when fecal incontinence was caused by a perineal tear.

Adolescent↗
PubMed1996

[Tumor cells in peritoneal irrigation fluid in conventional and laparoscopic surgery for colorectal carcinoma].

BACKGROUND: In minimal invasive cancer surgery port-side metastases are observed. The most plausible theory of there development is by tumor cell contamination during the operation. This prospective controlled study was designed to evaluate the moment of liberation of cancer cells, frequency of implantation and follow up after laparoscopically assisted and open resections. METHODS AND PATIENTS: The peritoneal cavity is washed out 4 times with 200 mls of Ringer' solution (at the beginning of the operation, after central ligation of the vessels, after mobilisation of the cancer and at the end). The aspirate is centrifuged and stained by Papanicolaou. Follow up is by the protocol of the swiss cancer study group. Up to now 71 patients (35 laparoscopical, 4 conversions, 27 open, 5 peritoneal carcinomatosis) have entered the study. RESULTS: Positive cytology was found in 4/35 laparoscopic and 5/27 open resections. Excluding the first wash out 1/35 (3%) and 3/27 (11%) respectively were positive, however, none at the end of operation. Only in 4/5 peritoneal carcinomatosis tumor cells were present in the final wash out. Median follow up of patients with positive cytology was 9,5 months [6-15] for laparoscopy and 8 months [2-11] for open surgery. Three from each group were followed more than 7 months. No recurrence or port-side metastasis was observed. In patients with negative cytology two cancer progressions were detected. DISCUSSION: The significance of free tumor cells for the development of implantation metastases is unclear. In 8/13 patients cytology was positive at the beginning of the operation, and only patients with a peritoneal carcinomatosis demonstrated cancer cells in the final wash out. In laparoscopy no cells were found in the second and one in the third wash out, resulting in a 1/35 risk of cancer cell liberation. Whether this patient will develop a port-side metastasis is unknown. He is followed for 8 months without tumor progression. We believe that a positive cytology alone cannot be the reason for implantation metastases. CONCLUSION: Using the minimal invasive technique for colorectal carcinoma resection liberation of cancer cells tends to be less compared with open surgery. For further conclusions the time of follow up is not yet long enough.

Adult↗
PubMed1996

[Sources of hazards in laparoscopic colon surgery and how to avoid them].

From May 1993 to September 1994 98 patients with colon pathology were operated with the laparoscopic method. Criteria for exclusion were: patient's wish, tumor size or tumor infiltration in adjacent organs. The resection was carried out strictly according to the guidelines of open surgery. All operations were performed by two laparoscopically experienced visceral surgeons. All routine colon operations were included. The conversion rate was 13%. The rate of anastomotic leakage was 3.5% in both laparoscopic completed resections as well as in left-sided resections, which is comparable to the rate found in open resections. The rate of stenosis, showed a similar finding amounting to 3.5%. A complication subject to laparoscopic surgery occurred in one of our early cases, namely the severing of the ureter, this complication can be avoided with sufficient experience. Furthermore a portside hernia (1.2%) was due to laparoscopy and can be avoided as well by accurate suture of the trocar incisions. Initial postoperative hemorrhage (n = 4, one of which required operative revision) were no longer observed with increasing experience and careful choice of the trocar incision sites. An initially increased rate of wound infections could be reduced substantially by using a wound-protecting device during surgery. Laparoscopic colon resection is a safe method, which has a reduced rate of relevant complications in comparison to open procedures. Prerequisite for success is optimal technical equipment, an experienced and well coordinated team, and the understanding that conversion to an open procedure is not to be considered a complication.

Adult↗
PubMed1996

[Intraperitoneal tumor seeding in colorectal carcinoma surgery--a comparison of laparoscopic versus open procedures in a longitudinal study]].

Tumor cell spread during laparoscopically assisted (n = 35) and open (n = 27) resections of colorectal cancer or patients with peritoneal carcinomatosis (PC) (n = 5) was studied by repeated lavage. Positive cytology was found in 3% during laparoscopy, 11% during open surgery and 80% in PC. We conclude that the risk of cancer cell mobilisation is minimal in laparoscopic surgery.

Adult↗
PubMed1995

[Does laparoscopic colonic carcinoma surgery satisfy the radicality criteria of open surgery?].

Minimal invasive surgery is applicable to almost all colorectal operations, with major benefit for the patient. Technically even cancer operations can be performed. However, in laparoscopic assisted colorectal surgery the question of radicality outweighs that of performability and patient comfort. From a prospective series of 88 laparoscopic colorectal operations, 36 were for carcinoma. 34 patients who underwent conventional surgery were matched with regard to age, sex, type of operation and tumor stage (TNM, grading) to compare the two techniques. The two interventions followed exactly the same guidelines. We compared the length of the fixed specimens, the number of resected lymph nodes and the need for blood transfusions. Postoperative complications were noted and follow-up was 3-12 months. The data obtained showed no difference between the two treatment groups, with a slight trend towards laparoscopic surgery with regard to number of resected lymph nodes. A portside metastasis was observed 9 months after an initial tumor stage T4N1M1. The close relation between the portside and infiltration of the adenocarcinoma into the abdominal wall together with a drain placed through this whole was suspected to be the cause of this complication. We conclude that laparoscopic assisted colorectal surgery for cancer is equal to open operation regarding radicality of resection. Long term results are mandatory to determine the value of minimal invasive surgery in the field of oncology.

Adult↗
PubMed1995

[How safe is laparoscopic colon surgery?].

Like any new technique, laparoscopic colon surgery must display results of the same or even better quality than established methods. In this hospital every laparoscopic colon operation has been registered since 1993. Patients were informed orally or in writing that the laparoscopic procedure is a new surgical technique and that, in particular, long term results in colon carcinoma are lacking. Patients who did not undergo the laparoscopic method were those who did not agree to this type of surgery, had tumor infiltrations without extensive liver metastases, or tumor sizes where laparotomy to retrieve the specimen is not much smaller than the open surgery incision. All operations without exception were performed by two laparoscopically skilled abdominal surgeons. We used four 12 mm Troicarts placed in a diamond position, the criteria for mobilization and resection strictly following those of open surgery. In rectosigmoid resection the specimens were extracted suprapubically, with simultaneous implantation of the anvil, in the other cases at appropriate sites. The anastomoses were created either by the double stapling technique or with a single layer running suture. 88 patients underwent operation. The change to open surgery was 11%. The reasons for the change were chiefly inflamed, bleeding diverticulitis tumor, carcinoma infiltrations and, in one case, bleeding. The anastomosis failure rate of the descendorectostomy, and in all laparoscopic colon operations, was 4% and compares favourably with the literature. This was also true of stenosis incidence. The wound infection rate is on the whole the same as for open surgery. The complication in the descendorectostomy is reduced by half in the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The value of defecography for diagnosis of rectocele and rectal prolapse].

The role of defecography with respect to rectoceles and to any grade of rectal prolapses has not been defined so far. Therefore, we studied 42 out of 45 patients that were submitted to a defecography between 1988 and 1992 for defecation disorders of unknown origin. In particular, we compared the diagnosis obtained by anamnestic data and the physical examination with the defecographic results and the definitive diagnosis with regard to the chosen therapies and the results. Rectocele and rectal prolapse were very frequent pathologies with 69% and 33% respectively. Of 23 patients with a clinically palpable rectocele, defecography was false negative in 4 and moreover, it did not provide any information about the functional relevance of the rectocele. Yet, it disproved the clinically diagnosed prolapses in 6 of 15 subjects, but revealed one in 5 of 27 patients that were presumed normal. On the other hand, a previously not diagnosed rectocele was detected in 6 out of 19 patients by means of defecography, but none of them proved to be of any clinical relevance. Of all rectoceles, only 48% were regarded responsible for the patients' symptoms and were therefore operated. Hereby, the indication for a surgical approach based more on anamnestic data and the proctological examination than on radiographic findings. Contrarily, the indication for a rectopexy--even if given only in 4 of those 14 patients with any grade of invagination--mainly based on the dynamics during defecation as documented by defecography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Gastroenterostomy "par principe" or "de nécessité" in palliative therapy of pancreatic cancer?].

There has been a controversy for years concerning the value of the prophylactic gastroenterostomy (GE) in patients suffering from irresectable pancreatic cancer. A retrospective analysis of the patients undergoing palliative bypass-operations for pancreatic cancer at Zurich University Hospital between 1982 and 1990 revealed 53 patients (28 male, 25 female) with an average age of 68 years. Twenty-one patients received a double bypass, 18 received a hepaticojejunostomy, 12 a primary and 2 a secondary GE. Mortality and morbidity for double bypass were 14% and 33%, for hepaticojejunostomy 5% and 28% and for primary GE 25% and 50%. Secondary GE was associated with a mortality and morbidity of 1 of 2 cases. Two patients received a secondary GE and two more showed signs of duodenal obstruction amounting to 20% incidence for secondary duodenal obstruction. Delayed gastric emptying was observed in only 2 patients with primary GE. These data suggest the use of a prophylactic double bypass.

Aged↗
PubMed1993

[Sliding flap-plasty in treatment of anal fistula: a prospective study].

The common therapy for trans- and intersphincteric fistula usually is opening the fistula tract. Healing and rough continence thereafter is uneventful, but when follow-up is intensified and patient are asked for slight soiling and discharge many minor complaints become evident. Therefore we started a series of patients suffering from inter-, trans-, extrasphincteric or supralevatoric fistula with an advancement flap procedure after excision of the fistula, without dissection of any muscle fibre. Up to now 23 patients were operated including 5 with Crohn's disease. 17/23 were healed primarily and 6/23 failed to heal with 5 successful reoperations. 4/5 Crohn's patients operated during quiescent disease are healed. No discharge or soiling was reported after a follow-up time from 5 months to almost 2 years. In conclusion advancement flap gives best results in respect to continence. The flap should include not only mucosa but underlying internal sphincter muscle fibres too.

Adult↗
PubMed1992

[Retroperitoneal rectum perforation during barium enema].

The examination of rectum and colon with barium sulfate is a method which is increasingly replaced by the endoscopy; therefore, the routine of doing this examination is increasingly vanishing. This means that the risk of this method increases. We report a case and discuss the symptomatology as well as the management of a perforation of the rectum during an examination with barium sulfate.

Aged↗
PubMed1992

[The endoscopic treatment of malignant biliary tract stenoses with endoprostheses].

In 65 patients (36 men, 29 women; mean age 74 [43-90] years) obstructive jaundice caused by malignant biliary stenosis was treated by endoscopic retrograde insertion of a 10 or 12 F synthetic endoprosthesis. The rate of complications of the endoscopic intervention was 5% (n = 3), 30-day mortality rate was 11% (n = 7) and method-related mortality was 8% (n = 5). Good drainage was achieved in 39 of 41 patients (95%) with the 12 F endoprosthesis, and in 15 of 21 patients with a 10 F one (71%) (P less than 0.001). Renewed jaundice due to prosthesis occlusion occurred in 31 patients an average of 103 (11-350) days after placement. Interval until occlusion correlated with the site of the stenosis and the length of the endoprosthesis. Jaundice recurred earlier in patients with long prostheses and proximal biliary stenosis than in those with a short prosthesis and distal stenosis. In 20 patients with renewed jaundice the endoprosthesis was replaced endoscopically. At that time 13 of the patients had a cholangitis. Occlusion of the new endoprosthesis was more common in patients with cholangitis (9 of 13) than those without (2 of 7; P less than 0.05). These findings indicate that endoscopic biliary tract drainage should be performed with as short a 12 F endoprosthesis as possible. In view of the potential need for early change of endoprosthesis the biochemical parameters of cholestasis should be regularly monitored.

Adult↗
PubMed1992

[Preventive or therapeutic parathyroidectomy in primary hyperparathyroidism].

The only causal treatment of primary hyperparathyroidism (PHPT) is parathyroidectomy. There are indications in the literature that despite operation expectation of life is shortened because of an increased frequency of cardiovascular and malignant diseases leading to the recommendation for early surgery even in uncomplicated PHPT. It is easier to convince an asymptomatic patient of an operation when he is informed about complications and consequences of an expectative attitude. Therefore, we reviewed our 71 patients operated upon during a 4-year-interval, 58 of whom were followed-up. During 82 operations 115 pathologically altered parathyroid glands were removed. Two persistent paralyses of the recurrent nerve occurred, however, without alteration of the voice. Follow-up of 82% of patients revealed 2 cases of recurrent nephrolithiasis (1 hypercalcaemia, 1 normocalcaemia). Three (5%) true recurrences were found, but neither a pancreatitis nor a peptic ulcer was noted during long-term follow-up. None of the 137 patients operated for a bleeding or perforated peptic ulcer during the last 10 years and 1 of 55 patients with acute pancreatitis during the past 8 years suffered from a PH-PT. However, morbidity and mortality of these two conditions was high. Although correlation to PHPT was low we recommend early operation of PHPT because of the low morbidity rate, zero lethality and reduced expectation of life.

Adenoma↗
PubMed1992

[Anal condylomata acuminata in HIV positive patients].

Since July 1986 we started with following all patients with condylomata acuminata including HIV-testing and human papilloma virus (HPV) identification by DNA-DNA-hybridisation (southern blot). Seventy patients are included, 39 of them are seropositive. The ratio male to female is 59 to 11, in seropositives 35 to 4, in negatives 24 to 7. The average age is 28 and 31 years respectively. The number of homosexuals and junkies is significantly higher in seropositives. Seventeen patients are in HIV-stage II, 11 in stage III and 10 in stage IV according to CDC-classification. Characteristic for the seropositives was an extensive growth on the rectal mucosa and the very rapid growth of initially subtotally resected lesions in order to prevent stenosis. Sixty-five patients were treated by one stage radical operation with electrocauter. Surprisingly recurrency is more frequent in seronegatives, however, the lesion is much smaller in this group. A hypothesis to explain this observation is brought forward. Postoperative complications occurred only in HIV-stages III and IV. We therefore recommend single shot antibiotic prophylaxis in these patients. The HPV-identification showed no malignancy associated HPV-types in both groups but a higher incidence of HPV 11 in higher HIV-stages which we cannot explain. We conclude from our series that, if operation is indicated, one stage radical electrocoagulation of condylomata acuminata is a necessary procedure in seropositive patients and a save one in negative patients but antibiotic prophylaxis should be given in stage III and IV. Anal condylomata acuminata are a hint for possible HIV-positivity.

Adolescent↗
PubMed1992

[Is routine intra-operative cholangiography in laparoscopic cholecystectomy truly unnecessary?].

The introduction of laparoscopic cholecystectomy as method of choice for gall stone treatment reopened the question whether to continue with routine intraoperative cholangiography or to switch over to a selective indication. In order to set an accurate indication for selective intraoperative cholangiography it was our goal to develop a tool for preoperative identification of patients with a high risk of common bile duct stones. A preoperative score, indicating the risk of common bile duct stones, was designed. A history of jaundice, elevated levels of bilirubin, alkaline phosphatase, amylase (serum), ALAT (GPT) or ASAT (GOT), a common bile duct wider than 10 mm or containing concrements and multiple gallstones smaller than 10 mm were valued as risk indicators, whereas normal wide bile duct, large or solitary gallstones were valued as decreasing the risk of common bile duct stones. The retrospective screening of 289 consecutive conventional cholecystectomies (1986-1990) for these risk indicators demonstrated a good correlation of the risk score with the occurrence of common bile duct stones. A prospective application of the score, with improved ultrasound examination and routine preoperative intravenous cholangiography, mandatory for laparoscopic cholecystectomy at our institution, will define the high risk group definitely and allow an accurate selective use of intraoperative cholangiography.

Cholangiography↗