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Biomedical subjects

P Gertsch

Publications and source records attributed to P Gertsch.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Comparison of partial Billroth I, classical Billroth II gastrectomy and resection with Roux-en-Y reconstruction with reference to postoperative quality of life].

53 patients submitted to gastric resection and reconstruction either by means of Roux-en-Y gastrojejunostomy, Billroth I or Billroth II operation were followed for a mean of three years and compared for clinical status using the Visick grading system, dumping grading after the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Personal follow up by the same examiner corresponding to a standardized questionnaire and the objective grading revealed that our results for individual operations compared well with the reports of other studies investigating mostly only one type of operation for one criterion. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I and especially Billroth II reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Adult↗
PubMed1990

[Surgery of benign and malignant primary liver tumors].

Better, noninvasive, diagnostics, better knowledge of anatomy and of surgical techniques have been responsible for a considerable development of liver surgery during recent years. Primary malignant liver tumours can only be cured by resection. The decision for resectional surgery should be based on different tumor characteristics, of whom the nature of the liver tissue (normal or cirrhotic) in which the tumor develops in of utmost importance. A malignant tumor should be resected with save, tumor-free margins, leaving behind as much normal functional parenchyma as possible. The role of complementary therapies as e.g. chemotherapy, chemo-embolisation and arterial ischemia must be further developed. Liver transplantation will probably play a more important role in the future development of liver cancer treatment. Surgery for benign liver tumors can be restricted most of the time to a limited resection; extended hepatectomies are rarely necessary. The more deliberate use of intraoperative ultrasound and hepatic vascular exclusion as well as the more frequent use of ultrasound dissectors will allow safer liver surgery; this applies especially for the excision of benign solid liver tumors. Because of their degenerative risks, liver adenomas should be excised. Focal nodular hyperplasia and haemangioma remain rare indications for surgery. The low morbidity and mortality of elective liver resections should favour a more widespread use of surgery for the treatment of malignant as well benign liver tumors.

Adenoma↗
PubMed1990

[Postoperative course following stomach resection: a comparison of Billroth I, Billroth II and Roux-en-Y resection-reconstruction].

53 patients who underwent gastric resection and reconstruction either by Roux-en-Y gastro-jejunostomy, Billroth I or Billroth II operation, were followed for an average of three years and compared for clinical status using the Visick grading system, dumping grading by the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Response to a standardized questionnaire and objective grading showed that our results for individual operations compared well with others reports. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I, and especially Billroth II, reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach, provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Anastomosis, Roux-en-Y↗
PubMed1990

Management of the Mirizzi syndrome and the surgical implications of cholecystcholedochal fistula.

Several methods of handling the residual choledochal defects encountered during operation for type II Mirizzi syndrome have been described. Early experience with eight patients treated by a variety of procedures including direct suture and flap techniques led to disappointingly high morbidity and mortality rates. Since 1986 a standardized surgical approach has been used in four patients without complications or mortality. Essential to management are preoperative diagnosis by ultrasonography and endoscopic retrograde cholangiopancreatography and classification of the Mirizzi syndrome into two types as proposed by McSherry. Mirizzi type I consists of an extrinsic compression of the hepatic duct by a calculus impacted in the cystic duct or in Hartmann's pouch. This is treated by cholecystectomy with or without common bile duct exploration. In the more difficult Mirizzi type II, the stone has eroded into the hepatic duct causing a cholecystcholedochal fistula. This is treated by partial cholecystectomy and a cholecystcholedochoduodenostomy. This management strategy prevents inadvertent bile duct injury and has yielded satisfactory results.

Aged↗
PubMed1990

[Technic of papilloduodenectomy].

Local excision of preiampullary tumours first described in 1989 has been relegated in the background after introduction of pancreaticoduodenectomy in 1935. Recent reports suggest that ampullary excision may give good results. In order to define the place of this operation which may be a simple excision of the duodenal mucosa (ampullectomy) or a wide excision of the papilla encompassing the posterior duodenal wall and the distal bile and pancreatic ducts (papilloduodenectomy) it is important to make a clear distinction between these two techniques. We describe the technique of papilloduodenectomy and define the place of this operation, which may be useful in selected cases.

Ampulla of Vater↗
PubMed1990

Multiple tumors of the biliary tract.

Multiple synchronous tumors of the extrahepatic biliary tree are not frequently reported. Over a 2-year period, 54 operative procedures were performed for tumors of the extrahepatic biliary tract or periampullary region. In five of these cases, unsuspected tumors were observed. Of these, one patient had multiple benign papillomatosis of the extrahepatic biliary tree. All four of the other patients were found to have unsuspected small carcinomas of the gallbladder in association with mid- or low bile duct cancer. Multiple tumors of the extrahepatic biliary apparatus may occur more frequently than previously thought, and the incidence of unsuspected gallbladder cancer in association with bile duct cancer may be high. These tumors should be suspected and looked for in each instance by intraoperative endoscopy and careful histologic examination of the gallbladder.

Adenocarcinoma↗
PubMed1990

Hepatic abscess after biliary tract procedures.

Seven patients with hepatic abscess that developed after prior operation upon the biliary tract were treated during a two year period. In contrast with the fulminant clinical presentation of hepatic abscess usually associated with acute obstructive suppurative cholangitis, the presentation of hepatic abscess after prior biliary tract procedures was surprisingly indolent; several patients had been treated with oral antibiotics for several weeks or months with the presumptive diagnosis of nonsuppurative cholangitis. Thorough investigation of the entire biliary tree was necessary to identify associated biliary disease, which included biliary-enteric anastomotic stricture, intrahepatic stricture, excluded sectoral bile duct from iatrogenic injury and reflux of abnormally contaminated intestinal contents. Extensive reconstructions of the biliary tract were performed upon three patients. Recurrence of the abscess occurred once after percutaneous and once after surgical drainage and was managed by drainage of the associated excluded sectoral bile duct or fistulojejunostomy. Operative drainage of hepatic abscess after prior biliary operation may be preferable to percutaneous techniques to provide definitive surgical management of associated pathologic findings of the biliary tract.

Adolescent↗
PubMed1990

[Pneumoperitoneum and Mersilene mesh in the treatment of giant abdominal wall hernias].

Fourteen patients with giant abdominal hernias were treated at our institution from 1985-1989. In all cases the hernial orifice was at least 20 x 20 cm, and the hernia had at least a size of a child's head. In 11 cases a progressive preoperative pneumoperitoneum of 10-14 liters over 14-21 days was performed. This procedure was initially done in hospital and then on an outpatient basis. In 13 patients the hernia was repaired using a retromuscular/preperitoneal Mersilen-mesh fixed subcutaneously. In one patient the hernia could be repaired with a Mayo type repair after preparation with a pneumoperitoneum. Postoperative problems were minimal, and no recurrence has so far been observed after a follow-up period of 5 to 44 months. By the combination of preoperative pneumoperitoneum and a retromuscular Mersilen-mesh even giant abdominal hernias in polymorbid patients can be repaired.

Abdominal Muscles↗
PubMed1990

[Rupture of a subcapsular liver hematoma in the postpartum period associated with HELLP syndrome].

We describe the case of a 31-year-old woman who underwent a section caesarean and 24 hours later a laparotomy for treatment of a ruptured subcapsular liver hematoma due to a HELLP syndrome. The HELLP syndrome (hemolysis, elevated liver enzymes, low platelets count) is a serious complication of the pregnancy with or without eclampsia. This complication has a high mortality and morbidity and can occur during the pregnancy or after delivery. The diagnosis of a subcapsular hematoma of the liver should be considered in patients with acute abdominal pain in the last trimenon or just after delivery. Laparotomy must be performed at the first signs of hemodynamic instability.

Adult↗
PubMed1990

[Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery].

Cholangitis occurring after biliary-enteric anastomosis is a well-recognized but insufficiently analyzed surgical complication. Guidelines for assessment have not been established and management remains controversial. We examined a two-year experience with recurrent cholangitis following bilio-enteric anastomosis; cholangitis in the absence of anastomotic obstruction was surprisingly frequently encountered. Although selected cases without anastomotic stenosis may be amenable to nonoperative treatment, a low threshold for surgical reintervention should be maintained because radiologic assessment of anastomotic patency is often equivocal and the clinical problem is often best managed surgically.

Cholangitis↗
PubMed1990

The technique of papilloduodenectomy.

Papilloduodenectomy consists of precise and wide resection of the papilla of Vater, performed by stepwise incision of the posterior duodenal wall around the papilla, with sequential hemostasis followed by suture placement between the duodenal wall and bile duct. The end results after completion of the resection assures fixation of the biliary and pancreatic duct to the posterior wall of the duodenum, which minimizes the risk of biliary or pancreatic leakage. Results of local excision of the papilla of Vater for periampullary tumors appear satisfactory and this procedure may be particularly indicated for older or higher risk patients. Pancreaticoduodenectomy should probably remain the procedure of choice for reasonably fit patients with established malignant disease.

Adenocarcinoma↗
PubMed1989

Resectability of large focal liver lesions.

Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, 'hanging' tumours (n = 7) were resected in six cases, expansively growing 'pushing' tumours (n = 19) were resected in 18 cases, and infiltrating, 'invasive' tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (less than 5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.

Humans↗
PubMed1989

[The resectability of large focal liver lesions].

This paper presents a simple clinical concept of tumor morphology considered to be of value in the preoperative assessment of focal liver tumours. Based on preoperative clinical and radiological investigation and laparotomy in a large number of liver lesions, we propose a classification of liver tumours of special value in the preoperative assessment of resectability of large primary and secondary liver tumours.

Adenoma↗
PubMed1989

"Piggy back" adult orthotopic liver transplantation.

In analogy to liver transplantation techniques developed in children, a method of adult liver grafting is described in which the recipient, intra- and retrohepatic, inferior vena cava is completely preserved.

Adult↗
PubMed1989

[Follow-up after surgery of the bile ducts].

The main emphasis of aftercare after surgery of the biliary tract is on monitoring the bile flow as a means of assessing the underlying disease and the patient's postoperative condition. If there is evidence of a bile flow disturbance, the cause must be discovered and eliminated in order to prevent secondary lesions from occurring in the liver.

Bile Duct Diseases↗
PubMed1989

[After-care following surgery of the pancreas].

Postoperative treatment after pancreas surgery is concentrated on the function of the exocrine and endocrine part of the gland. While functional disturbances of the endocrine pancreas may give rise to serious problems associated with diabetes, functional disturbances of the exocrine pancreas are less important. On the other hand, flow disorders of the exocrine pancreas may lead to pancreatitis, fistulas, cysts, and abdominal sepsis. Pancreatic tumours are not infrequently apudomas whose biology has an important bearing on the after-treatment. Thrombophlebitic splenomegaly may lead to portal and possibly to segmental portal hypertension. In this event, a careful follow-up examination will be needed to decide whether further surgery is necessary.

Humans↗