Successful canine small bowel preservation in simple cold storage for 48 hours using a dextran-40-based solution.
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Adenosine↗
Biomedical subjects
R Schlumpf
Publications and source records attributed to R Schlumpf.
[Laparoscopic cholecystectomy: results and complications--remaining indications for open cholecystectomy].
Since the introduction in 1987, laparoscopic cholecystectomy (LC) became the method of choice to treat symptomatic cholecystolithiasis. The results of four multicenter studies show a morbidity rate of 3.0% and a mortality rate of 0.05%. Injuries to the common bile duct or to an accessory bile duct occurred in 0.43% of cases and were recognized and treated intraoperatively in 31.3%. Conversion to open cholecystectomy was performed in 4.9%. Patients were discharged to home after 3.0 to 4.4 days (european cases) and returned to full time employment 10 to 14 days following intervention. Indication for primary open cholecystectomy have become rare and include absolute contraindications to perform LC and relative contraindications, including certain cases of severe acute or chronic inflammation, especially when patients previously have undergone upper abdominal surgery.
Cholecystectomy↗
[Retroperitoneal sarcoma. Therapy and course].
The incidence of retroperitoneal soft tissue sarcomas is with 0.1 to 0.2 percent very low. The tumors most often present as asymptomatic masses until the lesions are quite large, compared with the anatomic part, resulting in compression of nerves, vessels, bowel etc. The recommended management is the aggressive radical tumor excision including the pseudocapsule followed by a consequent clinical, ultrasonography and CT-scan follow-up. Tumor recurrences should be attempted in the same manner as primary tumors.
Adolescent↗
[Thoracoscopic resection of a schwannoma].
Schwannomas are most often benign tumors originating from the sheath of peripheral nerves. Most are asymptomatic and detected incidentally on a routine chest X-ray. Resection is generally recommended to confirm the diagnosis. In a 35-year-old patient we resected and removed an intrathoracic schwannoma of the 6th intercostal nerve thoracoscopically. The technique of resection and protected removal is described.
Adult↗
Technique of laparoscopic cholecystojejunostomy with a Roux-en-Y loop.
In order to avoid laparotomy in patients with biliary obstruction due to inoperable carcinoma of the pancreatic head, we evaluated the feasibility of a bypass operation using minimal invasive measures. A technique of laparoscopic cholecystojejunostomy was tested in adult pigs who had undergone clip occlusion of the distal common bile duct to imitate choledochal obstruction. Complete biliary bypass was restored with a cholecystojejunostomy via a Roux-en-Y loop using two circular staplers (21, 25, or 29 mm diameter), introduced through a prototype 33-mm-diameter trocar, used to effect the proximal and distal anastomoses. Seven pigs operated on in this way recovered easily, with normal weight gain and without technical complications. Contrast radiography of the biliary bypass at autopsy on day 28 confirmed patent and leak-free anastomoses and functional bypass. We conclude that laparoscopic cholecystojejunostomy with a Roux-en-Y loop is a feasible technique and results in an uncomplicated postoperative course and a biliary bypass with optimal function. Endoscopic application of circular staplers for laparoscopic enterobiliary and enteroenteral anastomosis is practical and safe.
Abdomen↗
Minimal invasive surgery for treatment of enlarged symptomatic liver cysts.
Congenital solitary liver cysts are a common finding, but they are usually asymptomatic; however, symptoms occur in about 16% and then require treatment. Ideally, complete or partial resection of the cyst is the treatment of choice but always implies invasive surgery. We report the case of a 50-year-old woman suffering from a massively enlarged cyst in the left liver lobe. We decided to resect the extraphepatic part of the cyst by laparoscopic surgery. The patient was discharged absolutely asymptomatic 3 days following surgery. We conclude that open resection of symptomatic congenital liver cysts should be replaced by laparoscopic removal when cysts are mostly extrahepatically located. The laparoscopic procedure combines the advantages of minimal invasive surgery with the demand for a radical effective treatment.
Cysts↗
[Intraoperative ultrasound--an alternative to cholangiography in laparoscopic cholecystectomy? A prospective study].
The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomy. A 360 degree-sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients entered into the study. In the beginning 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones and their postoperative history was uneventful. In the 50 patients operated on subsequently both laparoscopic sonography and IOC were tried. IOC was not performed due to technical failure in 4 patients and due to allergic reactions to contrast media in one patient. Thirty-one patients demonstrated normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In three cases a stone was seen on IOC and intraoperative sonography. In one case a duodenal diverticulum containing debris, demonstrated by IOC, was the reason for a false positive sonographic finding. Sensitivity and specificity of laparoscopic sonography concerning the visualisation of bile duct stones were 100 and 98%, respectively. The time necessary for the examination was significantly shorter in laparoscopic sonography than in intraoperative cholangiography (p = 0.0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered a safe, fast and non-invasive alternative to intraoperative cholangiography.
Adolescent↗
[Significance of laparoscopic surgery in the treatment of cholecysto- and choledocholithiasis].
The management of common bile duct stones during laparoscopic cholecystectomy contains some controversy. Our first aim is to detect choledocholithiasis preoperatively making use of a preoperative ultrasound and cholangiogram routinely. Laparoscopic cholecystectomy will follow a preoperative ERCP with endoscopic sphincterotomy and stone extraction in this desirable situation. Cystic duct cholangiography which should become a routine procedure during laparoscopic surgery is feasible in 90-99% and will detect unsuspected common duct stones and iatrogenic bile duct injuries with an accuracy rate of 75.4-90%. This investigation can replace the preoperative cholangiogram in future. A intraoperatively detected common bile duct stone can be managed nowadays by ERCP and sphincterotomy postoperatively or by converting the laparoscopic cholecystectomy into an open common bile duct exploration. Laparoscopic common bile duct exploration is of increasing demand but not yet a routine procedure. If choledocholithiasis will be diagnosed postoperatively, a ERCP with papillotomy will be performed as well. An inquiry among 50 members of the Swiss society of laparoscopic and thoracoscopic surgery (ALTC) with 3718 laparoscopic cholecystectomies pointed out their opinion about the management of common bile duct exploration during laparoscopic surgery in the presented paper.
Cholangiopancreatography, Endoscopic Retrograde↗
Prognostic factors of hemolytic uremic syndrome in renal allografts.
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Adult↗
Acute vascular rejection with hemolytic uremic syndrome in kidneys from non-heart-beating donors: associated with secondary grafts and early cyclosporine treatment?
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Acute Disease↗
[Laparoscopic cholecystectomy in Switzerland. Critical retrospective evaluation of the first 3,722 cases. Swiss Professional Society of Laparoscopic and Thoracoscopic Surgery].
In a national prospective multicenter study 3722 laparoscopic cholecystectomies (LC) performed by 179 surgeons in 50 Swiss institutions were analysed with special regard to technique and complications. Conversion to open cholecystectomy was necessary in 259 patients (7.0%), either expectively without intraoperative complications (4.5%) or due to intraoperative complications (2.5%). Three patients (0.08%) died within 30 days after operation and a total of 39 patients (1.0%) had to be reoperated. 31 (0.8%) bile duct injuries were registered. Common bile duct (CBD) stones were treated mainly by ERCP. In 8 cases laparoscopic removal of common bile duct stones was attempted and performed successfully in 6 patients. Postoperatively patients were discharged home after a mean of 4.4 days and returned to work after 14.0 days (range: 2-28). Laparoscopic cholecystectomy became the gold standard to remove the gallbladder, but further development is needed, to establish laparoscopic treatment of biliary tract stones in the near future.
Adolescent↗
[Removal of kidneys from donors with circulatory arrest. A simple procedure in lessening the shortage of donor kidneys].
The increasing list of patients waiting for an organ transplantation shows clearly the shortage of donor organs at disposal. This shortage is particularly high in the field of kidney allotransplantation. As the nephrectomy in non-heart beating (NHB) donor is technically practicable in most of our hospitals, the aim of this contribution is to pass on further informations about the nephrectomy to those doctors who are interested in the procedure. The first part of the paper explains the different facts of the end staging renal disease in Switzerland and of transplantation activity. We focus then on the conditions and preparations of the nephrectomy in NHB donor, the exact technique of the operation and the organ perfusion. As it is shown by different studies, the long-term results of NHB donor kidneys are good. The nephrectomy in NHB donor is an effective method to solve kidney shortage.
Brain Death↗
Kidney procurement from non-heartbeating donors: transplantation results.
To overcome the shortage of kidneys (kdn's) available for transplantation we reactivated kdn procurement from non-heartbeating donors (NON-HBD). In this study, we reviewed our results with 34 kdn's from NON-HBD, transplanted between 1985 and 1991, and compared these with 34 control kdn's procured from heartbeating donors (HBD) matched for age, sex, primary graft or retransplant and transplant year. There was no difference in cold ischemia time, preservation solutions used, duration and type of preoperative dialysis, number of HLA mismatches and serum antibody levels between the two groups. The only significant findings were a lower diuresis in the last hour in the donors in the NON-HBD group, and a significantly higher serum creatinine level compared to the HBD group. The 1-year patient and graft survival rates were 89.4% and 84.9% for the HBD group, and 78% and 76.1% for the NON-HBD group respectively. There was need for dialysis support in the first posttransplant week in 10 out of 34 (29%) recipients in the HBD and 17 out of 34 (50%) recipients in the NON-HBD group. Primary non-function was observed in 1 of 34 (3%) recipients in the HBD group versus 3 of 34 (9%) in the NON-HBD group. None of the differences were statistically significant. There was also no difference in average serum creatinine levels at days 1, 3, and 7, at 1 month and at 1 year between the HBD and NON-HBD groups. In the NON-HBD group 6 of 34 kdn's (18%), 5 of which were retransplants, showed vascular rejection, 5 of them associated with haemolytic uremic syndrome (thrombotic microangiopathy); 2 of these 6 kdn's recovered, and 4 failed (2 with primary non-function). This important observation needs to be investigated further. The results is this study showed, however, that good short- and long-term results can be achieved with kdn's from NON-HBD. We concluded that organ procurement from NON-HBD is an adequate approach to an important cadaver donor source that in general is not effeciently used, but could significantly increase the number of kdn grafts in most transplant programs.
Adult↗
Thoracoscopic resection of benign schwannoma.
The recent improvement of endoscopic surgical instruments allows new therapeutical application of thoracoscopy. We report a thoracoscopic resection of a benign schwannoma of the 6th intercostal nerve in a 35-year-old patient. The operative technique and extraction of the tumor from the chest is described. Postoperative morbidity was minor. We consider the thoracoscopic resection as first choice of treatment.
Adult↗
Penetration of fleroxacin into human lung, muscle, and fat tissue.
Fleroxacin is a new fluoroquinolone with established potent antimicrobial and pharmacokinetic properties, and the aim of this study was to determine its rate of penetration into human lung, muscle, and fat tissues. In a total of eight patients undergoing lung surgery, plasma and tissue concentrations of unmetabolized fleroxacin were determined. This was done in subgroups of two patients each, receiving either 6, 8, 12 or 24 hours prior to surgery one single oral dose of 400 mg fleroxacin. It was found that fleroxacin penetrates well into muscle and lung tissues, but not into fat tissue. The levels in muscle and lung were 1.1 to 4.7 times higher than the according plasma concentrations.
Adipose Tissue↗
Injury to an accessory bile duct during laparoscopic cholecystectomy.
Anatomic variations of the bile duct system are frequent. Accessory cholecystohepatic ducts have been reported, but remain unrecognized in most patients. We present the case of an 53-year-old woman suffering from cholecystolithiasis. Five days after laparoscopic cholecystectomy, symptomatic bile collection in the peritoneal cavity was found. Endoscopic retrograde cholangio-pancreatography (ERCP) with papillotomy showed a bile leak in the gallbladder bed. During relaparoscopy, we were able to identify and to clip an accessory bile duct in the caudal part of the gallbladder bed. Symptomatic injury of an accessory bile duct is a rare complication of laparoscopic cholecystectomy and difficult to prevent. Intraoperatively we recommend the use of operative cholangiography to reveal anatomic variations. Postoperatively the leak can be identified by ERCP, but sphincterotomy should be done simultaneously. If necessary, however, the injury can be repaired by laparoscopic means.
Bile Ducts↗
72-hour preservation of the canine pancreas: successful replacement of hydroxyethylstarch by dextran-40 in UW solution.
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Adenosine↗
[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↗