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Biomedical subjects

W Spangenberger

Publications and source records attributed to W Spangenberger.

15 recordsLinked to original sources
PubMed1992

Evaluation of routine upper digestive tract endoscopy before laparoscopic cholecystectomy.

Endoscopy of the upper digestive tract was performed in 376 patients with symptomatic gallstone disease before elective laparoscopic cholecystectomy. Abnormalities were found in 60 patients (16.0 per cent); these included peptic ulcer (n = 14), gastric erosions (n = 15) and oesophagitis (n = 11). Thirty patients were treated medically and two by endoscopic polypectomy. In four patients endoscopy led to cancellation of cholecystectomy; in two the complaints have persisted. Statistical analysis of 28 variables showed few significant differences in symptoms between patients with normal and those with abnormal appearances at endoscopy. It is concluded that routine endoscopy before laparoscopic cholecystectomy is neither clinically useful nor cost effective in patients with symptomatic gallstone disease. This conclusion is related exclusively to patients with typical gallstone symptoms according to the definition used in this department.

Adolescent↗
PubMed1992

Laparoscopic cholecystectomy: technical performance, safety and patient's benefit.

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.

Cholecystectomy↗
PubMed1992

Laparoscopic surgery in children and adolescents with suspected appendicitis: results of medical technology assessment.

Laparoscopy has been performed in 43 patients aged up to 18 years with suspected appendicitis; 20 were children 8-15 years and 23 adolescents 16-18 years of age. Diagnostic laparoscopy was successful in 36 (84%) patients; in 7 (16%) subsequent laparotomy was necessary to establish the diagnosis, in 4 (9%) because the appendix was not visualized. Laparoscopic appendectomy was done in 33 (77%) patients, additional laparoscopic adhesiolysis in four and inversion of a diverticulum in one. Changing to laparotomy during the laparoscopic operation was necessary in one patient because of a technical problem and in another because of bleeding of the appendicular artery. Laparoscopy was totally free of complications in 33 (77%) patients; another 9 (21%) had surgical or technical problems without negative outcome for the patient. In one (2%) patient a wound infection led to a negative outcome; there were no other laparoscopy-related events. The mean intensity of pain on the first day after laparoscopic appendectomy was 31 points (Visual Analogue Scale with 100 points) and decreased to nearly zero on the third day; 37% of patients needed opioids on the first and none on the third day. There was no statistical difference for pain intensity and consumption of analgesics after appendectomy via laparoscopy versus laparotomy. We conclude that diagnostic and therapeutic laparoscopy in children and adolescents with suspected appendicitis is a safe and effective procedure.

Adolescent↗
PubMed1992

[Routine gastroscopy before laparoscopic cholecystectomy: evaluation of the technology in 376 patients].

We performed endoscopy of the upper digestive tract in 376 patients before elective laparoscopic cholecystectomy. Abnormalities were found in 60 (15.9%); 14 patients had peptic ulcers, 15 gastric erosions, and 11 oesophagitis. Because of endoscopic findings 30 patients were treated medically and 2 by endoscopic polypectomy. Endoscopy lead us to cancel cholecystectomy in 4 patients; in 2 the complaints have persisted. Patients with abnormal endoscopic findings showed few significant differences in 40 variables (history and symptoms) compared with patients with normal findings. The incidence of ulcers, erosions or oesophagitis in patients over 72 years of age without loss of weight was 28.6%, compared with an overall incidence of 10.6%. Endoscopy confined to this group of patients, however, would have shown only 15% of all lesions. Consequently these predictors for endoscopic abnormalities had no practical benefit. Technology assessment according to the criteria of Fineberg et al. showed a health improvement for only 2 patients (0.5%). We conclude that routine endoscopy before laparoscopic cholecystectomy is not clinically useful in patients with symptomatic gallstone disease. This is exclusively related to patients with typical gallstone symptoms according to our definition.

Adolescent↗
PubMed1991

Conventional versus laparoscopic cholecystectomy and the randomized controlled trial. Cholecystectomy Study Group.

We considered using a randomized trial to assess the value of laparoscopic cholecystectomy in the treatment of symptomatic gallstones. The pros and cons for the timing of such a trial were in favour of not beginning the trial until surgeons learned to use the new procedure safely and effectively, and until key endpoints and outcome indices could be identified and assessed using valid measures. Instead an observational study was implemented to monitor the learning curve of surgeons as they mastered the laparoscopic equipment and procedures, and to assess the responses of the patients to the procedure. In the first 100 patients, the procedure proved to be as safe and feasible to use as conventional surgery, and there were strong benefits in terms of quicker recovery of the patients with less pain, discomfort, and a reduced length of hospital stay. The responses of the surgeons and the patients to the new procedure now place ethical constraints on the planning of a randomized controlled trial. Currently, comprehensive surveillance and monitoring of laparoscopic cholecystectomy is the only realistic method with which to assess the impact of this new technology in our clinic.

Adult↗
PubMed1991

[Conservative surgery--choice of procedure and strategy: invasive versus minimally invasive surgery].

From the patient's view conservative surgery means less stress and strain through therapeutic interventions. Important criteria for assessment are freedom of pain, preservation of health or quick recovery from bodily impairments as well as reestablishment of integrity and fitness. The surgeon meets the patient's expectations through a careful interview, an operation with a minimally traumatizing access, a rather reliable technique and a careful follow-up. Endoscopic surgery most likely complies with this conception. This is shown in a prospective observational study on laparoscopic cholecystectomies in 500 patients and can also be expected for future indications.

Activities of Daily Living↗
PubMed1990

[Laparoscopic cholecystectomy--initial experiences and results].

In a prospective pilot study on 100 consecutive patients with symptomatic cholelithiasis the laparoscopic cholecystectomy shows to be a safe technic without mortality and a low complication rate (3%). The time of operation is influenced by a learning curve of the operation-team and depends on the technical equipment. The postoperative hospital stay is 3 days in median. Postoperatively the pain-intensity is low and decreased very fast. These increased the patients perioperative comfort.

Adult↗
PubMed1989

[Indications for construction of stoma pouches].

Despite the advances of reconstructive surgical techniques, there are still indications for enterostoma constructions. Terminal colostomies are constructed after abdominoperineal rectal amputations. The terminal ileostomy is the procedure of choice after total colectomies for Crohn's disease. Loop colostomies are still a possibility for stool diversion procedures and for decompression in acute colonic obstruction. Loop ileostomies reduce load before ileal anastomoses and are increasingly used as diverting stomas in cases of colonic anastomoses. The cecal tube fistula, which does not divert the fecal stream completely, has the special advantage of easy, spontaneous closure.

Colostomy↗
PubMed1989

[Score systems, their importance for the intensive care patient].

Scoring systems are a technique for defining patients for scientific and management purposes. A hypothetical, severely ill patient with cirrhosis, peritonitis, renal insufficiency and coagulation problems can be precisely classified: Child C, Mannheim-Peritonitis-Index 34 and APACHE II score 27 which results in a mortality of at least 70% of patients. At our own hospital, the continuous APACHE score (CAPS) has been developed and tested. The CAPS performed better than daily APACHE scores and provided useful trend information for the individual patient.

Critical Care↗
PubMed1988

[Evaluating endoscopy].

Endoscopy is a safe technique with a sensitivity and specificity superior to those of conventional diagnostic procedures, which it has consequently replaced. In doing so, it has also altered many diagnostic and therapeutic concepts. Moreover, endoscopy has positively influenced the previously unaffected course of certain diseases, e.g. upper G. I. bleeding. Endoscopy benefits both the patient and the physician. Although no complete cost-benefit analysis is available, preliminary reports have been favourable. These aspects indicate that endoscopy is highly valuable in a clinical setting. It must be pointed out, however, that endoscopy as a whole has not yet been fully analyzed in any single given clinical study.

Diagnosis, Differential↗