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  • 1
    Electronic Resource
    Electronic Resource
    Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later (1988)
    Springer
    Dysphagia 2 (1988), S. 222-227 
    Details
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02414431
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 367-376 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; En bloc esophagectomy ; Mediastinal lymphadenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die en-bloc Oesophagektomie erfaßt neben der Entfernung der Speiseröhre die mediastinale Lymphadenektomie incl. der Resektion von V. azygos und Ductus thoracicus. Zusätzlich beinhaltet sie die suprapankreatische abdominelle Lymphadenektomie und bei oberhalb der Trachealbifurkation gelegenen Tumoren auch die cervicale Lymphadenektomie. Die Operationstechnik kann als ausgereift und standardisiert angesehen werden. Mögliche Komplikationen sind Nachblutungen (3,3%), Chylothorax (1,6%) und Trachealäsionen (4,9%). Die Letalität liegt in erfahrenen Zentren unter 10%, im eigenen Krankengut bei 6,6%. Die en-bloc Oesophagektomie ermöglicht ein exaktes Staging des Oesophaguscarcinoms, führt in einem hohen Prozentsatz zur kompletten Tumorentfernung (R0-Resektion) und scheint die Prognose früher Tumorstadien (T1/2 N0/1) zu verbessern.
    Notes: Summary En-bloc esophagectomy not only comprises the elimination of the esophagus but also the mediastinal lymphadenectomy and the resection of the azygos vein and thoracic duct. Additionally the suprapancreatic abdominal lymphadenectomy is included and in tumors located orally of the tracheal bifurcation also the cervical lymphadenectomy. The surgical technique can be estimated as fully developed and standardized. Possible complications are postoperative hemorrhage (3.3%), chylothorax (1.6%) and tracheal lesions (4.9%). The mortality rate ranges under 10% in experienced centers, in our own patients around 6.6%. With en-bloc esophagectomy an exact staging of esophageal cancer becomes possible. In a high percentage complete tumor elimination (R0-resection) can be achieved and it seems that herewith prognosis in early tumor stages (T1/2 N0/1) can be improved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01272555
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  • 3
    Electronic Resource
    Electronic Resource
    281. Sind die Ergebnisse nach Refundoplicatio schlechter als nach primärer Fundoplicatio? (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 900-900 
    Details
    ISSN: 1435-2451
    Keywords: Fundoplication ; Refundoplication ; Functional results ; Fundoplicatio ; Refundoplicatio ; Funktionelle Ergebnisse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 7/82 bis 12/86 wurden 45 Fundoplikationen und 35 Refundoplikationen durchgeführt. Nach Refundoplicatio waren intra- und postoperative Komplikationen wesentlich häufiger; die Letalität betrug 0% für die Fundoplicatio und 3% für die Refundoplicatio. Bei der Nachuntersuchung nach im Mittel 30 Monaten unterschieden sich die funktionellen Ergebnisse nicht: Der Ruhedruck des unteren Oesophagussphincters lag im Normbereich (15 bzw. 12 mm Hg); pH-metrisch konnte in beiden Gruppen kein gastrooesophagealer Reflux mehr nachgewiesen werden. Trotz des höheren Operationsrisikos und höherer Morbidität im Vergleich zur Erstoperation ist die erneute Fundoplicatio aufgrund gleich guter funktioneller Ergebnisse auch für den Zweiteingriff gerechtfertigt.
    Notes: Summary From July 1982 to December 1986, 45 fundoplications and 34 refundoplications were performed. After refundoplication, the postoperative complications were more frequent. There was no postoperative deaths after fundoplication, but lethality was 3% after refundoplication. The mean follow-up time was 30 months; functional results were comparable in both groups: lower esophagus sphincter pressure was normal in both groups (15 and 12 mm Hg); no gastroesophageal reflux could be detected either. Despite a higher operative risk and higher morbidity, a fundoplication is justified if the primary procedure fails, since equally good results can be obtained.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298065
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  • 4
    Electronic Resource
    Electronic Resource
    325. Fundoplicatio (1983)
    Springer
    Langenbeck's archives of surgery 361 (1983), S. 891-892 
    Details
    ISSN: 1435-2451
    Keywords: Fundoplication ; Reflux disease ; Postfundoplication syndrome ; Fundoplicatio ; Refluxkrankheit ; Post-Fundoplicatio-Syndrom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Fundoplicatio ist die sicherste und am besten untersuchte Antirefluxoperation. Voraussetzung für ein gutes Ergebnis ist eine sorgfältige Indikationsstellung zur Operation und eine einwandfreie Operationstechnik. Beides wird im Film detailliert dargestellt. Bei fehlerhafter Operationstechnik ist mit der Entwicklung von sogenannten Post-Fundoplicatio-Syndromen zu rechnen, die ebenfalls aufgezeigt werden.
    Notes: Summary Fundoplication is the safest and best investigated antireflux operation. However, the preconditions are exact diagnosis and perfect operative technique. Both are demonstrated in detail in the film. If the operative technique is faulty, the postfundoplication syndrome can be counted on developing, which is also discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01276151
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    301. Transthorakale „en-bloc-Resektion” des Oesophaguscarcinoms (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 924-924 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal carcinoma ; En-bloc esophagectomy ; Mediastinal lymphadenectomy ; Esophagogastrostomy ; Oesophaguscarcinom ; En-bloc-Oesophagektomie ; Mediastinale Lymphadenektomie ; Oesophago-Gastrostomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Film zeigt die Technik der en-bloc-Oesophagektomie beim Oesophaguscarcinom. Bei dieser Operationstechnik werden der Oesophagus nebst angrenzendem mediastinalem Lymph- und Fettgewebe inclusive der V. azygos und des Ductus thoracicus entfernt. Diese Ausräumung des Mediastinums führt zu einer mediastinalen Lymphadenektomie. Zusätzlich werden Ausmass und Technik der abdominellen Lymphadenektomie gezeigt. Die Rekonstruktion der Speisepassage erfolgt durch Mageninterposition mit cervicaler Oesophago-Gastrostomie.
    Notes: Summary The film shows the technique of en-bloc esophagectomy in esophageal carcinoma. With this surgical technique it is possible to resect the esophagus with the surrounding lymphatic and fatty tissue, including the azygos vein and the thoracic duct. This mediastinectomy leads to a regional lymphadenectomy. In addition, the extent and technique of abdominal lymphadenectomy are also shown. Reconstruction of the food passageway is done by gastric interposition with cervical esophagogastrostomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298086
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    Paper (German National Licenses)
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