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  • 1
    Electronic Resource
    Electronic Resource
    Laparoskopische 2/3-Resektion des Magens mit intracorporaler Anastomose nach Y-Roux (1998)
    Springer
    Der Chirurg 69 (1998), S. 467-470 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Laparoscopic surgery ; Partial gastrectomy ; Duodenal ulcer. ; Schlüsselwörter: Laparoskopische Chirurgie ; Magenresektion ; Ulcus duodeni.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei einem Patienten mit rezidivierendem Ulcusleiden und Blutungskomplikationen unter medikamentöser Therapie wurde eine laparoskopische 2/3-Resektion des Magens mit intracorporaler Anastomose nach Roux-Y durchgeführt. Die Operation ließ sich ohne größere Schwierigkeiten in 3 Std bei einem Blutverlust von 〈 10 ml fertigstellen. Der 6tägige postoperative Krankenhausaufenthalt verlief unkompliziert, der weitere Verlauf von bisher 2 Monaten ebenfalls. Diese Operation wie auch eine Durchsicht der in der Literatur publizierten Ergebnisse haben uns gezeigt, daß eine Magenresektion in geeigneten Fällen durchaus laparoskopisch durchgeführt werden kann.
    Notes: Summary. In a patient with recurrent ulcer disease under medication, which was complicated by episodes of bleeding, a laparoscopic partial gastric resection with intracorporal Roux-en-Y anastomosis was performed. The operation was completed within 3 h with blood loss 〈 10 ml. The postoperative hospital stay of 6 days was uncomplicated as was the further follow-up (2 months so far). This operation and the study of results published in the literature showed us that a gastric resection can certainly be performed laparoscopically in the appropriate patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050440
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  • 2
    Electronic Resource
    Electronic Resource
    Nebenschilddrüsencarcinom in Zusammenhang mit einem postoperativen Durchgangssyndrom (2000)
    Springer
    Der Chirurg 71 (2000), S. 1489-1492 
    Details
    ISSN: 1433-0385
    Keywords: Keywords: Parathyroid carcinoma – Hyperparathyroidism – Hypercalcemia – Symptomatic transitory psychotic syndrome. ; Schlüsselwörter: Nebenschilddrüsencarcinom – Hyperparathyreoidismus – Hypercalciämie – Durchgangssyndrom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei einem 78 jährigen Patienten bestand nach Laparotomie ein schweres Durchgangssyndrom. Bei anhaltender Somnolenz stellten sich cardiopulmonale Dekompensationszeichen und eine Darmatonie ein. Eine fortbestehende Hypercalciämie führte zur Diagnose eines primären Hyperparathyreoidismus. Nach Resektion eines großen Nebenschilddrüsencarcinoms kam es zu einer kontinuierlichen Besserung der gesamten Symptomatik.
    Notes: Abstract. We present a 78-year-old patient who suffered from symptomatic transitory psychotic syndrome after laparotomy. Persisting somnolence appeared with cardiopulmonary decompensation and gastrointestinal atony. Due to prolonged hypercalcemia primary hyperparathyreoidism was diagnosed. Resection of a large carcinoma of the parathyroids led to continuous clinical improvement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040051249
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  • 3
    Electronic Resource
    Electronic Resource
    Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 212-218 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Gastric perforation — Peritonitis — Laparoscopic versus open repair — Pneumoperitoneum — Abdominal sepsis — Septic shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional open repair of gastric perforation and abdominal lavage for associated peritonitis. Methods: To simulate gastric perforation, female Duroc pigs were subjects to standardized gastrotomy. Either 6 or 12 h after gastric perforation, the animals underwent either traditional open or laparoscopic repair of the gastric defect and peritoneal lavage. The subjects were divided into the following four groups: peritonitis for 6 h and open surgery (group I) or laparoscopic surgery (group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group IV). After an observation period of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics suggestive for septic shock, bacteremia, and endotoxemia. Results: There were no significant differences between group I and II. Mortality was 22% in group III, as compared to 78% in group IV (p= 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly higher than in group III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac output suggested a higher incidence of septic shock in group IV. Conclusion: Critical appraisal of laparoscopic surgery is warranted in conditions associated with severe, longstanding peritonitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900637
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  • 4
    Electronic Resource
    Electronic Resource
    Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 898-901 
    Details
    ISSN: 1432-2218
    Keywords: Perforated gastroduodenal ulcer ; Laparoscopic surgical repair ; Pneumoperitoneum ; Peritonitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopic surgical repair of perforated gastroduodenal ulcer is technically feasible. To study the effect of a pneumoperitoneum on the extent and severity of peritonitis this animal study was devised. In rats gastric ulceration was induced by instillation of ethanol (50%, 2 ml) and followed by gastrotomy to simulate perforation. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. In PP groups CO2 was insufflated intraperitoneally 6, 9, 12, and 24 h after gastrotomy. In controls the abdomen was only punctured. Animals were sacrificed 5 h after the end of PP or abdominal puncture. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observed; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P〈0.05), and 42% (P〈0.05) in controls. The mean PSS was 20.8 (standard deviation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P〈0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 83% and 100% in the PP group compared to 42% (P〈0.05) and 50% (P〈0.01) in controls. The mean PSS was 22.1 (1.5) in the PP group compared to 11.8 (2.4) (P〈0.01) in the controls. In rats a pneumoperitoneum aggravates the extent and severity of peritonitis, when the interval between gastric ulcer perforation and pneumoperitoneum lasts 12 h or longer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00768887
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  • 5
    Electronic Resource
    Electronic Resource
    A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 683-688 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Pneumoperitoneum — Parietal peritoneum — Peritonitis — Mesothelium — Ultrastructural integrity — Scanning electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis—e.g., peptic ulcer perforation. This study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum in perforation-induced peritonitis. Methods: Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia–d; IIa–d) or to sham perforation (groups IIIa–d, IVa–d). In group I (a–d) and III (a–d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a–d) and IV (a–d), simple puncture of the abdominal cavity was performed, and specimens were taken at corresponding times. Results: In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly, scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation (groups Ib–c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups IIa–c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly completely vanished and the mesothelium was breaking apart into multiple soils. Conclusions: In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901073
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  • 6
    Electronic Resource
    Electronic Resource
    Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 734 -736 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Nonparasitic liver cysts — laparoscopic deroofing — omental transposition flap
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900438
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 924-927 
    Details
    ISSN: 1432-2218
    Keywords: Splenectomy ; Laparoscopy ; Spleen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between early 1992 and December 1994, laparoscopic splenectomy was performed in 27 patients with idiopathic thrombocytopenia (ITP), hairy-cell leucemia, HIV, or Hodgkin's disease. In all cases medical treatment, especially cortisone therapy, failed. In Hodgkin's disease the splenectomy was combined with liver biopsies and dissection of parailiacal, paraaortic, and mesenteric lymph nodes for abdominal staging. The operation was performed using four trocars; the splenic vessels were divided by a linear stapler. In general the spleen was removed in a bag through a slightly enlarged trocar incision or after morcellation. Three patients needed a small laparotomy for the removal (laparoscopic assisted). In a recent case of Hodgkin's disease the intact spleen was removed via posterior colpotomy. In 22 of 27 cases (81%) the operation was finished laparoscopically. Five times a conversion to conventional laparotomy was necessary because of bleeding of enlarged lymph nodes at the hilum. Wound infections occurred in two cases. In one patient with ITP the platelet count did not improve and continuous blood loss led to relaparotomy at the 1st postoperative day. No surgical bleeding was found. All patients tolerated a fluid diet at the 1st postoperative day and hospitalization time was 4.4 days (range 3–14). Regarding the low complication rate and the advantages of a smaller abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and laparoscopic abdominal staging has a substantial benefit for the patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00768896
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