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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic reoperations after failed and complicated antireflux operations (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 681-686 
    Details
    ISSN: 1432-2218
    Keywords: Total and partial refundoplication ; Laparoscopic transhiatal esophagectomy ; Laparoscopic Collis-Nissen gastroplasty ; Laparoscopic gastrectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nineteen patients underwent laparoscopic reoperations for failed or complicated antireflux operations from a total of 248 patients with gastroesophageal reflux disease who had been operated on by this approach. Sixteen had been submitted to open surgery and three to laparoscopic surgery over a period ranging from 5 days to 31 years before the study. Three patients had been submitted to two open antireflux surgeries previously. Seventeen patients had recurrent reflux esophagitis after different types of surgeries, and two patients presented with gastric strangulation after fundoplication. The causes of recurrence were: slipped total fundoplications (3), disruption of total and partial fundoplications (6), too-tight total fundoplication (1), too-low (gastric) partial fundoplication (1), Allison procedure (1), partial fundoplication and paraesophageal hernia (2), and unknown (3). The laparoscopic approach was used in 18 patients and a laparoscopic-thoracoscopic approach in 1. The procedures included laparoscopic total fundoplications (11), partial fundoplications (4), transhiatal esophagectomy (1), Collis-Nissen (1), Roux-en-Y gastrectomy and thoracoscopic vagotomy (1), and intrathoracic fundoplication (1). One patient was converted to open surgery. Intraoperative complications included 1 pneumothorax, 1 gastric perforation, and 1 esophageal perforation during the introduction of a Maloney dilator. Mean operative time was 210 min, ranging from 140 to 320 min. Mean hospital stay was 3.1 days after treatment of failed operations and 22 days after treatment of complications. Postoperative complications included subcutaneous infection (1), gastric fistula (1), and liver hematoma (1). The results have been excellent and good in 84.3% of the patients after a mean follow-up of 13 months. We concluded that laparoscopic reoperations are technically feasible with good preliminary results provided that the mandatory expertise is available.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187939
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Mechanisms and avoidance of esophageal perforation by anesthesia personnel during laparoscopic foregut surgery (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 979-982 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Esophageal perforation — Anesthesia personnel — Laparoscopic foregut surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention. Methods: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review of the operative reports. Results: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic foregut operations for an overall incidence of 0.8%. Conclusion: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close communication between the surgeon and anethesiologist and safe techniques of dilator insertion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900218
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 933-935 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Common bile duct exploration — Choledochotomy — Biliary stent
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: One hundred eighty-one patients were submitted to laparoscopic common bile duct exploration. Methods: A transcystic approach was used in 147 patients, choledochotomy in 14, and both in 20. The indications to perform a choledochotomy included stones larger than 20 mm, stones proximal to the cystic duct entrance, and cases in which the transcystic duct approach proved impossible or unsuccessful. Results: The common bile duct was drained by a T-tube in four patients, by laparoscopic sphincterotomy in one, by laparoscopic choledochoduodenostomy in one, and by a 10 Fr endoprosthesis in 28. The stent placement was technically feasible in all patients but one. The biliary drainage was adequate. Mean hospital stay was 2.1 days. Complication was limited to one umbilical infection and one self-limited biliary leak. Conclusions: The procedure proved to be technically simple, safe, and efficient, and resulted in a low morbidity rate and short hospital stay.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900750
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Laparoscopic management of choledocholithiasis (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1399-1403 
    Details
    ISSN: 1432-2218
    Keywords: Common bile duct stones ; Laparoscopic choledocholithotomy ; Electrohydraulic lithotripsy ; Laparoscopic sphincterotomy ; Laparoscopic choledochoduodeno anastomosis ; Laparoscopic end-to-end CBD anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors report on a group of 114 patients with common bile duct (CBD) stones who were treated by laparoscopic surgery. Management through the cystic duct was considered the first option. Choledochotomy was used for those patients in which the cystic approach was not possible or was unsuccessful. Transcystic lithotripsy was considered for patients with CBD stones in disproportion with the size of the cystic duct. Laparoscopic antegrade sphincterotomy was indicated as a drainage procedure. The transcystic approach was used in 89.5% of the patients; choledochotomy was used in 6.2%; and both ways were used in 4.3%. Different procedures were used, including mechanical and electrohydraulic lithotripsy, choledochotomy with T-tube or endoprostheses drainage, laparoscopic sphincterotomy, end-to-end common bile duct anastomosis, and choledochoduodenum anastomosis. One of the patients was in the 21st week of pregnancy. The laparoscopic approach to choledocholithiasis was successfully performed in 94.8% of the patients. Mean hospital stay was 1.7 days. There was a 6.2% incidence of complications and the mortality rate was 0.9%. In 84.3% of the patients, the transcystic approach was used successfully, with a complication rate of 4.9% and a mean hospital stay of 1.6 days. Three patients were converted to open surgery early in this series. Thus far, one patient has presented residual CBD stones. The results obtained suggest that laparoscopic common bile duct exploration is a technically feasible procedure, with low complication and mortality rates, although it requires adequate selection of patients and a variety of techniques and types of equipment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187344
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    Paper (German National Licenses)
    Fulltext
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