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  • 1
    Electronic Resource
    Electronic Resource
    A combined laparoscopic-endoscopic method of assessment to prevent the complications of short esophagus (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 626-627 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Gastroesophageal reflux disease — Esophagus — Short esophagus — Peptic stricture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. As antireflux surgery has been used increasingly for gastroesophageal reflux disease (GERD), a need has arisen for an accurate method to assess esophageal length. There are a number of preoperative tests that can help surgeons to establish the presence of a short esophagus, but intraoperative assessment after esophageal mobilization is the standard method. In this era of laparoscopic surgery, the surgeon mobilizes the esophagus extensively from the abdomen and then determines if mobilization is sufficient. We report an intraoperative technique that combines laparoscopic with endoscopic methods to determine the position of the gastroesophageal junction. Because two physicians are required, there is additional operating room time, resulting in increased costs. However, these costs are offset by the assurance that the complications of the short esophagus can be avoided. With experience, modifications were made, resulting in the technique described herein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901056
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    A new form of access for endo-organ surgery (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 738-741 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Endo-organ — Percutaneous endoscopic gastrostomy — Gastric surgery — Intraluminal surgery — Operative port
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Intraluminal gastric surgery provides a new treatment option for various disease processes. This study assesses the safety of a new large-diameter percutaneous endoscopic gastrostomy (PEG) for intraluminal surgery. Methods: Investigators at six institutions were asked to complete a standard questionnaire to assess the difficulties associated with the assembly and introduction of the PEG, plus intraoperative and postoperative problems related to placement of the device. Results: In terms of assembly; 1.9% of respondents reported difficulty obtaining complete vacuum of the balloon tip, and 3.8% had difficulty fitting the graduated dilator to the balloon-tipped cannula. Difficulties associated with introduction of the PEG included disengagement of the dilator from the balloon-tipped cannula (0%), extraction of the dilator-port assembly (0%), difficult PEG pullout (1.9%), abdominal wall bleeding (0%), and difficult PEG dilator separation (7.5%). Intraoperatively, 7.5% of respondents reported inadequate skin bolster fitting, 1.9% had CO2 leakage into the peritoneal cavity, 0% had inadvertent PEG extraction, and 0% reported injury to the esophagus, colon, or small intestine. Postoperatively, there was a 9.4% rate of wound infection, a 1.9% rate of gastrocutaneous fistula, and a 1.9% rate of esophageal, colon, or small intestine injury. Conclusions: The large-diameter PEG is safe and effective for endo-organ surgery. Additional preventive measures for PEG site infection should be investigated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901089
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Left side thoracoscopically assisted gastroplasty (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 508 -512 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Short esophagus — Thoracoscopy treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Laparoscopic antireflux surgery is the procedure of choice for gastroesophageal reflux disease (GERD). However, many clinicians have reservations about its application in patients with complicated GERD, notably those with esophageal shortening. In this report, we present our experience with the laparoscopic management of the shortened esophagus. A total of 235 patients with primary GERD underwent laparoscopic antireflux procedures, 38 of whom were suspected preoperatively to have a shortened esophagus. Of the 235 patients, 8 (3.4%) needed a left thoracoscopically assisted gastroplasty in addition to laparoscopic Toupet repair (n= 4) or Nissen fundoplication (n= 4). Complications included pleural effusion (n= 1), pneumothorax (n= 2), and minor atelectasis (n= 1). The average hospital stay was 3 days. Results were satisfactory in 7 of 8 patients, with a mean follow-up of 20.2 months (range, 9–34 months). The surgical management of the shortened esophagus is difficult. However, the role of minimally invasive techniques is justified. Early results are appealing, with less morbidity, satisfactory control of GERD related symptoms, and a shortened hospital stay.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000091
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Persistent dysphagia after laparoscopic vagotomy (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 330-335 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Dysphagia — Fundoplication — Laparoscopy — Peptic ulcer — Vagotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic vagotomy represents a new and less invasive treatment for peptic ulcer disease, but the problem of postvagotomy dysphagia has not been solved. The aim of this study was to determine the etiologic factors related to long-term laparoscopic postvagotomy dysphagia. Methods: Two female and 11 male patients with a mean age of 48.5 years who underwent laparoscopic vagotomy were investigated retrospectively. Preoperative diagnosis included duodenal ulcer resistant to medical treatment, gastric hypersecretion, gastric outlet obstruction, cholelithiasis, and gastroesophageal reflux disease (GERD). Ten patients underwent laparoscopic highly selective vagotomy, and three patients had laparoscopic truncal vagotomy with gastrojejunostomy or pyloroplasty. Nine of these patients had a Nissen fundoplication in conjunction with the vagotomy. Results: The median long-term follow-up period was 47 months. Two patients complained of severe dysphagia, one of moderate dysphagia, and two of mild dysphagia. Neither type of vagotomy nor an additional fundoplication was correlated with the severity of postoperative long-term dysphagia. Severity of postoperative dysphagia was associated with severity of preoperative dysphagia (r= 0.752, p= 0.003) but not with heartburn (r= 0.358, p= 0.531) or regurgitation (r= 0.024, p= 0.938). The cause of preoperative dysphagia varied; however, all of these patients had GERD and consequent esophageal lesions. Conclusion: Preexisting dysphagia appears to play an integral role in persistent postoperative dysphagia. Care must be taken to construct a loose fundoplication in patients with dysphagia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640020060
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 464 -468 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Gastroesophageal reflux disease — Gastroplasty — Manometry — Preoperative testing — Short esophagus — Stricture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Esophageal shortening is a known complication of advanced gastroesophageal reflux disease that may preclude a tension-free antireflux procedure. A retrospective analysis was performed to test the accuracy of preoperative testing. Methods: From September 1993 to December 1998, 39 patients underwent esophageal mobilization with intraoperative length assessment. Patients were selected on the basis of irreducible hiatal hernia, stricture formation, or both. Patients in the upright position with a fixed hiatal hernia larger than 5 cm on an esophagram were considered to have a short esophagus. Manometric length two standard deviations below the mean for height was considered abnormally short. Results: In 31 patients, intraoperative mobilization was sufficient to allow the gastroesophageal junction to lie 2 cm below the diaphragmatic crus, so no esophageal-lengthening procedure was required. Eight patients with a short esophagus required an esophageal-lengthening procedure after complete mobilization. Two patients subsequently underwent intrathoracic migration of the gastroesophageal junction (GEJ), with recurrence of symptoms and required gastroplasty during the second surgery. An esophagram had a sensitivity of 66% and a positive predictive value of 37%, whereas manometric length had a sensitivity of 43% and a positive predictive value of 25% for the diagnosis of short esophagus. The preoperative endoscopic finding of either a stricture or Barrett's esophagus was the most sensitive test for predicting the need for a lengthening procedure. Conclusions: Manometry and esophagraphy are not reliable predictors of the short esophagus. Additional tests and/or tests combined with other parameters are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640020023
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    Paper (German National Licenses)
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