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  • 1
    Electronic Resource
    Electronic Resource
    „Keine Komplikationen“– Traum jedes Chirurgen ? (1996)
    Springer
    Der Chirurg 67 (1996), S. 862-864 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Complications ; Morbidity ; Mortality ; Zero. ; Schlüsselwörter: Komplikationen ; Letalität ; Null.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die statistische Wahrscheinlichkeit unerwünschter Ereignisse (Komplikationen, Versterben des Patienten), die in einer festen Anzahl von Patienten (n) bisher nicht aufgetreten sind, können nach einer einfachen Formel von Hanley berechnet werden. Sie gibt die obere Grenze des 95-%-Konfidenzintervalls für ein solches Ereignis an: Obere Grenze des 95-%-Konfidenzintervalls = maximales Risiko = 3:n (für n≥ 30). Chirurgen sollten diese einfache Regel im Kopf behalten, wenn Komplikationsraten von null in der Literatur berichtet werden bzw. wenn schwere Komplikationen (bis jetzt) nicht aufgetreten sind.
    Notes: Summary. The probability of adverse and undesirable events during and after operations that have not yet occurred in a finite number of patients (n) can be estimated using Hanley's simple formula, which gives the upper limit of the 95 % confidence interval for the probability of such an event: Maximum risk = upper limit of 95 % confidence interval = 3/n (for n 〉 30).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002532
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  • 2
    Electronic Resource
    Electronic Resource
    Laparoscopic and conventional closure of perforated peptic ulcer (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 831-836 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Ulcer, perforated peptic — Closure, laparoscopic vs conventional
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. Methods: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. Results: Consumption of analgesics was lower in the laparoscopic group. Conclusions: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900171
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  • 3
    Electronic Resource
    Electronic Resource
    Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD) (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 413 -426 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Consensus development conferences — Laparoscopic antireflux operations — Outcome assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic antireflux surgery is currently a growing field in endoscopic surgery. The purpose of the Consensus Development Conference was to summarize the state of the art of laparoscopic antireflux operations in June 1996. Methods: Thirteen internationally known experts in gastroesophageal reflux disease were contacted by the conference organization team and asked to participate in a Consensus Development Conference. Selection of the experts was based on clinical expertise, academic activity, community influence, and geographical location. According to the criteria for technology assessment, the experts had to weigh the current evidence on the basis of published results in the literature. A preconsensus document was prepared and distributed by the conference organization team. During the E.A.E.S. conference, a consensus document was prepared in three phases: closed discussion in the expert group, public discussion during the conference, and final closed discussion by the experts. Results: Consensus statements were achieved on various aspects of gastroesophageal reflux disease and current laparoscopic treatment with respect to indication for operation, technical details of laparoscopic procedures, failure of operative treatment, and complete postoperative follow-up evaluation. The strength of evidence in favor of laparoscopic antireflux procedures was based mainly on type II studies. A majority of the experts (6/10) concluded in an overall assessment that laparoscopic antireflux procedures were better than open procedures. Conclusions: Further detailed studies in the future with careful outcome assessment are necessary to underline the consensus that laparoscopic antireflux operations can be recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900382
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  • 4
    Electronic Resource
    Electronic Resource
    Long-term results after laparoscopic cholecystotomy in a child with symptomatic gallstone disease (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 671 -672 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Cholelithiasis — Cholecystotomy — Laparoscopy — Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Cholecystotomy has been suggested for symptomatic gallstone disease in selected children. This suggestion is supported by a potential reduction in the frequency of the so-called postcholecystotomy syndrome. To our knowledge, laparoscopic cholecystotomy has not been reported yet. However, gallstone recurrence has been reported up to 4 years after conventional cholecystotomy and therefore we waited to publish our results for that period of time. A 12-year-old girl with idiopathic symptomatic gallstone disease and a normal kinetic of the gallbladder underwent laparoscopic cholecystotomy. The laparoscopic technique was similar to laparoscopic cholecystectomy but the gallbladder was left in place and multiple gallstones were removed. Intraoperative cholecystoscopy revealed three additional small stones. They were removed by subsequent lavage of the gallbladder. Choledocholithiasis was excluded by intraoperative cholangiography and the gallbladder was closed using an Endo GIA. There were no intraoperative or postoperative events. The patient is free of complaints without recurrent gallstones on ultrasound examination today, 4 years after the operation. Laparoscopic cholecystotomy represents a feasible alternative to laparoscopic cholecystectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900419
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  • 5
    Electronic Resource
    Electronic Resource
    Percutaneous endoscopic duodenostomy (PED) (1987)
    Springer
    Surgical endoscopy and other interventional techniques 1 (1987), S. 123-126 
    Details
    ISSN: 1432-2218
    Keywords: PEG ; PED ; Enteral nutrition ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00312700
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  • 6
    Electronic Resource
    Electronic Resource
    Long-term results of Troidl's technique of endoscopic pneumatic dilatation for achalasia of the esophagus (1987)
    Springer
    Surgical endoscopy and other interventional techniques 1 (1987), S. 155-164 
    Details
    ISSN: 1432-2218
    Keywords: Achalasia ; Dilatation ; Myotomy ; Endoscopy ; Long-term results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective clinical trial, 26 consecutive patients underwent endoscopic pneumatic dilatation over a 10-year period. Dilatation was achieved by means of a ballon attached to a normal gastrointestinal fiberscope. With the endoscope in an inverse position, the device was placed in the cardia and the dilatation process was monitored macroscopically. Before dilatation, patients suffered from dysphagia (92%), reduced speed of swallowing (100%), symptom aggravation under stress (73%), weight loss (50%), aspiration, pain, regurgitation, and vomiting. After dilatation and long-term follow-up (mean of 5 years), symptoms could be markedly reduced, especially the speed of eating and symptom aggravation under stress. Excellent and good results (Visick scale) were achieved in 76%. Fair results were achieved in 20%. To date, perforation and other complications have not occurred. Mortality was zero. Our series was an uncontrolled trial, so the results are hardly comparable to other studies. Furthermore, the small number of patients in our study represents a weak point with regard to complications. We conclude that the main advantages of the procedure are its simplicity and practicability. The simple procedure may be the method of choice in elderly patients. Of course, no final decision can be made until a well-designed controlled trial has been carried out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00590923
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic and conventional closure of perforated peptic ulcer (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 831-836 
    Details
    ISSN: 1432-2218
    Keywords: Ulcer, perforated peptic ; Closure ; laparoscopic vs conventional
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: After the first successful laparoscopic closure of a perforated peptic ulcer in 1990, 18 patients with laparoscopic closure were compared to 16 patients with conventional surgery. Methods: The endpoint adverse events (complications), pain intensity, operation time, fever, leucocytosis, and duration of hospital stay showed no clinically relevant differences. Results: Consumption of analgesics was lower in the laparoscopic group. Conclusions: Laparoscopic closure of perforated peptic ulcer is technically feasible. The safety of the method and the benefit for the patient need proof by means of a randomized controlled trial.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00189544
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  • 8
    Electronic Resource
    Electronic Resource
    Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 268-269 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Abdominal wall paresis — Laparoscopic procedures — Incisional hernia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A case of combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy is reported. The paresis possibly occurred by a lesion of the N. intercostalis when extending the incision for stone extraction. Possibly the paresis was a predisposing factor for the development of an incisional hernia. The causes of abdominal wall paresis are explored with a review of the literature. In spite of minimal trauma to the anterior abdominal wall in laparoscopic procedures, the risk of iatrogenic lesions remains.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900960
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  • 9
    Electronic Resource
    Electronic Resource
    The E.A.E.S. Consensus development conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 550-563 
    Details
    ISSN: 1432-2218
    Keywords: Consensus development conferences ; Laparoscopic cholecystectomy ; Laparoscopic appendectomy ; Laparoscopic inguinal hernia repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10–13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15–17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00206852
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  • 10
    Electronic Resource
    Electronic Resource
    The individual patient and evidence-based medicine – a conflict? (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 417-422 
    Details
    ISSN: 1435-2451
    Keywords: Key words Evidence-based medicine ; Doctor ; patient relationship ; Conflict
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The doctor–patient relationship is characterised by clinical situations that reflect different degrees of impairment of the patient’s quality of life on the one hand and different degrees of threat to the patient’s life on the other. Typical patterns of these situations from absent or minimal to severe impairment of well being or threat to life are described. With regard to this, the doctor–patient communication is still suffering from considerable deficits. For the latter, a possible philosophical framework and reason is given. The potential of evidence-based medicine to ease this conflict by bringing into the game the current best-available scientific evidence is discussed, and some inherent serious limitations of evidence-based medicine are shown. Besides these drawbacks, doctors are usually very reluctant and lazy to integrate evidence-based results into their daily practice. In the author’s view, evidence-based medicine is a reasonably new tool. However, it should not yet be overestimated in its potential to influence and improve daily clinical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050224
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