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  • 1
    Electronic Resource
    Electronic Resource
    Additional mechanisms of hiatal hernia recurrence and its prevention (1999)
    Springer
    Hernia 3 (1999), S. 215-220 
    Details
    ISSN: 1248-9204
    Keywords: Hiatal hernia ; Fundoplication ; Recurrences ; Mechanisms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The conventional hiatal hernia repair is a tension repair. Large defects such as those associated with an intrathoracic stomach can have a high rate of recurrence resulting in esophageal symptoms and in some instances gastric strangulation. Numerous additive procedures are used to secure the stomach in the abdominal cavity including mesh buttressing, fundoplication, anterior abdominal wall gastropexy and fundus diaphragmatic suture fixation. The optimal repair is unknown primarily because crura closure failure is poorly understood. A literature review was used to determine the proven causes of hiatal hernia recurrence. Early postoperative vomiting, surgeon inexperience, short esophagus and no crus closure are documented causes. In a series of 19 hiatal hernia recurrence repairs from our institution, additional causes such as suture pull-out and trauma have been established as additional mechanisms of recurrence. Increased intra-abdominal pressure associated with motor vehicle accidents was the precipitating factor in 2/19 patients. Suggested methods for prevention of hiatal disruption and resultant hernia are proposed which include: a postoperative antiemetic regimen, restricted activity in the early postoperative period, an assessment technique for the short esophagus when utilizing a laparoscopic approach, crus closure calibration and inclusion of the diaphragmatic fascia when performing hiatal closure for large paraesophageal hernias and the short esophagus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01194430
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Outcomes assessment and minimally invasive surgery (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 883 -890 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Minimally invasive surgery — Outcomes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Outcomes assessment is being used increasingly to shape practice patterns in all areas of medicine. Although outcomes assessment is not a new concept, the widespread application of outcomes measurement for modifying practice is novel. Instead of focusing on results of interventions in highly controlled environments, outcomes studies usually report results as they occur in uncontrolled, real-world environments. Recently, the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) has initiated a society-wide initiative to monitor outcomes in patients undergoing various laparoscopic operations. Methods: Pertinent literature is reviewed as it relates to outcomes assessment. The historical background underpinning the modern interest in outcomes is outlined. Definitions of terms useful for understanding outcomes research are given. The impact of outcomes assessment on minimally invasive surgery, both positive and negative, are examined. The SAGES outcome initiative is introduced. Conclusions: Although outcomes studies usually do not provide information on the causes of observations made, they have gained in popularity because they provide information about patient perceptions of disease, disability, and treatment. Minimally invasive surgical procedures often are reported in terms of outcomes assessment because a controlled clinical trial was rendered impossible by early and widespread application of laparoscopic surgery. The SAGES outcomes initiative will provide the necessary tools for the participation of surgeons in the process of practice profiling.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000220
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Complications and recurrences associated with laparoscopic repair of groin hernias (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1316-1323 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopic complications ; Inguinal hernia ; Laparoscopic herniorrhaphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the laparoscopic technique is a new approach to groin hernia, it is becoming more widely accepted as an alternative to traditional open techniques. This study is a preliminary review of complications and recurrences. A questionnaire specific for complications was sent to each investigator. From 12/89 to 4/93, 1,514 hernias were repaired; 119 (7.8%) were bilateral and 192 (12.7%) recurrent. There were 860 indirect, 560 direct, 43 pantaloon, 37 femoral, and 6 obturator hernias, and 8 were not specified; 553 were repaired using a transabdominal preperitoneal mesh technique (TAPP), 457 with a total extraperitoneal technique (TEP), 320 with intraperitoneal onlay mesh (IPOM), 102 by ring closure, and 82 involved plug and patch technique. Eighteen intraoperative and 188 postoperative complications were seen. The total complication rate was 13.6%, of which 1.2% were intraoperative. Of the intraoperative complications, 12 were related to the laparoscopic technique, three were related to the hernia repair, and one was related to anesthesia. The rate of conversion to open was 0.8%. Of the postoperative complications, there were 95 local, 25 neurologic, 23 testicular, 23 urinary, 10 mesh, and 12 miscellaneous. There were 34 recurrences after the 1,514 hernia repairs (2.2%). The follow-up was reported in 828 patients for an average of 13 months. The recurrence rate varied drastically with the technique: A 22% recurrence rate after the plug and patch vs 3%, 2.2%, 0.7%, and 0.4% with the ring closure, IPOM, TAPP, and TEP, respectively. Laparoscopic repair of groin hernia can be safely performed. Complications, mostly minor, diminish with experience. The recurrence rate is less with large mesh which is anchored.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188291
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  • 4
    Electronic Resource
    Electronic Resource
    Incidence of complications following laparoscopic hernioplasty (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 16-21 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Hernioplasty ; Technique ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Smaller individual series on the outcome of laparoscopic hernioplasty techniques have been reported. This study reports on the complications of 3,229 laparoscopic hernia repairs performed by the authors in 2,559 patients. The TAPP (transabdominal preperitoneal) technique was the most frequently performed: 1,944 (60%). The totally preperitoneal technique was performed 578 (18%) times. The IPOM (intraperitoneal onlay mesh) repair was performed 345 (11%) times. The plug-and-patch technique was used 286 (9%) times and simple closure of the hernia defect without mesh was used in 76 (2%) repairs. Overall, there were 336 (10%) complications: 17 (0.5%) major and 265 (8%) minor. There were 54 (1.6%) recurrences, with a mean follow-up of 22 months. The TAPP technique had 19 (1%) recurrences and 141 (7%) complications. There were four bowel obstructions in this subgroup from herniation of small bowel through the peritoneal closure and trocar sites. The totally preperitoneal technique had no recurrence and 60 (10%) complications. The IPOM group had 7 (2%) recurrences and 47 (14%) complications. The plug-and-patch technique had 26 (9%) recurrences and 24 (8%) complications. The simple closure of the internal ring had 2 (3%) recurrences and 10 (13%) complications. Laparoscopic hernioplasty is not without complications. Training, experience, and attention to technique will prevent some of these complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187878
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    An intraluminal surgical approach to the management of gastric bezoars (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 831-834 
    Details
    ISSN: 1432-2218
    Keywords: Trichobezoar ; Gastrostomy ; Laparoscope instrument ; Foam-rubber stent
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Trichobezoars are difficult to remove endoscopically, often cause nausea and vomiting, and can result in small-bowel obstruction. A patient with a trichobezoar presented to our clinic with symptoms of partial small-bowel obstruction. Multiple attempts at flexible endoscopic removal were unsuccessful. Two large-diameter percutaneous gastrostomies with an inflatable balloon and distal foam-rubber stent to assure intragastric positioning were introduced under general anesthesia. Visualization was provided by a 0° panavision laparoscope placed through one of the gastrostomies. The bezoar was removed through the second gastrostomy using standard laparoscopic instruments. The patient made an uneventful recovery. This is the first reported case of percutaneous removal of a trichobezoar. We conclude large-diameter gastrostomies may serve as a port of access for numerous other intraluminal procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00190094
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  • 6
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy: A critical appraisal (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 28-34 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopy ; Laparoscopic colectomy ; Colectomy ; Colon resection ; Colon and rectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups (P 〈0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group (P 〈 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050298
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    Paper (German National Licenses)
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