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  • 1
    Electronic Resource
    Electronic Resource
    Laparoskopische colorectale Chirurgie – Versuch der Bewertung einer neuen Technologie (1997)
    Springer
    Der Chirurg 68 (1997), S. 794-800 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Colorectal surgery ; Laparoscopic techniques ; Cancer surgery ; Costs ; Technology assessment ; Schlüsselwörter: Colorectale Chirurgie ; laparoskopische Technik ; Carcinomchirurgie ; Kosten ; Technologiebewertung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Ziel der Untersuchung war, die Wertigkeit der laparoskopischen colorectalen Chirurgie zu untersuchen. Von 131 Patienten wurden 80 (61 %) laparoskopisch operiert. Bei 13/93 (14 %) wurde konvertiert. 47 (59 %) litten an einem Carcinom, 41 wurden kurativ operiert. Zum Vergleich dienten 48 offen operierte Patienten. Die Komplikationsrate war nach laparoskopischer Technik reduziert, Reoperationen waren nicht notwendig, die Rekonvaleszenz war rascher; erste Nahrungsaufnahme und erster Stuhlgang traten früher auf. Die Krankenhausverweildauer war verkürzt (15,3 vs. 8,1 Tage). Die Schmerzen waren in Ruhe und Bewegung signifikant geringer. Resektatlänge, Resektionsabstände und Anzahl der entfernten Lymphknoten waren gleich. Portmetastasen wurden nicht beobachtet. Eine verminderte Morbidität, ein verkürzter Krankenhausaufenthalt, verminderte Schmerzen, eine schnellere Rekonvaleszenz bei adäquater Radikalität und akzeptablen Kosten sprechen für die laparoskopische Technik.
    Notes: Summary. The aim of this study was to access the importance of the laparoscopic colorectal resection. Of 131 patients 80 were operated on laparoscopically. The conversion rate was 14 % (13/93). A total of 47 patients suffered from cancer. Curative resection was performed in 41 patients (87 %). For comparison, 48 patients who underwent open resection were used. The complication rate was lower after laparoscopy and no reoperation was performed. Patients recovered quicker and their first oral food intake and bowel movement were earlier. Hospital stay was shorter (15.3 vs. 8.1 days), and pain at rest and in motion was significantly reduced. Equal numbers of mesenteric lymph nodes were retrieved; adequate margins of resection could be obtained and the length of resected bowel did not differ. No port metastases were observed. Reduced morbidity, reduced hospital stay, reduced abdominal pain, quicker reconvalescence, and reduced overall health care costs are strong arguments in favor of laparoscopic colectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050272
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  • 2
    Electronic Resource
    Electronic Resource
    Diagnosis and treatment of common bile duct stones (CBDS) (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 856-864 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Common bile duct stones — Gallbladder — Bile duct calculi — Laparoscopic cholecystectomy — Endoscopic retrograde cholangiopancreaticography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Common bile duct stones (CBDS) are a frequent problem (10–15%) in patients with symptomatic cholecystolithiasis. Over the last decade, new diagnostic and surgical techniques have expanded the options for their management. This report of the Consensus Development Conference is intended to summarize the current state of the art, including principal guidelines and an extensive review of the literature. Methods: An international panel of 12 experts met under the auspices of the European Association of Endoscopic Surgery (EAES) to investigate the diagnostic and therapeutic alternatives for gallstone disease. Prior to the conference, all the experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The preconsensus document compiled out of this correspondence was altered following a discussion of the external evidence made available by the panel members and presented at the public conference session. The personal experiences of the participants and other aspects of individualized therapy were also considered. Results: Our panel of experts agreed that the presence of common bile duct stones should be investigated in all patients with symptomatic cholecystolithiasis. Based on preoperative noninvasive diagnostics, either endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiography should be employed for detecting CBDS. Eight of the 12 panelists recommended treating any diagnosed CBDS. For patients with no other extenuating circumstances, several treatment options exist. Stones can be extracted during ERCP, or either before or (in exceptional cases) after laparoscopic or open surgery. Bile duct clearance should always be combined with cholecystectomy. Evidence for further special aspects of CBDS treatment is equivocal and drawn from nonrandomized trials only. Conclusions: The management of common bile duct stones is currently undergoing some major changes. Many diagnostic and therapeutic strategies need further study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900729
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Ultrasonography—the stethoscope of the surgeon in the era of endoscopic surgery (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1163-1164 
    Details
    ISSN: 1432-2218
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00591042
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  • 4
    Electronic Resource
    Electronic Resource
    Evaluation of the effects of a pneumoperitoneum with carbon dioxide or helium in a porcine model of endotoxemia (2000)
    Springer
    Langenbeck's archives of surgery 385 (2000), S. 199-206 
    Details
    ISSN: 1435-2451
    Keywords: Key words Gas laparoscopy ; Pneumoperitoneum ; Endotoxemia ; Sepsis ; Porcine model ; Carbon dioxide ; Helium ; Laparoscopy in critically ill patients ; Hemodynamics ; Acid–base balance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: The expansion of the laparoscopic techniques to the critically ill patient is currently under debate. In order to evaluate the potential risks of performing laparoscopy in a body with signs of sepsis, the effects of the pneumoperitoneum were studied in a porcine model of mild endotoxemia. Methods: Twenty-eight pigs were separated into four groups of seven animals: untreated control (C), 2 µg/kg/h endotoxin (E), endotoxin and a pneumoperitoneum (3 h, 15 mmHg) with CO2 (EC) or with helium (EH). Hemodynamic and homeostatic variables were studied for a period of 5.5 h. Primary endpoints were arterial and mucosal pH and the ATP content of the bowel wall. Statistical evaluation was performed using analysis of variance and the Bonferroni test. Results: Endotoxin infusion induced characteristic symptoms of early sepsis: increase of arterial CO2, pulmonary arterial, portal venous, and pulmonary artery wedge pressure, and decrease of arterial pressure, cardiac output, arterial and mucosal pH. An additional pneumoperitoneum led to aggravation of all criteria with significant alterations in arterial and mucosal pH, arterial CO2, wedge and portal venous pressure. The most striking derangement of mean values was observed for mucosal pH (EC: 7.40, EH: 7.54) and arterial pH (EC: 7.15, EH: 7.18). In group EC, two animals died in septic shock. Conclusion: Applying a pneumoperitoneum during an ongoing sepsis significantly deteriorates hemodynamic and homeostatic variables, thus enhancing the risk of severe complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050265
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    Paper (German National Licenses)
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