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  • 1
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ninety-eight patients (26 females), who presented with erosive and/or ulcerative oesophagitis, despite at least a 3-month period of treatment with standard doses of cimetidine (≥ 1200 mg daily) or ranitidine (≥ 300 mg daily), were included in a double-blind, randomized trial to compare omeprazole (40 mg o.m.) with a high dose of ranitidine (300 mg b.d.). The treatment was given for 4–12 weeks; endoscopy assessment and laboratory screening were performed on entry to the trial and thereafter every fourth week. Endoscopic healing was defined as complete epithelialization of all macroscopic erosions or ulcers in the squamous epithelium. An ‘intention-to-treat’analysis of the clinical datarevealed omeprazole to be superior to ranitidine : 63 % of those patients who were given omeprazole were heaIed endoscopically after a 4-week period of treatment, compared with only 17 % of those given ranitidine. This difference in healing rate persisted during the 12-week study period (90% DS 47% after 12 weeks; P 〈 0.0001). Reflux symptoms were more rapidly and completely relieved with omeprazole : heartburn resolved completely in 86% of patients treated with omeprazole for 4 weeks compared with 32% in the ranitidine group (P 〈 0.0001). The mean basal gastrin concentrations increased only in those given omeprazole from 18.9 pmol/L at pre-entry to a mean value of 31.7 pmol/L on the last day of omeprazole administration. In ranitidine-treated patients no significant increase in basal gastrin concentration was observed. Both drugs were well tolerated with few adverse events, which were mainly mild and transient. These results demonstrate the superiority of omeprazole over a high dose of ranitidine in the treatment of resistant reflux oesophagitis.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 22 (1998), S. 964-968 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Laparoscopic surgery is regarded as a major improvement reflected by a rapid recovery and low perioperative and postoperative morbidity. In obese patients the gains of this new technique may be affected by obesity-related problems, such as impaired respiratory function, high intraabdominal pressure, thick abdominal wall, and liver steatosis. This review describes the development of laparoscopic vertical banded gastroplasty (VBG) and gastric bypass procedures; and it addresses questions such as feasibility, comparability to open procedures, procedure-related problems, and recovery. The clinical outcome after laparoscopic VBG and gastric bypass is also updated. Up to May 1997 we have operated on 105 patients with laparoscopic VBG and another 26 completed laparoscopic gastric bypass procedures. The weight loss after both procedures are in accordance with the weight loss seen with open surgery. Procedure-related complications are described in detail in this paper. It is concluded that laparoscopic bariatric surgery will remain an area of importance for clinical practice, research, and development.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 260-263 
    ISSN: 1432-2218
    Keywords: Key words: Chest physiotherapy — Laparoscopic surgery — Fundoplication — Vertical banded gastroplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Chest physiotherapy is a common practice after open reflux and obesity surgery. It is now possible to perform fundoplication and vertical banded gastroplasty (VBG) by the laparoscopic technique. The aim of this study was to evaluate in a prospective, randomized, controlled trial whether chest physiotherapy affects the postoperative course. Method: A series of 40 patients underwent laparoscopic fundoplication; another 40 underwent laparoscopic VBG. Twenty patients in each series received prophylactic chest physiotherapy; the other 20 served as control patients and were not given any information or training. Results: Postoperatively, all patients had a significant reduction in respiratory function, measured as oxygen saturation, forced vital capacity, and peak expiratory flow, but the differences between the groups within each series were not significant. Postoperatively, one patient in the VBG treatment group had hypoxemia (SaO2 〈92%) versus two control patients. One control patient developed postoperative pneumonia. Conclusions: This study indicates that routine chest physiotherapy is not necessary in patients undergoing laparoscopic upper gastrointestinal surgery, such as fundoplication and VBG.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 1209-1212 
    ISSN: 1432-2218
    Keywords: Key words: Gastroesophageal reflux disease — Fundoplication — Laparoscopy — Direct costs — Indirect costs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: As part of a prospective observational trial, we set out to determine the direct and indirect costs of an open versus a laparoscopic fundoplication for chronic gastroesophageal reflux disease (GERD). Methods: Two groups of patients, each comprising 28 subjects, were studied. Results: All patients received a functioning fundoplication that did not require any additional therapy. Because 19 and 12 patients in the open and laparoscopy groups, respectively, were employed in the work force, we were able to assess the costs due to loss of production. The mean operating time was similar for both groups, but postoperative stay differed significantly; though it amounted to 8 days for the open group, it was only 2 days for the laparoscopy group. Postoperative sick leave was 29.9 days in the open and 9.9 in the laparoscopy group (p 〈 0.05). The costs of the operations were 18,363 SEK for laparoscopy and 12,856 SEK for conventional fundoplication. On the other hand, the cost for hospital stay amounted to 35,488 SEK in the open group but was only 25,571 SEK for those undergoing laparoscopy. When we add outpatient visits, endoscopies, and other medical expenses, the total direct costs in the laparoscopy group come to 27,693 SEK, as compared to 37,482 SEK for the open fundoplication. The indirect medical costs, which were dominated by loss of production (36,732 versus 12,126 SEK), came to 37,126 and 12,595 SEK in the open and laparoscopy groups, respectively. Conclusions: The total community-based costs for the open and laparoscopic operations for chronic GERD amounted to 74,608 and 40,289 SEK, respectively. Thus, we would recommend the laparoscopic procedure in most cases.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 636-638 
    ISSN: 1432-2218
    Keywords: Gastroplasty ; Gastric bypass ; Morbid obesity ; laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The present report describes the technical details of laparoscopic bypass for morbid obesity. Methods: The laparoscopic approach was attempted in eight patients and completed in six. In these latter patients the stomach was divided with an endoscopic linear cutter (ETC 60 Ethicon), and a antecolic jejunal loop was brought to the proximal pouch and anastomosed by use of manual suture technique supported with locking clips for knotting substitutes [Lapra-Ty (Ethicon)]. Distal to the gastrojejunostomy a side-to-side enteroanastomosis was also performed. Results: Five patients in whom the laparoscopic procedure was completed had an unevenful postoperative period and a rapid recovery. However, one patient had a postoperative left-sided pleuropneumonia that required prolonged hospital stay. Of those who were converted, one was because of a large steatotic left liver lobe and another was due to a perforation of the small intestine. Conclusions: These early results indicate that gastric bypass for the treatment of morbid obesity can be safely performed with laparoscopic techniques. Further development in this field should be encouraged.
    Type of Medium: Electronic Resource
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