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  • 1
    Electronic Resource
    Electronic Resource
    Sphincter preserving techniques: from anterior resection to coloanal anastomosis (1998)
    Springer
    Langenbeck's archives of surgery 383 (1998), S. 397-401 
    Details
    ISSN: 1435-2451
    Keywords: Key words Rectal cancer ; Surgery ; Coloanal anastomosis ; Postoperative function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nowadays surgery offers a complete spectrum of techniques for the treatment of rectal cancers. Progress in preoperative diagnostic techniques, especially in endoluminal ultrasound, and in the knowledge of anorectal physiology allows the surgeon to adopt a very individual strategy for the various tumor types. The situation has changed even for tumors of the middle and distal thirds of the rectum, which formerly were treated predominantly by abdominoperineal exstirpation. These can also be treated by sphincter-preserving techniques, the most ambitious of which is intersphincteric resection with coloanal anastomosis. Our experience shows that this method is not only comparable to the alternatives of conventional anterior resection and extirpation in terms of postoperative morbidity and mortality but also achieves excellent oncological results. Of course, anorectal function is significantly altered by this type of surgery. Still, after an adaptive period of about 6–12 months a very satisfactory functional result is reached. Further functional improvement, especially in the early postoperative period, can possibly be expected from reconstruction with creation of a colon pouch.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050151
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of intravenous ketamine on gastrointestinal motility in the dog (1995)
    Springer
    Intensive care medicine 21 (1995), S. 584-589 
    Details
    ISSN: 1432-1238
    Keywords: Ketamine ; Gastrointestinal motility ; Pain, post-operative ; Critical care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The purpose of this trial was to clarify the effets of intravenous ketamine at anaesthetic and sub-anaesthetic dosages on gastrointestinal motility. Design 20 beagles (group 1: 3 mg/ketamine/kg/h,n=10; group 2: 30 mg ketamine/kg/h,n=10), were investigated. Gastric emptying (nuclide gastric emptying studies, liquid and semi-solid test meal), intestinal transit time (Hydrogen breath test with lactulose) and intestinal motor function (perfusion manometry with 8 measuring ports) were determned. As a control condition, the tests were performed on all dogs in the two groups during infusion of physiological saline solution. Results No significant differences in the motility patterns were present between 3 mg ketamine/kg/h and the control condition. For group 2, a moderately significant (p〈0.05) increase in the interdigestive motility index was observed for 30 mg k ketamine/kg/h. However, this did not change the transit criteria. There was no significant difference between ketamine and control condition tests with regard to cycle and phase lengths or the propagation rate of the activity front. Conclusions We conclude that ketamine provokes no basic changes in gastrointestinal motility, at either sub-anaesthetic doses. It can there-fore be used to advantage in the continuous postoperative analgesia of intensive care patients, where repeated interventions are necessary and no cardiopulmonary contraindications are present.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700164
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  • 3
    Electronic Resource
    Electronic Resource
    Studies of the vascular anatomy of the mesorectum support the concept of the total mesorectal excision (2000)
    Springer
    Techniques in coloproctology 4 (2000), S. 151-156 
    Details
    ISSN: 1128-045X
    Keywords: Key words Mesorectal vascular pattern ; Stain marking ; Specimen angiography ; Total mesorectal excision
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The relation between the mesorectal vessels and the mesorectal fascia needs to be clarified, as a total mesorectal excision (TME) probably derives its advantage from the fact that the visceral or mesorectal fascia can be regarded as a “tumor-tight packaging” and does not contain anatomically preformed perforations. The purpose of this investigation was to study both rectal arterial supply and vascular distribution pattern within the mesorectum. The arterial supply to the rectum was studied with the injection technique in 12 porcine and 28 human TME specimens. We stain-marked 12 porcine and 15 human specimens. Thirteen human specimens were angiographed after filling their arterial bed with a radio-opaque substance. The superior rectal artery is the main rectal artery. Terminal branches extend downwards and forward around the rectum to the level of the levator and muscle. The superior rectal artery and vein were found to be enclosed in a fibrous sheath. The main mesorectal vessels do not penetrate the mesorectal fascia. This study supports the hypothesis of bilateral somatic and one central visceral compartment in the pelvis and implies the absolute necessity of tumor removal within an intact mesorectal fascia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101510070007
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  • 4
    Electronic Resource
    Electronic Resource
    Loose fascial closure and fascial defects: effects on laparotomy healing in rats (2000)
    Springer
    Hernia 4 (2000), S. 67-71 
    Details
    ISSN: 1248-9204
    Keywords: Wound healing ; Suture tension ; Incisional hernia ; Microangiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Every suture technique in surgery aims at connecting tissue structures until stable scar formation has developed. Although the negative effects of high suture tension on the mechanical properties of the developing scar are well known, the applied suture tension has not been standardized and depends on the surgeon's experience. In this study the effects of low suture tension on laparotomy closure were studied in rats and an incisional hernia model was developed. Median laparotomies were closed by running suture using Foley-catheters with a diameter of 2.4, 4.8 and 7.2 mm as distance holders. In another group, an abdominal wall defect of 2 cm diameter was created and covered internally by larger omentum. After 28 days laparotomies closed using a distance holder with diameter of 2.4 and 4.8 mm had healed without developing fascial dehiscence or incisional hernia. With 7.2 mm catheters all animals developed a ruptured abdomen. All animals with abdominal wall defects developed incisional hernias with stable hernial sacs without significant inflammatory reaction. Laparotomy closure intentionally performed with a surplus of suture material of up to 21% per stitch in a 4 cm incision does not result in a disturbance of wound healing or hernia formation. Creating an abdominal wall defect with an internal covering of great omentum in rats reliably results in incisional hernia formation closely resembling that found in humans. These results underline the necessity to further determine values for tissue-specific suture tension experimentally.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02353745
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  • 5
    Electronic Resource
    Electronic Resource
    Use of progressive pneumoperitoneum in the repair of giant hernias (2000)
    Springer
    Hernia 4 (2000), S. 105-111 
    Details
    ISSN: 1248-9204
    Keywords: Hernia ; Tension-free repair ; Pneumoperitoneum ; Mesh ; Preoperative preparation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Preoperative progressive pneumoperitoneum is a well-known, but sporadically used procedure in preparing patients with giant inguinal or incisional hernias for operation. The technique requires the frequent insufflation of air into the abdominal cavity in order to make room to accommodate herniated viscera and facilitate fascial repair with minimal tension. In 11 patients with giant inguinal and incisional hernias a preoperative progressive pneumoperitoneum was performed. Due to a lack of compliance it had to be terminated without operation in one patient. Minor complications appeared in almost all patients, but after pneumoperitoneum a tension-free closure of the fascial defect was successful in all patients. The direct suture of the defect was successful in 4 patients with primary hernias, while in all cases of recurrent hernias an additional fascial augmentation by alloplastic meshes was required. Until now no recurrences have appeared. We conclude that the progressive pneumoperitoneum is a useful adjunct in the preoperative preparation of patients with giant hernias. It is not a competing, but a complementary procedure to mesh repair in patients with huge defects or fascial weakness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02353758
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  • 6
    Electronic Resource
    Electronic Resource
    Femoral hernia in childhood: evaluation of sonography as a diagnostic aid (1999)
    Springer
    Hernia 3 (1999), S. 19-21 
    Details
    ISSN: 1248-9204
    Keywords: Femoral hernia in childhood ; Sonography ; Operative technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Between 1986 and 1997, 1,970 children up to the age of 15 were operated for inguinal hernia at the University Surgical Clinic of the RWTH Aachen. During this period, we operated on 6 children for femoral hernia (0.3% of the total number of hernia operations). A preceding inguinal hernia appeared to favor femoral hernia in childhood. In our view, preoperative diagnostic examination of children using sonography is an absolute requirement. Our surgical method consisted of closing the hernial orifice using a continuous double-row suture. The success of our surgical approach has been confirmed by non-recurrence of the complaint.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01576735
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  • 7
    Electronic Resource
    Electronic Resource
    Diaphragm replacement: An experimental animal study (1997)
    Springer
    Hernia 1 (1997), S. 123-127 
    Details
    ISSN: 1248-9204
    Keywords: Diaphragm replacement ; Absorbable material ; Electromyography ; Physical and histologic examination ; Animal study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We performed an open experimental study for evaluation of rapidly absorbable material of bovine serosa for diaphragm replacement. A total of 100 Sprague-Dawley rats were randomly assigned to five groups of equal size. In the control group (n=20) incision of the diaphragm was followed by primary suture. The animals of the four other groups underwent partial resection of the left hemidiaphragm. The defects were repaired by lyophilized dura, polytetrafluorethylene (PTFE), autologous transversus muscle or rapidly absorbable bovine serosa. We performed electromyography (EMG) and postmortem physical examinations of elasticity and load capacity of the different materials as well as histologic examinations after three and six months. A total of 89 animals survived and were subject to the analysis. There were no differences between the groups concerning growth and weight gain. The EMG showed normal function for the absorbable material and the transversus muscle. Only scanty physiologic waves were registered in the PTFE group. Load capacity measurements showed the lowest value of 4.71 N for the native diaphragm; all other materials had much higher values (17.66 N – 51.99 N) with a peak load capacity in the PTFE group. Measurements of elasticity displayed similar results. The native diaphragm had the lowest value (1516 N/m); much higher values were found in all the other materials tested (3905 N/m – 7654 N/m) with again peak values for PTFE. The differences of all materials compared to native diaphragm were statistically significant (p〈0.05). The histologic examinations revealed strong foreign body reactions in the dura and PTFE groups. The absorbable bovine serosa had vanished three months postoperatively. Short-term absorbable bovine serosa tested successfully as a partial replacement of the diaphragm in this experimental study on rats. There may be additional indications for this material if a temperary replacement is intended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02426416
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  • 8
    Electronic Resource
    Electronic Resource
    Abdominal wall compliance after Marlex® mesh implantation for incisional hernia repair (1998)
    Springer
    Hernia 2 (1998), S. 113-117 
    Details
    ISSN: 1248-9204
    Keywords: Incisional hernia ; Marlex mesh ; Abdominal wall compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In view of the poor results of suturing techniques, incisional hernias are often best repaired with biomaterials. Their use brings the recurrence rate to below 10%, but patients sometimes complain of discomfort and restricted abdominal mobility. We report our experience with 41 patients after implantation of a Marlex®-mesh in a preperitoneal, retromuscular position (mean follow-up period 16.7 months). The effect of implanted meshes on abdominal wall mobility was measured noninvasively with the aid of three dimensional stereography and compared with a non-operated healthy control group (n = 21). The commonest early postoperative complication was seroma in 32% of cases, usually relieved by aspiration. Infection and hematoma were less frequent at 4.9% and 12.2% respectively. Three patients developed a recurrent hernia. During follow-up 7.3% experienced pain during heavy activities, 29.3% during daily activities and 4.9% at rest. Three dimensional stereography showed a highly significant (p 〈 0.001) decrease in abdominal wall mobility following mesh implantation, compared to a non-operated control group. Improved composition of the mesh material involving a smaller proportion of polypropylene and greater elasticity, should be considered for the future, in order to reduce patient discomfort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01250024
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  • 9
    Electronic Resource
    Electronic Resource
    Recommendations for treatment of contralateral inguinal hernias in children (1999)
    Springer
    Hernia 3 (1999), S. 53-56 
    Details
    ISSN: 1248-9204
    Keywords: Contralateral hernia ; Children ; Incidence ; Predisposing disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It is impossible to determine whether or not a child will develop a contralateral hernia after inguinal hernia repair. There exists no risk score for the occurrence of a contralateral hernia. This well-known fact prompted us to perform the underlying study. In a retrospective trial, we reviewed the files of all children operated on for inguinal hernias in our department from January 1986 until December 1994. During this period, we performed 1721 hernia repairs on 1708 children aged 0–16 years. In 96 (5.6%) of these patients, the indication to operate was a contralateral hernia following previous unilateral repair. Comparison of the ages at the time of primary inguinal repair of those children who developed a contralateral hernia (n=96) and those who did not (n=1612) showed a significantly increased incidence of contralateral hernias if the primary operation was performed before the age of two months (p〈0.0001). Diseases predisposing to hernias were found in 38% of all children (prematurity, dystrophia, ventriculo-peritoneal shunt, ascites, asthma). The authors recommend a contralateral exploration for children under the age of two months if they have any predisposing disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01194602
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  • 10
    Electronic Resource
    Electronic Resource
    Altered collagen synthesis in fascia transversalis of patients with inguinal hernia (1999)
    Springer
    Hernia 3 (1999), S. 181-187 
    Details
    ISSN: 1248-9204
    Keywords: Collagen I ; Collagen III ; Hernia ; Fascia transversalis ; Surgical mesh
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to substantiate the hypothesis as to whether an altered metabolism of type I and type III collagen should be included as pathophysiological considerations of inguinal hernia development or not. Therefore, fascia transversalis derived from patients with indirect hernias (n=9), direct hernias (n=7) and from controls (n=7) were investigated both by immunohistochemistry and protein analysis (Western Blot). Both immunohistochemical analysis and Western Blot analysis showed that the ratio of the relative amounts of type I to type III collagen was significantly decreased in the fascia transversalis of patients with indirect and direct inguinal hernias compared with controls (p〈0.001). The relative reduction of the collagen I/III ratio may be explained by a concomitant increase in collagen type III synthesis in both hernia-families. In contrast to the control group there was no significant difference between patients with direct and indirect hernia. It is concluded that the change in collagen type I / III ratio, with the resulting altered physical properties, might essentially predispose individuals to the development of inguinal hernia. Thus, an altered collagen metabolism would provide an additional theoretical basis for the use of alloplastic materials, such as surgical meshes, and an explanation for the disappointing high recurrence rates after appropriate primary hernia repair, particularly if mesh-free techniques have been used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01194422
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