ISSN:0253-4886    

DOI:10.1159/000172395

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Indications for a laparoscopic approach to surgically treatable diseases are expanding rapidly. With that expansion, physiological and pathological changes during CO2 pneumoperitoneum become more and more apparent. In the cardiovascular system, CO2 pneumoperitoneum decreases venous back flow from the lower extremities but increases cardiac preload and vascular resistance. In the respiratory system, CO2 insufflation results in a hypercapnia which can easily be monitored and corrected in a ventilated patient. Splanchnic and especially mesenteric and renal blood flow are decreased by up to 30%. Therefore, pneumoperitoneum should be applied at a minimal pressure with evacuation of CO2 at the end of surgery especially in patients with preexisting cardiovascular, pulmonary or renal diseases, in the elderly, and in obese patients.

ISSN:0253-4886    

DOI:10.1159/000172396

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Forty male rats weighing 150 g were operated on with gastrectomy with esophagoduodenostomy, antrectomy, fundectomy, or bilateral truncal vagotomy with pyloroplasty. Unoperated rats served as controls. The rats were freely fed, but not pair-fed, until sacrifice by exsanguination after 8 weeks. The pancreas was excised, weighed, and analyzed for contents of water, protein, amylase, and DNA. Basal levels of serum gastrin and plasma cholecystokinin (CCK) were only measured at sacrifice. Eight weeks after the operation, gastrectomized and antrectomized rats had lowered serum gastrin concentrations, while fundectomized and vagotomized rats had increased concentrations as compared with control rats. The concentration of plasma CCK was increased in fundectomized rats only. The operated rats had a lower body weight than the controls. The pancreatic wet weight relative to the body weight was increased after gastrectomy and vagotomy, but decreased after antrectomy. The protein content was lowered after antrectomy, but the content relative to the body weight was increased after gastrectomy and vagotomy. Antrectomy decreased the DNA content, while the other operative procedures were without similar effect. The pancreas was atrophic after antrectomy with a decreased DNA content, whereas gastrectomy evoked a slight hypertrophy, although both procedures induced hypogastrinemia. Fundectomy did not evoke any changes in the pancreas, whereas vagotomy increased the amylase content. Neither the concentration of gastrin in serum nor the concentration of CCK in plasma correlated with any of the changes in the pancreatic parameters studied. Thus, gastric surgery in the rat influenced the pancreatic integrity, but the observed changes were unrelated to basal levels of serum gastrin and plasma CCK.

ISSN:0253-4886    

DOI:10.1159/000172397

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total pancreatectomy was the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986 which showed no benefit. From 1986 the Whipple procedure became our standard operation. In the following 41 patients, a Whipple procedure was performed in 19 patients, and a total pancreatectomy was still performed in 22 patients because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph-node-negative patients, the 1-, 3-, and 5-year survival rates were 54, 24, and 15%, respectively. For node-positive patients, the 1-and 3-year survival rates were 46 and 4%, respectively, and there were no survivors at 54 months. This difference was statistically not significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For node-negative patients, the 1-, 3- and 5-year survival rates were 50, 59, and 25%, respectively. For node-positive patients, the 1-year survival rate was 21%. This difference was significant (p = 0.007). This study highlights the fact that extended radical surgery does not improve overall survival, but stage II and III disease (Hermreck classification) was associated with a prolonged survival.

ISSN:0253-4886    

DOI:10.1159/000172398

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Total gastrectomy often results in considerable weight loss and malnutrition. Studies indicate that decreased food intake might contribute to weight loss after total gastrectomy, but fed matched controls were not used in those studies. Serum proteins are used as parameters of malnutrition but might not be adequate to assess malnutrition after total gastrectomy. We measured food intake, weight gain per kilojoule of food intake, body weight, serum protein and albumin in gastrectomized and sham-operated fed matched minipigs over a period of 12 months. Total gastrectomy resulted in reduced food intake, reduced weight gain per kilojoule of food intake and in underweight, while fed matched sham-operated controls increased their body weight as did unoperated controls. Serum protein and albumin were initially decreased after total gastrectomy, but increased with time and were not different from sham-operated controls by the end of the study. Our data indicate that reduced food intake and a reduced efficiency to convert food into body weight result in body weight loss after total gastrectomy. This suggests that a hypercaloric food intake should be recommended after total gastrectomy, while serum proteins might not correctly reflect malnutrition after total gastrectomy.

ISSN:0253-4886    

DOI:10.1159/000172399

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The results of revisional surgery for ileostomy complications in a referral centre have been reviewed. 34 of 129 (26%) of patients who had their primary surgery in our unit have required revisional surgery for a variety of stomal complications. A total of 54 patients with ileostomy complications underwent a total of 115 revision operations. Of these patients, 25 have required at least one further revision operation. Reoperation rates were higher for Crohn’s disease (30%) than ulcerative colitis (19%), which reflects complications related directly to Crohn’s dise

ISSN:0253-4886    

DOI:10.1159/000172400

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The prognosis of patients with esophageal carcinoma is poor. This is especially true for stage-IV disease, regardless of the therapy applied. In a retrospective analysis we compared survival time and palliation after radiation therapy or resection in patients with stage-IV esophageal cancer who were treated between 1971 and 1991 at the University of Freiburg. The data were extracted from the files of the Departments of Surgery and Radiology, and processed by a computerized data program. For statistical purposes univariate and multivariate analyses were performed. 93 of a total of 504 patients had stage-IV disease. 22 patients received surgical treatment (12 transmediastinal resection; 10 thoracoabdominal resection), whereas 71 patients were irradiated (mean dosage 48 Gy). 45 patients received radiation therapy with a dosage of ≧ 50 Gy. The mean age of the resected patients was 51 years (range 23-65), and 60 years (range 33-81) for the irradiated patients. Perioperative hospital mortality was 18.2%, whereas 8.5% of the patients died while receiving radiation therapy. The 2-year survival rate was 18.8% for resected patients and 0% for irradiated patients with a mean survival time of 15 (range 1-120) and 4 months (range 1-17; p = 0.0016), respectively. The ability to swallow was impaired or not improved in 59.6% of the irradiated patients, whereas 38.8% of the resected patients suffered from stenosis of the anastomoses (p = 0.035). Based on these results, we conclude that resection of the esophagus leads to better palliation and a longer survival time than radiation therapy in patients with stage-IV esophageal cancer, provided the patient is in an otherwise satisfying conditio

ISSN:0253-4886    

DOI:10.1159/000172401

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Groin and abdominal wall hernias constitute a frequent condition and contribute substantially to both elective and emergency surgery. Incarcerated hernias, given their dangerous potential, are usually admitted and operated upon on an emergency basis. Occasionally, a patient suspected of having an incarceration is rushed to the theater. During operation, often a condition other than a hernia is found. These misdiagnosed cases are the subject of this retrospective study, in which the records of 952 operations performed for hernia of any kind during a 2-year period were reviewed: the misdiagnosed cases were identified (postoperative diagnosis other than hernia), and their physical findings and history, pre- and postoperative diagnosis, and type of anesthesia were compared and analyzed. The investigation revealed that 17.5% of all the emergency operations (57 in total) were misdiagnosed and rushed to theater. In 90% of these cases, local or regional anesthesia would have sufficed if operated upon for the correct pathology – found intraoperatively. In our opinion, such a frequent condition as groin and abdominal hernias should represent no diagnostic dilemma, and every effort should be done to avoid unnecessary risks and complications. A brief literature review offers the correct approach to anamnesis, physical examination, and differential diagnosis of hernias while emphasizing the importance of proper preoperative diagnosis, particularly in the emergency settin

ISSN:0253-4886    

DOI:10.1159/000172402

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Reoperative pelvic surgery for fistulae secondary to radiation, inflammation or malignancy is often associated with postoperative infection and healing complications. Seven cases illustrating the management of complex pelvic fistulae are presented with emphasis on the plastic surgical techniques employed. We believe that buttressing fistula repair sites or filling pelvic defects with well-vascularized, nonirradiated tissue facilitates healing and lessens fistula or abscess recurrence despite the presence of contamination. Key factors in successful muscle flap transposition are knowledge of muscle vascular supply, arc of rotation and muscle mass.

ISSN:0253-4886    

DOI:10.1159/000172403

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

This article describes our approach to the technical aspects of the Roux-en-Y gastric bypass. Because of an unsatisfactory experience with vertical-banded gastroplasty, we changed our primary operative procedure to that of Roux-en-Y gastric bypass. The technical modifications described in this report have been gleaned from experience and complications related to partitioning of the stomach with two staple lines as opposed to our current approach of completely separating the proximal and distal gastric pouches. With the current approach, we have been happy with the results; weight loss has been reproducible, and stomal ulcer formation has been minimal.

ISSN:0253-4886    

DOI:10.1159/000172404

出版商:S. Karger AG    

年代:1996

数据来源: Karger