Skills (8)
Publications (242) View all
-
Article: Impact of prolapse mass on Contour(®) Transtar™ technique for third-degree rectal prolapse.
[show abstract] [hide abstract]
ABSTRACT: PURPOSE: Contour® Transtar™ procedure for rectal prolapse is a promising technique according to safety and efficacy. One potential surgical problem is failure of the stapler due to the thick rectal wall. In order to evaluate the practicability and the impending limitations of the Contour® Transtar™ technique, we reviewed our data with special respect to the necessity of additional anastomosis suturing. METHODS: A prospective analysis of 25 consecutive patients, which underwent Contour® Transtar™ procedure from January 2009 to July 2012, was performed. For statistic analysis, the groups with and without additional suturing of the anastomosis were evaluated according to patient characteristics and surgical outcome. RESULTS: Twenty-five patients, three men and 22 women, underwent transanal Contour® Transtar™ stapling procedure for rectal prolapse. Due to stapling failure, additional suturing of the anastomosis was necessary in 4 of 25 procedures (16 %). Age (74.1 vs. 83.1 years) and body mass index (30.8 vs. 22.7 kg/m(2)) were significantly different with and without additional suturing. Operative time was longer (62 vs. 31 min), more cartridges were used (12 vs. 6), and the specimen weight was higher (220 vs. 107 g) in patients with additional suturing. Early postoperative complications were observed in two patients without anastomosis suturing including one patient with bleeding and systemic inflammatory reaction in one case. Postoperative stay did not differ between both groups. CONCLUSION: Patients with extensive obesity, which present with a substantial rectal prolapse, may need additional suturing of the rectal anastomosis after Contour® Transtar™ stapling. This causes prolonged operative time. However, this does not correlate with complications and it is not related to significant longer hospital stay.International Journal of Colorectal Disease 02/2013; · 2.38 Impact Factor -
Article: Mesenteriales Lymphangiolipom – eine Rarität als Zufallsbefund
[show abstract] [hide abstract]
ABSTRACT: Hintergrund: Lymphangiome, speziell Lymphangiolipome sind extrem seltene Tumoren im Mesenterium. Es sind benigne Raumforderungen mit vorwiegender Manifestation in der Kindheit, die aber aufgrund ihrer Größe, eines ummauernden Wachstums und ihrer Rezidivneigung häufiger zu Problemen führen können. Fallbeschreibung: Ein 46-jähriger Patient stellte sich beschwerdefrei zu einer internistischen Vorsorgeuntersuchung vor. Bis auf zwei Hörstürze 2006 und 2008 war die Vorgeschichte leer. Eine umfassende Voruntersuchung 2 Jahre zuvor war ohne auffälligen Befund geblieben. In der abdominellen Sonographie fiel eine große (ca. 12x10x7 cm) cystische mehrfach septierte Raumforderung mit echofreiem Inhalt ohne Vaskularisation im rechten Mittel- und Unterbauch auf. Ein umfassendes internistisches Routinelabor incl. Echinococcusserologie (der Patient war Jäger) war unauffällig. Auch in der abdominellen MRT zeigte sich eine zystisch-liquide Raumforderung ohne Vaskularisation der Septen, eine Verbindung zum Darm oder zu anderen Organen war nicht nachweisbar. Es erfolgte die explorative Laparatomie mit Hemicolektomie rechts und Anlage einer Ileotransversostomie. Die Histologie ergab die Diagnose eines Lymphangiolipoms, einer chronischen Appendicitis sowie einer chronischen Lymphadenitis der ileocolischen Lymphknoten ohne Hinweis für Malignität oder Spezifität. Der postoperative Verlauf war unkompliziert. Schlussfolgerung: Das Lymphangiom bzw. die Subspezifität Lymphangiolipom ist eine seltene Differentialdiagnose cystischer intraabdomineller Tumoren. Mögliche Komplikationen sind Ileus, Invaginationen und auch ein ummauerndes Wachstum. Abdomineller Ultraschall erhebt in der Vorsorge wichtige Befunde auch bei beschwerdefreien Patienten. Background: Lymphangioma is an uncommon tumor, an intraperitoneal lymphangiolipoma is exceedingly rare. These tumors are principally benign, but lead to complications due to their size and localization. Case Report: A 46 year old male patient presented for a regular medical check up. Apart from a hearing loss 2006 and 2008 he reported no previous or chronic diseases. An extensive health examination had been performed two years ago and had been without pathological results. Abdominal ultrasound revealed a large polycystic lesion in the right middle and lower abdomen, approximately 12x10x7 cm in size. There was no vascularisation in the septae. In MRI, the tumor appeared cystic as well without communication to the intestinal wall. Laboratory values including echinococcus serology was without pathological results. An explorative laparotomy was done with right hemicolectomy and subsequent ileotransversostomy. Histologically, a lymphangiolipoma was diagnosed, as well as a chronic appendicitis and chronic lymphangitis of the ileocolic lymph nodes. Postoperatively, the patient recovered without any complications. Conclusion: Lymphangiomas, especially lymphangiolipomas, are an extremely rare differential diagnosis of intraabdominal cystic tumors. Potential complications included ileus, intussusception or an immuring growth. Abdominal ultrasound can reveal important pathological findings even in symptom- free patients. Schlüsselwörter: Prävention–Ultraschall–Lymphangiom–mesenteriales Lymphangiolipom Key Words: prevention–ultrasound–lymphangioma–mesenteric lymphangiolipoma04/2012; 105(12):948-951. -
Article: Actinomyces infection mimicking tumor-progression in rectal cancer under neoadjuvant therapy.
Acta oncologica (Stockholm, Sweden) 02/2012; 51(2):270-2. · 2.27 Impact Factor -
Article: Laparoscopic assisted sigmoid resection for diverticular disease.
[show abstract] [hide abstract]
ABSTRACT: Laparoscopic assisted sigmoid resection (LASR) has become a widely accepted procedure in colorectal surgery. In the last decade, numerous variations of surgical details have been established. In order to demonstrate a feasible technique, this video is provided. LASR is performed using four ports. The first port is inserted via open access by a minilaparotomy in the right paraumbilical region. Two ports are sited in the right lower abdomen, including one 12-mm port in the following incision above the pubic symphysis. The forth port is inserted in the left upper abdomen. The procedure starts with the removal of adhesions, the peritoneal incision is performed medially, and a medial to lateral approach to the mesocolon and the inferior mesenteric artery (IMA) is carried out. After identifying the left ureter, the IMA is either clipped or sealed about 1.5 to 2 cm from the origin in order to preserve the autonomous plexus. Then dissection is continued on Gerota's fascia. After lifting the rectosigmoid, dissection is continued in the avascular plane until the mesentery of the upper rectum is mobilized. Then the remaining lateral adhesions are dissected with preservation of the gonadal vessels and the left ureter. The distal resection line is always in the upper rectum, which is easily identified by the lack of tenia. After sealing the mesorectum, the rectum is dissected using a linear stapler. Thereafter, a minilaparotomy above the pubic symphysis is performed and a device for protection and retraction of the wound is inserted. Dissection of the mesosigmoid and the descending colon is carried out extracorporally. The anvil of a circular stapling device is inserted in the descending colon, which is then returned into the peritoneal cavity. Running sutures closes the incision, and the anastomosis is carried out laparoscopically in a "double stapling" technique. The video describes the efficacy and technical feasibility of laparoscopic surgery for diverticular disease and demonstrates its effect regarding perioperative morbidity and functional outcome.Langenbeck s Archives of Surgery 12/2011; 397(3):487-90. · 1.81 Impact Factor -
Article: Thoracoscopic resection of a combined esophageal leiomyoma and diverticulum: a case report.
[show abstract] [hide abstract]
ABSTRACT: We report the case of a 66-year-old male patient with a combined esophageal leiomyoma and diverticulum. On account of the low incidence, there is little literature available with regard to the management of those conditions. Our patient underwent a simultaneous thoracoscopic enucleation of the leiomyoma and resection of the diverticulum. Though endoscopic enucleations of myoma and resections of diverticula have been described earlier, to our knowledge, we are the first, who performed those procedures in a single operation, which seems to be feasible and safe.Surgical laparoscopy, endoscopy & percutaneous techniques 02/2011; 21(1):e16-8. · 1.23 Impact Factor
