Jefrey Vermeulen

Publications (12)19.99 Total impact

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  Available from: Quirijn Eijsbouts

  Article: The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037).

  Hilko A Swank, Jefrey Vermeulen, Johan F Lange, Irene M Mulder, Joost A B van der Hoeven, Laurents P S Stassen, Rogier M P H Crolla, Meindert N Sosef, Simon W Nienhuijs, Robbert J I Bosker, [......], André J L D'Hoore, Alex Kartheuser, Christophe Remue, Helma M U van Grevenstein, Joop L M Konsten, Donald L van der Peet, Marc J P M Govaert, Alexander F Engel, Johannes B Reitsma, Willem A Bemelman
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  ABSTRACT: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy.The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90%) in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis. Nederlands Trial Register NTR2037.
  BMC Surgery 10/2010; 10:29. · 1.33 Impact Factor
• Article: [Hospital mortality after emergency surgery for perforated diverticulitis].

  Jefrey Vermeulen, Martijn P Gosselink, Wim C J Hop, Johan F Lange, Peter-Paul L O Coene, Erwin van der Harst, Wilbo F Weidema, Guido H H Mannaerts
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  ABSTRACT: To assess which factors predict in-hospital mortality after emergency surgery for acute perforated diverticulitis. Multicenter retrospective study. From 1995-2005 a total of 291 patients underwent surgery to treat perforated diverticulitis in five teaching hospitals in Rotterdam, the Netherlands. The relation to postoperative mortality of patient-related risk factors such as age, gender and classification according to the American Society of Anesthesiologists (ASA); disease severity factors such as Hinchey score and Mannheim peritonitis index (MPI); surgery-related risk factors, such as type of surgery, e.g. Hartmann’s procedure (HP) or resection with primary anastomosis; surgeon, and time of operation were evaluated using multivariate analysis. The total postoperative in-hospital mortality was 29%. HP was performed 211 times and primary anastomosis was performed 75 times. HP was significantly more frequently performed in patients with higher values of age, ASA, Hinchey and MPI (all: p < 0.01). Multiple logistic regression analysis showed that age, ASA classification, Hinchey score, MPI and the absence of a specialist gastrointestinal surgeon during surgery, were important prognostic factors of mortality. Surgical technique was not related to postoperative mortality (adjusted odds ratio for mortality (HP versus primary anastomosis): 1.3; 95% CI: 0.6-2.9; p = 0.54). The type of surgery did not appear to be a risk factor for high postoperative mortality. As well as patient-related risk factors, including age, ASA and severity of disease scores, such as Hinchey score and MPI, the absence of a specialist gastrointestinal surgeon during surgery was found to be a factor associated with high mortality risk.
  Nederlands tijdschrift voor geneeskunde 06/2010; 153(25):1209-14.
• Source

  Available from: Vah Jan

  Article: Avoiding or reversing Hartmann's procedure provides improved quality of life after perforated diverticulitis.

  Jefrey Vermeulen, Martijn P Gosselink, Jan J V Busschbach, Johan F Lange
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  ABSTRACT: The existing literature regarding acute perforated diverticulitis only reports about short-term outcome; long-term following outcomes have not been assessed before. The aim of this study was to assess long-term quality of life (QOL) after emergency surgery for perforated diverticulitis. Validated QOL questionnaires (EQ-VAS, EQ-5D index, QLQ-C30, and QLQ-CR38) were sent to all eligible patients who had undergone emergency surgery for perforated diverticulitis in five teaching hospitals between 1990 and 2005. Differences were compared between patients that had undergone Hartmann's procedure (HP) or resection with primary anastomosis (PA) and also compared to a sex- and age-matched sample of healthy subjects. Of a total of 340 patients, only 150 patients (44%) were found still alive in July 2007 (median follow-up 71 months). The response rate was 87%. In patients with PA, QOL was similar to the general population, whereas QOL after HP was significantly lower. The presence of a stoma was found to be an independent factor related to worse QOL. The deterioration in QOL was mainly due to problems in physical function and body image. Survivors after perforated diverticulitis had a worse QOL than the general population, which was mainly due to the presence of an end colostomy. QOL may improve if these stomas are reversed or not be performed in the first place.
  Journal of Gastrointestinal Surgery 04/2010; 14(4):651-7. · 2.83 Impact Factor
• Source

  Available from: PubMed Central

  Article: Treatment of perforated diverticulitis with generalized peritonitis: past, present, and future.

  Jefrey Vermeulen, Johan F Lange
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  ABSTRACT: The supposed optimal treatment of perforated diverticulitis with generalized peritonitis has changed several times during the last century, but at present is still unclear. The first cases of complicated perforated diverticulitis of the colon were reported in the beginning of the twentieth century. At that time the first therapeutic guidelines were postulated in which an initial nonresectional procedure was provided to be the safest plan of management. After many years in which resection had become standard practice, today, one century later, again (laparoscopic) nonresectional surgery is presented as a safe and promising alternative in treatment of complicated perforated diverticulitis. The question rises what had happened to close the circle? This paper includes a historic summary of changing patterns in surgical strategies in perforated diverticulitis complicated by generalized peritonitis.
  World Journal of Surgery 03/2010; 34(3):587-93. · 2.36 Impact Factor
• Article: The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitis^Aand Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis^Bin perforated diverticulitis (NTR2037)

  Hilko Swank, Jefrey Vermeulen, Johan Lange, Irene Mulder, van der Hoeven Joost, Laurents Stassen, Rogier Crolla, Meindert Sosef, Simon Nienhuijs, Robbert Bosker, [......], Hoore, Alex Kartheuser, Christophe Remue, van Grevenstein Helma, Joop Konsten, van der Peet Donald, Marc Govaert, Alexander Engel, Johannes Reitsma, Willem Bemelman
  [show abstract] [hide abstract]
  ABSTRACT: Abstract Background Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). Methods/Design In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann&apos;s procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann&apos;s procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and power = 90%) in favour of the patients with resection with primary anastomosis. Secondary endpoints for both arms are the number of days alive and outside the hospital, health related quality of life, health care utilisation and associated costs. Discussion The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis. Trial registration Nederlands Trial Register NTR2037
  BMC Surgery. 01/2010;
• Article: Fistula formation to the bladder and to a corpus alienum as a rare complication of diverticulitis: a case report.

  Jefrey Vermeulen, Naomi van Hout, Rene Klaasen
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  ABSTRACT: Fistula formation is a known complication of diverticulitis. Treatment of a diverticular fistula depends on the comorbidity of the patient and the severity of the disease. A 59-year-old man presented to the Emergency Department with chronic lower back pain that was being treated with a neurostimulator. He presented with severe sepsis, and an abscess formation near the neurostimulator. An abdominal and pelvic computed tomography scan revealed diverticulitis complicated by fistula formation to the neurostimulator and bladder. He was successfully treated by a two-stage procedure: first, exploration and drainage of the abscess, with removal of the foreign body, followed by a sigmoid resection 1 week later. In rare but severe presentations of diverticular disease, it is very important to limit initial treatment to the most threatening disorder.
  Journal of Emergency Medicine 12/2009; 43(2):e87-8. · 1.31 Impact Factor
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  Available from: Bettina E Hansen

  Article: Long-term survival after perforated diverticulitis.

  J Vermeulen, M P Gosselink, W C J Hop, E van der Harst, B E Hansen, G H H Mannaerts, P-P L O Coene, W F Weidema, J F Lange
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  ABSTRACT: Short-term survival after emergency surgery for perforated diverticulitis is poor. Less is known about long-term survival. The aims of this study were to evaluate long-term survival after discharge from hospital and to identify factors associated with prognosis. All patients who underwent emergency surgery for perforated diverticulitis in five hospitals in Rotterdam, the Netherlands, between 1990 and 2005, were included. The association between type of surgery (Hartmann's procedure or primary anastomosis) and long-term survival was analysed using multivariate Cox regression analysis, taking into account age American Society of Anesthesiology (ASA) classification, Hinchey score, Mannheim Peritonitis Index (MPI) and surgeon's experience. In addition, survival of the patients was compared with that of the matched general Dutch population. Of 340 patients included in the study, 250 were discharged alive from hospital. The overall 5-year survival was 53%. Survival was significantly impaired compared with the expected matched gender-, age- and calendar time-specific survival. Overall survival was significantly related to age and ASA classification. Hinchey score, MPI, number of re-interventions, the surgeon's experience and type of procedure did not influence long-term survival, although a trend was found for Hartmann's procedure to be a risk factor for poorer survival compared with primary anastomosis (hazard ratio for mortality: 1.88; 95% confidence interval, 0.96-3.67; P = 0.07). Long-term survival of patients after perforated diverticulitis is limited and mainly caused by the poor general condition of the patients, rather than by the severity of the primary disease or calendar-time and type of procedure.
  Colorectal Disease 11/2009; 13(2):203-9. · 2.93 Impact Factor
• Article: [Treatment for diverticulitis not thoroughly researched].

  Werner A Draaisma, Bryan J M van de Wall, Jefrey Vermeulen, Cagdas Unlu, Niels de Korte, Hilko A Swank
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  ABSTRACT: In the Netherlands approximately 14,000 patients are referred to hospital for diverticular disease each year. Overall controversy persists about four aspects of treatment of the different stages of diverticulitis, i.e. the role of antibiotics in the treatment of mild diverticulitis, the question of whether elective surgical resection is justified in recurrent diverticulitis or in persisting abdominal symptoms after an episode of diverticulitis, the question of whether patients with purulent peritonitis due to perforation may be treated with laparoscopic peritoneal lavage instead of Hartmann's procedure, and finally, whether resection with a primary anastomosis is a feasible and safe alternative to Hartmann's procedure in the surgical treatment of Hinchey III or IV diverticulitis. These questions will be addressed in four upcoming Dutch randomised trials.
  Nederlands tijdschrift voor geneeskunde 01/2009; 153:A648.
• Article: Reversal of Hartmann's procedure through the stomal side: a new even more minimal invasive technique.

  Jefrey Vermeulen, Wietske Vrijland, Guido H H Mannaerts
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  ABSTRACT: Several minimal invasive, mainly laparoscopic-assisted, techniques for reversal of Hartmann's procedure (HP) have been published. The purpose of this pilot study was to assess a minimal invasive procedure through the stomal site that may compare favorably with open or laparoscopic-assisted procedures in terms of operative time, hospital stay and postoperative complications. HP reversal through the stomal side was attempted in 13 consecutive patients. Lysis of intra-abdominal adhesions was done manually through an incision at the formal stoma side, without direct vision between thumb and index finger. The rectal stump was identified intra-abdominally using a transanal rigid club. A manually controlled stapled end-to-end colorectal anastomosis was created. Mean duration of operation was 81 min (range 58-109 min); mean hospital stay was 4.2 days (range 2-7 days). In two patients the procedure was converted because of strong adhesions in the lower pelvic cavity around the rectal stump that could not be lysed manually safely. No complications occurred in the patients in whom reversal was completely done through the stomal site. In our opinion, restoration of intestinal continuity through the stomal side after HP is a feasible operation, without need for additional incisions. In the hands of a specialist gastrointestinal surgeon this technique can be attempted in all patients, as conversion to a laparoscopic-assisted or an open procedure can be performed when necessary.
  Surgical Endoscopy 08/2008; 22(10):2319-22. · 4.01 Impact Factor
• Article: Outcome after emergency surgery for acute perforated diverticulitis in 200 cases.

  Jefrey Vermeulen, George P Akkersdijk, Martijn P Gosselink, Wim C J Hop, Guido H Mannaerts, Erwin van der Harst, Peter-Paul L O Coene, Wibo F Weidema, Johan F Lange
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  ABSTRACT: Mortality and morbidity rates of acute perforated diverticulitis remain high. The ideal treatment is still controversial. The object of this study was to compare patients with perforated diverticulitis treated either by resection with primary anastomosis (PA) or Hartmann's procedure (HP). A multicenter study was carried out on 200 consecutive patients with acute perforated diverticulitis who were presented in the surgical units of four affiliated teaching hospitals in Rotterdam, The Netherlands, between 1995 and 2005. Mortality and morbidity were compared in relation to type of surgery, ASA classification, age, gender, Mannheim Peritonitis Index (MPI), Hinchey score, surgeon's experience, and the time of operation. There was a tendency for more severely affected patients (Hinchey, MPI, ASA and age) to undergo HP. Multivariate logistic regression analysis showed no significant difference in mortality between HP and PA. After HP, more patients needed one or more reinterventions to treat postoperative complications compared to PA. Besides, HP resulted in a longer total hospital and intensive care unit stay. Specialist colorectal surgeons performed significantly more frequently a PA instead of a HP and had fewer postoperative complications than general surgeons. The time of operation did not influence the choice of surgical procedure. Selected patients with perforated diverticulitis can be managed well by PA, as it does not seem to be inferior to HP in terms of severe postoperative complications that need surgical or radiological reintervention and mortality. This decision should be made while taking into account the patient's concomitant diseases, response on preoperative resuscitation and the availability of a surgeon experienced in colorectal surgery.
  Digestive Surgery 02/2007; 24(5):361-6. · 1.22 Impact Factor
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  Available from: ajol.info

  Article: Impaired anastomotic healing after preoperative radiotherapy followed by anterior resection for treatment of rectal carcinoma.

  Jefrey Vermeulen, Johan F Lange, Erwin van der Harst
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  ABSTRACT: Patients with rectal carcinoma undergoing total mesorectal excision (TME) have a lower recurrence rate with preoperative radiotherapy (RT). The aim of this study was to assess the side-effects in patients who had preoperative RT compared with those who did not receive it (because of palliative resections, advanced age or refusal). From January 2001 to March 2003, 40 patients underwent resection and double-stapled anastomosis for rectal carcinoma. We compared 17 patients who received RT followed by resection and low rectal anastomosis, with 23 patients who did not have RT. After surgery 7/17 of the patients who had received RT developed anastomotic leaks. Anastomotic leakage was seen only once in the patients who did not have RT (41% v. 4%, p = 0.006). A protective stoma, which was performed in 11 patients in the RT group, did not prevent anastomotic leakage (4/11 leakage with stoma v. 3/6 leakage without stoma, p = 0.64). Median hospital stay was longer in the RT group (17.4 v. 13.7 days, p = 0.017). There was no difference in the number of minor postoperative complications between the two groups (24% v. 22%). Compared with surgery alone, preoperative short-term RT increased the number of anastomotic leaks and hospital stay, whether or not a protective stoma was performed.
  South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 03/2006; 44(1):12, 14-6. · 0.29 Impact Factor
• Article: Nitric oxide production is maintained in exercising swine with chronic left ventricular dysfunction.

  David B Haitsma, Daphne Merkus, Jefrey Vermeulen, Pieter D Verdouw, Dirk J Duncker
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  ABSTRACT: Left ventricular (LV) dysfunction caused by myocardial infarction (MI) is accompanied by endothelial dysfunction, most notably a loss of nitric oxide (NO) availability. We tested the hypothesis that endothelial dysfunction contributes to impaired tissue perfusion during increased metabolic demands as produced by exercise, and we determined the contribution of NO to regulation of regional systemic, pulmonary, and coronary vasomotor tone in exercising swine with LV dysfunction produced by a 2- to 3-wk-old MI. LV dysfunction resulted in blunted systemic and coronary vasodilator responses to ATP, whereas the responses to nitroprusside were maintained. Exercise resulted in blunted systemic and pulmonary vasodilator responses in MI that resembled the vasodilator responses in normal (N) swine following blockade of NO synthase with N(omega)-nitro-L-arginine (L-NNA, 20 mg/kg iv). However, L-NNA resulted in similar decreases in systemic (43 +/- 3% in N swine and 49 +/- 4% in MI swine), pulmonary (45 +/- 5% in N swine and 49 +/- 4% in MI swine), and coronary (28 +/- 4% in N and 35 +/- 3% in MI) vascular conductances in N and MI swine under resting conditions; similar effects were observed during treadmill exercise. Selective inhibition of inducible NO synthase with aminoguanidine (20 mg/kg iv) had no effect on vascular tone in MI. These findings indicate that while agonist-induced vasodilation is already blunted early after myocardial infarction, the contribution of endothelial NO synthase-derived NO to regulation of vascular tone under basal conditions and during exercise is maintained.
  AJP Heart and Circulatory Physiology 07/2002; 282(6):H2198-209. · 3.71 Impact Factor