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ABSTRACT: Two of the most commonly used open prosthetic tension-free techniques for inguinal hernia repair are Lichtenstein's operation and the mesh plug repair. The technique of choice remains a subject of ongoing debate. The objective of the present investigation was to compare the two surgical procedures with respect to associated morbidity and recurrence rates.
Five hundred and ninety-five patients with 700 primary or recurrent inguinal hernias were randomized to undergo either Lichtenstein's operation or mesh plug repair. The primary endpoint of the investigation was the recurrence rate 1 year after surgery. Secondary endpoints were perioperative complications and reoperation rates.
At 12-month follow-up, 597 hernia repairs (85.3 per cent) were evaluated. There were no significant differences regarding recurrence rates and perioperative complications. However, there was a significant difference in the overall reoperation rate between the two treatment groups, with 13 reoperations (4.2 per cent) in the Lichtenstein group and four (1.4 per cent) in the mesh plug group (P = 0.047).
Lichtenstein's operation and the mesh plug repair are comparable with respect to perioperative complications and recurrence rates.
British Journal of Surgery 02/2007; 94(1):36-41. · 4.61 Impact Factor
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ABSTRACT: The aim of this study is to obtain functional results of the long-term follow-up after TME and ileocecal interposition as rectal replacement.
The study included patients operated on between March 1993 and August 1997 who received an ileocecal interposition as rectal replacement. Follow-up was carried out 3 and 5 years postoperatively. For statistical analysis, the paired t-test, rank test (Wilcoxon), and chi-square or Fisher's exact test were applied; level of significance, P<0.05.
Forty-four patients were included in the studies. Of these, five were not available and four patients could not be evaluated (dementia 1, radiation proctitis 1, fistula 1, pouchitis 1). Seventeen patients died during the observation period; 12 died of the disease. Recurrence of the disorder occurred in 2 of 35 patients (5.7%); 26 and 18 patients, 3 and 5 years postoperatively, respectively remained in the study. At 5 years, 78% of the patients were continent; mean stool frequency was 2.5+/-1.6 per day.
Functional results and subjective assessment of ileocecal interposition were constant at 3 and 5 years postoperatively. If construction of a colonic J-pouch is not possible due to lack of colonic length, especially after prior colonic resections, the ileocecal interpositional reservoir may offer an alternative to rectal replacement.
International Journal of Colorectal Disease 11/2004; 19(6):574-9. · 2.38 Impact Factor
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ABSTRACT: The optimal reconstruction procedure after gastrectomy is still a matter of debate. The ileocecal interpositional graft offers an excellent reservoir capacity, the preservation of duodenal passage, and a natural antireflux barrier (ileocecal sphincter).
We prospectively analyzed the quality-of-life outcome in 20 patients undergoing ileocecal interpositional graft (13 subdiaphragmatic reconstruction, 7 intrathoracic reconstruction) after gastrectomy in a University Hospital and a Canton Hospital (mean follow-up 6 months), operative and postoperative morbidity, body weight, reflux, and dumping symptoms. In a smaller series of nine patients we performed functional tests such as gastric emptying measurements, glucose tolerance tests, and manometry of the gastric substitute.
The mean gastrointestinal quality-of-life index in the subdiaphragmatic reconstruction group 114, and that in the intrathoracic reconstruction group was 106. Mild reflux and dumping symptoms were noted by no patients in the former group and by two of seven patients in the latter. In the smaller series of nine patients gastric emptying time was faster in the intrathoracic group, but no difference in plasma glucose level was found between the two groups.
Reconstruction after gastrectomy with an ileocecal interpositional graft achieves good quality of life with an acceptable morbidity. The technique seems to reduce the occurrence of postoperative reflux and dumping symptoms.
International Journal of Colorectal Disease 08/2002; 17(4):268-74. · 2.38 Impact Factor
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ABSTRACT: Most patients with chronic peptic ulcer disease have Helicobacter pylori (H. pylori) infection. In the past, immediate acid-reduction surgery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery.
In 47 consecutive patients (mean age = 64 years, range 27-91) suffering from acute peptic ulcer perforation the preoperative presence of H. pylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of H. pylori eradication with a triple regimen were prospectively studied.
Of these patients 73.3% were positive for H. pylori, regardless of the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Thirty-eight per cent underwent a simple laparoscopic repair. Conversion rate to laparotomy reached a high of 32%. The main reasons for conversion were the size of the ulcer, and/or diffuse peritonitis for a duration of over 12 hours with fibrous membranes difficult to remove laparoscopically. In the H. pylori positive patients, eradication was successful in 96% of the cases. Mortality and morbidity rates were greater in the laparoscopic group (p < 0.05). Follow-up (median 43.5 months) revealed no need for reoperation for peptic ulcer disease and no mortality.
We have found a high prevalence of H. pylori infection in patients with perforated peptic ulcers. An immediate and appropriate H. pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to a triple eradication protocol was excellent in the hospital setting.
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 02/2001; 131(7-8):99-103. · 1.89 Impact Factor
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ABSTRACT: Stereotactic biopsy techniques supersede conventional hook-wire localization followed by open excision to clarify the dignity of nonpalpable mammographic lesions. The advanced breast biopsy instrumentation (ABBI) allows stereotactically guided excision of a specimen up to 20 mm in diameter on an outpatient basis under local anaesthesia.
Demographic information, mammographic and pathological findings, complications, subsequent interventions and sensitivity as well as efficiency of a series of 144 planned ABBI procedures were documented (largest published single institution series).
The ABBI procedure was successfully performed in 93.8% (135/144); accurate diagnosis was made in 99.3% (134/135), sensitivity for malignant lesions was 96.9% (31/32) and morbidity was 1.5%. Consistent with other published series margins of the biopsy cylinder containing a malignant lesion were involved in 83.9% (26/31).
Excisional biopsy using the ABBI system is a reliable diagnostic tool with a low incidence of morbidity. The therapeutic use is of limited potential.
Swiss Surgery 02/2000; 6(3):111-5.
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ABSTRACT: The choice of the best reconstruction technique following resection of either the stomach or the rectum remains a matter of discussion. While there is no problem in reconnecting intestinal segments, which do not serve as a reservoir, there are many different operation techniques to replace the stomach and rectum, producing significantly different functional results. The ileocecal segment offers an excellent intestinal reservoir combined with an antireflux mechanism, thus presenting an ideal replacement for the stomach. For replacement of the rectal reservoir as well, the ileocecal segment may be used in the first line of treatment.
The ileocecal segment was used in 20 patients following gastric resection and lymphadenectomy to reconstruct the intestinal passage between the esophagus and the duodenal stump (group A). In some further 44 patients (group B) the ileocecal segment was used to replace the rectum between the descending colon and the dentate line following resection for very low-grade rectal cancer. Mortality and morbidity were investigated in both groups. In group A quality of life, weight loss, dumping and reflux symptoms were evaluated. In group B continence, discrimination, defecation quality, urge and the patient satisfaction were investigated. All data were recorded prospectively.
Early and late mortality were not different compared to other reconstruction types. In each group one patient died within 60 days postoperatively due to myocardial infarction. The morbidity following stomach replacement was 20%, following rectal replacement 4.6% during hospitalization and 13.8% during follow-up, respectively. One patient complained about heartburn, but endoscopically no pathology was detected in any patient. Three months postoperatively the patients' weight remained stable or started to increase. Three months following rectal replacement 87% of the patients were continent with further improvement over 2 years. Soiling mainly during the night remained over 2 years in 44%. 88% of the patients were completely satisfied 2 years postoperatively.
The replacement of either the stomach or the rectum using the ileocecal segment with an adequate surgical technique is safe and produces excellent functional outcome regarding the reconstruction of the intestinal passage as well as the reservoir function of the primary organ. Furthermore, preservation of the duodenal passage after gastrectomy may prevent dysregulation of the endocrine and exocrine pancreatic hormones.
Der Chirurg 06/1999; 70(5):552-61. · 0.70 Impact Factor
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ABSTRACT: Die Rekonstruktionsmethodik nach Resektion intestinaler Hohlorgane gibt noch immer Anlass zu Diskussionen. Während Darmabschnitte
ohne Reservoirfunktion problemlos ersetzt oder überbrückt werden können, bestehen für den Ersatz des Magens und des Rectums
verschiedene Operationsverfahren, die funktionell deutliche Unterschiede aufweisen. Das ileocoecale Segment bietet eine ausgezeichnete
Reservoirfunktion und eine Antirefluxbarriere, womit es sich als Magenersatz geradezu anbietet. Dieselbe Reservoirfunktion
steht auch als Rectumersatz zur Verfügung. Methode: Bei 20 Patienten wurde nach totaler Gastrektomie und Lymphadenektomie zur Rekonstruktion der intestinalen Kontinuität das
ileocoecale Segment zwischen Oesophagusstumpf und Duodenalstumpf interponiert. Bei 44 Patienten wurde nach Resektion eines
tiefsitzenden Rectumcarcinoms die intestinale Kontinuität mit einem ileocoecalen Interponat zwischen Colon descendens und
Analschleimhaut wiederhergestellt. Letalität und Morbidität wurden bei beiden Operationen untersucht. Beim Magenersatz wurden
Lebensqualität, Gewichtsverlauf, Dumping- und Refluxsymptome evaluiert. Beim Rectumersatz wurden Grob- und Feinkontinenz,
Diskrimination, Evakuationsqualität, „urge“ und subjektive Zufriedenheit der Patienten ausgewertet. Alle Daten wurden prospektiv
erhoben. Ergebnisse: Früh- und Spätletalität bei beiden Operationen sind vergleichbar mit anderen Rekonstruktionstypen. Je ein Patient verstarb
innerhalb der 60-Tages-Grenze an einem Myokardinfarkt. Die Morbidität nach Magenersatz betrug 20 %, nach Rectumersatz in der
Frühphase 4,6 %, im Verlauf 13,8 %. Subjektive Refluxsymptome wurden bei einem Patienten nach Magenersatz eruiert, endoskopisch
waren alle Patienten unauffällig. Das Gewicht blieb nach 3 Monaten konstant oder stieg an. Beim Rectumersatz waren nach 3
Monaten 87 % der Patienten kontinent mit einer weiteren Besserung der Grobkontinenz über 2 Jahre. Die Feinkontinenz war nach
2 Jahren bei 56 % gut. 88 % der Patienten waren nach 2 Jahren mit dem Resultat zufrieden. Schlussfolgerung: Die Interposition eines ileocoecalen Segmentes zum Magen- oder Rectumersatz ist bei geeigneter chirurgischer Technik eine
sichere Operation mit guten funktionellen Resultaten, sowohl was die Rekonstruktion der intestinalen Kontinuität als auch
die Wiederherstellung der Reservoirfunktion des Primärorganes angeht. Beim Magenersatz ist außerdem durch die Erhaltung der
duodenalen Passage die exo- und endokrine Hormonregulation des Pankreas gewährleistet.
The choice of the best reconstruction technique following resection of either the stomach or the rectum remains a matter
of discussion. While there is no problem in reconnecting intestinal segments, which do not serve as a reservoir, there are
many different operation techniques to replace the stomach and rectum, producing significantly different functional results.
The ileocecal segment offers an excellent intestinal reservoir combined with an antireflux mechanism, thus presenting an ideal
replacement for the stomach. For replacement of the rectal reservoir as well, the ileocecal segment may be used in the first
line of treatment. Method: The ileocecal segment was used in 20 patients following gastric resection and lymphadenectomy to reconstruct the intestinal
passage between the esophagus and the duodenal stump (group A). In some further 44 patients (group B) the ileocecal segment
was used to replace the rectum between the descending colon and the dentate line following resection for very low-grade rectal
cancer. Mortality and morbidity were investigated in both groups. In group A quality of life, weight loss, dumping and reflux
symptoms were evaluated. In group B continence, discrimination, defecation quality, urge and the patient satisfaction were
investigated. All data were recorded prospectively. Results: Early and late mortality were not different compared to other reconstruction types. In each group one patient died within
60 days postoperatively due to myocardial infarction. The morbidity following stomach replacement was 20 %, following rectal
replacement 4.6 % during hospitalization and 13.8 % during follow-up, respectively. One patient complained about heartburn,
but endoscopically no pathology was detected in any patient. Three months postoperatively the patients' weight remained stable
or started to increase. Three months following rectal replacement 87 % of the patients were continent with further improvement
over 2 years. Soiling mainly during the night remained over 2 years in 44 %. 88 % of the patients were completely satisfied
2 years postoperatively. Conclusion: The replacement of either the stomach or the rectum using the ileocecal segment with an adequate surgical technique is safe
and produces excellent functional outcome regarding the reconstruction of the intestinal passage as well as the reservoir
function of the primary organ. Furthermore, preservation of the duodenal passage after gastrectomy may prevent dysregulation
of the endocrine and exocrine pancreatic hormones.
Der Chirurg 01/1999; 70(5):552-561. · 0.70 Impact Factor
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ABSTRACT: The optimal inguinal hernia repair technique is a matter of debate. The Shouldice operation has long been regarded as the gold standard. While specialized hernia clinics have reproduced good results, a recurrence rate for trainees and non-specialized surgeons of between 10% and 15% seems to be more common. Laparoscopic hernia surgery has brought decreasing postoperative morbidity, low post-operative disability and early return to work. These advantages of a tension-free technique are due to the use of a prosthetic mesh. It is largely the efforts of Gilbert, Lichtenstein and Rutkow/Robbins which have popularized the use of prosthetic mesh by an open anterior approach in the USA.
Since January 1997 we have prospectively evaluated the open mesh plug repair described by Rutkow/Robbins in Basel and Lugano. We have operated on 110 patients (103 male, 7 female). All patients were interviewed 4 weeks postoperatively at our clinic.
There were no major complications. Two patients underwent reoperation for drainage of a haematoma. There was no early recurrence or infection. After 4 weeks 82% of all patients were back to normal activity. An early return to work has been noted (10 days on average for sedentary workers).
The main advantages of this technique are simplicity, low cost, reduced post-operative disability and early return to work. It is much too early to say anything concerning recurrence in this series.
Schweizerische medizinische Wochenschrift 10/1998; 128(38):1401-7. · 1.68 Impact Factor
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ABSTRACT: In clinical practice a long Roux-en-Y reconstruction is most often used for gastric replacement. Among various postgastrectomy symptoms, alcaline reflux is the most disturbing. A great variety of different pouch reconstructions with or without duodenal bypass only control reflux in part. The ileocoecal interposition has been placed between the oesophagus and the duodenum as a gastric substitute in 14 patients without postoperative mortality. This preliminary series demonstrates an excellent control of alcaline reflux and a good quality of life, according to the Eypasch score. Dysphagia or stasis in the distal oesophagus are absent as is gas bloating. This type of reconstruction, which is simpler than some of the pouch reconstructions, probably deserves more attention and may perhaps be perfected by varying the length of ileum and volume of ascending colon to be interposed.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:66-71.
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ABSTRACT: The ileocecal interpositional graft is an alternative method for replacing the distal esophagus and the stomach. A pedunculated ileocecal interpositional graft rotated 180 degrees clock-wise and placed across the hiatus between the proximal esophagus and the duodenum could act as a reservoir and protect against reflux (ileocecal valve) while preserving the duodenal passage. Two patients underwent this operation (the first patient has been observed for 12 postoperative months). We also used this technique to replace the stomach alone below the diaphragm, a technique that had been abandoned in the surgical literature since 1952, although the concept and initial experiences were already promising at that time. In favor of these attractive features of the ileocecal interpositional graft as gastric replacement, we have begun a controlled examination of this method.
Archives of Surgery 10/1997; 132(9):1038-42. · 4.24 Impact Factor
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ABSTRACT: Injuries of the small bowel following a blunt abdominal trauma are rare (incidence 6%). The diagnosis is difficult and therefore often missed. The aim of this paper is to acquire an useful diagnostic sequence of our own results in comparison to the literature.
The diagnostic procedures and the time of the final diagnosis of 13 patients with this rare injury have been retrospectively analysed.
Two of these 13 patients died in the emergency room. Five of the remaining 11 patients had signs of peritonitis at the first examination. These were confirmed by findings either in peritoneal lavage (3), ultrasound (1) or X-ray (1). Patients without signs of peritonitis revealed no pathological signs at the first examination with these diagnostic tools. Correct diagnosis was achieved on 7/11 patients within 24 hours. The diagnosis of small bowel injury was confirmed by the rest of the patients (n = 4) after an average of 11 days after trauma.
Initial assessment with diagnostic tools as ultrasound, peritoneal lavage or X-ray is poor. Therefore repetitive controls (Nowadays by ultrasound) are indicated. The CT is a valuable tool to detect an organ lesion in hemodynamic stable patients with positive proof of liquid in the ultrasound. Today the value of the diagnostic laparoscopy is not established. It should be considered that a local ischemia due to the blunt trauma can cause a delayed perforation.
Swiss Surgery 02/1995;
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ABSTRACT: We present a new feeding schedule for the Göttingen minipig after extended gastric resection. Having a clever feeding regime and postoperative care minipigs may survive even in case of extended gastric resection and reconstruction. This enables important survival experiments to be done in regard to new operative techniques in Man. Postoperatively we started immediately to feed the minipigs with soft feed in the form of Hill's prescription diet canine/feline a/d. This feed composition consists of highly nutritious proteins and has little crue fibres. This was followed by the standard dry pellet feed KLIBA Minipig 3000. Follow-up over 16 weeks didn't reveal any feeding regime related complications.
Journal of Experimental Animal Science.
