Paul J. Klingler's research while affiliated with University of Innsbruck and other places

Publications (100)

Article
High-resolution manometry of the esophagus has gained worldwide acceptance, using different solid-state catheters. Thus, normal values for lower esophageal sphincter (LES) resting pressure in suspected gastroesophageal reflux disease patients have been established using water-perfused manometry. These standard values are commonly applied using also...
Article
Gastroesophageal reflux disease (GERD) is the most common foregut disease, with a great impact on quality of life and with intestinal, respiratory and cardiac symptoms and implications of carcinogenesis of the oesophagus. Medical therapy often fails, due to the complex pathophysiology of GERD. Surgery can cure the disease, since it is able to resto...
Article
Tumors and perforation of Meckel's diverticulum are rare manifestations. A gastrointestinal stromal tumor in a Meckel's diverticulum causing perforation and subsequent peritonitis in a 75-year-old man is presented. The literature on tumors in Meckel's diverticulum is extensively reviewed and discussed.
Article
In patients with gastroesophageal reflux disease (GERD) it is still controversial as to which type of antireflux procedure-the Nissen or the partial posterior fundoplication-offers the lower rate of side effects in the long term. In this follow-up study the Nissen fundoplication was performed only in GERD patients with normal oesophageal peristalsi...
Article
Most surgeons gain their first clinical experience with surgical robots when performing cholecystectomies. Although this procedure is rather easily applicable for the da Vinci surgical system, the long-term outcome after this operation has not yet been clarified. This study follows up our institutional first series of robotic cholecystectomies (Jun...
Article
The aberrant left hepatic artery (ALHA) is an anatomic variation that may present an obstacle in laparoscopic antireflux procedures. Based on our experience, we addressed the following questions: How frequent is ALHA? When or why is it divided? What is the outcome in patients after division of the ALHA? From a prospective collected database of 720...
Article
Background: The preperitoneal mesh repair of inguinal hernias has technical limitations in cases with large hernias or persistent processus vaginalis. Air leakage from excessive dissection of the sac can result in a loss of space, and conversion to a transperitoneal or even an open technique has been described. Methods: Ligation of the hernia sac...
Article
We sought to compare methods for determining intrabolus cricopharyngeal pressure as a possible indicator for cricopharyngeal myotomy. We determined multiple intrabolus pressures in the cricopharyngeal region of 20 normal volunteers, of whom 12 were 20 to 35 years old and 8 were older than 75 years. Data were collected using a commercially available...
Article
Background: Gastro-oesophageal reflux disease has a complex pathophysiology. Therefore, therapeutic considerations should not only include the peptic component of the disease. Methods: A variety of studies in rats and in humans demonstrate the consequences of gastro-oesophageal reflux and medical and surgical interventions in terms of inflammation,...
Article
To investigate whether Barrett's metaplasia may develop despite effective medical therapy. Gastroesophageal reflux disease has a multifactorial etiology. Therefore, medical treatment may not prevent complications of reflux disease. Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barre...
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Full-text available
Ischemic vascular disease of the upper extremity represents a difficult therapeutic problem wherein medical treatment often fails. Epidural spinal cord stimulation has been shown to be an effective alternative in severe peripheral arterial disease. Although this method has been used for nearly two decades only limited experience exists in Raynaud's...
Article
The metabolism of flavopiridol (FLAP), a novel anticancer drug currently undergoing clinical development, was investigated in rat and human liver microsomes. In the presence of uridine 5'-diphosphoglucuronic acid, two biotransformation products (M1 and M2) could be detected. Formation of metabolite M1 and M2 in terms of enzymatic efficacy (Vmax/K(M...
Article
The operative mortality and morbidity of laparoscopic fundoplication are lower than for the open procedure. Questions have been raised regarding its long-term durability. One hundred seventy-one patients who had undergone laparoscopic Nissen fundoplication at least 5 years previously answered a questionnaire. During this period, 291 patients underw...
Article
The surgical trend after proctocolectomy at present is to perform a pelvic pouch reservoir with an ileoanal anastomosis. Before that a continent ileal Kock pouch was the procedure of choice, which enabled the patient to collect the intestinal discharge for several hours and avoid involuntary escape of reservoir contents, thus making the wearing of...
Article
The aberrant left hepatic artery (ALHA) is an anatomic variation which may be an obstacle in the laparoscopic gastric banding operation. Based on our experience, our mission was to answer the questions: How frequently is an ALHA encountered? Is division necessary? Are there any additional complications in cases where the ALHA is preserved? In a pro...
Article
Laparoscopic adjustable gastric banding has become the prefered method for the surgical treatment of morbid obesity in Europe. It is not known whether this procedure may induce gastroesophageal reflux and whether it may impair esophageal peristalsis. Laparoscopic adjustable gastric banding (Swedish band) was performed in 43 patients (median body ma...
Article
The aim of this study was to determine the clinical utility of transthoracic echocardiography (TTE) as a screening method for the detection of abdominal aortic aneurysms (AAA). Each patient who was referred to the echocardiography laboratory TTE was included into the study. After complete cardiac assessment the abdominal aorta was evaluated. Patien...
Article
To evaluate the early and late outcome of mesenteric revascularisation in patients who had had elective mesenteric revascularisation for chronic intestinal ischaemia. Retrospective review. Academic clinic, United States. 19 consecutive patients (7 men, 12 women; mean age 70 years, range 53-83). Angiography showed that 2 mesenteric vessels were affe...
Article
Empyema complicating laparoscopic fundoplication is exceedingly rare, as is Capnocytophaga infection in the immunocompetent host, with the exception of gingivitis. We report a 29-year-old healthy man who presented with Capnocytophaga empyema 10 days after uneventful elective, laparoscopic Nissen fundoplication for gastroesophageal reflux disease. T...
Article
A 70-year-old male patient had a venous port catheter implanted into his right subclavian vein for neoadjuvant radio-chemotherapy of a rectal carcinoma (T3N0N0). Due to the patient's difficult venous access the catheter was left in situ after treatment. 31 weeks later he was admitted to the hospital because of parasternal and subclavicular pain. Ph...
Article
Cystic adrenal lesions can be either cortical or medullary, and distinguishing between these 2 types of lesions may be important in patient management. Pheochromocytomas, which are adrenal medullary neoplasms, typically manifest with hypertension, headaches, palpitations, tachycardia, sweating, and anxiety symptoms; however, 10% to 17% of patients...
Article
Accurate placement of a pH electrode requires manometric localization of the lower esophageal sphincter (LES). Combined manometry/pH devices using water-perfused tubes attached to pH catheters and the use of an electronic "LES locator" have been reported. We investigated whether accurate placement of pH probes can be achieved using such a probe, an...
Article
The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...
Article
Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well...
Article
Since the first laparoscopic fundoplication was performed, the frequency of antireflux surgery has increased rapidly with some centers now having an experience of about 1,000 procedures. The question arises whether this increase is due to a change in indications for the surgical treatment of gastrointestinal reflux disease (GERD) despite the simult...
Article
The ploidy values of the epithelial component were determined in a series of thymomas and organotypic thymic carcinomas using image cytometry and the results were compared with the histological tumour subtypes according to the histogenetic classification introduced by Marino, Müller Hermelink, and Kirchner (MMHK). Forty‐six cases of thymic epitheli...
Article
Various substances and agents have been evaluated to prevent postoperative adhesion formation. Recently a sodium hyaluronate-based bioresorbable membrane was introduced with promising clinical results. Its application was regarded as safe and efficient. We present the first reported case of a severe inflammatory reaction to a bioresorbable membrane...
Article
The ploidy values of the epithelial component were determined in a series of thymomas and organotypic thymic carcinomas using image cytometry and the results were compared with the histological tumour subtypes according to the histogenetic classification introduced by Marino, Müller Hermelink, and Kirchner (MMHK). Forty-six cases of thymic epitheli...
Article
Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Therefore, we designed a study to analyze the etiology, frequency, diagnosis using ultrasound, and treatment of RSH. A total of 1,257 patients admitted for abdominal ultrasound for acute abdominal pain or unclear acute abdominal disorders were evaluated. In 23 (1.8%) pat...
Article
Laparoscopic techniques can be used to treat patients whose antireflux surgery has failed. Case series. Two academic medical centers. Forty-six consecutive patients, of whom 21 were male and 25 were female (mean age, 55.6 years; range, 15-80 years). Previous antireflux procedures were laparoscopic (21 patients), laparotomy (21 patients), thoracotom...
Article
The aim of this study was to report on a rare cause of small-intestinal obstruction caused by small-intestinal enteroliths. We present three different cases of enterolith formation in the small intestine. One occurred after nontropical sprue, one patient had multiple jejunal diverticula, and another patient had enterolith formation in a blind loop...
Article
A case of acute, spontaneous cervical hemorrhage caused by a ruptured aneurysm of the inferior thyroid artery is described. This lesion was accompanied by an arteriovenous fistula within the thyroid gland that caused a flow-induced aneurysm. Diagnosis and treatment were successfully performed by selective angiography with endovascular occlusion and...
Article
Purpose The aim of this study was to report on a rare cause of small-intestinal obstruction caused by small-intestinal enteroliths. METHODS: We present three different cases of enterolith formation in the small intestine. One occurred after nontropical sprue, one patient had multiple jejunal diverticula, and another patient had enterolith formation...
Article
Achalasia is an uncommon motility disorder of the esophagus with an uncertain etiology. Considerable debate exists regarding the most effective treatment for long-term relief of symptoms. For decades, pneumatic dilatation has been the primary treatment option, and surgery was reserved for patients who required repeated dilations or for those who we...
Article
Achalasia is an uncommon motility disorder of the esophagus with an uncertain etiology. Considerable debate exists regarding the most effective treatment for long-term relief of symptoms. For decades, pneumatic dilatation has been the primary treatment option, and surgery was reserved for patients who required repeated dilations or for those who we...
Article
The response of esophageal strictures to laparoscopic antireflux surgery remains controversial. The aim of this study was to examine the outcome of patients with medically refractory esophageal strictures caused by severe gastroesophageal reflux disease and treated surgically. A prospective follow-up analysis was completed using data obtained from...
Article
Full-text available
Disseminated infection after intravesical bacille Calmette-Guérin instillation for bladder cancer is a rare but potential complication. Vascular infection is an additional serious complication but is seldom reported. We present the first report of a small series of patients with vascular infections after intravesical bacille Calmette-Guérin instill...
Article
The aim of this review is to assess the indications for, and surgical approach to, laparoscopic splenectomy (LS) and to propose a recommendation for the surgical approach to LS. The reports of LS were reviewed with a detailed analysis of indications, surgical technique, and clinical outcome. Thirty-two articles including a total of 643 patients (54...
Article
A traumatic diaphragmatic hernia is a well-known complication following blunt abdominal or penetrating thoracic trauma. Although the majority of cases are diagnosed immediately, some patients may present later with a diaphragmatic hernia. A tension fecopneumothorax, however, is a rarity. We report on a patient who, 2 years after being treated for a...
Article
Paraesophageal herniation of the stomach is a rare complication following laparoscopic Nissen fundoplication. We retrospectively reviewed our experience with 720 patients undergoing laparoscopic Nissen fundoplications. Seven patients were found to have postoperative paraesophageal hernias requiring reoperation. The clinical presentation, diagnostic...
Article
The aim of this review is to assess the indications for, and surgical approach to, laparoscopic splenectomy (LS) and to propose a recommendation for the surgical approach to LS. The reports of LS were reviewed with a detailed analysis of indications, surgical technique, and clinical outcome. Thirty-two articles including a total of 643 patients (54...
Article
Various techniques have been reported for the laparoscopic treatment of benign gastric lesions, depending on the site of the lesion. Recently, a new technique of endo-organ gastric surgery has been developed that is particular useful for the treatment of lesions on the posterior gastric wall. We report on two patients with submucosal gastric tumors...
Article
Open antireflux surgery produces good long-term control of disease, but new interest in the surgical management of gastroesophageal reflux disease has been stimulated by the introduction of minimally invasive techniques to perform standard antireflux procedures. In the past some scepticism existed among gastroenterologists who quoted the poor surgi...
Article
The surgical management of gastroesophageal reflux disease has been simplified by the availability of minimally invasive techniques to treat this condition. The indications and selection of patients remain the same as for open surgery and initial results with laparoscopic antireflux surgery show long-term results equal to, or better than open proce...
Article
Various techniques have been reported for the laparoscopic treatment of benign gastric lesions, depending on the site of the lesion. Recently, a new technique of endo-organ gastric surgery has been developed that is particular useful for the treatment of lesions on the posterior gastric wall. We report on two patients with submucosal gastric tumors...
Article
Reflux gastritis is caused by the excessive reflux of alkaline duodenal content into the stomach and can lead to intractable symptoms. The main cause of pathologic duodenogastric reflux (DGR) is previous gastric surgery in which the pylorus is removed or rendered dysfunctional. The entity of abnormal DGR without previous gastric surgery is called "...
Article
Vasoactive intestinal polypeptide (VIP)-secreting tumors of the pancreas represent a rare subtype of pancreatic islet cell tumors with an estimated incidence of 0.2 to 0.5 per million per year. We provide data on a relatively large series of patients with VIP-secreting tumors and review current literature regarding this specific entity. A retrospec...
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Full-text available
Primary malignant tumors of the thoracic and abdominal aortas are extremely rare. In most cases, a diagnosis is established either postmortem or after an emergency operation for embolic complications. We present the case of a thoracic aortic angiosarcoma in a 71-year-old man who initially was seen with peripheral embolization. The management of the...
Article
Partial posterior fundoplication improves esophageal peristalsis in patients with gastroesophageal reflux disease (GERD) associated with poor esophageal body function. The aim of this study was to investigate whether postoperative administration of cisapride enhances the effect of surgery on esophageal peristalsis. Laparoscopic partial posterior fu...
Article
Full-text available
Superior vena cava (SVC) syndrome caused by long-term use of indwelling catheters is an infrequent but increasingly common complication. Because collateralization often is sufficient, surgical treatment rarely is indicated. We present a case of a patient with severe symptomatic SVC syndrome as a result of the long-term use of indwelling hemodialysi...
Article
Appendicitis and its complications remain a common problem affecting patients of all age groups. Foreign bodies are a rare cause of appendicitis. We tried to define potentially dangerous foreign bodies that may cause appendicitis and summarize general guidelines for their clinical management. A 100-year literature review including 256 cases of inge...
Article
A cystic lesion in the body of the pancreas was detected during staging workup of a 59-year-old woman with T-cell lymphoma of the tongue. After six cycles of chemotherapy the pancreatic lesion was unchanged. Suggestive ulceration of the vulva with edema appeared at the end of chemotherapy. After right vulvar excision, distal pancreatic resection wi...
Article
Full-text available
The development of postoperative leaks of the thoracic duct after neck dissection or vascular surgery of the subclavian and vertebral artery is a well-known but rare complication. Usually, an injury of the duct manifests immediately after the operation with chylous drainage. Presentation as a postoperative lymphocele is rare. Operative treatment ma...
Article
We sought to determine the utility of esophageal manometry in an older patient population. Consecutively performed manometry studies (470) were reviewed and two groups were chosen for the study, those > or = 75 yr of age (66 patients) and those < or = 50 years (122 patients). Symptoms, manometric findings (lower esophageal sphincter [LES], esophage...
Article
To demonstrate a simple and effective repair of a poorly constructed ileal J-pouch with an extensive long efferent limb. A retrospective case review was performed. The surgical procedure described preserves additional ileum and enlarges the ileal reservoir. The procedure succeeded in resolving the patient's complaints of partial obstruction, weight...
Article
In an endemic goiter area patients with hyperparathyroidism (HPTH) frequently also have thyroid abnormalities. In a retrospective study of 95 patients with HPTH we assessed the diagnostic accuracy of imaging techniques (ultrasonography or radionuclide scanning) for preoperative localization of parathyroid adenomas. Altogether 86% of our patients ha...
Article
We report the case of a serious complication resulting from laparoscopic fenestration of a hepatic cyst. Seven months after the procedure had been performed, the cyst had recurred and ruptured, leading to massive bleeding. Bleeding control and enucleation of the cyst were carried out successfully by conventional surgery. The patient recovered rapid...
Article
Endoskopische Antirefluxchirurgie ersetzt zunehmend die traditionellen Operationsverfahren in der Behandlung der therapierefraktären gastrooesophagealen Refluxkrankheit. Diese laparoskopischen Verfahren sind jedoch technisch sehr anspruchsvoll. Komplikationen können aber durch eine sorgfältige Auswahl der Patienten sowie durch die geeignete chirurg...
Article
Laparoscopic antireflux surgery is rapidly replacing traditional operations for the treatment of medically refractory gastroesophageal reflux disease. These procedures are technically demanding. Troublesome side effects can be minimized by carefully selecting patients and using a meticulous and appropriate technique. Extensive follow-up data are no...
Article
A case is reported of an elective appendectomy in a patient with known ingestion of a sharp foreign body. The metal drill bit was ingested unintentionally 3 months before presentation at our institution. Plain abdominal films demonstrated the foreign body in the right lower abdominal quadrant. Because the gold dental drill bit was sharp and thought...
Article
It is not known whether antireflux surgery is more effective than medical therapy to control respiratory symptoms (RS) in gastroesophageal reflux disease (GERD). In 21 GERD patients with RS, reflux was assessed by endoscopy, manometry, and pH monitoring. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed foll...
Article
A further operation is required in a small proportion of patients who have had prior antireflux surgery. This has a surprisingly good chance for success in appropriately evaluated patients. The surgeon must make very specific decisions regarding the surgical approach. The use of laparoscopy for redo surgery is being defined.
Article
To evaluate the alteration of apoptosis in the esophageal epithelium during the esophagitis-Barrett esophagus-adenocarcinoma sequence. Archival tissue samples of 85 lesions in 58 cases were used. The lesions represented 7 groups: normal esophagus (n = 10), reflux esophagitis (n = 12), Barrett metaplasia (n = 21), Barrett low-grade dysplasia (n = 17...
Article
Paraesophageal hernias require surgery to avoid potentially serious complications. To evaluate paraesophageal hernia repair using the laparoscopic approach. Case series. University hospital and foregut testing laboratory. Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram...
Article
Although it is frequently stated in the literature that thoracotomy is one of the most painful operative incisions, few data supporting this view are available. Patients' postoperative pain experience can be assessed on the basis of their usage of patient-controlled analgesia. In a prospective trial the daily self-administered doses of analgesics i...
Article
The availability of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD) has shown this technique to be safe and well tolerated. In large series of patients the technique has proven its value with good short-term results. During the period 1991-1996 we performed 595 laparoscopic antireflux procedures in patients with GERD afte...
Article
Liver cysts are not uncommon. Rarely, they become symptomatic and require intervention. Surgery is the usual form of treatment; laparoscopic cyst unroofing has recently been introduced. The current status of diagnosis and conventional therapy of hepatic cysts was summarized. The surgical literature was surveyed to collect all reported cases of mini...
Article
In this case report, the functional anastomoses of the uterine arteries are demonstrated. In our opinion, the selective ligation of one or both uterine arteries is the method of choice for treating severe gynaecological or obstetrical bleeding complications. Successful haemostasis and preservation of the uterus can be achieved permitting future spo...
Article
Unlabelled: In this study, we investigated the implication of oxygen-derived free radicals in reflux esophagitis of humans. For this purpose we assessed oxidative stress in distal esophageal biopsies of controls, patients with various grades of esophagitis, Barrett's esophagus with and without severe associated esophagitis and patients following N...
Article
Background Diagnostic tools available for nonepithelial vulvar lesion are individual experience, ultrasonography, computed tomography, and magnetic resonance imaging (MRI). Use of MRI in our specialty still is being defined. Two primary advantages of MRI versus ultrasonography and computed tomography are that images can be obtained in any orientati...