TP Hüttl's research while affiliated with Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie and other places

Publications (138)

Article
Operative Massnahmen sind fester Bestandteil der Therapie der morbiden Adipositas und ihrer Folgeerkrankungen. Die Zielsetzung geht zunehmend weg von der alleinigen Gewichtskontrolle hin zur Kontrolle des gesamten Metabolismus. Diese sog. metabolische Chirurgie hat sich zur effektivsten Therapieform des Diabetes mellitus Typ 2 (DMT2) bei Adipösen e...
Article
Operative Maßnahmen sind fester Bestandteil der Therapie der morbiden Adipositas und ihrer Folgeerkrankungen. Die Zielsetzung geht zunehmend weg von der alleinigen Gewichtskontrolle hin zur Kontrolle des gesamten Metabolismus. Diese sogenannte metabolische Chirurgie hat sich zur effektivsten Therapieform des Diabetes mellitus Typ 2 bei Adipösen ent...
Chapter
Wenngleich der Ein-Anastomosen-Bypass (Omega-Loop-Bypass, Mini-Gastric-Bypass; Abb. 11.1) derzeit ähnlich emotional diskutiert wird wie die Sleeve-Gastrektomie, so belegen die publizierten Daten doch eine hohe Effektivität auch unter metabolischen Aspekten mit sehr guten Remissionsraten bezüglich des Typ-2-Diabetes bei gleichzeitiger sehr guter Gew...
Chapter
Bei der Adipositas handelt es sich um eine Erkrankung, die – wenn auch in unterschiedlicher Häufigkeit – in jeder Altersgruppe vorkommt. In den letzten Jahren hat die Prävalenz der Adipositas im Kindes- und Jugendalter deutlich zugenommen. Obwohl das Hauptaugenmerk weiterhin auf der Prävention und der konservativen Therapie liegen sollte, gewinnt d...
Article
At the latest in its extreme forms obesity can no longer be treated successfully by conservative means. Surgical interventions such as sleeve gastrectomy, gastric bypass and gastric banding lead to sustained improvement in quality of life for suitable, morbidly obese patients by bringing about a reduction in body weight and comorbidities and an inc...
Article
Fragestellung: Ziel der Studie war es, den Mikronährstoffstatus von Adipositaspatienten vor und nach laparoskopischer Sleeve-Gastrektomie (LSG) und den potenziellen Nutzen einer Supplementation zu untersuchen. Material und Methodik: 53 Adipositaspatienten, die sich einer LSG in der Chirurgischen Klinik in München-Bogenhausen, Deutschland, unterzoge...
Article
Chirurgische Interventionen sind aus dem interdisziplinaren Gesamtkonzept zur Behandlung der Adipositas nicht mehr wegzudenken. Zunehmend findet jedoch ein Wandel in der Zielsetzung statt – weg von alleiniger Gewichtskontrolle hin zur Kontrolle des gesamten Metabolismus. Diese sog. metabolische Chirurgie hat sich zur effektivsten Therapieform des D...
Article
Background The aim of bariatric surgery has changed from only weight reduction to controlling metabolic disease. Metabolic surgery is not only the most effective therapy for treating obesity-related diabetes mellitus type 2, but is also key for the treatment of all other obesity-associated diseases. Discussion Gastric bypass, sleeve gastrectomy, ga...
Article
At the latest in its extreme forms obesity can no longer be treated successfully by conservative means. Surgical interventions such as sleeve gastrectomy, gastric bypass and gastric banding lead to sustained improvement in quality of life for suitable, morbidly obese patients by bringing about a reduction in body weight and comorbidities and an inc...
Article
Spätestens in ihrer extremen Form ist die Adipositas durch konservative Maßnahmen nicht mehr erfolgreich therapierbar. Chirurgische Eingriffe wie Schlauchmagen, Magenbypass und Magenband führen bei geeigneten morbid adipösen Patienten zu einer nachhaltigen Lebensqualitätsverbesserung durch Senkung von Körpergewicht und Komorbiditäten, speziell des...
Chapter
Die akute gastrointestinale Blutung stellt mit mehr als 6000 Krankenhauseinweisungen pro Jahr die häufigste Notfallsituation in der Gastroenterologie dar. Das Überleben dieser Patienten hängt im Gegensatz zur okkulten Blutung wesentlich von einer raschen und effizienten Diagnostik und Therapie ab. Die Letalität gerade der oberen Gastrointestinalblu...
Chapter
Einführung Kaum eine Innovation der letzten 100 Jahren hat die Chirurgie so verändert wie die Einführung der videoendoskopischen oder „minimalinvasiven Chirurgie“ (MIC). Videoendoskopische Techniken werden inzwischen in allen operativen Gebieten eingesetzt, technische Neuerungen und Operationstechniken beeinflussen sich wechselseitig und führen zu...
Article
Full-text available
Upside-down stomach (UDS) is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. Symptoms may vary heavily as they are related to reflux and mechanically impaired gastric emptying. UDS is associated with a risk of incarceration and volvulus development which both might be complicated by acute g...
Chapter
Bei der Therapie der Adipositas müssen viele Aspekte berücksichtigt werden, um ein optimales Ergebnis zu erreichen. Da es sich um ein chronisches Problem handelt, sollte jedes Therapiekonzept langfristig angelegt sein. Gleichzeitig bedeutet jede Therapie für den Betroffenen und das Behandlungsteam einen hohen Aufwand und nicht zuletzt hohe Kosten,...
Article
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Viele Patientinnen nach bariatrischer Chirurgie sind im fertilen Alter, und die Zahl an Schwangerschaften nach den Operationen nimmt stetig zu. Viele Schwangere leiden an Übelkeit und Erbrechen, eine Sonderform ist die Hyperemesis gravidarum mit Symptomen, die den möglichen Komplikationen nach bariatrischen Eingriffen erschreckend ähnlich sind. Wir...
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Full-text available
Background Obesity is associated with abnormal fasting and postprandial lipids, which may link obesity with atherosclerosis. We explored fasting and postprandial lipids in morbidly obese patients treated with sleeve gastrectomy and in control subjects. Methods After fasting for 12 h 15 morbidly obese patients (BMI 51.4±6.5 kg/m2, 43.7±12.6 years)...
Article
Objective: Bariatric surgery is an established therapy for morbid obesity. We evaluated the effects of sleeve-gastrectomy on weight, glucose and lipid metabolism and prevalence of metabolic-syndrome for up to 2 years. Methods: In 52 morbidly obese patients weight, BMI, total-cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, Lipoprotein...
Article
Obesity surgery (bariatric surgery) expands in Germany as a consequence of the growing prevalence of overweight and obesity and due to new surgical methods, minimal access techniques, and an enormous increase in scientific studies. The German surgical society has implemented new guidelines as an instrument of quality improvement. A systematic liter...
Article
Background and aims: Unsatisfactory patient compliance and unfavorable results of weight loss let centers prefer the Roux-en-Y gastric bypass (RYGB) as a combined restrictive and malabsorptive procedure. The aim of this study was to evaluate results of laparoscopic adjustable gastric banding (LAGB) versus laparoscopic RYGB. Setting: The study wa...
Article
Hintergrund: Übergewicht und Adipositas haben in Deutschland endemische Ausmaße erreicht. Infolgedessen nimmt die Zahl der Adipositas-Operationen (bariatrische Chirurgie) rasant zu. Neue minimal invasive Operationsmethoden und die Zunahme wissenschaftlicher Evidenz tragen zur Erkenntnis bei, dass im multimodalen Behandlungskonzept der Adipositas un...
Article
Einleitung: Anamie, epigastrische Schmerzen und Herzrhythmusstorungen werden vor allem bei alteren Patienten lange symptomatisch behandelt bis meist eine Rontgen-Thorax-Aufnahme die Diagnose „grose hiatale, paraosophageale Hernie oder Upside-Down-Magen„ ergibt. Ob eine operative Therapie meist laparoskopische Reposition mit Hiatusplastik und ggf. F...
Article
Bariatric surgery has increased in numbers, but the treatment of morbid obesity in Germany still needs improvement. The new interdisciplinary S3-guideline provides information on the appropriate indications, procedures, techniques, and follow-up care. Systematic review of the literature, classification of the evidence, graded recommendations, and i...
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Full-text available
The young field of obesity surgery (bariatric surgery) in Germany expands as a consequence of the rapid increase of overweight and obesity. New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent...
Article
Treatment of type 4 hiatal hernia using a minimally invasive approach is challenging and requires good familiarity with this technique. From October 1992 to August 2010, 40 patients with a median age of 68 years underwent laparoscopic anterior hemifundoplication surgery for upside-down stomach and were included in our prospective study. The median...
Article
In the case of obese type-2 diabetics, diabetes remission rates of up to 80% can be achieved by surgical procedures. The S3 guideline recommends four surgical approaches: Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion with duodenal switch (BPD-DS). The surgical indication is made when conservative therap...
Article
Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been described, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in o...
Article
Einleitung: Die Adipositaschirurgie nimmt weltweit stark zu. Deutschland liegt in dieser Entwicklung hinter anderen Industrienationen mit vergleichbarer Gewichtsverteilung in der Bevolkerung zuruck. Ziele: Durch eine Umfrage sollte der aktuelle Stand der bariatrischen Chirurgie in Bayern, exemplarisch fur die Situation in Deutschland, ermittelt wer...
Article
Nach einer adipositaschirurgischen Behandlung haben die Patienten gute Chancen, rund 60% ihres Übergewichts langfristig zu verlieren. Gleichzeitig normalisieren sich oft auch Blutzucker und Blutdruck. Das Morbiditätsrisiko sinkt um ein Vielfaches.
Article
ZusammenfassungBei einer Risiko-Nutzen-Analyse der bariatrischen Chirurgie stehen insbesondere das Sterblichkeitsrisiko, die Beeinflussung der Adipositas-assoziierten Komorbidität sowie die damit verbundenen Gesundheitsausgaben im Mittelpunkt der Diskussion. Die Literaturdaten zeigen, dass das adjustierte Risiko, an einer nichtoperativ behandelten...
Article
Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. Cultural as well as organisational differences can result in significant variations of postoperative length of stay. AIM OF THE PRESENT STUDY: The aim of this study is to evaluate whether differences in postoperative length of stay and early postoperative out...
Article
Background Postradiotherapy or malignant esophagotracheal fistulas still represent a dilemma. In the absence of surgical options attempts are made to close the fistula endoscopically by means of esophageal and/or tracheal stents. Tracheal stent placement in laryngectomy patients with terminal stomas is particularly problematic due to the risk of st...
Article
Postradiotherapy or malignant esophagotracheal fistulas still represent a dilemma. In the absence of surgical options attempts are made to close the fistula endoscopically by means of esophageal and/or tracheal stents. Tracheal stent placement in laryngectomy patients with terminal stomas is particularly problematic due to the risk of stent disloca...
Article
Unter „morbider Adipositas” (krankhafter Fettleibigkeit) versteht man eine chronische, multifaktorielle, oft anlagebedingte Erkrankung mit exzessiver Fettablagerung. Mittlerweile sind die Grenzen der konservativen Therapie erkannt und es wurden Leitlinien formuliert, unter welchen Voraussetzungen eine chirurgische Therapie empfehlenswert ist.
Article
Several studies have shown that laparoscopic hernia repair for large paraesophageal hiatal hernia is associated with a high recurrence rate. Therefore, some authors recommend the use of prosthetic meshes. Considering the dynamic area between the esophagus and the diaphragmatic crura with its constant motion, it is astonishing that only a minor numb...
Article
The aim of this study was the evaluation of the management of cholecysto- and choledocholithiasis and outcome of -laparoscopic as well as open cholecystectomy (CHE) and common bile duct (CBD) exploration in Bavaria, Germany. A written questionnaire -in-cluding 201 structured items was sent to all 180 hospitals and departments performing gen-eral or...
Article
Increased viscosity and supersaturation of cholesterol in gallbladder bile, as well as an impaired motility of the gallbladder, are considered to be important factors in the pathogenesis of cholesterol gallstones. However, the relation of these parameters has not yet been determined. Bile viscosity (mPa s) was measured by rotation viscosimetry and...
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Case Report: A 42-year-old female presented with longstanding symptoms suggestive of gastroesophageal reflux disease improved after proton pump inhibitor treatment. An upper endoscopy revealed an intrathoracic position of the stomach (type 4 hiatal hernia) with no mucosal abnormality. Barium swallow demonstrated gastric herniation with gastric volv...
Article
Laparoscopic sleeve gastrectomy (LSG) was initially introduced for super-obese patients in a two-step concept in order to reduce the perioperative risk. Many years before a very similar technique - the Magenstrasse and Mill (M & M) operation - was developed by Johnston in Leeds / UK as a "more physiological" bariatric procedure with acceptable weig...
Article
A resection with tumor free resection margin is the treatment of choice for the most primary and secondary liver tumors. Resection of liver tumors should be part of a multi-modal therapeutical strategy and the oncologist should be involved regularly. Modern radiological imaging with helical-CT and MRI with the possibility of 3D-reconstruction of th...
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Full-text available
Recently it has been postulated that gallbladder mucin hypersecretion observed in the pathogenesis of cholesterol gallstone disease may be induced by biliary lipid peroxidation. Ursodeoxycholic acid treatment reduces mucin concentration and the formation of cholesterol crystals in the gallbladder bile of patients with cholesterol gallstones and thi...
Article
Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspec...
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Full-text available
Background The incidence of Zenker’s diverticulum is low (2/100,000). Standard surgical treatment is cricopharyngeal myotomy with diverticulectomy. Various minimally invasive surgical approaches pursued recently have treated Zenker’s diverticulum adequately. The functional minimally invasive therapy is performed alternatively using an Endo-Gia stap...
Article
Full-text available
This study aimed to evaluate the accuracy of functional cine-MRI in detecting abdominal adhesions. For this study, 89 consecutive patients with adhesion-related complaints after previous abdominal surgery underwent preoperative workup including cine-MRI in transverse and sagittal orientations for a dynamic examination of an induced visceral slide....
Article
Endoscopic treatment of large or colonoscopically inaccessible polyps or early stage tumors in the colon holds the risk of incomplete resection and colonic perforation. The combination of colonoscopy and laparoscopy offers a minimally invasive treatment modality for the complete resection of polyps with low risk. Aim of this study was to assess the...
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Full-text available
A 43-year-old woman with recurrent hiccup and discomfort in the right upper abdomen was diagnosed by computed tomographic (CT) scan with a cystic tumor in the right liver. Echinococcus serology was negative. A laparoscopic procedure was chosen as standard therapy for symptomatic cystic liver tumors. The presumed tumor turned out to be a diaphragmat...
Article
The surgical technique of transoral diverticulostomy by a modified Endo-GIAtrade mark Stapler (Multifire Endo GIA, Tyco Healthcare) is described. Experiences of this procedure in 31 patients are analysed and compared with different endoscopic and conventional surgical therapies of Zenker's diverticula, which are reported in the literature. From Jan...
Article
Ziel der Untersuchung: Technik und eigene Ergebnisse der transoralen Staplerdivertikulostomie mittels eines modifizierten transoral eingeführten Klammerschneideinstrumentes (Multifire Endo GIA™, Tyco Healthcare) werden in einem Literaturvergleich analysiert. Alternative minimal invasive Verfahren wie Koagulationsverfahren mit CO2-Laser oder Argon-P...
Article
The incidence of Zenker's diverticulum is low (2/100,000). Standard surgical treatment is cricopharyngeal myotomy with diverticulectomy. Various minimally invasive surgical approaches pursued recently have treated Zenker's diverticulum adequately. The functional minimally invasive therapy is performed alternatively using an Endo-Gia stapler inserte...
Chapter
Background: Several endoscopic antireflux therapies were recently described that aim at creating an antireflux barrier and reducing or eliminating the need for long-term medication or fundoplication. These techniques use 3 approaches to improve gastro-oesophageal barrier function: tightening of the gastro-oesophageal junction by creation of plicati...
Article
Cholecystolithiasis has an enormous clinical and socioeconomic impact due to its high prevalence and the risk to develop severe complications. 80% of persons with gallstones are asymptomatic at the time of diagnosis. After a first episode of biliary symptoms, about 70% of patients will experience recurrent biliary symptoms within 2 years, and 1-2%...
Article
Background: A number of different surgical procedures have been described for the treatment of gastroesophageal reflux disease. Moreover, modifications and completely new techniques are being introduced on a regular basis. Nonetheless, in most cases of novel laparoscopic techniques profound experimental data have not been collected prior to their...
Article
This study aimed to evaluate the development and outcomes of laparoscopic antireflux surgery in Germany using a nationwide representative survey. A written questionnaire including 34 detailed questions and 288 structured items about diagnostic and therapeutic approaches, number of procedures, complications, and mortality was sent to 546 randomly se...
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Laparoscopy has become a popular approach for the surgical treatment of benign and even malignant colorectal diseases. Several authors have reported better preserved immunity in patients undergoing laparoscopic compared with conventional colorectal surgery. The present study addresses the hypothesis that specific and nonspecific immunity are differ...
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A recent German Multicenter Study comprising 3 070 laparoscopic colorectal resections indicates that complete intracorporeal anastomoses are performed in only 1.8 % cases. The aim of our study was to review and analyse the safety of complete intracorpeal anastomosis. In a literature survey we searched for complete intracorporeal anastomosis with di...