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Biomedical subjects

A Emmermann

Publications and source records attributed to A Emmermann.

12 recordsLinked to original sources
PubMed1997

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap.

BACKGROUND: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. METHODS: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. RESULTS: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2-14) postoperative day. Follow-up was performed with abdominal ultrasound for 2-43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). CONCLUSIONS: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques.

Adult↗
PubMed1996

[Therapy splitting: are intra-operative cholangiography and surgical bile duct revision still indicated?].

The role of therapeutic splitting in cases of cholecystolithiasis and choledocholithiasis has to be reviewed since laparoscopic bile duct exploration might be an alternative. To assess the need of the new approach we evaluated our results of the therapeutic splitting. Between 1988-1992 a cholecystectomy was performed in 577 cases either as an open (n = 274) or laparoscopic (n = 277) procedure. Pre- or postoperative endoscopic retrograde cholangiopancreatography (ERC/P) was performed if the clinical presentation, laboratory findings or ultrasound showed signs of choledocholithiasis. In the laparoscopic cases no intraoperative cholangiography was carried out. The patient follow-up was evaluated by a questionnaire. 128 patients were suggested to have a common bile duct (CBD) stone and had a preoperative ERC/P. In 68 cases stones were extracted. After cholecystectomy 19 ERC/P's were performed. In 4 patients residual stones after preoperative ERC/P were detected. So far occult stones were found in 5 cases. Intraoperative cholangiography was performed additionally in the patients with open cholecystectomy n = 207¿, of whom two demonstrated choledocholithiasis. Endoscopic clearance of the common bile duct was achieved in all patients. Minor complications occurred after ERC/P in 1.5%. Within a median follow-up time of 48 months patients with endoscopic papillotomy did not develop further CBD stones or a cholangitis. The therapeutical splitting facilitates in all patients with cholecysto- or choledocholithiasis a successful clearance of the CBD. Intraoperative cholangiography is not necessary according to our experience. With an experienced endoscopic team the therapeutic splitting should be the preferred treatment modality compared to the laparoscopic bile duct exploration, which will probably lead to a high complication rate if performed outside specialized centers.

Adolescent↗
PubMed1996

[Laparoscopic cardiomyotomy in achalasia].

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the conventional operation, the laparoscopic approach promised to have advantages concerning postoperative convalescence. Between May 94 and October 95 four patients with achalasia underwent a laparoscopic cardiomyotomy. In all patients endoscopic therapy was tried. With the minimal invasive approach a myotomy of the esophagus was only shortly extended on the stomach. All patients had an endoscopic control of extension of the myotomy and intact mucosa during the operation. An antireflux procedure was not performed. Operation time came to 60 to 130 minutes. All patients immediately could swallow without problems and were discharged between day 2 and 8 postoperatively. During the follow-up (up to 18 months) all patients were free of dysphagia and regurgitation. The dynamic x-ray of the esophagus showed a free passage into the stomach. Only one patient claimed mild symptoms of reflux. Cardiomyotomy can very well be performed laparoscopically, leads to good functional results and shows the expected advantages for patients concerning postoperative convalescence. The need for an antireflux procedure is discussed controversially in the literature. It might be unnecessary if the myotomy is only shortly extended to the stomach.

Adolescent↗
PubMed1995

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat.

Laparoscopic surgical repair of perforated gastroduodenal ulcer is technically feasible. To study the effect of a pneumoperitoneum on the extent and severity of peritonitis this animal study was devised. In rats gastric ulceration was induced by instillation of ethanol (50%, 2 ml) and followed by gastrotomy to simulate perforation. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. In PP groups CO2 was insufflated intraperitoneally 6, 9, 12, and 24 h after gastrotomy. In controls the abdomen was only punctured. Animals were sacrificed 5 h after the end of PP or abdominal puncture. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observed; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P < 0.05), and 42% (P < 0.05) in controls. The mean PSS was 20.8 (standard deviation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P < 0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 83% and 100% in the PP group compared to 42% (P < 0.05) and 50% (P < 0.01) in controls. The mean PSS was 22.1 (1.5) in the PP group compared to 11.8 (2.4) (P < 0.01) in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

[Incomplete ileus of carcinoid tumor of the small intestine--limits of laparoscopic surgical technique].

A patient with small bowel obstruction is presented. Separating adhesions at the terminal ileum laparoscopically a carcinoid tumour at Bauhin's valve was overlooked. Two weeks later the patient was resubmitted because of obstructive problems and the tumour was diagnosed at a conventional laparotomy. Basing on this case problems of laparoscopic treatment of bowel obstruction are discussed in general, and in special the decreased tactile abilities of the surgeon are mentioned.

Carcinoid Tumor↗
PubMed1995

Laparoscopic splenectomy. Technique and results in a series of 27 cases.

Between early 1992 and December 1994, laparoscopic splenectomy was performed in 27 patients with idiopathic thrombocytopenia (ITP), hairy-cell leucemia, HIV, or Hodgkin's disease. In all cases medical treatment, especially cortisone therapy, failed. In Hodgkin's disease the splenectomy was combined with liver biopsies and dissection of parailiacal, paraaortic, and mesenteric lymph nodes for abdominal staging. The operation was performed using four trocars; the splenic vessels were divided by a linear stapler. In general the spleen was removed in a bag through a slightly enlarged trocar incision or after morcellation. Three patients needed a small laparotomy for the removal (laparoscopic assisted). In a recent case of Hodgkin's disease the intact spleen was removed via posterior colpotomy. In 22 of 27 cases (81%) the operation was finished laparoscopically. Five times a conversion to conventional laparotomy was necessary because of bleeding of enlarged lymph nodes at the hilum. Wound infections occurred in two cases. In one patient with ITP the platelet count did not improve and continuous blood loss led to relaparotomy at the 1st postoperative day. No surgical bleeding was found. All patients tolerated a fluid diet at the 1st postoperative day and hospitalization time was 4.4 days (range 3-14). Regarding the low complication rate and the advantages of a smaller abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and laparoscopic abdominal staging has a substantial benefit for the patients.

Adolescent↗
PubMed1994

[Colpotomy for specimen removal in laparoscopic surgery].

The removal of the specimen is one of the major problems in laparoscopic colon surgery. In two female patients we have found a solution in the colpotomy. It is easy to perform and hardly recognized by the patient. Other large specimen as a kidney or spleen can also be removed this way. An elongation of an incision in the abdominal wall can be avoided. The pneumoperitoneum is preserved by a special clamp for the extraction via colpotomy. The removal of a specimen via colpotomy is a conclusive step towards, minimal invasive surgery'.

Adult↗
PubMed1993

[Staging laparoscopy in Hodgkin's disease. A valid alternative to staging laparotomy].

A 30-year-old man with Hodgkin's disease, stage IA, had received radiotherapy to the supradiaphragmatic lymph nodes two years ago. During follow-up observations the patient felt well, but sonography revealed three tumours in the spleen. The erythrocyte sedimentation rate was found to be raised to 50/75 mm. Therefore, splenectomy and staging of the other parts of the abdomen for histological clarification and deciding on further therapeutic action were indicated. Thus splenectomy with bilateral liver wedge resections were performed laparoscopically, together with excision of mesenteric, paraaortic and para-iliac lymph nodes. The patient was discharged home on the 4th postoperative day. Histological examination revealed stage IIIE Hodgkin's disease. This case demonstrates that in favourable conditions staging laparoscopy can obtain the same information as conventional staging laparotomy, but it is much better tolerated by the patient.

Adult↗
PubMed1993

[Laparoscopic splenectomy].

From August until October 1992 laparoscopic splenectomy has been performed upon three patients with idiopathic thrombocytopenia. The splenic vessels were divided by an Endo-GIA. The spleen could be removed through a slightly extended trocar-incision. The Idiopathic thrombocytopenia without an enlarged spleen provides a possible indication for laparoscopic surgery.

Adult↗
PubMed1990

Repair of infected defects of the chest wall by transposition of greater omentum.

Myocutaneous flaps have a firm role in the reconstruction of soft tissue defects. Furthermore the supply of extremely infected defects of the chest wall with involvement of the ribs is problematic, especially in irradiated regions. The use of the omental transposition flap is an alternative to the latissimus dorsi myocutaneous flap in treatment of such a deficiency associated with necrosis of the ribs and uncovered pleura. The authors have used this method successfully on eight patients. The scope of this technique is not confined to the chest wall. It can also be extended to defects of the region of the axilla and other parts of the body. For checking the extension and constitution of the greater omentum pre-operatively a laparoscopy under local anaesthesia is always carried out. All patients seen by the authors experienced primary healing of the omentum and chest wall. After surgical resection of primary or metastatic chest wall malignancies, irradiation is essential or useful in many cases. Risks of this therapy include damage to underlying parenchyma and overlying skin. The overall incidence of chest wall ulceration from radiation therapy for breast and chest wall lesions is about 5%. In most cases, however, the defects are often the product of both radiation and surgical trauma. These generally deep, foul-smelling and infected wounds are an extreme burden for the patient and a challenge for the surgeon. Conservative treatment never results in wound closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗