Biomedical subjects

C Ackermann

Publications and source records attributed to C Ackermann.

At least 55 records · Page 3Linked to original sources

PubMed1991

[Early and long-term results following ileum-anal pouch anastomosis].

Between 1984 and 1989 21 patients underwent proctocolectomy and were reconstructed with ileal-pouch-anal anastomosis using a J-pouch. 18 patients had ulcerative colitis and 3 adenoma of the colon. In 16 of 21 patients the operation was performed in a three-stage way: (1.) total colectomy; (2.) proctomucosectomy, ileal-pouch-anal anastomosis and protective ileostomy; (3.) ileostomy closure. 5 patients had a two-stage operation (3 patients with adenoma of the colon, 2 patients with low or no steroid medication). Operative mortality was 0%. Complications were seen in 4 of 21 patients after colectomy (sepsis, pelvic abscess in 2 instances, ileus), in 4 of 21 patients after ileal-pouch-anal anastomosis (pouch-vaginal fistula, pelvic abscess, anastomotic stricture, ileus) and in 2 of 19 patients after closure of ileostomy (pouch-vaginal fistula). In 19 of 21 patients the ileostomy is closed. All of these patients are fully continent during the day and only 2 patients are slightly incontinent at night. The average stool evacuation is 4 to 5 during the day and once to twice at night. All patients are very satisfied with the result.

Adenomatous Polyposis Coli↗

PubMed1991

[What does surgery in cholelithiasis accomplish today?].

Cholecystectomy is the only definitive treatment of gallbladder stones. This procedure thus remains the standard with which alternative treatment modalities have to be compared. The comparison must take into account the most recent surgical results, as much progress has been made in the past twenty years by improved perioperative management, wider use of antibiotics, earlier timing of operation, etc. The result achieved at the surgical clinic of the St-Claraspital in Basle over a 6-year period (1984-1989) may serve as an example of such progress: 1631 operative procedures for biliary stones resulted in an overall mortality of 0.18%. Mortality of simple cholecystectomy was 0.07% (in patients below 60 years of age 0%). 0.9% of patients undergoing cholecystectomy and common duct exploration died (0% of patients below 60 years of age). Comparison of two time periods (1972-80 and 1984-89) reveals a decrease in mortality by a factor of 3-4 and a decrease in morbidity by a factor of 2. The late results of biliary surgery are also satisfactory. In a prospective survey at the St-Claraspital 90.6% of all surgical patients were well one year postoperatively. An organic biliary pathology was only rarely responsible for the complaints in symptomatic patients. An extrabiliary organic or functional pathology is the usual cause of late postoperative symptoms. Such pathology frequently exists before the biliary procedure and therefore has no connection with the biliary disease or the operation performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

[Results of fundoplication in reflux esophagitis].

A retrospective study of 71 patients treated with Nissen-Rossetti fundoplication for a symptomatic esophagitis shows that 82% of the patients are satisfied and symptom-free 2 1/2 years after surgery. 18% have recurrent reflux disease, 15% need medicamentous therapy to control their symptoms, 3% were reoperated on. Possible explantation for recurrent reflux disease are wrap dislocation and wrap disrupture. With one exception recurrences occurred within the first 12 months after operation.

Adult↗

PubMed1991

[Inflammatory bowel diseases (Crohn disease and ulcerative colitis). Possibilities and limitations of surgical therapy].

Ulcerative colitis can be cured by surgical therapy. Indications for surgery are severe disease not controlled by medical therapy, complication of colitis and prophylaxis of malignancy. Operation of choice is proctocolectomy and ileoanal anastomosis with pelvic ileal pouch, preserving continence. Alternatives are colectomy and ileo-recto-anastomosis if the rectum is free of disease and proctocolectomy with ileostomy if the rectum is involved. Crohn's disease cannot be cured by surgery. Indications for surgery are obstructing or perforating complications of enterocolitis. Basis of surgical therapy is resection, which should be restricted to the severely diseased bowel segment. Structureplasty can correct short bowel stenosis without resection. Surgery for anal Crohn's disease should be limited to drainage of septic complications. Postoperative results support a tendency towards early surgery in ulcerative colitis, while surgery in Crohn's disease should be reserved for severe and complicated disease.

Anastomosis, Surgical↗

PubMed1990

[A year experience with extracorporeal shockwave lithotripsy of gallstones].

43 patients with symptomatic gallbladder stones were treated by extracorporeal shockwave lithotripsy and oral bile acids. In all patients the stones were successfully fragmented during the first lithotripsy session. 33 patients underwent 2-4 treatment sessions. In 16 out of 43 patients the stones disappeared within 7.9 months. The rate of stone dissolution was dependent on the number and size of stones. 3 patients required surgery because of frequent colic in one case, cholecystitis in one case and lack of cooperation in one case. No important side effects were noted except mild pancreatitis 3 weeks after lithotripsy in one patient. Results at this center of extracorporeal shockwave lithotripsy combined with oral bile acids indicate that this treatment may become an alternative to cholecystectomy in patients with a small number (less than 3) of stones not exceeding 30 mm in diameter.

Adult↗

PubMed1990

[Surgery in esophageal carcinoma: risks and results].

Surgical treatment of esophageal cancer is largely palliative. To clarify the indication it is necessary to assess the effectiveness of the palliation in relief of dysphagia and the operative risks. In a retrospective study we analyzed the perioperative morbidity and follow-up in 25 patients with carcinoma of the esophagus treated between 1984 and 1988 (5 years). With combined anesthesia, early extubation and intensive pulmonary therapy, no perioperative respiratory insufficiency was observed. Perioperative mortality was 0%. An anastomotic leak in 2 patients with a cervical anastomosis was healed in both cases by conservative management. On hospital discharge all patients were able to eat normally. 13 patients died after 1 year on average (4 months to 3 years). 12 patients are alive 6 months to 4 years after operation, 10 of them without symptoms. Our results show that with optimal perioperative management of esophageal carcinoma low morbidity is possible and good palliation of dysphagia is feasible.

Adenocarcinoma↗

PubMed1990

[Reoperation for para-esophageal hiatal hernia following fundus plication].

A paraesophageal hiatus hernia was found in 15 of 86 patients examined radiologically due to symptoms after fundoplication (Nissen-Rosetti). 7 patients were reoperated 4 months to 12 years after fundoplication. Hernia repair was achieved by narrowing of the hiatus with sutures (4), attachment of the left lobe of the liver (1) or a Gore-tex patch (1). Additional surgical measures were fundophrenicopexy (4) and ventral corpopexy (4). At follow-up 2-19 years later, 4 of 5 patients had symptomatic improvement but none was symptom free. On x-ray 2 patients had recurrent paraesophageal hernias and 1 patient a slipped fundoplication. We conclude that reoperation for paraesophageal hiatus hernia after fundoplication, with the attendant technical difficulties, is only indicated if severe symptoms are present.

Adult↗

PubMed1990

[Technique of bile duct revision].

In view of the progress of endoscopic treatment of common bile duct pathologies the management of retained common duct stones following simple cholecystectomy has become a minor problem. Nevertheless duct stones should be recognized and removed during the cholecystectomy procedure. High risk patients or extreme forms of acute inflammation are an exception. For this purpose a standardized technique of revision of the common bile duct is recommended. We describe such a technique of the exploration of the common bile duct by means of manual extraction, Fogarty catheter, irrigation, distension--irrigation and flexible choledochoscopy.

Cholecystectomy↗

PubMed1990

[Emergency diagnosis of cecal volvulus].

Twelve cases of coecal volvulus have been analysed. Given typical signs, plain radiography of the abdomen should assure diagnosis. Chronic volvulus requires a colon contrast enema for confirmation of diagnosis.. Immediate laparotomy is mandatory.

Adult↗

PubMed1989

[Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences].

Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution.

Adult↗

PubMed1989

[Long-term results following fundus plication and vagotomy in reflux disease. Complaints after 10-20 years].

In 109 patients with primary reflux disease in whom combined fundoplication and vagotomy had been performed, the clinical results were evaluated by questionnaire 10-20 years (median 15.7 years) after operation. Indication for additional vagotomy was severe reflux disease and/or increased gastric acid output in 56 (A) and coexistent ulcer disease in 53 (B) patients. Vagotomy was truncular (with pyloroplasty) in 49, selective gastric (with pyloroplasty) in 50, and proximal gastric in 10 patients. Follow-up was available from 64 patients (59.6%). The results were as follows: 17.2% (A 19.4%, B 7.1%) had reflux symptoms, while 9.5% (A 11.4%, B 7.1%) needed medical antireflux therapy. Dysphagia was present in 28.2% (A 13.9%, B 35.7%), and gas-bloat in 54.7% (A 55.5%, B 53.6%). Typical postvagotomy symptoms were diarrhea in 23.5% (A 30.6%, B 14.3%) and dumping in 25.0% (A 22.2%, B 28.6%). Using the Visick classification criteria we found grade I and II in 73.4%, grade III in 17.2% and IV in 9.4%. Symptoms are frequent after fundoplication and vagotomy. The clinical result is more favourable in group B and for the combination of fundoplication with proximal gastric vagotomy.

Deglutition Disorders↗

PubMed1989

[Surgery in para-esophageal hiatal hernia: technic and results].

40 patients with paraesophageal hiatus hernia have undergone surgery over a period 25 years' period. Surgery consisted of gastropexy in 38 patients (ventral corpopexy in 32, fundophrenicopexy in 19), narrowing of the hiatus in 24 and fundoplication in 14. There was one operative death (2.5%). On follow-up 3 to 24 years later (mean 12.5 years) 17 of 20 patients (85%) have good or excellent results. 2 patients without additional antireflux surgery had to be reoperated later because of severe reflux disease (secondary fundoplication). 1 patient with gastropexy and fundoplication has recurrent reflux disease. X-ray studies in 18 patients showed recurrent paraesophageal hiatus hernia in 9 (50%). After operation for paraesophageal hiatus hernia a good clinical long-term result can be expected. To reduce the frequency of recurrent hernia, technical modifications should be considered.

Adult↗

PubMed1989

[Palliative biliodigestive anastomosis in non-resectable cancer of the head of the pancreas--with or without preventive gastroenterostomy?].

In 226 patients with malignant obstructive jaundice over a 10-year period (1975-1984) 92 presented with an unresectable carcinoma of the head of the pancreas and were treated with a palliative bilioenteric diversion: in 52 cases alone, in 20 cases with a therapeutic gastroenterostomy because of early duodenal obstruction, and in 20 cases with a simultaneous prophylactic gastroenterostomy. The latter did not increase perioperative morbidity (25% vs. 50% in bilioenteric diversion alone), mortality (5% vs. 19%) nor length of hospital stay (19.9 vs. 20.6 days). Later on patients with a prophylactic gastroenterostomy showed a decreased incidence of chronic vomiting (15% vs. 42%). No secondary gastroenterostomy was performed in this group, vs. 14% (6 patients) in cases with bilioenteric diversion alone (mortality 33%). We recommend the simultaneous prophylactic gastroenterostomy which does not increase morbidity, mortality and length of hospital stay and helps avoiding a risky secondary gastroenterostomy.

Aged↗

PubMed1989

[Can recurrent reflux disease following fundoplication be prevented by adding a vagotomy?].

Recurrent reflux disease is one of the main problems after fundoplication. Reducing gastric acid secretion by adding a vagotomy could theoretically be of beneficial value in controlling reflux. The clinical results of 109 patients were assessed 10 to 20 years after combined fundoplication and vagotomy for primary reflux disease. Indication for an additional vagotomy was severe reflux disease or increased gastric acid output in 56 and coexistent ulcer disease in 53 patients. Data from 64 patients (59.6%) were analyzed. Results were as follows: 17.2% had persistent or recurrent reflux disease, 9.5% needing medical treatment. The results were similar with different types of vagotomy: 18.5% and 14.8%, respectively for truncular vagotomy and pyloroplasty (27 pts.) 17.9% and 7.4%, respectively for selective gastric vagotomy and pyloroplasty (28 pts.), and 11.1% and 0%, respectively for proximal gastric vagotomy (9 pts.). Compared with the results after fundoplication alone, an additional vagotomy does not seem to prevent recurrent reflux disease.

Adolescent↗

PubMed1989

[Therapy and prognosis in 102 liver injuries].

Case histories of 102 patients with liver trauma were analyzed. 88% sustained blunt and 12% penetrating liver injury. 71% of all patients had a polytrauma. The liver injuries were classified in 4 types. With 25 patients primary resuscitation was unsuccessful, in 12 of these cases even though immediate laparotomy and aortic clamping was performed in the emergency room. In 62 of the remaining 77 patients haemostasis was accomplished with minor surgical procedures (lethality 16%), in 13 cases major surgery had to be performed (lethality 62%). Packing was used in one patient only. Prognosis of liver trauma depends mainly on associated injuries and on severity of liver trauma.

Adolescent↗

PubMed1989

[Paraesophageal hiatal hernia--risks and surgical indications].

During a 25-year period, 40 patients with paraoesophageal hiatus hernia were operated on by narrowing of the hiatus and gastropexy. The main symptoms were: epigastric pain (40%), reflux symptoms (25%), cardiac symptoms (20%), dysphagia (20%) and dyspnea (8%). Six patients were free of symptoms. Anaemia was present in 33%, gastric ulcer in 15%. Six patients (18%) had to be operated on as emergencies because of gastric ulcer complications in 4 (3 perforations, 1 severe bleeding) and incarceration in 2 patients. Considering the important risk of acute complications in paraoesophageal hernia an elective gastropexy seems generally advisible--also in patients with few or no symptoms, provided there are no contraindications.

Adult↗

PubMed1988

[Long-term results following fundus plication. Symptoms after 10 to 20 years].

10 to 20 years (median 15.1 years) after fundoplication for primary reflux disease, 257 patients were asked to complete a questionnaire concerning their symptoms. Data of 163 patients (64.3%) were analyzed. Results were as follows: 21.4% of the patients had persistent or recurrent reflux symptoms, about half (9.8%) needing medical treatment. Adverse side effects of fundoplication were frequent (dysphagia in 28.2% and gas-bloat in 50.3%). Using the Visick classification criteria we found Visick grade I and II in 75.5%, grade III in 17.2%, and IV in 7.4%.