Biomedical subjects

C Bönner

Publications and source records attributed to C Bönner.

4 recordsLinked to original sources

PubMed2003

[Rectal prolapse--laparoscopic resection and results].

postoperatively Seventeen females presenting rectal intussusception with a combined outlet obstruction underwent laparoscopic resection of the rectum (n = 4) or rectum and sigma (n = 13). Mean age was 61.5 +/- 9.7 years, mean duration of surgery took 117 +/- 30.4 minutes, realimentation started 3.5 +/- 1.3 days postoperatively and the mean stay in hospital lasted 11.8 +/- 2.9 days. In all patients an ano-rectal pressure-measurement and EMG were carried out. There was a significant lower resting-pressure of the anal sphincter in comparison to a normal collective of healthy patients with 67.8 +/- 21.6 cm H2O (p < 0.006). Postoperatively one severe complication with a generalized peritonitis and a resulting ARDS occurred. No perioperative mortality had to be remarked. Our results show that laparoscopic resection in patients with a rectal intussusception and outlet obstruction is safe. Wether rectal intussusception apart of rectal prolapse is an entity of its own, has to been shown in further investigations.

Adult↗

PubMed2001

Laparoscopic-assisted coloscopic polypectomy.

PURPOSE: Patients with colorectal polyps often display a large kink or distinct mucosal fold in the area where the polypectomy is to take place. As a result, there is a higher risk of perforation or partial ablation during an endoscopic polypectomy. Is it safer to perform an endoscopic polypectomy using the control and assistance of a laparoscope? Can a segment resection of the colon that would otherwise be necessary be avoided? METHODS: An endoscopic polypectomy using a laparoscope was conducted on six patients whose colorectal polyps were in an anatomically unfavorable location. The need for an open or laparoscopic segment resection or colotomy was indicated in all cases. The growth was located in the rectosigmoidal transition in five patients and in the region of the left flexure in one patient. We decided that an endoscopic polypectomy using the assistance of a laparoscope would be the most comfortable and technically elegant method, as well as easy. Except the well-known risks of laparoscopy and endoscopic polypectomy, no other risks have been seen in our patients. The affected area of the colon, the sigma, and the left flexure were mobilized and stretched as much as possible to enable a simultaneous and low-risk endoscopic polypectomy. In one case, we had to conduct a fractionated ablation because of a very wide-based finding. RESULTS: The operation averaged 57 minutes, and no operation-specific complications were observed. Postoperative recovery in the hospital was very short and averaged 2.5 days. The histopathologic findings were benign in all cases, but a serious dysplasia was diagnosed in one patient. CONCLUSIONS: The laparoscopic-assisted polypectomy is a safe method to remove even complicated polyps in anatomically unfavorable locations.

Colon↗

PubMed2001

[Fournier gangrene as a rare complication after stapler hemorrhoidectomy. Case report and review of the literature].

Fournier's gangrene is a well known often fatal fasziitis of the pelvic floor following ano-rectal, urologic and gynecologic infections. Although rarely it is described as a complication of operative anal procedures and predisposing factors such as diabetes, alcoholism, immune-defects and consumptive diseases. To our knowledge the described case of a lethal outcome after staplerhemorrhoidectomy is the first one reported in literature.

Aged↗

PubMed1995

Is manometry essential for surgery of chronic fissure-in-ano?

PURPOSE: Although many studies reported the association between high anal sphincter pressures and anal fissures, one question is open to date: is manometry really necessary for surgical management/does manometry influence the outcome? METHODS: Between October 1, 1990 and December 31, 1991, lateral sphincterotomy was performed in 177 patients with chronic anal fissure. In all patients the operation was performed as an outpatient procedure under local anesthetic. Electromanometry of the anal canal was carried out preoperatively to demonstrate the raised resting pressure profile within the anal canal. At the same time the maximum squeezing pressure was determined by electromanometry, and electromyography was performed to detect dysfunction of the external sphincter or the levators. The control group consisted of 14 proctologically healthy patients with a resting pressure of 74.4 +/- 8.9 and a maximum squeezing pressure of 130.2 +/- 15 (cm H2O). On the basis of resting pressures determined in healthy patients, an upper limit of 90 was defined as normal, taking into account the standard deviation and standard error rate. For statistical comparison patients were divided into two groups, retrospectively. All patients in Group A had a resting pressure of < or = 90, and all patients in Group B had a resting pressure of > 90. Six weeks after operation electromanometry was again performed to determine the resting pressure profile and maximum squeezing pressure of the sphincter system, and patients were examined to determine whether the fissure had healed. RESULTS: As a result of the lateral sphincterotomy, the resting pressure was lowered in all patients from 106.6 +/- 21.5 to 80.9 +/- 10.4 and maximum squeezing pressure from 149.3 +/- 27.6 to 135.3 +/- 27.2. Both results were highly significant (P < 0.001, chi-squared). Regarding either reduction in postoperative resting pressure or continence, Groups A and B did not differ statistically. In Group A soiling occurred in 3.2 percent and Grade 1 incontinence in 3.2 percent (1 patient each), and in Group B only one patient (0.7 percent) complained of soiling. Recurrences occurred in 9.7 percent of patients in Group A and in 2.1 percent of patients in Group B (3 patients in each case). CONCLUSION: Electromanometric examinations showed that internal sphincterotomy significantly reduces pressure within the anal canal, thus permitting the anal fissure to heal. No significant continence problems were observed. Although manometric selection of patients leads to different results regarding both postoperative continence and recurrence, these differences are not statistically significant. Therefore, it follows that, in experienced hands and using a standardized technique, manometry before surgical management of anal fissure by lateral sphincterotomy is probably superfluous.

Adult↗