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C Töns

Publications and source records attributed to C Töns.

33 records · Page 2Linked to original sources
PubMed1993

[Inguinal hernia repair with local anesthesia--a comparative analysis].

Since February 1992 local anaesthesia has been routinely used for repair of inguinal hernias at the Surgical Department of the RWTU Aachen. All 607 patients undergoing Shouldice repair of primary inguinal hernia between January 1990 and March 1993 were retrospectively analysed with reference to need for analgesics, length of stay in hospital, and rate of complications. In addition, 50 patients treated with local anaesthesia and 50 patients treated under general anaesthesia underwent prospective pain analysis using a visual analogue scale and spirometric tests. Following local anaesthesia we found fewer need of analgesics, shorter stays in hospital, and less complications. The pain level was lower and ventilatory function was better. Repair of inguinal hernia with local anaesthesia is a safe method of lowering the risks involved in the operation and improving patient comfort without increasing complications.

Adolescent↗
PubMed1993

[Surgery for inguinal hernia in Germany 1992: a survey of 1,656 German clinics].

A questionnaire of 1656 German surgical departments shows the preferentially applied procedures: in hernia of childhood Rehbein/Grob (24.1%) and Gross/Ferguson (24.4%). In primary hernia of adults Shouldice repair (47.7%), in recurrent hernia Shouldice-repair as well. McVay, mesh or plug-techniques are applied only for problematic cases of recurrent hernia. Laparoscopic hernia-repair is accepted in less than 10% of clinics.

Adolescent↗
PubMed1991

Anal sphincter function after intersphincteric resection and stapled ileal pouch-anal anastomosis.

This study was done to determine the effect of the direct ileal pouch-anal anastomosis upon pressure and sensory components of the anal canal and ileal pouch. These findings were related to postoperative continence. Thirty-three patients with ileal pouch-anal anastomosis (25 continent, eight with episodic minor incontinence) were studied 3 +/- 0.3 and 25 +/- 5 months after ileostomy takedown. The maximum resting pressure in the anal canal was significantly lower in patients with an imperfect result (35 +/- 5 mm Hg) than in continent patients (44 +/- 5 mm Hg) (P less than 0.05). Postoperatively the maximum squeeze anal pressure was slightly greater in continent than in incontinent patients (99 +/- 8 mm Hg vs. 87 +/- 7 mm Hg) (P greater than 0.05). The postoperative recto-(ileo-)anal inhibitory reflex was present in 27 percent. The linear correlation between strength of rectal (ileal) distension and depth resp. duration of internal sphincter relaxation as preoperatively observed disappeared postoperatively in every group of patients. Simultaneous measurements of pouch and anal pressure in patients with imperfect results revealed a reduced positive pouch anal pressure gradient compared to the continent group. This low pouch-anal pressure gradient is thought to be responsible for the increased incidence of soiling in some of our patients.

Adenomatous Polyposis Coli↗
PubMed1991

[Controlled study of cremaster resection in Shouldice repair of primary inguinal hernia].

237 Shouldice operations with resection of the cremaster muscle from the Department of Surgery of the RWT University of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle from the Department of Surgery of the Elizabeth Hospital in Essen. The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in early-postoperative complications. In the group without resection of the cremaster muscle the incidence of chronic inguinal pain was reduced. However, avoidance of the cremaster resection is not advisable because it leads to atypical indirect recurrences and totally higher recurrence rate (2.6%), so four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documentated. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrates the important influence on the technique of repair. Based on our results the resection of the cremaster muscle is an essential part of Shouldice's hernia repair.

Adult↗
PubMed1991

[Results of Parks postanal repair in idiopathic anal insufficiency].

To assess the functional results of postanal repair of faecal incontinence we carried out clinical, physiological and radiological studies in 31 patients. Continence was improved in 26 (84%) patients, 19 (62%) of whom regained normal continence at a minimum of 12 months follow-up. A successful clinical outcome after postanal repair does appear to be related more to an improvement in sphincter pressures than to any reduction of the anorectal angle.

Anal Canal↗
PubMed1990

[Incisional hernia. Causes and principles of repair].

Up to 11% of all coeliotomies result in incisional hernias, their repair is followed by recurrences in up to 46%. To control the incidence of these complications transverse and oblique incisions with a skin incision of sufficient length should be prefered. At the first operation the abdominal wall should be closed by a single continuous suture with an absorbable material. Non-absorbable materials should be used for hernia repair. The doubling of the facial structures gives no advantage. Alloplastic materials are restricted to problem hernias.

Abdominal Muscles↗
PubMed1990

[Cremaster resection in Shouldice repair. A prospective controlled bicenter study].

The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. 237 Shouldice operations with resection of the cremaster muscle of the Department of Surgery of the RWTH of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle of the Department of Surgery of the Elisabeth Hospital in Essen. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in postoperative complications. In the group without resection of the cremaster muscle four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documented. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrate the important influence on the technique of repair. Based on our results the resection of the cremaster muscle in an essential part of Shouldice's hernia repair.

Female↗
PubMed1990

[Repair of recurrent inguinal hernia. Tactics, technic and results].

Based on 301 surgical repairs of recurrent groin hernias perioperative management and recommended techniques for preparation and repair of various kinds of recurrent hernias are presented. Follow-up examinations could be performed on 175 patients, representing 88.8% of 197 patients who underwent surgery for recurrent hernias. Shouldice's technique for hernia repair proved to be the treatment of choice for recurrent groin hernias with a recurrence rate of 2.9% (5/175). Early postoperative complications occurred up to the 14th day following surgery. Frequently they could not be documented due to an average postoperative hospitalization period of 6.2 days only. The rates of postoperative complications were 8.1% prior dismission and 12.6% within two weeks after the operation respectively.

Adolescent↗
PubMed1990

[The ramus genitalis syndrome following hernia repair. A clinical study concerning its preventability].

Postoperative chronic inguinal pain was studied in 460 patients who underwent Shouldice repairs. A follow-up investigation (91.9%) found a reduced incidence of chronic inguinal pain by preparing the genital branch of the genito-femoral nerve and severing it if necessary. By proceeding in this fashion, the incidence of inguinal entrapment syndromes can be reduced below 2% without influencing the early postoperative complication rate (5.5% and 6.7%) or the recurrence rate (0.5% and 0.96%). Compared with the ilio-inguinalis syndrome the ramus genitalis syndrome is an important cause of chronic inguinodynia after hernia repair.

Genitalia↗
PubMed1986

The use of synthetic absorbable suture materials (polyglycolic acid and polydioxanone) in the low pressure circulatory system of growing organisms.

Synthetic absorbable sutures were used for surgery in the cardiovascular low pressure system of growing beagle dogs. Right atrial incisions were closed with this material in 20 dogs. In another 20 dogs caval anastomoses were performed in continuous suture technique. Repeated angiographies and histological examination were performed after observation periods between 5 and 180 days. No clinical complications occurred. Postoperatively patent anastomoses grew with the surrounding tissue, while stenotic anastomoses attained normal luminal diameter after suture absorption. Synthetic absorbable suture materials are recommended for use in the cardiovascular low pressure system, especially in the correction of congenital anomalies.

Animals↗
PubMedDate not supplied

Local versus general anesthesia for Shouldice repair of the inguinal hernia.

Since February 1992 local anesthesia (LA) has been used routinely for repair of inguinal hernias at our surgical department. All patients undergoing Shouldice repair of primary uncomplicated inguinal hernia between January 1990 and March 1993 were analyzed retrospectively concerning the need for analgesics, length of stay in hospital, and rate of complications. In addition 50 patients after LA and 50 patients after general anesthesia underwent prospective pain analysis using a visual analogous score and spirometric tests (FEV1 and peak flow). After LA we found less need of analgesics, shorter hospital stays, and fewer complications. The pain level was lower, and ventilatory function was less affected. Repair of the inguinal hernia using LA is a safe method to lower the risk of the operation and to improve the patient's comfort without increasing complications.

Adolescent↗
PubMedDate not supplied

CT and MRI of experimentally induced mesenteric ischemia in a porcine model.

OBJECTIVE: Our goal was to assess the value of CT and MRI for the detection of bowel wall changes in experimentally induced mesenteric ischemia. METHODS: in 18 female pigs, a percutaneous embolization of the superior mesenteric artery was performed with buthyl-2-cyanoacrylate and Lipiodol (1:1) (experimental group). In six animals, only diagnostic imaging and histologic evaluation were performed (control group). CT was carried out 3, 6, and 12 h after occlusion. Incremental CT (1 s scan time, 5 mm slice thickness, 7 mm increment, 120 kV/290 mAs) and spiral CT (slice thickness 5 mm, pitch 1.5, 120 kV/165 mA) were performed pre and post contrast injection (Somatom Plus/Siemens). Serial CT was carried out after intravenous contrast injection (1 ml/kg, 2 ml/s). MRI (Magnetom 1.5 T; Siemens) was performed with T1 (pre and post 0.01 mmol/kg Gd-DTPA; Magnevist; Schering, Germany), T2, and proton density images in axial orientation. Slice thickness was 3 mm and slice gap 1 mm. Additionally, a T1-weighted GE sequence (multislice FLASH 2D) was obtained in dynamic technique (before and 30, 60, and 90 s after contrast agent injection) with a slice thickness of 5 mm. Biometrical monitoring included blood pressure, heart frequency, blood cell count, electrolyte status, blood gas analysis, and determination of serum lactate. Image evaluation included morphological analysis and determination of the enhancement pattern. Histological specimens were obtained and analyzed according to the Chiu classification. RESULTS: The histologic workup of the specimen 3, 6, and 12 h after vascular occlusion revealed an average Chiu state 3, 4, and 5. On CT, the bowel wall had a thickness of 4.7 mm on average in the ischemic segments. There was a significant difference from the control group (average 3 mm). Free intraperitoneal fluid and intramural gas were seen after 12 h of ischemia in 80%. In ischemic bowel segments, no mural enhancement was seen. Normal segments and the bowel of the control animals showed an enhancement of 34 HU on average (SD = 3.1 HU; p.<0.01). In MRI, S/N and C/N differed significantly between experimental and control groups in T1 and proton density images. In ischemic segments of all phases, the bowel wall did not show contrast enhancement. Healthy segments and bowel of control animals showed a significant enhancement (p<0.01). CONCLUSION: Cross-sectional imaging has a high sensitivity for delineation of ischemic bowel wall segments. The enhancement pattern of the bowel wall enables detection of location, extent, and cause of a acute arterial mesenteric ischemia with high accuracy in an early phase.

Animals↗