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D Hahnloser

Publications and source records attributed to D Hahnloser.

14 recordsLinked to original sources
PubMed2007

Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis.

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is performed routinely for chronic ulcerative colitis. METHODS: Using data from a prospective database and annual standardized questionnaires, functional outcome, complications and quality of life (QoL) after IPAA were assessed. RESULTS: Some 1885 IPAA operations were performed for chronic ulcerative colitis over a 20-year period (mean follow-up 11 years). The mean age at the time of IPAA was 34.1 years, increasing from 31.2 years (1981-1985) to 36.3 years (1996-2000). The overall rate of pouch success at 5, 10, 15 and 20 years was 96.3, 93.3, 92.4 and 92.1 per cent respectively. Mean daytime stool frequency increased from 5.7 at 1 year to 6.4 at 20 years (P < 0.001), and also increased at night (from 1.5 to 2.0; P < 0.001). The incidence of frequent daytime faecal incontinence increased from 5 to 11 per cent during the day (P < 0.001) and from 12 to 21 per cent at night (P < 0.001). QoL remained unchanged and 92 per cent remained in the same employment. Seventy-six patients were eventually diagnosed with indeterminate colitis and 47 with Crohn's disease. CONCLUSION: IPAA is a reliable surgical procedure for patients requiring proctocolectomy for chronic ulcerative colitis and indeterminate colitis. The clinical and functional outcomes are excellent and stable for 20 years after operation.

Adolescent↗
PubMed2006

Video-assisted sacral nerve stimulation.

BACKGROUND: Sacral nerve simulation (SNS) is an accepted therapy for patients with urinary or bowel dysfunction. However, infection rates are as high as 20% and can result in removal of the expensive device. We present a new video-assisted technique minimizing the risk of infection. METHODS: Between April and July 2005, six consecutive women of median age 68 years (range, 60-74), with faecal incontinence (4 patients) and idiopathic constipation (2 patients) underwent video-assisted electrode implantation for SNS. The motor response of the pelvic floor during percutaneous nerve evaluation and implantation of the permanent lead was monitored by a video optic (same as that normally used for laparoscopic or endoscopic procedures) placed between the legs of the patients. The video optic and the perianal area were completely covered with drapes, separating them from the operating field. RESULTS: All but one screening was successful, and no wound infections at the electrode or at the pocket of the stimulator were noted (mean postoperative follow-up, 8 weeks). CONCLUSIONS: With the use of a video optic, the anus and the implantation site can be completely separated and contamination during the operation becomes unlikely. Furthermore, the response of the pelvic floor to the stimulation is better visualized. We routinely recommend the use of video equipment for SNS electrode implantation.

Aged↗
PubMed2006

Outcome and cost analysis of sacral nerve stimulation for faecal incontinence.

BACKGROUND: Sacral nerve stimulation (SNS) may be successful in treating incapacitating faecal incontinence. The technique is expensive, and no cost analysis is currently available. The aim of this study was to assess clinical outcome and analyse cost-effectiveness. METHODS: Thirty-six consecutive patients underwent a two-stage SNS procedure. Outcome parameters and real costs were assessed prospectively. RESULTS: SNS was tested successfully in 33 of 36 patients, and 31 patients were stimulated permanently. In the first stage, eight of 36 patients reported minor complications (pain, infection or electrode dislocation), resulting in a cost of euro 4053 (range euro 2838-7273) per patient. For the second stage (permanent stimulation), eight of 33 patients had an infection, pain or loss of effectiveness, resulting in a cost of euro 11,292 (range euro 7406-20,274) per patient. Estimated costs for further follow-up were euro 997 per year. The 5-year cumulative cost for SNS was euro 22,150 per patient, compared with euro 33,996 for colostomy, euro 31,590 for dynamic graciloplasty and euro 3234 for conservative treatment. CONCLUSION: SNS is a highly cost-effective treatment for faecal incontinence. Options for further reduction of SNS costs include strict patient selection, treatment in an outpatient setting and using cheaper devices.

Adolescent↗
PubMed2006

A prospective comparison between clinical outcome and open-configuration magnetic resonance defecography findings before and after surgery for symptomatic rectocele.

BACKGROUND: The correlation between clinical symptoms and anatomical findings by conventional imaging is poor in patients with rectoceles. The aim of this prospective study was to assess and to correlate symptomatic changes after anterior levatorplasty with morphologic changes visualized by magnetic resonance defecography (MRD). METHOD: Fourteen women with a median age of 57 (range 37-83) accepted to participate. Seven of 14 had previous hysterectomy. Patients underwent MRD before surgery and again 6 months postsurgery. Pre- and postoperative symptoms and quality of life (QoL) (Eypasch) were assessed. Faecal and urinary incontinence were graded (Wexner- / Hanley-score). RESULTS: The median Eypasch-score improved from 90 (range 38-106) to 106 (range 29-133) after surgery (P = 0.016). Similarly, the Wexner-score ameliorated from 8 (range 0-20) to 4.5 (range 0-18; P = 0.02). Seven patients described new dyspareunia postoperatively. The median follow up was 16.5 months (range 9-45). The median rectocele size decreased from 37 mm (range 30-48) preoperatively to 12 mm (range 0-42) postoperatively (P = 0.004). Furthermore, enteroceles were corrected and pelvic floor descent was significantly reduced after surgery. Only the clinical symptom of incomplete evacuation strongly correlated with the respective radiological finding of contrast dye trapping (Rho = 0.822; P = 0.001). CONCLUSION: Anterior levatorplasty improved QoL in patients with symptomatic rectocele. Postsurgical correction of rectocele is accurately documented by MRD. Only moderate correlation between morphologic and clinical improvements was observed.

Adult↗
PubMed2005

[Sacral nerve stimulation in the treatment of faecal incontinence].

The sacral nerve stimulation is a new promising procedure for faecal incontinence in patients in whom conservative treatments have failed. In contrast to more invasive restorative surgeries (e.g. dynamic graciloplasty or artificial sphincter), sacral nerve stimulation can be tested and performed in outpatient under local anaesthesia. From May 2001 to April 2004, 25 consecutive patients with faecal incontinence underwent percutaneous test-stimulation during 10 to 14 days. The test was positive in 16 of them (64%) in whom a permanent implantation of an internal pulse generator was performed. During the follow up of this group a significant reduction of the number of incontinence episodes and a considerable improvement of quality of life was demonstrated. Complete investigations and restrictive patient selection, as well as a carefully follow up are recommended for the success in sacral nerve stimulation therapy.

Adult↗
PubMed2005

New screening technique for sacral nerve stimulation under local anaesthesia.

BACKGROUND: The purpose of this study was to assess the influence of the type of anaesthesia (local vs. general) and of the electrode used (test electrode vs. tined lead) on a successful screening period. METHODS: Between May 2001 and January 2004, we performed 25 percutaneous nerve evaluation (PNE) tests in 20 patients (11 women). The first 15 PNE tests were followed by introducing a conventional electrode, and since 2003 by a tined lead electrode. Success was defined as reduction of symptoms by more than 50%. RESULTS: A stimulator was implanted in 13 (68%) patients, including 4 of 14 screened with the conventional electrode and 9 of 10 screened with tined lead electrode (p=0.005). Eleven (44%) of the PNE tests were done under local anaesthesia, but the success rate was not influenced by the type of anaesthesia (local 46% vs. general 61%, p=0.682). CONCLUSIONS: PNE testing and implantation of the tined lead electrode can be easily performed at the same time under local anaesthesia. The use of the new tined lead electrode significantly increased the success rate for the screening phase.

Adult↗
PubMed2005

[Indications for laparoscopic colorectal resections--also for cancers?].

In the last decade, laparoscopy has dramatically changed colonic surgery. Laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Significant benefits can be expected with a laparoscopic approach relative to decreased pain, ileus, length of hospital stay, disability, and possibly, adhesion formation and subsequent bowel obstruction, and improved cosmesis. However, all those benefits are secondary in the treatment of cancer; tumor-free survival must be the primary goal. Early comparative studies have shown that laparoscopic colectomy for cancer is safe, feasible, and an oncologic adequate resection can be performed with acceptable operative times and conversion rates. The most recent results of prospective randomized trials are now showing similar survival and cure rates after laparoscopic colectomy. There is evidence that laparoscopic colectomy for curable cancer results in equivalent cancer related survival compared to open colectomy when performed by experienced surgeons. The surgical techniques are demanding and require a level of standardization to achieve success. Laparoscopic colorectal surgery for cancer will have a definite role in the future.

Adenomatous Polyposis Coli↗
PubMed2004

[Laparoscopy resection for colon cancer. The new standard?].

Surgical resection is the primary treatment for colon cancer. The introduction and acceptance of laparoscopic colectomy for cancer has been gradual for a number of reasons including the fact that it is technically challenging, has less than dramatic patient benefits, and perhaps most significantly it could theoretically represent a compromise as an oncologic procedure. Evidence suggests that laparoscopic colectomy for colon cancer is safe, feasible, and an oncologic adequate resection can be performed with acceptable operative times and conversion rates. It may result in improved outcomes when performed by experienced surgeons. The recently published results from the largest and first prospective randomized trial with sufficient statistical power have shown that laparoscopic colectomy is as effective as open colectomy in preventing recurrence and death from colon cancer. In experienced hands, laparoscopic colectomy for the cure of colorectal cancer appears to be equivalent to open surgery and may become standard in selected patients.

Colectomy↗
PubMed2003

The APC E1317Q variant in adenomatous polyps and colorectal cancers.

Genetic susceptibility may play a role in many colorectal cancers (CRCs). Known syndromes such as familial adenomatous polyposis and hereditary nonpolyposis CRC account for <5% of CRCs. The germ-line missense variant of the APC gene, E1317Q, has been proposed to confer a risk for colonic adenomatous polyps (adenomas), but not for CRCs in the general population. These findings are contradictory and controversial. In the present study, 608 cases (377 patients with CRC, 145 patients with 4-100 lifetime adenomas, and 86 with < or =3 lifetime adenomas), and 679 controls (362 spouses and 317 patients with normal colonoscopy) were screened for the APC E1317Q variant. The frequency of heterozygotes for E1317Q among patients with CRC (2.4%), patients with 4-100 adenomas (1.4%), and < or =3 adenomas (3.5%) did not differ from spouse controls (2.8%). When CRC patients were examined by DNA mismatch repair status, age at onset (< or =age 50 versus >50), or family history of CRC, no differences in the frequency of E1317Q were found. The APC variant E1317Q does not appear to be associated with increased risk for colorectal neoplasia in the general population. However, when we used normal colonoscopy controls (E1317Q carrier frequency = 0.3%), the prevalence of E1317Q was significantly increased in CRC patients, in patients with < or =3 adenomas, and in CRC patients with intact mismatch repair status, suggesting a possible role for E1317Q in colorectal tumorigenesis. These results underscore the importance of carefully defining the controls to be used in comparisons of allele frequencies.

Adenoma↗
PubMed2003

Laparoscopic colectomy for colon cancer.

Surgical resection is the primary treatment for colon cancer. The introduction and acceptance of laparoscopic colectomy for cancer has been gradual for a number of reasons including the fact that it is technically challenging, has less than dramatic patient benefits, and perhaps most significantly it could theoretically represent a compromise as an oncologic procedure. Preliminary evidence suggests that laparoscopic colectomy for colon cancer is safe, feasible, and can be performed with acceptable operative times and conversion rates. Furthermore, it may offer important patient-related advantages and the same extent of resection as in open surgery can be achieved. It may result in improved outcomes when performed by experienced surgeons. The early experience with high rates of wound recurrences has not been realized in current reports. Ongoing prospective, randomized trials should establish whether laparoscopic colectomy is as effective as open colectomy in preventing recurrence and death from colon cancer; until then this procedure is not considered standard for patients with curable colon cancer.

Adenocarcinoma↗
PubMed2002

[Laparoscopic surgery of colorectal cancer. Apropos of 103 interventions].

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer and to evaluate the oncologic follow-up. METHODS: Between March 1993 and December 2000 103 patients with colorectal cancer were treated by laparoscopy. Surgical, pathologic and follow-up data were recorded in a prospective registry database and analyzed by type of resection. RESULTS: A total of 42 women and 61 men with a mean age of 66.7 years underwent 9 right hemicolectomies, 6 left hemicolectomies, 35 sigmoidectomies, 41 low anterior resections and 12 abdominoperineal resections. Conversion was necessary in 14.5%. Postoperative complications occurred in 21 patients (20.3%) and decreased with experience. Hospital mortality was 0.9%. All cancers (31% stage UICCI, 28% stage II, 37% stage III et 3% stage IV) were resected with tumor-free margins and the mean number of lymph nodes was 19.6. Patients resumed solid diet on the second postoperative day and mean hospitalization was 12.6 days. Three port site recurrences, 4 local recurrences and 10 distant metastases occurred after a mean follow-up of 34.5 months (8-92). CONCLUSION: Laparoscopic colorectal cancer surgery is technically feasible with acceptable morbidity and low mortality. An oncologic adequate resection can be performed. To determine whether the recurrence rates and the survival data are equivalent to open surgery, prospective randomized trials are necessary.

Adult↗
PubMed2001

Risk factors for complications of laparoscopic Nissen fundoplication.

BACKGROUND: Although the rate of complications from laparoscopic Nissen fundoplication is low and the adverse postoperative sequelae are well known, both are disturbing for the patient. Identifying risk factors could be helpful in the better selection of patients for this procedure. METHODS: A retrospective review of 126 patients with a mean follow-up period of 3.5 years was conducted. The patients' demographics, pre- and postoperative symptoms, and outcomes were analyzed and compared. RESULTS: Three groups of patients were distinguished: (group 1) 9 patients with intraoperative complications (5 with perforation, 3 with hemorrhage, 1 with pneumothorax); (group 2) 16 patients with postoperative complications (5 with severe dysphagia, 4 with failure, 2 with pneumonia, 2 with incisional hernia, 1 with intestine perforation, 1 with fundoplication herniation, 1 with infection, 1 with gastric ulcer); and (group 3) 101 patients without any complications. The patients'demographics, preoperative symptoms, and preoperative studies were comparable in all three groups. The body mass index (BMI) was significantly higher (p < 0.05) statistically in group 1 (32.4 kg/m2) and group 2 (33.6 kg/m2) than in group 3 (28.7 kg/m2). However, the Visick grade and the subjective outcome were similarly good in all three groups. CONCLUSIONS: Although preoperative studies and symptoms do not seem to predict complications of laparoscopic Nissen fundoplication, patients with an increased BMI were at increased risk for complications in this study. Therefore, such patients should be counseled appropriately regarding the greater likelihood of intraoperative and postoperative complications.

Adult↗
PubMed1999

Internal fixation of distal radius fractures with dorsal dislocation: pi-plate or two 1/4 tube plates? A prospective randomized study.

BACKGROUND: Severely comminuted distal radius fractures can be treated by different methods. Our routine procedure in dorsal dislocated fractures is the dorsal stabilization with two 1/4 tube plates. The new pi-plate is an other device that matches optimally the anatomy of the distal radius and allows a near half-circumferential dorsal buttress of comminuted intraarticular and extra-articular radial fractures. METHODS: In a prospective randomized study, comminuted distal radius fractures with dorsal displacement were stabilized either with two 1/4 tube plates or with the pi-plate. All patients were reviewed at 1, 3, and 6 months after surgery by thorough clinical examination and standard radiographs of both wrists. Results were analyzed and compared in both groups. RESULTS: Subjective and objective results in the pi-plate group are disappointing. Although optimal anatomic results were achieved, the complication-rate was high (14.3%) and the range of motion was limited. At final review, extension and flexion of the injured wrist had recovered to an average of 67% of the normal, contralateral side. Radial and ulnar deviation were limited to 64%, whereas pronation and supination reached 89% and 87%, respectively. Overall, results were good to excellent only in 56%. In a comparable group of patients with similar fractures and stabilization with two 1/4 tube plates, 82% of patients achieved excellent to good results, wrist motion was significantly better (p < 0.05), and no complications occurred. CONCLUSION: With open reduction, cancellous bone grafting, and internal plate fixation in comminuted distal radial fractures, excellent results can be achieved. In our experience, we cannot recommend the 7pi-plate in its current shape and prefer to stabilize distal radius fractures and dorsal fragment dislocations with two 1/4 tube plates.

Adolescent↗