Biomedical subjects

F H Hetzer

Publications and source records attributed to F H Hetzer.

15 recordsLinked to original sources

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↗

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

External pelvic rectal suspension (the Express procedure) for full-thickness rectal prolapse: evolution of a new technique.

OBJECTIVE: The Délorme's operation for rectal prolapse is a safe procedure but has a high recurrence rate. We aimed to develop an operation akin to it, but designed to reduce this deficit. PATIENTS AND METHODS: Thirty-one consecutive patients with rectal prolapse were included in the study. Initially, a conventional Délorme's procedure was performed and sutures or strips of Gore-Tex were attached circumferentially to the apex of the prolapse, tunneled subcutaneously, and anchored to the external surface of the pelvis. Subsequently, the procedure was modified. Acellular porcine collagen strips were used and buried within the apex without plication of the denuded rectal musculature. Patients were formally assessed preoperatively and four months postoperatively by symptom and quality of life questionnaires and subsequently by regular clinical review. RESULTS: In the Gore-Tex group (N = 11; males:females = 10:1; mean age, 61 years) three patients underwent suture repair and eight had strip fixation. All suture repairs developed sepsis and one patient had a recurrence. Seven of the strip fixations (88 percent) developed sepsis that resulted in implant extrusion. There was one full-thickness and one mucosal recurrence after a median follow-up of 25 months. In the collagen group (N = 20; males:females = 2:18; mean age, 63 years), sepsis occurred in four patients, requiring surgical intervention in one patient (5 percent) (cf Gore-Tex group, P = 0.002). There was one mucosal and three full-thickness (15 percent) recurrences after a median follow-up of 14 months (cf Gore-Tex group, P = not significant). Significant improvements in symptom and quality of life scores were recorded in both groups at four months. CONCLUSION: A new, minimally invasive perineal procedure for rectal prolapse has been developed and initial data testify to its relative safety provided collagen is used. It remains to be seen whether long-term recurrence rates will be lower than those of conventional perineal procedures.

Aged↗

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

[New modalities and concepts in the treatment of hemorrhoids].

The surgical treatment of haemorrhoids has significantly changed by introducing new techniques in the last years. Nowadays, low grade haemorrhoids, grade II and III, are easily and painfree treatable by a minimal invasive, Doppler transducer guided ligation of the haemorrhoidal arteries. In cases of circular protruding haemorrhoids, grade III and IV; the stapled mucosectomy described by Longo is also a new effective treatment. Both procedures can be performed for an outpatient or with short hospital stay and allows patients to return to work earlier compared to conventional techniques. Additionally, due to the new techniques the treatment of haemorrhoids is less painful and has increased patients' satisfaction. Therefore, the traditional haemorrhoidectomy, the Milligan-Morgan or the Ferguson procedure, has become less common and is only performed in a few special indications.

Female↗

PubMed2003

Experimental model of continent colostomy using rectus abdominis neosphincteroplasty.

BACKGROUND: Use of dynamic myoplasty to create a continent stoma has produced promising results, but long-term stoma continence has not been achieved. The aim of the study was to establish and test a new model. METHODS: Three types of dynamic rectus abdominis sphincteroplasty around a colostomy and two conditioning protocols were tested in ten domestic pigs. Continence was assessed by means of conventional defaecography and neosphincter manometry after 8 and 12 weeks. The neosphincter muscle was studied histologically to assess the transformation of muscle type. RESULTS: Use of a distal rectus muscle sling surrounding the stoma by 270 degrees with a low-frequency conditioning protocol achieved a continent colostomy for more than 12 h on each of 5 consecutive days. The neosphincter had a 40-mm high-pressure segment with mean pressure of 74 (range 67-82) mmHg. The proportion of type I muscle fibres increased from 38 (range 32-42) to 74 (range 66-78) per cent after 12 weeks of conditioning. CONCLUSION: This pilot study demonstrated the feasibility of a continent stoma in an animal model with a dynamic rectus neosphincter. Long-term results should be confirmed in a larger series before use in humans can be considered.

Animals↗

PubMed2002

[Prospective assessment of the learning curve and safety of stapler hemorrhoidectomy].

INTRODUCTION: Stapled haemorrhoidectomy (SH) is a recently introduced procedure for the surgical excision of haemorrhoids. Actually, there is only limited information concerning the impact of the learning curve, complication rates and long-term results. Therefore, a prospective single-center study was performed with special regard to the learning curve and clinical safety of SH. METHODS: The data of 61 SH performed between March 1999 and May 2001 were analyzed. Operating times, complication rates and outcome results were prospectively recorded and then correlated to the surgical experience of the operating team. Postoperative pain was measured using the visual analogue scale (VAS). Sphincter lesions represented by the patient's incontinence and muscle defects were analyzed by using Williams incontinence score and histological examination of the resected specimen. Clinical follow-up studies were performed three and twelve weeks postoperatively. RESULTS: There were 18 patients with grade II haemorrhoids, 38 patients with grade III haemorrhoids, and five patients with grade IV haemorrhoids. Both, operating times and complication rates decreased with more surgical experience. The mean pain score during the first four postoperative days was 1.9 (range 0-8). Mean hospital stay and mean convalescence time were 1.7 days (range 1-5 days) and 10 days (range 1-31 days), respectively. Incontinence scores revealed only minor differences between pre- and postoperative values. CONCLUSIONS: SH represents a safe and effective new treatment modality for symptomatic haemorrhoids. Meticulous surgical technique and experience are mandatory to achieve excellent clinical results, e.g., reduced postoperative pain, shortened hospital stay and convalescence. We adopted SH to our surgical armamentarium for the treatment of haemorrhoids grade III and recurrent haemorrhoids.

Adolescent↗

PubMed2001

[Fecal incontinence: therapy of congenital sphincter dysplasia in adulthood--a case report].

The dynamic graciloplasty has gained acceptance in the therapy of intractable fecal incontinence. With a success-rate of 60 to 80%, the dynamic graciloplasty is a good alternative towards a permanent colostomy for individual cases. Furthermore, adults suffering from congenital anal atresia may be well treated by this therapy as described in this case. Following surgery, an accurate follow-up is inevitable in these patients, including training of neosphincter control. After 8 to 12 weeks the training-process of the neosphincter-control should be finished. At this point of time the patient will have obtained defecation-control and should be able to execute voluntary defecations.

Adult↗

PubMed2001

[Contact litholysis of gallstones with methyl tert-butyl ether in risk patients--a case report].

INTRODUCTION: Before laparoscopic cholecystectomy and endoscopic therapy became gold standard the nonsurgical treatment of symptomatic cholelithiasis, i.e. contact dissolution using methyl-tert-butyl ether (MTBE), was a valuable alternative. Even nowadays, stone dissolution may be helpful in critically ill patients. CASE REPORT: A 85-year-old man admitted in poor general condition due to cholangitis with septicemia following endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and partial stone removement because of impending perforation of the gallbladder empyema was treated by a percutaneous cholecystostomy with a pigtail catheter. After clinical improvement a successful contact dissolution was initiated by irrigation of the common bile duct and gallbladder with MTBE. The patient is asymptomatic three months after treatment. DISCUSSION: Symptomatic cholelithiasis is usually treated by endoscopic techniques. Percutaneous cholecystostomy in association with contact litholysis using MTBE is an effective treatment in patients who can not be operated due to critical conditions. The success rate in case of cholesterol stones averages 70 to 95% depending on number and size of stones. It is a non-invasive treatment with few side effects. CONCLUSION: In high-risk patients with severe cholecystitis, percutaneous catheter cholecystostomy combined with contact litholysis using MTBE is a successful, safe, and cheap treatment.

Aged↗

PubMed2000

[Anal fissure--a new therapy concept].

The anal fissure is one of the most frequent causes for anal pain. Conservative treatment usually consists of laxatives, local anesthetics and nitroglycerin cream. These therapies have a high recurrency rate. Surgical interventions, i.e. manual dilatation and sphincterotomy are fraught with the danger of fecal incontinence. The completely reversible effect of botulinum toxin injection opens new possibilities in the treatment of anal fissures. Its use is discussed as part of a 3-stage therapeutic regimen.

Administration, Topical↗

PubMed2000

Three-dimensional contrast-enhanced MRI using an intravascular contrast agent for detection of traumatic intra-abdominal hemorrhage and abdominal parenchymal injuries: an experimental study.

The aim of this study was to compare the performance of 3D MRI in conjunction with an intravascular contrast agent to spiral contrast-enhanced CT, regarding the detection of abdominal parenchymal injuries as well as peritoneal hemorrhage in an animal model. Liver and kidney injuries were created surgically in six female pigs under general anesthesia. All pigs underwent contrast-enhanced spiral CT and 3D MR imaging following administration of an intravascular contrast agent (NC100150 Injection). Two readers rated their confidence independently on MR and CT data sets using a five-point scale for the presence of organ injury and hemoperitoneum. Autopsy findings served as standard of reference. Sensitivity and specificity for MR in detecting hepatic and renal injuries as well as hemoperitoneum was 100%. Computed tomography was less accurate with sensitivity and specificity values of 90 and 94%, respectively. Receiver operating characteristics (ROC) analysis revealed a higher confidence when interpretation was based on MR images. In an animal model 3D MR imaging in conjunction with an intravascular contrast agent proved highly accurate in detecting and localizing parenchymal injuries to the upper abdomen as well as in detecting intraperitoneal blood collections.

Abdominal Injuries↗

PubMed1999

Comparison of three dimensional magnetic resonance imaging in conjunction with a blood pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding.

BACKGROUND AND AIMS: To compare the performance of 3D magnetic resonance imaging (MRI) in conjunction with an intravascular contrast agent with that of scintigraphy, with respect to detection and localisation of gastrointestinal haemorrhage in vivo in pigs. METHODS: Intraluminal bleeding sites were surgically created in the small bowel and colon of six pigs. The animals underwent scintigraphy with (99m)Tc labelled red blood cells and 3D MRI following administration of an intravascular contrast agent (NC100150) at five minute intervals over 30 minutes. For analysis, the intestinal tract was divided into six segments. Based on the two evaluated methods, each segment was characterised on a five point scale regarding the presence of a bleed. At autopsy, the surgically manipulated bowel segments were inspected for the presence of haemorrhage. RESULTS: Bleeding was confirmed at autopsy in 18/36 segments. Contrast extravasation with subsequent movement through the bowel could be documented on MRI data sets. All segments were correctly characterised, resulting in 100% sensitivity and specificity for MRI. Based on scintigraphy, interpretation of seven segments (19%) was false (sensitivity/specificity of 78%/72%). Differences in diagnostic performance were evident in the receiver operator characteristic (ROC) analysis, with an area under the MRI curve of 0.99 and under the scintigraphy curve of 0.85. CONCLUSION: In conjunction with an intravascular contrast agent, 3D MRI permits accurate detection and localisation of gastrointestinal bleeding. The extent and evolution of intestinal bleeding can be determined with repeated data acquisition.

Animals↗

PubMedDate not supplied

Is growth influencing diameter and function of laparoscopic TESA hepaticojejunostomy? A comparison of adult minipigs and juvenile domestic swine.

Current treatment of obstructive jaundice includes endoscopic stenting and open surgical bypass. To combine the advantages of surgical bypass with the minimal invasive approach of endoscopic stenting we developed a laparoscopic technique, transient endoluminally stented anastomosis (TESA). As shown previously, small-diameter anastomoses (e.g., hepaticojejunostomy) by TESA technique can be performed reliably in growing domestic swine. This further preclinical trial was designed to exclude growth of the animals as the main reason for these excellent results. After ligation of the common bile duct, a laparoscopic Roux-en-y hepaticojejunostomy was performed 7 days later by TESA with a reabsorbable radiopaque polyglycolic acid stent. In group A (n = 7) growing domestic pigs and in group B (n = 5) adult minipigs were operated on. Laboratory parameters were controlled weekly. Stent degradation was followed by weekly abdominal x-ray. At necropsy 6 months after surgery, cholangiography was performed and the anastomoses were measured. Mean weight gain was 140.7 +/- 10.9 kg in domestic pigs versus 5.8 +/- 1.6 kg in minipigs. Cholestasis normalized within 7 days postoperatively. Duration of stenting was not significantly different between groups. Cholangiography at necropsy showed immediate runoff through the anastomoses in both groups. The diameter of the anastomosis was 4.7 +/- 0.5 mm in group A versus 3.0 +/- 0.4 mm in group B (p = 0.03). In conclusion, functionality of the small-diameter TESA hepaticojejunostomy is not related to age and growing factors in pigs, justifying its application in human as the next step of investigation.

Anastomosis, Surgical↗