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F J Berends

Publications and source records attributed to F J Berends.

18 recordsLinked to original sources
PubMed2006

Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass.

BACKGROUND: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. METHODS: From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery. RESULTS: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%)--a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m2, and decreased to 45.8+/-8.9 kg/m2 after LAGB and was again reduced to 37.7+/-8.7 kg/m2 after RYGBP within our follow-up period. CONCLUSION: Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.

Adult↗
PubMed2004

Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus.

BACKGROUND: Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. METHODS: In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections. RESULTS: Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p < 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p < 0.05) and shorter intensive care unit stay (1 vs 2 days; p < 0.05). There were no differences in morbidity, mortality, and hospital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease. CONCLUSIONS: Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear.

Aged↗
PubMed2004

Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study.

BACKGROUND: Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a relapse occurs after some time. A relapse may be associated to the presence of accessory spleens and splenosis. The purpose of this study was to compare the operative outcome and the hematological results on the long term of a series of LS with a historic series of OS for the treatment of ITP. METHODS: A retrospective review was done of 50 consecutive patients who underwent LS for ITP. Patient characteristics, outcome of surgery, and hematological results were compared to a historical group of patients who underwent conventional splenectomy for ITP (n = 31). Response to splenectomy was defined in three groups: complete remission, partial remission, and no response. Grouping was based on hematological data. RESULTS: Concerning operative outcome and postoperative complications, there was a significant difference in favor of LS. Moreover, the hematological outcome of both groups showed no differences after a median period of 66 months (OS) and 35 months (LS), respectively. CONCLUSIONS: Hematological results after laparoscopic splenectomy for ITP are comparable to those after open splenectomy in both the short and the long term.

Adolescent↗
PubMed2002

Technical considerations and pitfalls in laparoscopic live donornephrectomy.

BACKGROUND: Recent developments in laparoscopic solid organ surgery suggest a possible reduction in postoperative discomfort and disability for kidney donors. Technical aspects and the influence of surgical experience in laparoscopic donor nephrectomy were evaluated. METHODS: The clinical outcome of 57 laparoscopic donor nephrectomies (LapNx) was compared with that for a historic control group of 27 open donor nephrectomies (OpenNx). RESULTS: Three conversions to open nephrectomy (5.2%) were necessary. Postoperative complications were minor and comparable in both groups. Patients who underwent laparoscopic surgery demonstrated significantly less postoperative pain and a shorter hospital stay, but operative time and warm ischemia time were significantly longer. Graft survival after LapNx was 100% during a median follow-up period of 13 months. Operative time for LapNx decreased considerably with experience gained and seemed to be less for right nephrectomy. Stenotic ureter-bladder anastomoses occurred after LapNx in four patients during the first half year (7.0%), but this problem seemed to be resolved after modification of the technique. CONCLUSION: LapNx is associated with less postoperative discomfort and improved convalescence.

Case-Control Studies↗
PubMed2001

The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response.

BACKGROUND: Both laparoscopic and conventional surgery result in activation of the systemic immune response; however, the influence of the laparoscopic approach, using CO2 insufflation, is significantly less. Little is known about the influence of alternative methods for performing laparoscopy, such as helium insufflation and the abdominal wall lifting technique (AWLT), and the systemic immune response. METHODS: Thirty-three patients scheduled for elective cholecystectomy were randomly assigned to undergo laparoscopy using either CO2 or helium for abdominal insufflation or laparoscopy using only the AWLT. The postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein (CRP) and interleukin-6 (IL-6). The postoperative immune response was assessed by measuring monocyte HLA-DR expression. RESULTS: CRP levels were significantly higher 1 day after helium insufflation when compared with CO2 insufflation; however, no differences were observed 2 days after surgery. The AWLT resulted in significantly higher levels of CRP both 1 and 2 days after surgery when compared with either CO2 or helium insufflation. A small increase in postoperative IL-6 levels was observed in all groups, but no significant differences were seen between the groups. After both helium insufflation and AWLT a significant decrease in HLA-DR expression was observed, in contrast to the CO2 group. CONCLUSION: Carbon dioxide used for abdominal insufflation seems to limit the postoperative inflammatory response and to preserve parameters reflecting the immune status. These findings may be of importance in determining the preferred method of laparoscopy in oncologic surgery.

Abdominal Muscles↗
PubMed2001

Technical considerations in laparoscopic liver surgery.

BACKGROUND: Laparoscopic solid organ surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. Laparoscopic liver surgery mainly comprizes diagnostic procedures and treatment of liver cysts. However, we believe there is room for a laparoscopic approach to the liver in selected cases, with the benefits that may be expected from laparoscopic solid organ surgery. METHODS: Between 1993 and 2000, 10 patients with various lesions of the liver underwent laparoscopic surgery. Indications consisted of cystic disease (n = 2), hemangioma (n = 2), focal nodular hyperplasia (n = 2), liver abcess (n = 1), and liver metastasis (n = 3). Laparoscopic treatment varied from fenestration (n = 3) to wedge resections (n = 5), and formal left lateral hepatectomy (n = 2). RESULTS: The mean patient age was 54 years (range, 34-71 years). The mean operative time, including laparoscopic ultrasonography, measured 180 min (range, 80-240 min). Peroperative blood loss ranged from 200 to 450 ml. There was no mortality. In two patients, conversion to laparotomy was necessary. There were no postoperative complications. The mean hospital stay was 6 days (range, 4-11 days). CONCLUSION: Laparoscopic treatment should be considered in selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver.

Adult↗
PubMed2001

Endoscopic treatment of benign esophageal tumors: case report of three patients.

Benign esophageal tumors are rare. Enucleation of the tumor is considered when the patient reports problems. The traditional approach is to use thoracotomy or laparotomy if the tumor is located in the distal esophagus. The use of minimally invasive techniques permits enucleation with all the concomitant advantages. Our experience with the minimally invasive management of three benign esophageal tumors is described. The methods and results of preoperative studies are reported. The surgical technique is described. Two patients could be managed using thoracoscopy, and one patient required conversion to laparoscopy. All the patients had complete and quick recoveries.

Cysts↗
PubMed2001

Epiphrenic diverticula: minimal invasive approach and repair in five patients.

Epiphrenic esophageal diverticula are rare and often asymptomatic. If surgery is mandatory, a thoracotomy is used to resect the diverticulum. The results of a minimal invasive approach and repair in five patients are presented. These patients, who all presented with an epiphrenic diverticulum, were evaluated using barium swallow study, esophagoscopy, and manometry. The diverticula were approached by thoracoscopy in all patients and a description of the surgical technique is given. The diverticula were resected using a right-sided approach in four patients. One patient with a diverticulum in the distal esophagus required conversion to laparoscopy. A myotomy was performed in two patients because of high pressures in the lower esophageal sphincter. The postoperative course was uncomplicated in four patients. One patient with Ehlers-Danlos disease had a complicated course owing to leakage, resulting in two re-operations by means of thoracotomy. There was no mortality. The minimal invasive approach of epiphrenic diverticula is feasible. The long-term results are awaited.

Diverticulum, Esophageal↗
PubMed2000

Laparoscopic detection and resection of insulinomas.

BACKGROUND: Laparoscopic ultrasonography as a diagnostic tool for the localization of islet cell tumors has been described before, but few reports on laparoscopic resection of insulinomas exist. We retrospectively reviewed the results of our experience with laparoscopic detection and the resection of insulinomas to determine its feasibility. METHODS: Between February 1996 and February 1999, 10 patients underwent operation for organic hyperinsulinism at our institution. Patient and clinical characteristics were studied retrospectively. Laparoscopic ultrasonography was performed to localize the insulinoma and then laparoscopic resection was performed. RESULTS: Eight women and 2 men underwent operation for hyperinsulinism. In 6 patients the insulinoma could be resected laparoscopically, either by enucleation (5 patients) or by resection of the pancreatic tail (1 patient). Four procedures were converted to laparotomy for the proximate location of the insulinoma to the portal vein or pancreatic duct (3 procedures) and failure to identify the insulinoma (1 procedure). The overall success rate of preoperative localization of an insulinoma with the use of various imaging techniques was 60% (6/10 patients). Laparoscopic ultrasonography could identify an insulinoma in 90% of the patients (9/10 patients). The median hospital stay was 7 days. CONCLUSIONS: Laparoscopic ultrasonography followed by laparoscopic removal of the insulinoma in patients with clinically manifested hyperinsulinism is a feasible and safe technique with low morbidity and fast postoperative recovery. Preoperative localization studies appear of limited value.

Adolescent↗
PubMed2000

Retroperitoneal endoscopic ligation of lumbar and inferior mesenteric arteries as a treatment of persistent endoleak after endoluminal aortic aneurysm repair.

A 74-year-old man receiving long-term anticoagulation therapy for intermittent atrial fibrillation had a type II endoleak after endovascular abdominal aortic aneurysm repair. During an 8-month follow-up, the endoleak persisted, and the aneurysm failed to decrease in diameter. By means of a left flank retroperitoneal endoscopic surgical approach, the aneurysm was dissected free, and the lumbar arteries emanating from the aneurysm, as well as the inferior mesenteric artery, were ligated with titanium clips. A postoperative spiral computed tomography scan depicted one pair of unclipped lumbar arteries just proximal to the aortic bifurcation. After immediate reoperation with the same approach, complete thrombosis of the aneurysm sac was radiographically confirmed.

Aged↗
PubMed2000

Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases.

OBJECTIVE: To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy (ERA). SUMMARY BACKGROUND DATA: Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors. METHODS: Clinical characteristics and outcomes of 111 ERAs from January 1994 to December 1999 were evaluated. RESULTS: Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indications were Cushing syndrome (n = 22), Cushing disease (n = 8), ectopic adrenocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheochromocytoma (n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size varied from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 114 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minutes, with median blood loss of 121 mL. The conversion rate to open surgery was 4.5%. The complication rate was 11%. Median postoperative hospital stay was 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate was 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%. CONCLUSION: For benign adrenal tumors less than 6 cm, ERA is recommended.

Adolescent↗
PubMed1999

[Laparoscopic splenectomy for hematological diseases; results in 28 patients].

OBJECTIVE: To evaluate the first results of laparoscopic splenectomy for haematological diseases and the learning curve. DESIGN: Retrospective. PATIENTS AND METHODS: Data of all patients who underwent a laparoscopic splenectomy in October 1994-July 1998 in the University Hospital Rotterdam, Department of surgery, the Netherlands, were collected from electronic databases. Data on postoperative complications were collected from medical records. Patients with splenomegaly (> 15 cm) were not eligible for the procedure. RESULTS: 28 patients were eligible for a laparoscopic splenectomy. The male:female ratio was 1:4. The mean age was 35 years. The indications for surgery were idiopathic thrombocytopenic purpura (ITP; n = 24), Gilbert syndrome (n = 1), spherocytosis (n = 1), thalassaemia (n = 1) and haemolytic anaemia with ITP (n = 1). Conversion to an open procedure was necessary in 5 of 28 laparoscopic splenectomies (18%). The median operating time was 172 minutes. Complications occurred in four patients: pneumonia (n = 2), bleeding (n = 1) and urosepsis (n = 1). The median hospital stay was 5 days (range: 1-18). The first 14 laparoscopic splenectomies differed from the following 14 by a higher conversion rate (p = 0.01), a longer operation time (p = 0.002) and a longer hospital stay (p = 0.004). In 23 out of 25 patients with ITP the thrombocyte count became normal. CONCLUSION: Laparoscopic splenectomy is associated with a learning curve, with a high incidence of conversion in the early procedures. It appears to be a safe and effective operation.

Adolescent↗
PubMed1999

[Laparoscopic donor nephrectomy for kidney transplants from living family members: good preliminary results].

OBJECTIVE: Evaluation of safety and technical feasibility of laparoscopic live donor nephrectomy. DESIGN: Descriptive. METHOD: The per- and postoperative results were analysed of 15 patients subjected to laparoscopic live donor nephrectomy in the Erasmus Medical Centre Rotterdam, Dept. of General Surgery, the Netherlands. Both left and right nephrectomy were performed via the transperitoneal route. The kidney was removed via a subumbilical incision. RESULTS: Laparoscopic donor nephrectomy was attempted in 15 patients and completed successfully in 14. Conversion to flank incision was resorted to one patient because of a venous bleeding. Median operating time was 290 min (SD: 57). Mean warm ischaemia time was 7 min (range: 4-17), including laparoscopic harvest. All kidneys were functioning well after transplantation. The mean duration of postoperative hospitalization of the donors was 4 days. CONCLUSION: Laparoscopic live donor nephrectomy is a safe and technically feasible procedure in a kidney transplant programme involving a living relative.

Adult↗
PubMed1998

Port-site metastases. Impact of local tissue trauma and gas leakage.

BACKGROUND: Port-site metastases after laparoscopic procedures in patients with digestive malignancies have evoked concern. The pathogenesis of port-site metastases remains unclear. Two experiments in rats were performed to determine the impact of both tissue trauma and leakage of CO2 along trocars (chimney effect) in the development of port-site metastases. METHODS: Experiment I: Ten WAG rats had four 5-mm incisions in all abdominal quadrants. The incisions on the right side were crushed to induce tissue trauma. After inserting 5-mm trocars in all incisions, a pneumoperitoneum was created, and CC-531 tumor cells were injected intraperitoneally. CO2 was insufflated for 20 min. Experiment II: Ten WAG rats had 5-mm incisions in the left and right abdominal upper quadrant. A 5-mm trocar was inserted in the incision in the left upper quadrant, and a 2-mm trocar was inserted in the incision in the right upper quadrant. After insufflating the abdomen, CC-531 tumor cells were injected intraperitoneally. Total leakage of CO2 along the trocar in the right quadrant was 10 liters. After 4 weeks, in both experiments, the tumor deposits at the trocar sites were assessed. Statistical analysis was performed by the Wilcoxon matched-pairs test. RESULTS: Experiment I: The median weight of tumor deposits at the trocar sites without induced tissue trauma was 22 mg. At the traumatic port sites, median weight of tumor deposits was 316 mg (p = 0.007). Experiment II: The median weight of tumor deposits at the leaking trocar sites was 478 mg and at the control sites 153 mg (p = 0.009). CONCLUSION: Tissue trauma at trocar sites and leakage of CO2 along a trocar appear to promote implantation and growth of tumor cells at port sites.

Abdominal Muscles↗
PubMed1994

[Perforation rate and diagnostic accuracy in acute appendicitis].

OBJECTIVE: To determine perforation rate and diagnostic accuracy in acute appendicitis. DESIGN: Retrospective study. SETTING: Deaconesses' hospital Utrecht. METHOD: Data on 235 acute appendectomies performed between 1989 and 1991 were collected: duration of symptoms, doctor or patient delay, pathology, septic complications, and objective data such as body temperature, leukocyte count and sedimentation rate. RESULTS: Symptoms lasted on average 1.68 days and in 12.3% of the cases there was doctor delay, while an accurate diagnosis was made in 80%. The perforation rate was 18.3% and tended to be higher in young children and adults over 50. Septic complications ensued in 25% of the perforations. Perforation was associated with symptoms existing for longer than 48 hours. The number of negative appendectomies was 5 times higher in women than in men. The objective data were of limited diagnostic value. According to literature of the last 15 years, the mean value for perforation rate is 17% and for diagnostic accuracy 79%. CONCLUSION: In children and elderly appendicectomy should be considered earlier. For sexually mature women additional laparoscopy can be of help in decreasing the number of negative appendectomies. It is recommended not to observe patients too long.

Acute Disease↗