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G Kautz

Publications and source records attributed to G Kautz.

At least 19 recordsLinked to original sources
PubMed2003

Stent migration necessitating surgical intervention.

BACKGROUND: Internal drainage with transhepatically or endoscopically placed endoprostheses has been used for many years as a temporary or definitive treatment for biliary tract obstruction. As a late complication, stent migration may occur. METHODS: We reviewed our records to identify patients who were operated on for a migrated endoprosthesis that was causing complications. In all, five such patients were identified. RESULTS: One patient had a large bowel perforation. Bowel penetration led to an interenteric fistula in one patient and to a biliocolic fistula formation in another. Small bowel distension was found in two patients. Surgical treatment consisted of local excision in three patients, segmental resection in one patient, and a bypass operation in the patient with biliocolic fistula. Postoperatively, four patients recovered without problems, but one patient died during a complicated postoperative course. CONCLUSION: If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications.

Adult↗
PubMed1996

[Elective lymph node dissection in malignant melanoma--status of color Doppler findings].

Since there is still a controversial discussion about the ELND in melanoma patients, the purpose of this prospective study was to optimize the indication concerning ELND by ultrasound examinations. 144 patients with primary melanomas were checked every 3 months after excision. Echomorphologic pattern and intranodal vascularisation in the color-flow Doppler modus provide essential information for differential diagnosis. We found 47 patients (32.6%) with suspicious ultrasound lesions. 50% of these patients had no pathological clinical findings, the histological findings of excised lymph nodes were positive in all cases. It must be emphasized, however, that the group with lymph node metastases included 12 patients with low-risk-melanomas (2 x Tis, 10 x T1 < 1 mm tumor thickness). In comparison with a historical control group (141 patients), where ELND was performed routinely in high-risk-patients ( > T2), the incidence of ELND in our hospital decreased more than 50%; at the same time the percentage of detected lymph node metastases increased (twice).

Adult↗
PubMed1996

[Surgical therapy of hemorrhage after endoscopic sphincterotomy. Indications and technique].

Postinterventional bleeding occurs in 2.5% after endoscopic sphincterotomy (EST). It is the most frequent complication of this technique. According to the world literature the mortality of post-EST-bleeding averages 10%. According to a review of the world literature patients are often operated upon too rarely and too late. Direct surgical interventions at the Vaterian papilla should be omitted because of the danger of post-operative pancreatitis. From our point of view laparotomy and ligation of the gastroduodenal artery are recommended if periampullary injection of epinephrine fails to control the bleeding. The cessation of the bleeding should be controlled by intraoperative endoscopy. During the same surgical intervention the underlying disease for EST, e.g. common bile duct stones, ought to be treated surgically to prevent a new bleeding episode. If the underlying disease was already cured or in case of inoperability, selective embolization of the gastroduodenal artery presents an alternative option.

Ampulla of Vater↗
PubMed1993

[More successful and cost effective--the non-transendoscopic method of TPCD].

With TPCD best results are gained with large diameter endoprostheses. In this instance special duodenoscopes with a working channel of 3.2 or 4.2 mm are needed for the implantation of 10 or 12 French endoprostheses. Alternatively, using the non-transendoscopic technique large diameter endoprostheses of 14 or more French can be implanted independently from the diameter of the working channel with conventional endoscopes. We have used this method developed at our institution in 1204 patients since 1982 and compared its results with 192 patients in whom the transendoscopic technique with 7-10 French endoprostheses was administered. The success-rate (non-transendoscopic technique 94 vs transendoscopic technique 79%), early complications (5 vs 11%), method-specific mortality (0.3 vs 1%), in-hospital mortality (3.6 vs 21%) and late complications (19 vs 33%) are clearly in favour of the non-transendoscopic approach. The higher rate of early complications and consecutively higher in-hospital mortality of the transendoscopic method with 7-10 French endoprostheses was mainly due to frequent episodes of early cholangitis due to insufficient biliary drainage. The higher success-rate of the non-transendoscopic approach is method specific ("Prothesenleger" guidable). A change of the endoscope is not necessary in contradiction to the transendoscopic method. Additional costs of special duodenoscopes that can be used neither for ERCP nor sphincterotomy are superfluous.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholestasis, Extrahepatic↗
PubMed1993

[Indications, findings and complications of ERCP in pediatrics].

Endoscopic retrograde cholangio-pancreatography presents the only method which not only produces exact results concerning the morphology of the pancreatic and biliary ducts but also enables therapeutic access to these structures. In childhood ERCP is indicated if other non invasive diagnostic procedures do not help to establish a diagnosis or if further informations concerning indication or planning of an operation can be expected. In 25 children and 13 adolescents ERCP established the correct diagnosis in 95%. The success rate in newborns after the second month reaches 90%. For children before the age of 2 months a pediatric duodenoscope with a diameter of 7-9 mm is necessary. In obstructive jaundice, after trauma of the upper abdomen and especially in pancreatitis of unknown origin ERCP should be performed liberally, because a lot of exploratory laparotomies can be prevented, and significant findings for operative intervention can be collected. Moreover the causes of pancreatitis can be evaluated and treated definitely. With EST impressive improvements in the clinical course of obstructive jaundice, cholangitis and acute pancreatitis even in children and adolescents can be reached. In our own series 9 children (3 acute biliary pancreatitis, 3 chronic obstructive pancreatitis, 1 acute pancreatitis, 2 biliary duct stones with cholangitis or ampullary stenosis) were treated successfully without any significant complications. In acute pancreatitis an ERCP should be performed as early as possible (during 24-48 hours after onset of symptoms) because only in this instance the etiologic factors can be evaluated reliably and using endoscopic sphincterotomy of the sphincter proprius choledochi and/or the sphincter proprius pancreatis be treated adequately and with the lowest risk in time.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

[Therapeutic problems of cancers of the gallbladder].

Data of 32 patients who were operated for gallbladder carcinoma were evaluated in a retrospective meta-analysis. Results were compared with endoscopic retrograde cholangio-drainage (ERCP) using large size 12/14-French gauge endo-prostheses with side flaps to prevent migration. According to the TNM classification 84% of patients were classified as stage IV, 12.5% were in a stage III and 3% were in a stage II. Only 22% of cases were operated for cure (cholecystectomies, lymphadenectomy, wedge resection of the liver). All patients died in between one year on cancer, average survival was 158 days in TNM stage II, 183 days in stage III and 75 days in stage IV. Early complication rate was in stage III and 75 days in stage IV. Early complication rate was at 28% due to cardiac and pulmonary complications. No one died as a result of the operation. Endoscopic bile duct drainage (ERCP) for gallbladder carcinoma (n = 21) was shown to be superior to surgical results with an average survival of 160 days. Early complication rate (30 day interval) was at 5.6% (n = 1014), mostly due to tube occlusion with cholangitis; clinical mortality was 2.6% only (n = 393). Occlusion of the endoscopic 12/14-French gauge tube was seen after 213 days in average. Endoscopic therapy was shown to represent an independent way in gallbladder cancer treatment not only for patients defined as not suitable for operation. All own results were compared to the literature, therapeutic regimen in gallbladder carcinoma is summarized as an organigramm.

Adenocarcinoma↗
PubMed1990

[Clinical aspects, diagnosis and therapy of genuine bile duct cysts].

During an eight-year period eight patients with intra- or extrahepatic bile duct cysts were treated at our institution. One patient belonged to Type I, four to Type IV and three to Type V according to the classification by Alonso-Lej/Todani. The main symptom among the Type IV patients was jaundice, among the Type V patients abdominal pain. The correct diagnosis could be established by ERCP in seven of eight cases. Two type V patients with disease mainly confined to one lobe of the liver could be resected, one patient was treated endoscopically, the others underwent biliary drainage procedures.

Adolescent↗
PubMed1989

[Endoscopy in diseases of the bile ducts and pancreas].

The results of endoscopic therapeutic methods (EST, TPCD), which changed the therapy of the frequent biliary duct and of the diseases of the pancreas, are discussed and the literature and treatment of our own patients are discussed. The choice of optimal therapy for the patient is possible only if endoscopic methods are part of a combined endoscopic-surgical concept of therapy selected in close cooperation with the surgeon. The therapy of cholelithiasis and acute pancreatitis are used as examples.

Aged↗
PubMed1989

[Arguments for a revised concept in the therapy of acute pancreatitis. On the indications for conservative, endoscopic and surgical procedures].

From January 1, 1973 to October 31, 1987 we treated 271 patients suffering from acute pancreatitis at the Department of General Surgery at the University Münster, Westphalia. 159 (58.7%) presented with stage I, 75 (27.7%) with stage II, and 39 (13.6%) with stage III disease according to the Mainz classification for acute pancreatitis. In 147 cases an endoscopic sphincterotomy (EST) was performed. At a low method-specific morbidity (5.4%) we observed a mortality rate of 0% for stage I, 8% for stage II, and 22% for stage III. Altogether, a mortality rate of 13.3% was calculated for the necrotizing forms of acute pancreatitis after EST, compared to 36.5% for a conventionally (conservative therapy, operation) treated group.

Acute Disease↗
PubMed1988

[Long-term results of endoscopic sphincterotomy in patients with gallbladder in situ].

The place of endoscopic sphincterotomy (EST) as primary and sole invasive treatment was retrospectively analysed in 185 patients who had the procedure performed because of choledocholithiasis and/or stenosis of the papilla. EST was successful in 99.5%, with an early complication rate of 3.8%, an early mortality rate of 0.5% and an emergency operation rate of 0.5%. Freedom from stone in the choledochal duct or adequate bile flow was achieved in 94.1%. Late complications, on average 36.5 (6-75) months after the procedure, was 16.9%, late mortality 2.8% and operation rate for complications 5.6%. Even without stones in it the gallbladder was the cause of late complications in over 60% of cases. Comparison of results between operative treatment and EST indicated advantages of the former up to the age of 60 years, combined cholecystectomy and EST up to 70 years, while EST alone seems justified in older patients.

Adolescent↗
PubMed1987

[Value of diagnostic procedures in pancreatic cancer].

At the Surgical Department of Münster University in-patient treatment was applied to 320 patients for pancreas carcinoma, between 1977 and 1984. These cases were concomitantly studied for informative potentials of computed tomography (CT), sonography (Sono), and endoscopic retrograde cholangiopancreatography (ERCP). CT was performed on 163 patients (50.3 per cent), Sono on 180 (56.3 per cent), and ERCP on 90 (28.1 per cent). Highest sensitivity was recorded from ERCP, with 91.1 per cent of correctly positive diagnoses. CT gave correct positive findings in 70.5 per cent of all cases and Sono in 61.1 per cent. Resection rates were not increased by introduction of these new techniques, but the rate rather stayed at 14.8 per cent. While the period between hospitalisation and operation was slightly reduced, surgical intervention was too late for curative resection in most cases. In some highly advanced cases with distant metastases but absence of symptoms on the basis of CT findings, exploratory laparotomy was abandoned. The new methods have improved diagnostic accuracy rather than prognosis of pancreas carcinoma.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1983

Transpapillary bile duct drainage with a large-caliber endoprosthesis.

A new method for transpapillary bile duct drainage by means of a large-caliber endoprosthesis is described. It facilitates the transpapillary introduction of endoprostheses with an internal diameter of 3.5 to 5 mm irrespective of the actual diameter of the duodenoscope instrument channel. The method has been successfully employed in 6 out of 8 patients with malignant obstructive jaundice, uncomplicated by cholangitis. It offers an acceptable alternative to palliative surgical biliodigestive anastomosis.

Aged↗
PubMed1981

Endoscopic insertion of feeding tubes a new method for the management of upper digestive tract stenosis.

For patients requiring artificial feeding over a lengthy period, enteral alimentation via feeding tubes has proved to be the most practicable, and least harmful, method. The paper describes a new endoscopic method that facilitates the introduction of a feeding tube, even through stenoses of the upper digestive tract, or through areas of suture leakage after abdominal surgery. The method was successfully employed, without complications, in 13 patients; it was tolerated without serious inconvenience, and can be performed by the endoscopist and his assistant nurse.

Carcinoma↗