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Biomedical subjects

H Wehrli

Publications and source records attributed to H Wehrli.

At least 37 records · Page 2Linked to original sources
PubMed1990

[100 consecutive cases of surgical esophagus-cardia carcinoma].

100 esophagectomies were performed at the Waid Hospital in Zürich between 1981-1988. 55 patients underwent blunt esophagectomy without thoracotomy, 34 abdomino-thoracic resection with intrathoracic anastomosis, and 11 abdomino-thoracic resection with lymphadenectomy and cervical anastomosis. In 80% the tumor had spread through the esophageal wall or there were already regional lymph node metastases. Adenocarcinoma was found in 2/3 of the patients and epidermoid carcinoma in 1/3. 30-day mortality was 5%. The actuarial 5-year survival rate is 14%. Average hospital stay was 30 days. Blunt esophagectomy was mainly performed in older patients with tumor localization in the lower third. Abdomino-thoracic resection with cervical anastomosis was preferred for younger patients with tumor localization in the middle third. Surgical resection is the only curative therapy in esophageal cancer, but due to the often advanced tumor stage it is often only of palliative character.

Adenocarcinoma↗
PubMed1990

[Surgical therapy of severe idiopathic constipation].

Because surgery for severe idiopathic constipation is seldom indicated, careful preoperative evaluation is mandatory (colonoscopy with biopsy, whole gut transit study, evacuation proctography, electromyography, anorectal manometry) in order to classify chronic idiopathic constipation into two broad functional groups: "outlet obstruction" and "colonic inertia". Subtotal colectomy with ileorectal anastomosis yields a good outcome in 70-100% of cases with slow transit constipation. In contrast, there is a broad spectrum of surgical techniques in the treatment of outlet obstruction, among which anorectal myectomy seems to be appropriate for selected patients with good results in 54-92%. Our own small surgical experience with chronically constipated patients (n = 4, 1987-1989) is discussed and compared with the results in the literature.

Anal Canal↗
PubMed1989

[Surgical experiences with the arteriovenous hemodialysis shunt (1970-1988)].

Data were collected concerning 307 arteriovenous fistula for hemodialysis created in 186 patients between 1970 and 1988 at the Municipal Hospital Waid of Zurich. The average age of all patients was 52.7 years. The procedure which provides access for 97.2% of all patients is the radiocephalic fistula (Cimino-Brescia), which became dilated within 4 weeks in 82.9%. There was a primary failure rate of 11.2%. The patency rate was 60.2% after 3 years and 36.6% after 5 years. Early complications, especially thrombosis, occurred in 11.2% and were caused usually by technical faults or hypotonia. Late complications were discovered in 42.8% of the patients (22.5% thrombosis, 7% stenosis, 2.1% aneurysm, 2.6% infection, 2.7% steal syndrome and 5.9% skin alterations). During the average period of dialysis (4.6 years), 38% of the patients needed more than one fistula. In that situation too, the same radiocephalic fistula was performed in the contralateral forearm (30%) prior to perform advanced procedures like PTFE-grafts (29%), etc. The patency rate after 3 years was 60.4% for radiocephalic fistula and 69.7% for PTFE transplants. The shuntthrombosis was again the main early (9.9%) and late (24%) postoperative complication. With help of a surgical thrombectomy or more conservative procedures like anticoagulation, local thrombectomy and transluminal angioplasty, 81.2%, respectively 64% of the failed fistula could be restored. Other complications like bleeding, aneurysms and infections occurred especially in arteriovenous grafts (0.5-5.7%).

Arteriovenous Shunt, Surgical↗
PubMed1989

[Experiences with 169 mechanical colorectal anastomoses (1981-1984)].

An account is given of 169 rectal anastomosis performed with the EEA-stapler between 1981 and 1984 in the Municipal Hospital Waid of Zurich. The average age of the patients was 63.8 years. 71.6% of the operations have been performed because of a rectosigmoidal carcinoma (50.4% of them with lymph node metastasis) and 28.4% because of a benign rectal disease. 44.4% of the anastomosis were localized at 3.5 to 7 centimeter, 34.9% between 7.5-11 and 20.7% higher than 11 centimeter above the anus. We used the biggest loading unit of 31 millimeter diameter in 89% of all cases. A primary anastomotic insufficiency was discovered intraoperatively in 6.5% (anastomosis sutured or redone). 3.1% of the patients had a temporary colostomy. We found a 4.3% rate of secondary anastomotic insufficiency. All those colo-cutaneous fistula healed spontaneously. Non specific complications as thromboembolism, urinary or wound infection and others were detected in 31.3% of the cases. We found a perioperative mortality rate of 2.5% with no intraoperative deaths. 91.4% of the patients had a follow-up over 2-5 years. There was a need of dilatation of anastomotic stenosis in 2.5% of the cases within the first 4-8 postoperative months. 40.2% of the cancer patients died during their follow-up, two thirds of them within the first two years. The local recurrence rate after 2-5 years of the cancer patients who were operated curatively was 22.3% and 10.7% for distant metastasis. 60.2% were disease free. 54.5% of the recurrent disease was found in patients with primary tumors stage Dukes C2 and D.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Emergency interventions in complicated colonic diverticulosis].

An account is given in this paper of 480 patients who had been hospitalised for colonic diverticulosis or diverticulitis in the surgical department of the Municipal Waid Hospital of Zurich, between 1970 and 1986. Laparotomy had to be performed on 219 of them (45.6 per cent), among them 84 emergency interventions. The average age of these patients was 70.7 years. Indications for emergency surgery included diffuse or locally delimited peritonitis with abscess development in 72 patients, ileus in ten cases, and massive colon haemorrhage in two. The latter two cases were handled with good success by subtotal colectomy with ileorectostomy and, one of them with the source of bleeding known, by colotomy and suturing of that source of bleeding. Sigmaincontinence resection according to Hartmann has been considered the optional approach since 1977 to diffuse peritonitis and to many cases of ileus (n = 39). In more recent time, anastomosis has been used as primary approach to some patients who survived fibrinous abdominal peritonitis (n = 4). The mortality rate associated with drainage operations according to expectation, has been clearly higher than that following resection, the comparable figures being 32.3 and 17.2 per cent. That has been attributable to non-removal of the septic focus. After all, nowadays combined antibiotic therapy is commonly used for seven to ten days for simultaneous control of both aerobic and anaerobic pathogens. This has become routine practice and involves aminoglycoside, metronidazole, and ampicillin. Overall mortality associated with emergency interventions is clearly higher than that after planned operations, the figures being 22.6 and 4.4 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗