Biomedical subjects

Hermann Kessler

Publications and source records attributed to Hermann Kessler.

5 recordsLinked to original sources

PubMed2006

Changes in surgical therapy for Crohn's disease over 33 years: a prospective longitudinal study.

INTRODUCTION: Changes in surgery for Crohn's disease were analyzed in a single institution over a period of 33 years. MATERIALS AND METHODS: The data of all patients undergoing abdominal surgery for Crohn's disease between 1970 and 2002 were collected prospectively in an electronic database. The study period was divided into three periods of 11 years, each (group 1, 1970-1980; group 2, 1981-1991; group 3, 1992-2002). RESULTS: There was an increase in patients' age at time of hospital admission from 32.0+/-0.9 to 32.4+/-0.5 and 37.7+/-0.7 years, in the duration of disease from 4.9+/-0.3 to 7.3+/-0.3 and 8.8+/-0.5 years, and in the number of drug-induced remissions before surgery from 3.1+/-0.5 to 6.1+/-0.2 and 4.9+/-0.3 in groups 1, 2, and 3, respectively (p<0.01). The rates of elective surgery compared to urgent or emergency surgery increased from 69.5 to 81.4 and 80.9% in the corresponding groups (p<0.01). A significant decrease in hospital mortality was observed. The analysis of Crohn's complications demanding surgery revealed a significant increase of rates of stenosis and subileus. Furthermore, there was a significant increase in serious acute complications like free bowel perforations and peritonitis. CONCLUSION: Improved medical treatment may lead to higher rates of elective operations. However, prolonged conservative treatment may also increase the number of serious complications before surgery. Therefore, a multidisciplinary approach with early involvement of the surgeon is important to avoid any delay in indication to surgery.

Adult↗

PubMed2006

Laparoscopic surgery in inflammatory bowel disease: is the future already here?

PURPOSE OF REVIEW: Starting from easy operations like the creation of enterostomies, laparoscopic colorectal surgery has developed quickly towards comprehensive procedures like proctocolectomies. Because of their benign character, inflammatory bowel diseases are an ideal indication for laparoscopic surgical approaches. Inflammatory alterations of bowel and mesentery, however, may demand a high level of laparoscopic experience. RECENT FINDINGS: In severe anal Crohn's disease, laparoscopic stoma formation has become a standard procedure for low morbidity and reoperation rates. In comparison with conventional bowel resections for Crohn's disease, shorter times to first postoperative bowel movements and hospital stays have been observed with the laparoscopic approach. Even complex cases with previous surgery and enteric fistulas may be managed laparoscopically with a low complication rate. In ulcerative colitis, experience with laparoscopic restorative proctocolectomy is increasing, and its feasibility has been proven in multiple studies. An elevated risk of complications has been observed with increased body mass index and acute inflammation. Function and quality of life outcomes seem to be equivalent for open and laparoscopic surgery. SUMMARY: Laparoscopic management of Crohn's disease and ulcerative colitis is complex and may be demanding. Its feasibility has been proven in multiple studies and it is offered as a safe and durable alternative for selected patients. The selection criteria are under investigation.

Humans↗

PubMed2005

Laparoscopic total colectomy for slow-transit constipation.

INTRODUCTION: Total colectomy is the preferred surgical option in proven slow-transit constipation. With advances in technology and instrumentation, laparoscopic total colectomy has become feasible. METHODS: After a mechanical bowel preparation, the patient is placed in a modified lithotomy position and pneumoperitoneum is established. Using a subumbilical 12-mm trocar the camera is inserted. Two further 12-mm and 5-mm trocars, each, are used for access to the peritoneal cavity. In an approach from medial to lateral, ileocolic, middle colic vessels and the inferior mesenteric artery are divided. Medial mobilization is completed before the sigmoid is freed up laterally. The lateral mobilization continues orally to the descending, transverse, and ascending colon with the omentum being separated from the transverse colon completely. The mesorectum is divided using the harmonic scalpel, and the upper rectum is transected with either one or two passes of the endoscopic linear cutting stapler. The colon is exteriorized through a 5-cm Pfannenstiel incision. The terminal ileum is transected extracorporeally. After pneumoperitoneum has been reestablished, the ileorectal anastomosis is performed laparoscopically using a double-stapling technique. RESULTS: The video reports about a 56-year-old lady who had been suffering from chronic constipation since childhood and had become dependent on laxatives. A dolichocolon had been found in barium enema. A prolonged colonic passage was proven in an x-ray transit study. There were no intraoperative or postoperative complications. After surgery, first bowel movements occurred on the second day and the patient was discharged from the hospital on the sixth postoperative day. CONCLUSIONS: Laparoscopic total colectomy is a safe, feasible operation for slow transit constipation. With fast recovery and short length of stay it may become an attractive surgical approach.

Anastomosis, Surgical↗

PubMed2005

Tumor site predicts outcome after radiochemotherapy in squamous-cell carcinoma of the anal region: long-term results of 101 patients.

PURPOSE: This study was designed to assess the long-term results following radiochemotherapy in patients with anal squamous-cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy-free survival. PATIENTS AND METHODS: Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26-84) years. T categories (International Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy-one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three-field to four-field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5-fluorouracil at a dose of 1000 mg/m (2)/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m (2)/day on Days 1 and 29. Median follow-up time was was 7.5 (range, 1-16) years. RESULTS: Overall survival and colostomy-free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five-year-overall and colostomy-free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (< or =75 percent vs. >75 percent, P = 0.03) remained independent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy-free survival. CONCLUSIONS: With colostomy-free survival rates around 85 percent, long-term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.

Adult↗

PubMed2005

Laparoscopic resection rectopexy for rectal prolapse.

INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using five trocars. In the case reported, the inferior mesenteric artery is divided distally to the left colic artery branch. The sigmoid colon is mobilized medially and may be mobilized laterally up to the descending colon, depending on the extent of resection. The splenic flexure remains in place. The rectum is mobilized from the presacral fascia down to the pelvic floor, sparing the hypogastric nerves. The rectum is transected in its upper third and the colonic stump pulled outside after enlarging the left lower abdominal incision to a length of 5 cm. The colorectal anastomosis is established intracorporeally in a double-stapling technique. Three 2-0 braided nonabsorbable sutures are placed to attach the right lateral stalks of the rectum to the presacral fascia. Proctoscopic examination has to ensure that there is no luminal compromise or air leakage. RESULTS: The videotape reports about a 37-year-old male patient with a rectal prolapse of 8 cm in length. First symptoms had occurred in childhood. He reported about temporary constipation and repeated rectal bleeding. During surgery, an elongated sigmoid was found. Laparoscopic sigmoid resection and suture rectopexy were carried out. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the sixth postoperative day. CONCLUSION: Laparoscopic resection rectopexy is safely feasible as a minimally-invasive treatment option for rectal prolapse.

Adult↗