Biomedical subjects

I Baca

Publications and source records attributed to I Baca.

At least 19 recordsLinked to original sources

PubMed2003

[Laparoscopic segmental pancreas resection and pancreatic cystadenoma].

Aside from location, the complex anatomic relationships and advanced laparoscopic skills needed in selected cases of laparoscopic pancreas surgery have increased. We report a 55-year-old woman with cystic adenoma in the area of the corpus who was treated with complete laparoscopic corpus resection while preserving the head and tail of the pancreas and the spleen. The patient was placed in lithotomy position. Four trocars were placed. After opening the bursa, the pancreas showed a 6x6x6-cm, well-bordered, cystic tumor in the corpus. Tail and head of the pancreas were free of tumor and seemed inconspicuous. After exploration of the v. porte and v. lienalis, the healthy tissue in the head area of the pancreas was divided with the linear stapler. Preparation continued in the direction of the pancreatic tail while preserving the v. lienalis. After reaching the healthy pancreas in the tail region, the tumorous segment was resected. The resected pancreas segment was placed in an endobag until removal over a slightly widened trocar incision above the symphysis. The tail segment was anastomized in situ end-to- side with the first jejunum loop behind the Treitz's ligament. There was no postoperative complication, and the postoperative course was observed. The patient returned to normal activity within 10 days after operation. Retaining high surgical standards and preserving the healthy pancreas tissue and laparoscopic anastomosis, laparoscopic surgery in cases of benign tumors of the distal pancreas is possible with all the patient benefits of minimally invasive surgery.

Anastomosis, Surgical↗

PubMed2001

Laparoscopic inguinal hernia repair.

BACKGROUND: We performed a prospective study to evaluate the safety and efficacy of laparoscopic hernia repair in our hospital. METHODS: A total of 2500 consecutive laparoscopic transabdominal hernia repairs (TAPP) were performed in 1952 patients. Their average age was 59 years. We used a mesh. 12 x 15cm. RESULTS: The average operating time was 32 mins. We had a recurrence rate of 1.04%. There were 89 complications (3.56%). Three were bladder injuries, one of which necessitated conversion to an open laparotomy. Three of 38 hematomas required open exploration. Three patients were reoperated because of nerve irritation. An incarcerated trocar hernia occurred in six cases. There was one wound infection at the umbilical incision. There were no infections or incompatibility reactions at the mesh. The complication rate declined over time. At the same time, the rate of recurrence decreased as we acquired more experience in laparoscopic hernia repair. CONCLUSION: Laparoscopic hernia repair can be performed safely, with low rates of recurrences and few complications are low. This technique achieves good results combined with the benefits of minimal invasive procedures.

Adult↗

PubMed2001

[Technique of right laparoscopic hemicolectomy].

Patho-anatomic feature such as easy mobilisation of the colon segment on mesocolon, technically easy approach to the central lymphovascular pedicle, and the possibility of relative uncomplicated salvage and anastomosis warrant including this method in the procedures of modern colorectal surgery. Mobilisation from the vascularisized mesenterial bridges in a window technique, transection of the ileocolic lymphovascular pedicle, lateral and proximal mobilisation of ileocoecum, colon ascendance, right flexure and proximal transversum. After enlargement of one trocar incision the exteriorized colon is resected and an extracorporeal anastomosis is performed in the standard manner. With this standardized method, right hemicolectomy is easy, practicable, and repeatable and can be done with all the advantages of minimally invasive surgery.

Colectomy↗

PubMed2000

Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study.

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an anonymous registry database and analyzed by type of resection. Standard procedures were sigmoid or left colectomy, anterior resection, abdominoperineal resection, and right hemicolectomy. Follow-up information included incidence of local, distant, and port site recurrence and cancer-related death. RESULTS: A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; left colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was necessary in 6.3 percent (n = 25). Complications requiring reoperation occurred in 9 percent (n = 35). Complications that were treated conservatively occurred in 27.6 percent (n = 110). Thirty-day mortality was 1.8 percent (n = 7). First bowel movements resumed on the third postoperative day; patients did not use analgesics after a mean of five days. Mean postoperative hospitalization was two weeks. According to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative resection for Stage III cancer. Mean number of lymph nodes resected was 12.1. At a mean follow-up of 30 months, one port site recurrence was documented. No local recurrence was observed after curative resection of Stage I colorectal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patients (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer-related death occurred after abdominoperineal resection (4.9 percent). CONCLUSION: To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.

Abdomen↗

PubMed2000

[Endoscopic parathyroidectomy. Surgical technique in primary hyperparathyroidism].

We report our experience and technique of endoscopic removal of parathyroid adenomas in case of primary hyperparathyroidism. Scintigraphy, MRI scan and cervical ultrasound enable exact diagnosis and therefore exact localisation and placement of the three 5 mm trocars for endoscopic operation. The placement of the optic and the function trocars depends on the localisation of the adenoma. The free room to work in is created between thyroid and neck muscles and supported by insufflated CO2 with a pressure of 12 mm Hg. After the adenoma is taken out through an incision above the jugulum. With this technique we operated upon 3 patients successfully. Benefits for the patients seem to be a less painful postoperative course with minimal blood loss because of the exact exploration of the adenoma with minimal invasion of the surrounding tissue.

Adenoma↗

PubMed1999

[Laparoscopic gastric banding in morbid obesity].

Laparoscopic "Gastric Banding" is a modern, minimally invasive technique to induce significant weight loss in morbidly obese individuals. If performed according to the established principles of elective surgery, the procedure has to be classified as a serious offer to a specific group of patients, who have, as yet, been confronted with the option of futile conservative therapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, connected to a port-system. By the hourglass-like segmentation of the stomach a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and--psychologically intended--inducing an early feeling of satiety. The complexity of the pathogenetic impulses leading to severe nutritional obesity requires a serious risk/benefit appreciation with multidisciplinary responder-analyse. Apart from the main indications like overweight, patient history and obesity-associated disorders it is indispensable to include the psychological status of the patient and his capability of compliance into the decision-finding. With the inflatable inner surface of the band connected to the access port, the system is designed to permit postoperative regulation of the therapeutic outcome by percutaneous stoma size adjustment without further surgery. The placement of the band as well as the specific anatomical conditions of extremely obese patients involve severe risks such as primary organ lesions, post-operative pouch dilatation or "slippage" by herniation of the gastric wall. Therefore the technical performance of the implantation demands a high level of experience and practical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critical look to the modification of the surgical procedure, the size of the implant, the pouch and the stoma.

Gastroplasty↗

PubMed1998

[Technique of laparoscopic pancreatocysto-jejunostomy].

Usually the development of a pancreatic pseudocyst in the course of pancreatitis is followed by surgical intervention. In case of operation an internal drainage is preferred to an external according to general experience. We have developed a simplified technique of pancreatocysto-jejunostomy without Braun- or Roux-Y-anastomosis. Here we present our surgical strategy in the laparoscopic technique.

Anastomosis, Surgical↗

PubMed1998

[Laparoscopic hernia repair of recurrent hernias].

Successful treatment of recurrent inguinal hernias is still a problem, in spite of the availability of several different methods. We present our experience with laparoscopic TAP repair, which was performed in 154 patients with 168 recurrent inguinal hernias after traditional anterior repairs. Our results show an acceptable complication rate (5.4%, n = 9) and a low re-recurrence-rate (1.8%, n = 3), combined with the benefit of the minimal access technique, so that this procedure can be recommended in recurrent inguinal hernia repair.

Adult↗

PubMed1997

[Robot arm in laparoscopic surgery].

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.

Equipment Design↗

PubMed1997

[Prevention of thromboembolism in minimal invasive interventions and brief inpatient treatment. Results of a multicenter, prospective, randomized, controlled study with a low molecular weight heparin].

A prospective, randomised, controlled clinical trial was carried out in order to elucidate the incidence of venous thromboembolism in selected patients undergoing laparoscopic cholecystectomy and other types of minimally invasive surgery, as well as to show safety and efficacy of a low-molecular-weight heparin (LMWH) in the prevention of post-operative venous thromboembolism. Seven hundred and eighteen patients were randomly allocated to one of two groups: One group received physical measures for prevention of deep-vein thrombosis, i.e. graduated elastic stockings (n = 359). The second group also received graduated elastic stockings and, additionally, a LMWH (reviparin sodium, Clivarin) s.c. once daily (n = 359). For safety reasons, with respect to the untreated control group, patients with three or more risk factors for venous thromboembolism were not included into the trial. Diagnosis for DVT was systematically done by duplex scan. In this, rather artificial low-risk selection the overall incidence of thromboembolic events was surprisingly low: five cases of suspected pulmonary embolism, confirmed by scintigraphy in one case only, and one patient with phlebographically confirmed calf vein thrombosis. The use of reviparin for prevention of venous thromboembolism was safe and convenient--the rate of post-operative bleeding complications was 2.3% in the LMWH group, even lower than in the control group (3.2%). The real incidence of venous thromboembolism in patients undergoing laparoscopic cholecystectomy remains unclear. Further trials with unselected patients are needed.

Adolescent↗

PubMed1997

[Laparoscopy-assisted colorectal surgery. Early outcome in benign and malignant diseases--a prospective study of 120 patients].

We present our results with laparoscopic-assisted colorectal surgery in 120 patients during the time from January 1993 to September 1996. The types of procedures cover almost the whole spectrum of colorectal surgery. They included hemicolectomies, signmoid resections, low anterior resections, Hartmann closures, proctocolectomies and rectopexies. 127 patients were subjected to laparoscopic operation, 7 needed conversion to open surgery (7% conversion rate). Average operation time was 145 +/- 58 min, length of postoperative stay 12 +/- 4 days. Oral food intake was started at the second day postoperatively without major problems. We observed perioperative complications in 21 cases (17%). There were 5 anastomotic leaks, 4 wound infections, 1 pneumothorax and 2 postoperative bleedings, 4 patients had clinical signs of prolonged bowel paralysis, 2 patients died as a consequence of anastomotic leaks, 2 of other reasons. In the postoperative period we saw a marked faster recovery and a lower complication rate compared to our conventionally operated patients and postoperative pain was less. In cases of malignant disease no rise in rate of recurrence was observed during follow-up (average 18 months) compared to open surgery. Until the results of long-term studies are published laparoscopic procedures should still be restricted to early tumor stages and palliative procedures.

Adult↗

PubMed1995

[Laparoscopic interventions in acute and chronic diverticulitis].

UNLABELLED: Since the beginning of 1993 until May 1994 in our hospital 25 patients were operated upon for diverticular disease. 16 patients required a laparoscopic assisted elective one-stage resection. One laparoscopic Hartmann's procedure was performed on account of a free perforation. 4 patients underwent laparoscopic reconstruction of the intestinal continuity after an Hartmann's resection. In 4 cases it was necessary to change to the conventional procedure. TECHNIQUE: the patient is placed in dorso-sacral position (modified lithotomy position) in order to allow transanal colonic access. 4 trocars are necessary. The linear stapler is used to transsect the sigmoid colon and to dissect the entire mesentery. The left lateral trocar incision is enlarged to remove the specimen. The intracorporeal double staple anastomosis is created by a circular stapler. RESULTS: there were two wound infections, one postoperative bleeding and one small anastomotic leak. After the operation we observed all advantages of the laparoscopic procedure in form of less pain, earlier beginning of bowel movements, faster return to full diet and earlier hospital discharge. These positive results combined with the possibility of a standardized procedure encourage us to continue laparoscopic sigmoidectomy.

Acute Disease↗

PubMed1995

[Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation].

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.

Adult↗

PubMed1994

[Laparoscopic pancreatocystojejunostomy without entero-entero-anastomosis].

The gradual enlargement of a persistent pancreatic pseudocyst generally requires intervention. When the decision to carry out an operative procedure is made, preference should be given to internal rather than external drainage. We have developed a simple technique in which the pseudocyst is approached directly, to make a pancreatico-cystojejunostomy, which does not require a Braun- or Roux-en-Y anastomosis. We present our laparoscopic method, which opens up new possibilities in the treatment of pancreatic pseudocysts.

Aged↗

PubMed1992

Role of octreotide in the prevention of postoperative complications following pancreatic resection.

Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. We conducted a randomized, double-blind, placebo-controlled, multicenter trial in 246 patients undergoing major elective pancreatic surgery. Patients were stratified into a high-risk stratum (limited to patients with pancreatic and periampullary tumors) or low-risk stratum (patients with chronic pancreatitis). Patients received octreotide (3 x 100 micrograms) or placebo subcutaneously for 7 days perioperatively. Eleven complications were defined: death, leakage of anastomosis, pancreatic fistula, abscess, fluid collection, shock, sepsis, bleeding, pulmonary insufficiency, renal insufficiency, and postoperative pancreatitis. Two hundred patients underwent pancreatic head resection, 31 patients underwent left resection, and 15 patients had other procedures. The overall mortality rate within 90 days was 4.5%, with 3.2% in the octreotide group and 5.8% in the placebo group. The complication rate was 32% in the patients receiving octreotide (40 of 125 patients) and 55% in patients receiving placebo (67 of 121 patients) (p less than 0.005). In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.

Double-Blind Method↗

PubMed1992

[Prevention of thromboembolism in surgery--results of a survey in West German hospitals].

UNLABELLED: In 1990 a questionnaire on methods for prevention of deep venous thrombosis (DVT) and pulmonary embolism (LE) was mailed to 940 surgical centers in West Germany (FRG). The return rate was 60% or 564 answers, covering about 1,200,000 operations/year. The results are as follows: (1) Physical therapeutic measures (early mobilisation, elastic stockings) and drug administration are routinely used in all centers. The duration of prophylaxis is 3-8 days in 36% of centers, up to mobilisation in 31%, 9-16 days after operation in 17% and until demission in 16%. (2) A single drug regime is employed in 60% of centers (49% standard heparin, 9% low molecular heparin in combination with DHE) 40% of centers use all three drugs without clear cut guidelines concerning the indications. (3) The reported rates of thromboembolic complications diagnosed by clinical criteria are 0.55 +/- 0.62% for DVT and 0.22 +/- 0.29% for fatal or nonfatal LE. There is no evidence from the analysed data that the drug regimes influences the clinical outcome. CONCLUSION: The need for administration of drugs prevent DVT is widely accepted. A polypragmatic approach seems to be effective. However, standardized regimes for defined clinical conditions are desirable.

Bandages↗

PubMed1991

[Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study].

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.

Ampulla of Vater↗

PubMed1991

Liposarcoma of the esophagus.

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

Aged↗