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J Rechner

Publications and source records attributed to J Rechner.

7 recordsLinked to original sources
PubMed2001

[Technique of endoscopic subfascial CO2 insufflation-dissection of perforator veins].

Endoscopic subfascial dissection of perforating veins (ESDP) represents a new additional technique for treatment of greater saphenous system varicosities. We present a modification of ESDP, entitled endoscopic subfascial insufflation-dissection of perforating veins (ESIDP). In ESIDP CO2-insufflation induced enlargement of subfascial space (subfascial pneumocave) facilitates identification and dissection of perforating veins. From 1.1.1998 to 1.7.2000, 150 procedures of ESIDP have been conducted in 127 patients (90 females, 37 males). Identification of incompetent perforating and superficial veins and assessment of deep veins were performed preoperatively using duplex sonography. In addition to a description of the surgical technique, we present an overview about indications for ESIDP and possible ESIDP-related postoperative complications.

Carbon Dioxide↗
PubMed1998

Laparoscopic appendectomy does not change the incidence of postoperative infectious complications.

BACKGROUND: It is not clear whether the laparoscopic approach does decrease the incidence of postoperative infectious complications after appendectomy. METHODS: One hundred sixty-nine patients were randomized, 87 with laparoscopic (LA) and 82 with open appendectomy (OA). Patients in the OA group had a McBurney incision; LA was performed in the lithotomy position. RESULTS: Acute appendicitis was confirmed in 75% of patients. The appendix was perforated in 5 patients of the LA versus 2 patients of the OA group. No conversion to the open procedure was necessary. The median operating time was 35 minutes in the LA group and 31 minutes in the open group (P = 0.58). The median postoperative hospital stay was shorter after laparoscopic than after open surgery (3 days versus 4 days, P = 0.026), whereas the time required for return to work was not significantly different (14 versus 15 days). There were 5 (6%) patients with superficial wound infection following LA and 6 (7%) after OA (P = 0.67). Intra-abdominal fluid collections were found in 2 (2%) patients following LA and 3 (4%) patients following OA (P = 0.60). In the LA group, 3 patients presented with intra-abdominal hemorrhage and another 3 developed a paralytic ileus that was treated conservatively. CONCLUSIONS: Laparoscopic appendectomy is as safe and as effective as the open procedure; however, it does not decrease the rate of postoperative infectious complications.

Abdominal Abscess↗
PubMed1996

[Double balloon catheter for facilitating (laparoscopic) choledochus drainage].

In laparoscopic management of choledocholithiasis the drains available for bile-duct drainage are problematic. Since November 1991 we have given priority to the laparoscopic management of common bile-duct stones (n = 97). In cooperation with industry (W. Rüsch/D-Waiblingen), we have developed a double-balloon catheter for laparoscopic application. In 15 cases we used this double-balloon catheter. There were no complications like dislocation, obstruction or leakage. This new catheter facilitates the procedure of laparoscopic bile-duct exploration in choledocholithiasis. The operating time is reduced and removal of residual concrements is easily possible.

Catheterization↗
PubMed1996

[Laparoscopic therapy of choledocholithiasis].

The introduction of laparoscopic cholecystectomy has led to controversial discussions about the proceeding in case of coincident common bile duct stones. In our unit choledocholithiasis has been treated laparoscopically since November 1991. Basic requirement has been a routine intraoperative cholangiography. 67 patients with common bile duct stones were treated until January 1995. All patients underwent a follow up and the results were compared to other concepts. In 40 cases common bile duct stones were eliminated via cystic duct and in 27 cases by choledochotomy. The choledochus was drained routinely for postoperative x-ray control. In 9 cases we found residual concrements: 7 patients required postoperative endoscopic papillotomy and in 2 cases the calculi where eliminated with a dormia basket introduced via drainage tube. In one case surgical management was changed to laparotomy. Postoperative complications occurred in 8 cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day; one with bleeding from the cystic artery was treated by relaparoscopy. One patient developed a liver abscess and two patients a bilioma requiring ultrasound guided drainage. A superficial wound infection in one patient and a biliary leakage after removal of the drainage in two patients healed spontaneously. Due to an intact papilla with less stress to the patient, as well as a complication rate comparable with other published therapeutic concepts, this strategy can be recommended as a valuable alternative procedure.

Cholangiography↗
PubMed1996

[Laparoscopic versus conventional appendectomy: a prospective randomized study].

The discussion about laparoscopic appendectomy has increased since the introduction of this method. Randomized comparisons are still feasible, whereas this cannot be stated for other laparoscopic procedures (e.g., laparoscopic cholecystectomy). This randomized controlled trial included 170 patients. Open appendectomy was employed in 83 patients, and 87 were treated laparoscopically. The treatment groups were comparable regarding age, sex, Broca index, ASA classification, preliminary operations, and preoperative leucocytes. No statistically significant differences could be found with respect to surgical and general complications, operating time, consumption of analgesics and antibiotics, and return to work. The analysis revealed a statistically significant shorter hospital stay, a shorter time until return to normal physical activity, and a shorter duration of complaints for the laparoscopic group. We were unable to demonstrate any statistically significant advantage in using the open procedure.

Adolescent↗
PubMed1995

[Laparoscopy-assisted colon surgery--overview and personal experiences with 64 patients].

The number of laparoscopic or laparoscopic-assisted operations in abdominal surgery constantly increases. 64 patients between February 1992 and November 1993 underwent a laparoscopic assisted colorectal procedure. In 5 cases laparotomy was necessary. There were only 4 complications: one subileus treated conservatively and one peritoneal abscess was drained successfully under sonographic guidance; furthermore there were a postoperative pneumonia and a prolapse of the greater omentum in the area pierced by a 10 mm-trocar. The oncologic criteria for the resection of malignant tumours can be fulfilled in laparoscopic surgery. Our first experiences indicate that the advantages for the patient in laparoscopic procedures of the colon/rectum are the same as have been reported in laparoscopic cholecystectomy.

Aged↗