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Biomedical subjects

J Waninger

Publications and source records attributed to J Waninger.

At least 19 recordsLinked to original sources
PubMed1992

[Ambulatory follow-up care in laparoscopic cholecystectomy].

UNLABELLED: FUNDAMENTAL CONSIDERATIONS: With increasing frequency, laparoscopic procedures are now replacing conventional cholecystectomy. Given the choice, patients with cholecystolithiasis almost always opt for the former procedure. MAJOR POINTS: Because the laparoscopic procedure offers considerable advantages as compared with open surgery, the increased risk of local complications associated with it tends to be ignored. For example, injuries to the biliary ducts are about ten times as common as in the case of conventional cholecystectomy. Injuries to the bowel, previously unknown, are increasingly being observed. Symptoms associated with undetected injuries usually do not occur until the patient has been discharged. CONCLUSIONS: Ambulatory aftercare is particularly important following laparoscopic cholecystectomy. Complications need to be detected in good time in order to be able to institute appropriate counter-measures.

Ambulatory Care↗
PubMed1992

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses.

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.

Anastomosis, Surgical↗
PubMed1992

Laparoscopic cholecystectomy after unsuccessful shock-wave therapy.

Extracorporeal shock-wave therapy of gallstones was begun at the Surgical Department of the University of Freiburg, Germany, in March 1988; 85 patients were treated up to September 1991. The stone-free rate differed with the gallstone group. Patients with solitary stones less than 20 mm in diameter showed a significantly higher rate after 18 months of lithotripsy and dissolution therapy than patients with multiple stones (p < 0.01), that is, 83% and 49%, respectively. Open cholecystectomy was necessary for seven patients with complications following fragmentation. After starting laparoscopic cholecystectomy, eight patients decided in favor of this procedure because of constant biliary symptoms. These patients had a mean duration of dissolution therapy of 19 months. The minimal invasive procedure is an alternative for patients with unsuccessful lithotripsy and lysis who initially demanded conservative treatment. Indication for shock-wave therapy is limited to only a small group of patients with solitary cholesterol gallstones less than 20 mm who reject laparoscopic surgery.

Cholecystectomy↗
PubMed1991

[Laparoscopic cholecystectomy].

In a short space of time, laparoscopic cholecystectomy has become the operative treatment of choice in cholecystolithiasis. The performance of the operation, however, requires complex equipment, and became at all possible only with the aid of video technology. The indication depends both on the patient's symptoms and the experience of the operator. Prior surgery in the upper abdomen and complications of gallstones are considered relative contraindications, and portal hypertension an absolute contraindication. The advantages of this minimally invasive operative procedure are the minimal traumatization and improved postoperative well-being. The need for pain-killer is low, gastric tube and selective drainage are not required. Dietary build-up and mobilization are possible early on. Postoperative hospitalization is 2 to 3 days. The future will bring further developments in the field of laparoscopic operative interventions.

Cholecystectomy↗
PubMed1991

[Surgical techniques in Crohn disease and ulcerative colitis].

The usefulness of surgical treatment of inflammatory bowel disease is determined by the results that can be achieved. In Crohn's disease, in addition to minimal resections, non-resective procedures such as stricturoplasty, are also available for the treatment of acute and chronic complications. The operative treatment of peri-anal Crohn's lesions is determined by the acute or chronic complications that develop. Ulcerative colitis can be cured by complete removal of the colorectal mucosa, and malignant degeneration thus avoided. Continence-preserving colectomy with proctomucosectomy and ileo-anal pouch anastomosis obviates the need for a permanent ileostomy.

Colectomy↗
PubMed1991

[Temporary stoma in infancy and childhood].

Between 1979 and 1989 70 colostomies and ileostomies were performed in children at the University Clinic of Freiburg. 56 of them could be closed in the same period. Indications for the stoma were an acute abdomen in 37%, atresia in 26% and M. Hirschsprung in 21%. 79% of the stomata were performed in the first year of life. The most serious complications were prolapse, stenosis and retraction. 17% of the stoma complications required an operative treatment.

Adolescent↗
PubMed1990

Large-bile-duct stones--extracorporeal piezoelectric lithotripsy as adjuvant measure for endoscopic basket extraction.

Extracorporeal piezoelectric lithotripsy (EPL) was performed in 12 patients with large-bile-duct stones and intrahepatic stones. The Piezolith 2300 lithotripter (Wolf, Knittlingen, FRG) was used in all patients in whom routine endoscopic approaches for removal of the calculi had failed or were considered inappropriate because of large stone size or difficult localization. In 9 of the 12 patients the stones were fragmented. Complete stone clearance from the bile ducts was obtained in 8 of 10 patients by EPL alone or combined with one of the following: endoscopic extraction, mechanical lithotripsy or installation of solvents. Adjuvant EPL in conjunction with endoscopic therapy increased the success rate of nonsurgical treatment for bile duct stones from 73% to 95%. No clinically significant side effects or complications were noted.

Aged↗
PubMed1990

[Extracorporeal piezoelectric gallstone lithotripsy: initial surgical experience with a new treatment. Technique and indications].

The extracorporeal piezoelectric lithotripsy (EPL) is a new method for non-operative therapy of symptomatic gallbladder and problematic bile duct stones. The rare intrahepatic calculi were similarly disintegrated. Best results were reached with EPL as adjuvant measure or combined with oral cheno- and ursodeoxycholic acid therapy. EPL compared to other lithotripsy techniques is performed without any analgesia. That means advantage and patient's benefit.

Cholelithiasis↗
PubMed1989

[Litholysis and lithotripsy of gallstones. State of the art and prospects].

The combination of dissolution and shockwave treatment for cholesterol stones is successful in 80% of the patients. The indication is strictly limited to cholesterol stones of between ten and thirty millimeters in diameter, or three stones of similar mass. In 80% of common duct stones which cannot be removed by endoscopy, shockwave treatment is a successful adjuvant procedure. It is estimated that recurrent stones will occur in 50% of the cases after five years. As long as the problem of recurrent stones persists, the group of stone carriers suitable for conservative treatment cannot be definitevely defined.

Chenodeoxycholic Acid↗
PubMed1989

[Ultrasound diagnosis following blunt abdominal trauma. Sonography in acute and follow-up diagnosis].

Experience with ultrasonography as a non-invasive imaging procedure for acute and follow-up diagnostic evaluation of blunt abdominal trauma was analysed in a retrospective study. Between 1980 and 1988, more than 2,000 ultrasonographic investigations were performed for blunt abdominal trauma; 246 patients were laparotomized. Retrospectively, false results based on ultrasonography were less than 1% of all cases, so that the sole use of ultrasonographic diagnosis and the non-use of peritoneal lavage seems justified in cases of blunt abdominal trauma. A number of figures illustrate typical cases.

Abdominal Injuries↗