Biomedical subjects

J Zehetner

Publications and source records attributed to J Zehetner.

3 recordsLinked to original sources

PubMed2006

Five-year results of laparoscopic Toupet fundoplication as the primary surgical repair in GERD patients: is it durable?

INTRODUCTION: Most surgeons operate on gastroesophageal reflux disease (GERD) patients using the concept of "tailored approach," which depends on esophageal motility. We have abandoned this concept and performed laparoscopic Toupet fundoplication in all patients suffering from GERD, independent of their esophageal motility. METHODS: In a prospective trial we have assessed and evaluated our 5-year results of the first 100 consecutive patients treated with laparoscopic Toupet fundoplication. All patients were evaluated preoperatively by endoscopy and 24-h pH manometry. The patients were followed up clinically 1, 2, 6, 12 and 60 months postoperatively. The course of clinical DeMeester score, appearance and treatment of wrap-related side-effects as well as long-term outcome and patient satisfaction were evaluated. RESULTS: The 5-year follow-up rate was 87%. Laparoscopic Toupet fundoplication achieved a 5-year healing rate of GERD in 85%. Of all operated patients, 3.5% had to be reinstalled on a regular PPI treatment because of postoperative GERD reappearance. The median clinical DeMeester score decreased from 4.27 +/- 1.5 points preoperatively to 0.47 +/- 0.9 points 5 years postoperatively (p < 0.0005). Because of persistent postoperative dysphagia, 5% of the patients required endoscopic dilatation therapy. Persistent postoperative gas-bloat syndrome occurred in 1.1%. Wrap dislocation was identified in 3.4% of patients. Reoperation rate was 5%. Total morbidity rate was 19.5% and operative related mortality rate was 0%. Overall, 96.6% of patients were pleased with their outcome at late follow-up, and 95.4% of patients stated they would consider undergoing laparoscopic fundoplication again if necessary. CONCLUSION: Our long-term results showing a low recurrence and morbidity rate of laparoscopic Toupet fundoplication encourage us to continue to perform this procedure as the primary surgical repair in all GERD patients, independent of their esophageal motility. Laparoscopic Toupet fundoplication has proven to be a safe and successful therapeutic option in GERD patients.

Adult↗

PubMed2005

Screen height as an ergonomic factor in laparoscopic surgery.

BACKGROUND: The increasing number of routinely performed laparoscopic operations causes the surgeons' "screen work" time to rise constantly. A new ergonomic workload on the surgeons' upper spine and shoulders is created as a result of the standard screen height position on top of the laparoscopy towers. METHODS: Eight surgeons in the authors' surgical department were evaluated for the inclination/reclination angle of their cervical spine when using the laparoscopy towers in the authors' department and also at their favorable screen height. RESULTS: The laparoscopy towers used in the authors' department made 3 degrees to 14 degrees reclination of the cervical spine necessary. The interviewed surgeons preferred a position of slight inclination, with a median of 160 cm measured from the central screen height to the floor. CONCLUSION: Monitors of laparoscopy towers should be adapted to the surgeon's preferred screen height: at eye level frontally with a neutral or slight inclination of the cervical spine. The authors suggest a central screen height of 160 cm, with the monitor positioned in front of the surgeon. Newer equipment from the industry should be provided.

Cervical Vertebrae↗

PubMed2004

A 6-year experience with the Swedish adjustable gastric band Prospective long-term audit of laparoscopic gastric banding.

BACKGROUND: In morbid obesity conservative therapy often fails to reduce overweight permanently. As a consequence, several bariatric surgical procedures have been developed to achieve permanent excess weight loss. Among these, the laparoscopic restrictive procedures seem to be the least invasive. The aim of this prospective study was to assess and analyze the effects, complications, and outcomes after the implantation of the Swedish adjustable gastric band (SAGB) in long-term follow-up. METHODS: All consecutive patients with implantation of a SAGB between August 1996 and August 2002 were prospectively investigated. The placement of the SAGB was done by laparoscopy in all cases. Success was rated by the reduction of body mass index (BMI) excess weight loss (EWL), and reduction of comorbidities. "Nonresponders" to SAGB were defined as <30% EWL after a 3-year follow-up. Band-related complications were recorded and classified. Patient's outcome was assessed after 6 months and subsequently each year postoperatively. RESULTS: A total of 190 patients received a SAGB, 97% of whom could be followed up with a mean follow-up period of 39.4 months (duration of follow-up, 6-72). During follow-up, a significant reduction or improvement of BMI, EWL, and comorbidities were found. Nineteen percent of patients were identified as nonresponders. Early intraoperative and postoperative complications related to SAGB were one perforation of the gastric fundus (0.5%), one conversion (0.5%), one bleeding (0.5%), and two band infections (1.1%). The SAGB-related complications encountered during long-term follow-up were three port problems (1.6%), four band migrations (2.1%), five slipping/pouch dilatations (2.6%), and two band leakages (1.1%). All intra- and postoperative SAGB-related complications accounted for a total morbidity of 10.5%. Operative mortality was 0%. The overall reoperation rate was 8.5%. CONCLUSIONS: In long-term follow-up, SAGB is safe and effective. Our results demonstrate a significant EWL of 50% during the first 24 months. However, patient selection has to be improved to reduce the nonresponder rate. SAGB leads to a significant reduction of obesity-related comorbidities. SAGB is an attractive alternative in the surgical treatment of morbid obesity.

Adolescent↗