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Biomedical subjects

L P Stassen

Publications and source records attributed to L P Stassen.

13 recordsLinked to original sources
PubMed2001

Impact of randomized trials on the application of endoscopic techniques for inguinal hernia repair in The Netherlands.

BACKGROUND: One year after publication of a Dutch prospective trial randomizing patients with inguinal hernias to either endoscopic or open repair, a questionnaire was sent to all Dutch surgeons to evaluate the impact of this trial on the application of endoscopic inguinal hernia repair in the Netherlands. METHODS: All 780 registered Dutch surgeons were surveyed. The performance of endoscopic inguinal hernia repair, the technique and the indications, the involvement of surgical residents, the motives for use of conventional techniques, and the type of open repair were documented. RESULTS: The response rate was 100%. Endoscopic inguinal hernia repair was performed by 16% of Dutch surgeons. For 81% of the surgeons, the total extraperitoneal approach was the preferred endoscopic technique. Primary inguinal hernias were approached endoscopically by only 54% of these surgeons, and recurrent hernias by 92%. The technique of choice for open repair of primary hernias was the Shouldice repair. The predominant repair for recurrent inguinal hernias was the Lichtenstein technique. CONCLUSIONS: Although randomized clinical trials have provided evidence that the endoscopic approach to inguinal hernias is preferable, only 1 of 6 Dutch surgeons has adopted endoscopic inguinal hernia repair. Improvement in training of both surgical residents and surgeons and increasing awareness among medical doctors and patients about the benefits of endoscopic inguinal hernia repair are necessary to enhance the acceptance of this valuable technique for inguinal hernia repair.

Evidence-Based Medicine↗
PubMed2000

Recurrence and survival after resection of adenocarcinoma of the gastric cardia. Rotterdam Esophageal Tumor Study Group.

In a retrospective study, the results after resection of carcinoma of the gastric cardia in the era without neoadjuvant therapy or extended lymph node dissection were evaluated. All 184 patients who underwent resection between January 1983 and December 1993 were included. Recurrence of disease, survival and prognostic factors were determined. The overall cumulative 5-year recurrence rate was 71% and the survival rate 23%. Multivariate analysis identified locoregional lymph node and distant metastases as the crucial prognosticators of recurrence of disease and survival. These results were similar to those from a previous study concerning our patients operated during the years 1983-88. The prognosis of a resected cardiacarcinoma has remained unchanged in our hands over the past 10 years. These results stress the importance of exploring new ways, such as the use of new diagnostic tools, to optimize preoperative patient selection and more aggressive treatment regimens to improve final outcome.

Adenocarcinoma↗
PubMed1999

[The treatment of chronic fissure in ano with nitrate ointment].

A chronic anal fissure may be regarded as an ischaemic ulcer. Until recently, its treatment necessitated surgical intervention to lower the tension of the internal sphincter (lateral internal sphincterotomy), or manual dilatation of the anus. A disadvantage of both methods is the risk of permanent sphincter injury resulting in reduced continence. Local application of ointment containing nitroglycerin (glyceryltrinitrate) or isosorbide dinitrate reduces the pressure at rest in the anal canal and increases the anodermal blood circulation. Both ointments in most patients lead to healing of the chronic anal fissure. Nitroglycerin ointment in a prospective, randomized trial brought about better healing than placebo treatment. The advantage of the ointment treatment, the needlessness of sphincterotomy, is particularly important in cases of existing sphincter abnormalities. It has the disadvantage that it takes longer for the fissure pain to abate. The principal side effect is headache. In over 50% of the patients the treatment has to be continued for longer than 6 weeks. Little is known as yet about the risk of recurrence. Before surgical interventions as the treatment of first choice can be definitely replaced by treatment with nitrate ointment the good results of the ointment treatment have to be confirmed. Also, more has to be found out about the risk of recurrence, the optimal duration of the treatment and the choice of the type of nitrate ointment.

Administration, Topical↗
PubMed1999

Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias.

BACKGROUND: In most reports different techniques have been described for combinations of primary and recurrent hernias. The aim of this study was to investigate and compare the results of endoscopic total extraperitoneal repair (TEP) of primary and recurrent inguinal hernias. METHODS: From January 1993 to July 1995, 221 patients with an unilateral inguinal hernia (186 primary and 35 recurrent) underwent TEP repair. Follow-up, including physical examination, was performed at regular 3-month intervals. RESULTS: The mean operation time was 37.6 min. Minor perioperative complications occurred in 23 cases. Conversion was required for 16 patients (7.2%). Postoperative complications were reported for 11.7% of the patients. Hospital stay was short. Mean follow-up was 40.4 months. The recurrence rate was 3. 2% for primary hernias and 20% for recurrent hernias. CONCLUSIONS: This study confirms the preliminary success of TEP for primary inguinal hernia repair, as previously reported. The high recurrence rate after endoscopic repair of recurrent hernias needs to be studied further.

Adult↗
PubMed1999

Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy.

BACKGROUND: Although the recurrence rate for endoscopic herniography is low (0-3%), it is still debatable whether these recurrences should be corrected laparoscopically or by the conventional method. The aim of this study was to investigate whether these recurrences can be repaired by means of the laparoscopic approach with acceptable complication and recurrence rates. METHODS: From October 1992 to December 1997, 34 patients with recurrent inguinal hernias at physical examination underwent surgery at our institutions. All the recurrences occurred following endoscopic inguinal hernia repair with mesh prostheses. The recurrences were repaired endoscopically using a transabdominal approach. Depending on the size of the defect, a new polypropylene mesh was used. RESULTS: Mean surgery time was 69 min. There were no conversions to the anterior approach. After a mean follow-up of 35 months, no recurrences had been diagnosed. CONCLUSION: The transabdominal preperitoneal approach is a reliable technique for recurrent inguinal hernia repair after previous endoscopic herniorrhaphy.

Adult↗
PubMed1999

Endoscopic totally extraperitoneal repair of bilateral inguinal hernias.

BACKGROUND: Recurrence rates associated with bilateral inguinal hernia repair with a giant prosthesis (Stoppa procedure) are low. Endoscopic totally extraperitoneal bilateral inguinal hernia repair with a giant prosthesis combines the low recurrence rate of the Stoppa repair and the advantages of minimally invasive surgery. The aim of this retrospective study was to investigate whether extraperitoneal bilateral inguinal hernia repair could be performed by the minimally invasive, totally extraperitoneal approach. METHODS: From February 1993 to January 1998, 98 patients with bilateral inguinal hernias underwent surgery. A polypropylene 30 x 10 cm rectangular mesh or a 30 x 10/15 cm 'slipmesh' was used. Follow-up, including a physical examination, of 96 per cent of patients was performed. RESULTS: Median operative time was 60 min. Mostly minor intraoperative complications occurred. Conversion was required for two patients. Apart from one patient with a necrotic fasciitis who died from respiratory failure, only minor postoperative complications (10 per cent) occurred. Median hospital stay was 1 (range 1-21) days. Median recuperation time was 5 (range 1-22) days. Median follow-up (96 per cent) was 32 (range 7-57) months; there were six recurrences among 34 hernias in the group of 17 patients treated with 10 x 30 cm mesh and two (1 per cent) in the group that received 30 x 10/15 cm mesh (162 hernias in 81 patients). CONCLUSION: The endoscopic approach for the Stoppa procedure for bilateral inguinal hernia repair is a reliable method with minor complications. It ensures a short recuperation time and the recurrence rate is low owing to adequate overlap of the hernial defect when a 'slipmesh' is used.

Adult↗
PubMed1997

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.

Activities of Daily Living↗
PubMed1996

Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management.

UNLABELLED: Benign stricture formation at the cervical anastomosis after transhiatal esophagectomy with gastric tube interposition is an important source of morbidity. In a large group of patients (n = 269) who had undergone transhiatal esophagectomy with gastric tube interposition, we examined surgical and nonsurgical risk factors for the development of benign strictures at the cervical anastomosis. In addition, we evaluated the results of endoscopic bougie dilation in patients in whom an anastomotic stricture developed. RESULTS: During follow-up, 114 patients (42%) had a benign anastomotic stricture. Only a history of cardiac disease (P = 0.03), postoperative leakage at the anastomosis (p = 0.002), and a stapled rather than a hand-sewn anastomosis (p = 0.04) were found to be independent risk factors for the development of a stricture. In 27 of 60 patients with anastomotic leakage, contrast swallow examination demonstrated only a leak at the anastomosis. Endoscopic bougie dilation of anastomotic strictures was successful in 78% of patients after a median of three dilation sessions (range 1 to 28). In 3% of patients dilations were still being performed, and 19% of patients had died before normal swallowing had been achieved. In two of 519 (0.4%) dilation sessions a major complication occurred. CONCLUSIONS: (1) Patients with preoperative cardiac disease are at an increased risk for anastomotic stricture. (2) Even in patients having no symptoms, a contrast swallow can detect anastomotic leakage that results in an increased risk for the development of anastomotic strictures. (3) The benefit of the stapler device for anastomosis remains to be determined. (4) Endoscopic bougie dilation with the patient mildly sedated is a safe and effective method for the treatment of anastomotic strictures.

Adult↗
PubMed1994

Dynamic circle traction for severely comminuted intra-articular finger fractures.

Treatment of severely comminuted unstable intra-articular finger fractures has three goals: reconstruction of the articular surfaces, prevention of redislocation of those surfaces, and proper healing of the capsuloligamentous apparatus. Dynamic circle traction (DCT), as described by Schenck (1986), is based on these principles and is the first method of treatment combining traction with intermittent or continuous passive motion. In order to improve on this method we applied continuous, instead of intermittent, passive motion in a newly developed DCT-device (continuous dynamic circle-traction = CDCT). Its first clinical use is discussed below. Our results with DCT, in eight patients, and CDCT, in four patients, are encouraging. Full function was regained at follow-up, in both groups, in three-quarters of the metacarpophalangeal (MCP) and half of the proximal interphalangeal (PIP) joints involved. Average loss of range of motion of the other MCP and PIP joints was 3.7 degrees and 5.6 degrees respectively. Treatment with CDCT may yield better results than DCT; the small number of patients treated and the relatively short period of follow-up does not justify comparison of both methods.

Adult↗
PubMed1990

[Prevention of wound infection following abdominal surgery].

In the surgical department described, prevention of wound infection after abdominal operations involving endogenous bacterial contamination consists of a single preoperative administration of antibiotics according to a simple scheme, suitable for nursing staff also (using a combination of amoxicillin, tobramycin or metronidazole) with liberal application of open wound treatment. During the period from 1 July 1985 to 1 July 1986, 519 abdominal operations were performed, classified by increasing degree of contamination according to the classification of the American National Research Council (NRC) as NRC classes II to IV. In 371 cases, the wound was closed (NRC class II: 285; NRC class III: 86). In 148 cases (40%) the wound was intentionally left open (NRC class III: 51; NRC class IV: 97). In the group with NRC class II only two wound infections were seen. Inter alia there were no infections after 141 gall bladder/biliary tract operations, none after 46 gastrectomies and only one after 54 elective colon resections. In the group with NRC class III with 86 closed wounds, no wound infections occurred. All 148 wounds left open (NRC classes III and IV) healed smoothly, without significant morbidity, prolonged hospital stay or increase of the number of out-patient follow-up visits; moreover, the cosmetic results were good. With specific antimicrobial prophylaxis in a single administration combined with liberal open-wound treatment, postoperative wound infection after laparotomy appears to be virtually controlled.

Abdomen↗
PubMed1989

Repair of the proximal interphalangeal joint with a homograft.

We describe the delayed reconstruction of a destroyed proximal interphalangeal joint by implantation of a partial articular homograft in a 17-year-old boy. One year after the operation the joint is painless and has a normal range of motion.

Adolescent↗
PubMed1989

Post-appendectomy wound infection, a solved problem?

Over a 3.5 year period, 550 patients underwent an emergency operation under the diagnosis of acute appendicitis. The appendix proved to be normal in 82 patients, the other 468 patients had signs of acute inflammation with perforation in 142 cases. Management followed a strict protocol with single dose metronidazole as preoperative antibiotic prophylaxis and liberal open wound treatment in case of gross contamination. Consequently, the subcutaneous tissues and the skin were left open in 218 patients. The overall wound infection rate (1.3%) and the intra-abdominal abscess rate (1.1%) were extremely low. Open wound treatment was well accepted by the patients, did not prolong the hospital stay and gave good cosmetic results.

Acute Disease↗