Biomedical subjects

M Haberer

Publications and source records attributed to M Haberer.

4 recordsLinked to original sources

PubMed1998

[Changes in colitis surgery. II: Corrective interventions and conversion operations].

Over a period of 9 years in 48 patients already operated on for ulcerative colitis secondary surgical interventions had to be planned. 25 patients had an ileostomy (IS), 10 a Kock-pouch (KP), 11 an ileoanal pouch (IAP) and 2 an ileorectal anastomosis (IRA). Whereas in 4 patients only the subjective wish for another procedure with better quality of life predominated, in 44 patients (91.7%) also objective, sometimes multiple indications for reoperation existed. In 37 patients main indications were complications or dysfunctions of the preexisting procedures, combined with the need for further resection of the colitis in 6 of them. Resection of the residual colitis was the main indication in the remaining 7 patients. The aim of the reoperation in all patients was both complete elimination of the eventually persisting colitis and restoration of quality of life in the best way wished or possible. Our of 25 IS 3 remained, 3 were reconstructed, 17 were converted to KP and 2 to IAP. Out of 10 KP one remained and in 9 corrective surgery of the nipple valve was performed. Out of 11 IAP 2 had to be resected with construction of IS, 5 were converted to KP and 4 were corrected. Two IRA were converted to IAP. The rate of early complications was 8.3% (n = 4), lethality was zero. Late complications occurred in 13 cases (27.1%) and were associated ten times with KP. Complications of KP decreased with time to zero due to technical modifications. They could always be corrected restoring function. Since only one KP had to be resected due to severe pouchitis, KP was an important secondary procedure for 31 out of 48 patients also in the long-term course ensuring both complete elimination of colitis and good quality of life owing to voluntary fecal control.

Adolescent↗

PubMed1996

Biomechanical stabilization of the nipple valve in continent ileostomy.

Despite stapler stabilization, sliding complication of nipple valve function occur in 19 per cent of continent ileostomies. Because the tendency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of contacting intestinal walls was removed by selective ultrasonic fragmentation. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a median time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch. All are functioning well after a median of 4.6 (range 3.0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm2 was shown by endosonography. This procedure may provide long-term prevention of sliding complications in continent ileostomies.

Adenomatous Polyposis Coli↗

PubMed1996

Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone.

PURPOSE: We report the indications, technique, and results of conversion of the ileoanal pouch to the Kock's pouch in five patients. The indication was functional disturbance that could not be corrected by operation. Aim of the conversion operation was re-establishment of fecal control and complete preservation of existing ileal surface. METHODS: The ileal pouch was used again, and in one case an augmentation was made. The continence valve was made three times from the afferent loop and in two cases from a higher ileal segment. RESULTS: Following conversion, function was excellent in three patients with ulcerative colitis and in one patient with familial adenomatous polyposis. One woman who underwent proctocolectomy for slow-transit constipation needed a Brooke ileostomy for continuous abdominal distention pain. CONCLUSION: We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.

Adenomatous Polyposis Coli↗

PubMed1994

[Experiences with the Kock continent ileostomy].

First experiences with Kock-pouches (KP) in 34 patients operated on between 1987 and 1992 with stapler-stabilization of the nipple-valve are reported. 18 patients (52.9%) suffered from ulcerative colitis (CU), 7 patients (20.6%) from familiar adenomatous polyposis (FAP) and 9 patients (26.5%) from Crohn's colitis (CC). Each patient was inappropriate for ileo-anal pouch-procedure (IAP) and desired fecal control. Special indications for KP were identic with medical contraindications for IAP in 52.9%, refusal of IAP in 17.6% and loss of sphincter in 29.4%. In 25 patients with CU and FAP the rate of specific early complications was 24%. In 5 of 6 cases operative correction was successful. The rate of success was 96%, which could be maintained over time with a rate of 8.3% of late complications, that had to be corrected. In 9 patients with CC the rate of success was 77.8% due to two pouch resections in the early postoperative course. It decreased to 66.6% in the further course due to another resection later on. In CC, 3 out of 7 patients had repeated reoperations due to inflammatory complications of the disease not impairing pouch-function. A severe pouchitis was only observed in 2/18 patients with CU (11.1%). Thus, high rates of success in KP-surgery can be achieved for CU and FAP-patients. But it has to be kept in mind, that KP is not in concurrence with IAP, it is also an alternative to Brooke-ileostomy. Patients with CC are less appropriate, because the necessity for repeated reoperations due to recurrent disease reduces significantly the overall benefit of the patients, even if continence is preserved.

Adenomatous Polyposis Coli↗