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Biomedical subjects

M Oberwalder

Publications and source records attributed to M Oberwalder.

17 recordsLinked to original sources
PubMed2006

Do internal anal sphincter defects decrease the success rate of anal sphincter repair?

BACKGROUND: Anatomic anal sphincter defects can involve the internal anal sphincter (IAS), the external anal sphincter (EAS), or both muscles. Surgical repair of anteriorly located EAS defects consists of overlapping suture of the EAS or EAS imbrication; IAS imbrication can be added regardless of whether there is IAS injury. The aim of this study was to assess the functional outcome of anal sphincter repair in patients intraoperatively diagnosed with combined EAS/IAS defects compared to patients with isolated EAS defects. METHODS: The medical records of patients who underwent anal sphincter repair between 1988 and 2000 and had follow-up of at least 3 months were retrospectively assessed. Fecal incontinence was assessed using the Cleveland Clinic Florida incontinence score wherein 0 equals perfect continence and 20 is associated with complete incontinence. Postoperative scores of 0-10 were interpreted as success whereas scores of 11-20 indicated failure. RESULTS: A total of 131 women were included in this study, including 38 with combined EAS/IAS defects (Group I) and 93 with isolated EAS defects (Group II). Thirty-three patients (87%) in Group I had imbrication of a deficient IAS, compared to 83 patients (89%) in Group II. All patients had either overlapping EAS repair (n=121) or EAS imbrication (n=10). Mean follow-up was 30.9 months (range, 3-131 months). There were no statistically significant differences between the two groups relative to age (48.3 vs. 53.0 years; p=0.14), preoperative incontinence score (16.1 vs. 16.7; p=0.38), extent of pudendal nerve terminal motor latency pathology (left, 11.1% vs. 8%; p=0.58; right, 8.6% vs. 15.1%; p=0.84), extent of pathology at electromyography (54.8% vs. 60.1%; p=0.43), and length of follow-up (26.9 vs. 32.5 months; p=0.31). The success rates of sphincter repair were 68.4% for Group I versus 55.9% for Group II (p=NS). Both groups were well matched for incidence of IAS imbrication as well as age, follow-up interval, and physiologic parameters. The success rates of anal sphincter repair were not statistically significant between the two groups. CONCLUSION: A pre-existing IAS defect does not preclude successful sphincteroplasty as compared to repair of an isolated EAS defect. Thus, patients with combined anal sphincter defects should not be considered as poor candidates for sphincter repair.

Anal Canal↗
PubMed2006

Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease.

BACKGROUND: There is no general consensus regarding the timing of restorative proctocolectomy (RPC) in patients who have undergone subtotal colectomy with end ileostomy (STC). The aim of this study was to determine the impact of timing of RPC in patients who have undergone subtotal colectomy and end ileostomy for inflammatory bowel disease (IBD). METHODS: A retrospective medical record review of patients who had undergone RPC after STC was undertaken. Patients were divided into 3 groups according to timing of the completion proctectomy: 7 months. RESULTS: From 1990 to 2000, 91 patients had undergone RPC after STC for IBD. There were no statistically significant differences among the three groups relative to mean age, gender, final diagnosis, duration of disease, body mass index, comorbidity, extraintestinal manifestations, use of immunuosuppressives, or operative time. The number of intra-operative complications were significantly higher in the <or= 3 month group compared to the other groups. There was no significant difference in the overall incidence of postoperative complications among the 3 groups. Postoperative fistulas were significantly more common after RPC in Groups 1 and 2 as compared to Group 3. CONCLUSION: Restorative proctocolectomy performed within 3 months after the initial subtotal colectomy was associated with a significant increase in the incidence of intra-operative complications. Although this increase was not statistically significant, there was a significantly higher incidence of fistula formation when RPC was undertaken at up to 7 months after the subtotal colectomy for IBD. Thus, if possible, early RPC after subtotal colectomy should be discouraged.

Adult↗
PubMed2005

Quality of life after colectomy for colonic inertia.

BACKGROUND: Total abdominal colectomy (TAC) with ileorectal anastomosis represents the procedure of choice in patients with colonic inertia and relieves constipation in the majority of patients. The aim of this study was to assess postoperative long-term health related quality of life in these patients in relation to their functional outcome. METHODS: A consecutive series of patients with isolated colonic inertia who underwent TAC between 1993 and 1999 was identified from a clinical database and investigated in a cohort outcome study. Functional variables including the weekly number of bowel movements (BM), abdominal pain, bloating and distension, fecal incontinence, and the use of medications for BM assistance were assessed preoperatively and postoperatively. Main outcome measure was health-related quality of life assessed at follow-up using the SF-36 Health Survey. RESULTS: A total of 17 women with a mean age of 47.8 years (SD=14.3 years) were assessed and were followed postoperatively for 58.3+/-27.3 months. Preoperatively, all patients were constipated with less than one bowel movement per week, used laxatives, and experienced abdominal pain, bloating and distension. Postoperatively, all patients had some relief of constipation symptoms, with 3.7+/-2.8 bowel movements/day; 41% complained of abdominal pain, 65% of bloating, 29% required BM assistance, and 47% had occasional incontinence to gas or liquid stool. The SF-36 scores were significantly lower than those of the general population (p<0.005). In univariate regression analysis, postoperative abdominal pain was predictive for lower scores in general health and vitality and the need for BM assistance for lower scores in physical role functioning, social functioning, and emotional role limitations. CONCLUSIONS: After TAC, quality of life is significantly reduced in patients with colonic inertia despite successful relief of symptoms of constipation. Postoperative pain and functional impairment are predictive of lower quality of life scores.

Adult↗
PubMed2005

Assessment of long-term quality of life after laparoscopic and open surgery for Crohn's disease.

OBJECTIVE: Surgery for Crohn's disease (CD) is associated with a high recurrence rate and quality of life (QOL) in these patients is controversial. The aim of this study was to assess QOL in patients after laparoscopic and open surgery for CD by two different validated instruments, a generic nonspecific score and a specific gastrointestinal QOL index. PATIENTS AND METHODS: Patients with CD who underwent elective laparoscopic or open ileocaecal resection with primary anastomosis between 1992 and 2000 were followed for recurrence and surgery-related complications. QOL was assessed by the SF-36 Health Survey containing a mental (MCS) and a physical (PCS) component summary score and by the Gastrointestinal Quality of Life Index (GIQLI) developed by Eypasch. RESULTS: Thirty-seven patients with a mean age of 48.8 +/- 18.4 years including 23 females and 14 males were evaluated at a mean follow-up of 42.6 +/-25.8 months (minimum of 8 months). Twenty-one (57%) patients underwent laparoscopic resection and 16 (43%) open surgery. Both groups were well matched for age, gender, ASA class and body mass index. Fourteen (38%) patients developed recurrent disease and 3 (8%) had postoperative incisional hernias. Overall, QOL scores were 103 +/- 26.8 for the GIQLI, 47.2 +/- 11.8 for the PCS, and 49.2 +/- 11.5 for the MCS. The GIQLI correlated well with the SF36, correlation coefficient = 0.68 for GIQLI vs PCS (95% CI, 0.41,0.95) and 0.67 for GIQLI vs MCS (95%CI, 0.39, 0.95), respectively. When compared to the general US population, mean GIQLI scores (-13.8, P = 0.002) and mean PCS scores (-4.7, P = 0.001) were significantly lower in these patients than in healthy individuals. In a multivariate analysis of impact factors on QOL, recurrence within the follow-up period was the single significant determinant reducing the PCS (-35.1, P = 0.026) and the GIQLI (-36.1, P = 0.018). CONCLUSION: QOL is significantly reduced in patients with CD at long-term follow-up after both laparoscopic and open surgery. Recurrence is the only factor adversely affecting QOL of CD patients in remission irrespective of the operative technique applied.

Adult↗
PubMed2004

Anal ultrasound and endosonographic measurement of perineal body thickness: a new evaluation for fecal incontinence in females.

BACKGROUND: Perineal body thickness (PBT) is measured by endoanal ultrasonography. The literature has shown that women with obstetric trauma to the anal sphincter have decreased PBT, and a measurement of 10 mm or less has been proposed as abnormal. Therefore, this study aimed to compare the proposed definitions of normal to pathologic findings in patients with fecal incontinence (FI) and to correlate PBT with anorectal physiologic findings. METHODS: All female patients who had endoanal ultrasonography and PBT measurement for evaluation of FI were assessed and divided into three groups on the basis of PBT: 10 mm or less, 10 to 12 mm, more than 12 mm. The degree of FI (0 = complete continence; 20 = complete incontinence) was correlated with PBT. RESULTS: For this study, 83 female patients with a mean age of 59.7 years (range, 30-88 years) had endoanal ultrasonography and PBT measurement. Sphincter defects were suggested by endoanal ultrasonography in 77% of the patients in the three groups as follows: 57 (97%) of 59 patients, 4 (36%) of 11 patients, and 3 (23%) of 13 patients. The mean external sphincter defect angle was 110 degrees (range, 45-170 degrees ), and the mean FI score was 13.8. For 89% of the patients there was a history of vaginal delivery. As reported, 35% had undergone one or more prior perineal surgeries, 27% had both, and 4% denied having had either. A significant correlation between sphincter defect and PBT (p < 0.001) was noted. External sphincter defect angles were negatively correlated with PBT (p = 0.001). CONCLUSION: A PBT of 10 mm or less is considered abnormal, whereas a PBT of 10 mm to 12 mm is associated with sphincter defect in one-third of patients with FI. Those with a PBT of 12 mm or more are unlikely to harbor a defect unless they previously have undergone reconstructive perineal surgery.

Adult↗
PubMed2004

Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer.

BACKGROUND: Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB). METHODS: Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded. RESULTS: In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be "completely safe" in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062). CONCLUSIONS: The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.

Adult↗
PubMed2004

[Transperineal sonography in anorectal disorders].

AIM: Magnetic resonance imaging, computed tomography, endorectal and endoanal sonography are used for imaging of inflammatory and neoplastic conditions of the lower rectum, the anus and the perineum. These methods, however, have their limitations regarding accuracy, cost-effectiveness, and availability in the acute setting. Pain may be a limiting factor when introducing a probe into the anus. Percutaneous transperineal sonography is an acknowledged method for diagnosing anorectal malformations in children and infants and for diagnosis of prostatic disease. Until today, only limited reports regarding the value of transperineal sonography for evaluation of diseases of the lower rectum, the anus and the perianal region in adults are available. PATIENTS AND METHODS: Between 1997 and 2000 a total of 44 patients underwent transperineal sonography including B-mode and colour Doppler sonography for imaging anorectal structures using 3.5 MHz sector arrays and 7 MHz linear arrays. The lesions were also investigated using colour Doppler imaging. During examination the patient is positioned on his side. Orientation landmarks are the pubic symphysis and the prostate gland in men and the vagina in women. RESULTS: The spectrum of diseases of the current study population (44) included perianal fistulas (10), pararectal abscesses (7), fistulas with abscess (7), perianal inflammation without abscess (1), rectal (6) and anal carcinomas (3) and metastasis of a leiomyosarcoma (1). In 10 cases digital examination of the anus and rectum was not possible because of intense pain. In 34 patients (85 %) sonographic findings were confirmed by intraoperative diagnosis. CONCLUSION: Transperineal sonography proved to be an inexpensive, easily available diagnostic tool that may help in detecting a variety of pathological conditions of the lower rectum, the anus, and the perianal region.

Abdominal Abscess↗
PubMed2003

Meta-analysis to determine the incidence of obstetric anal sphincter damage.

BACKGROUND: The reported incidence of anal sphincter injury after first (11.5-35.0 per cent) and subsequent (3.4-12.1 per cent) vaginal deliveries varies widely. In addition, the reported incidence of associated faecal incontinence ranges from zero to 68.2 per cent. The aim of this study was to perform a meta-analysis of reported incidences of postpartum anal sphincter defect diagnosed by endoanal ultrasonography (EAUS) and associated incidences of faecal incontinence. METHODS: A Medline search yielded five studies with more than 100 subjects who underwent EAUS after childbirth for evaluation of anal sphincter disruption and who were questioned about symptoms of faecal incontinence, defined as any impairment in flatus and stool control but not including urgency of defaecation. A Bayesian meta-analysis was performed to produce one inference while accounting for potential heterogeneity among the five study populations. RESULTS: Meta-analysis of 717 vaginal deliveries revealed a 26.9 per cent incidence of anal sphincter defect in primiparous women and an 8.5 per cent incidence of new sphincter defects in multiparous women. Overall, 29.7 per cent of anal sphincter defects were symptomatic. Some 3.4 per cent of women experienced postpartum faecal incontinence without an anal sphincter defect. In a Bayesian calculation, the probability of postpartum faecal incontinence due to a sphincter defect was 76.8-82.8 per cent. CONCLUSION: : The incidence of occult anal sphincter disruption following vaginal delivery is much higher than commonly estimated. However, at least two-thirds of occult defects are asymptomatic postpartum. The probability of faecal incontinence associated with an anal sphincter defect was 76.8-82.8 per cent.

Anal Canal↗
PubMed2001

Results and complications after adjustable gastric banding in a series of 250 patients.

BACKGROUND: Morbid obesity contributes to many health risks including physical, emotional, and social problems. The increasing prevalence of obesity is a major public health concern since obesity is associated with several chronic diseases. Morbid obesity is the biggest independent risk factor for early mortality. Various options for the surgical treatment of morbid obesity have been developed with varying results. METHODS: Between January 1996 and December 1999, we operated on a series of 250 patients (200 women and 50 men) at the General Surgical Department of the University Hospital in Innsbruck. The parameters that were evaluated included age, preoperative and postoperative body mass index (BMI), type of surgery, and intraoperative and postoperative complications. RESULTS: The mean follow-up period was 12 months (range 3 to 18). The average preoperative weight was 135.5 kg (BMI 46.69 kg/m(2)). The average total weight-loss was 5.5 kg per month, reaching an average total of 35 kg after one year. The excess weight loss (EWL) after 12 months was 72%. Complications requiring reoperation occurred in 8.8%. CONCLUSIONS: In the first year after laparoscopic adjustable gastric banding, weight reduction of the study population was excellent. Additionally, the complication rate was reasonable with no mortalities.

Adult↗
PubMed2000

Organ transplantation and obesity: evaluation, risks and benefits of therapeutic strategies.

Obesity is a prevalent health problem that has discernible impact on all fields of surgery. However, little attention is paid in the literature to the underlying relation of surgical, immunological and metabolic links between transplantation and morbid obesity. Pre-operative obesity has been reported to worsen the outcome of organ transplantation. Impairment of graft function as well as decreased patient and graft survival can contribute to this effect. Post-transplant weight gain is common and may be attributed to an imbalance of the adipostatic and appetite stimulating hormones. Reduction of obesity before transplantation has to cope with limited time, increased risk of therapeutic side-effects in patients with end-stage organ failure, and psychosocial stress. Overweight reduction following organ transplantation interferes with diverse effects associated with immunosuppressive therapy. A case of adjustable gastric banding following renal transplantation is presented.

Adult↗
PubMed1998

Endosonographic image of a retrorectal bowel duplication: report of a case.

PURPOSE: Endosonographic image and surgical therapy of a retrorectal bowel duplication are described. METHODS, RESULTS, AND CONCLUSIONS: Compared with standard investigations, the most accurate information about a retrorectal mass in a 35-year-old woman could be obtained by means of endorectal ultrasound. Guided by endorectal ultrasound, the mass was excised using a transanal-transrectal approach, and Kraske's operation could be avoided. Additionally, histopathologic analysis of this rare disease is presented.

Adult↗
PubMed1997

Virtual computed tomography gastroscopy: a new technique.

BACKGROUND AND STUDY AIMS: The aim of the present study was to establish a suitable method for virtual computed tomography (CT) gastroscopy. PATIENTS AND METHODS: Three-millimeter helical CT scans of a pig stomach were obtained after air insufflation and instillation of diluted diatrizoic acid (Gastrografin), and with double contrast. In addition, three patients with gastric tumors were studied after ingestion of an effervescent agent (Duplotrast, 6 g) and intravenous injection of hyoscine butylbromide (Buscopan, 1 ml). Virtual endoscopy images were computed on a Sun Sparc 20 workstation (128 megabytes of random access memory, four gigabytes of hard disk space), using dedicated software (Navigator, General Electric Medical System Company). The endoscopy sequences were compared with real endoscopic examinations and with anatomical specimens. RESULTS: In the cadaver studies, the best results were obtained with plain air insufflation, whereas virtual CT gastroscopy with diluted contrast and with double contrast showed artifacts simulating polyps, erosions, and flat ulcers. Patient studies showed good correlation with the fiberoptic endoscopy findings, although large amounts of retained gastric fluid substantially reduced the quality of the surface reconstruction. CONCLUSION: These preliminary results show that virtual CT gastroscopy is able to provide insights into the upper gastrointestinal tract similar to those of fiberoptic endoscopy. However, due to the limited spatial resolution of the CT protocol used, as well as inherent image artifacts associated with the Navigator program's reconstruction algorithm, the form of virtual CT gastroscopy studied was not capable of competing with the imaging quality provided by fiberoptic gastroscopy.

Animals↗
PubMed1987

The elderly para- and tetraplegic: special aspects of the urological care.

This paper evaluates the influence of age on bladder rehabilitation and the incidence of secondary changes in the urinary tract with long standing paraplegia and tetraplegia and its consequences for the elderly patient. It demonstrates that age makes bladder rehabilitation in these patients more difficult, because of the decreased ability of the elderly to cope with the new situation, of pre-existing factors interfering with micturition like benign prostatic hyperplasia and cystocele and because of a delayed and at the end sometimes weak detrusor reflect activity. Long standing paraplegia is characterised by a high percentage of secondary structural changes in the lower urinary tract, especially at the bladder outlet. Once these changes are established the outflow resistance is further increased. These findings stress the need for early adequate management of the functional outflow obstruction based on careful urodynamic evaluation, before secondary structural changes occur. In this connection it is pointed out, that passive voiding by abdominal straining or by the Crede technique may cause unphysiologically high intravesical and intra-abdominal pressures and should then be replaced by intermittent catheterisation.

Age Factors↗