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Biomedical subjects

M von Flüe

Publications and source records attributed to M von Flüe.

At least 19 recordsLinked to original sources
PubMed2001

Prevalence of Helicobacter pylori infection in peptic ulcer perforations.

BACKGROUND: Most patients with chronic peptic ulcer disease have Helicobacter pylori (H. pylori) infection. In the past, immediate acid-reduction surgery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. METHODS: In 47 consecutive patients (mean age = 64 years, range 27-91) suffering from acute peptic ulcer perforation the preoperative presence of H. pylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of H. pylori eradication with a triple regimen were prospectively studied. RESULTS: Of these patients 73.3% were positive for H. pylori, regardless of the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Thirty-eight per cent underwent a simple laparoscopic repair. Conversion rate to laparotomy reached a high of 32%. The main reasons for conversion were the size of the ulcer, and/or diffuse peritonitis for a duration of over 12 hours with fibrous membranes difficult to remove laparoscopically. In the H. pylori positive patients, eradication was successful in 96% of the cases. Mortality and morbidity rates were greater in the laparoscopic group (p < 0.05). Follow-up (median 43.5 months) revealed no need for reoperation for peptic ulcer disease and no mortality. CONCLUSION: We have found a high prevalence of H. pylori infection in patients with perforated peptic ulcers. An immediate and appropriate H. pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to a triple eradication protocol was excellent in the hospital setting.

Adult↗
PubMed2000

[Surgery for idiopathic constipation. The modest role of successful surgery].

Treatment of idiopathic constipation requires precise definition of the physiological and pathophysiological changes. A colorectal work-up including colonoscopy, colorectal passage, colonic transit study, anorectal manometry, cinedefecography and electromyography help to distinguish between four different forms of idiopathic constipation: slow transit constipation, outlet obstruction, a combination of both problems and irritable bowel syndrome. 70% of patients with chronic constipation suffer from irritable bowel syndrome. In these cases there is no indication for surgery. Patients with pelvic outlet obstruction due to paradoxical puborectalis contraction can be successfully treated with biofeedback. Outlet obstruction due to rectal prolapse, rectocele and intussusception require surgery. Total colectomy with ileorectal anastomosis is the surgical option for selected patients with slow transit constipation. Where there is a mixed disorder, biofeedback for the outlet obstruction must be applied prior to colectomy for the inert colon. Thorough preoperative physiologic testing is mandatory for a successful outcome. When cases are carefully diagnosed and selected, the operative results are excellent.

Chronic Disease↗
PubMed1999

[Cecum reservoir].

UNLABELLED: The choice of the best reconstruction technique following resection of either the stomach or the rectum remains a matter of discussion. While there is no problem in reconnecting intestinal segments, which do not serve as a reservoir, there are many different operation techniques to replace the stomach and rectum, producing significantly different functional results. The ileocecal segment offers an excellent intestinal reservoir combined with an antireflux mechanism, thus presenting an ideal replacement for the stomach. For replacement of the rectal reservoir as well, the ileocecal segment may be used in the first line of treatment. METHOD: The ileocecal segment was used in 20 patients following gastric resection and lymphadenectomy to reconstruct the intestinal passage between the esophagus and the duodenal stump (group A). In some further 44 patients (group B) the ileocecal segment was used to replace the rectum between the descending colon and the dentate line following resection for very low-grade rectal cancer. Mortality and morbidity were investigated in both groups. In group A quality of life, weight loss, dumping and reflux symptoms were evaluated. In group B continence, discrimination, defecation quality, urge and the patient satisfaction were investigated. All data were recorded prospectively. RESULTS: Early and late mortality were not different compared to other reconstruction types. In each group one patient died within 60 days postoperatively due to myocardial infarction. The morbidity following stomach replacement was 20%, following rectal replacement 4.6% during hospitalization and 13.8% during follow-up, respectively. One patient complained about heartburn, but endoscopically no pathology was detected in any patient. Three months postoperatively the patients' weight remained stable or started to increase. Three months following rectal replacement 87% of the patients were continent with further improvement over 2 years. Soiling mainly during the night remained over 2 years in 44%. 88% of the patients were completely satisfied 2 years postoperatively. CONCLUSION: The replacement of either the stomach or the rectum using the ileocecal segment with an adequate surgical technique is safe and produces excellent functional outcome regarding the reconstruction of the intestinal passage as well as the reservoir function of the primary organ. Furthermore, preservation of the duodenal passage after gastrectomy may prevent dysregulation of the endocrine and exocrine pancreatic hormones.

Anastomosis, Surgical↗
PubMed1998

[Mesh-plug operation: a simple, rapid and complication-free technique for managing inguinal hernia].

INTRODUCTION: The optimal inguinal hernia repair technique is a matter of debate. The Shouldice operation has long been regarded as the gold standard. While specialized hernia clinics have reproduced good results, a recurrence rate for trainees and non-specialized surgeons of between 10% and 15% seems to be more common. Laparoscopic hernia surgery has brought decreasing postoperative morbidity, low post-operative disability and early return to work. These advantages of a tension-free technique are due to the use of a prosthetic mesh. It is largely the efforts of Gilbert, Lichtenstein and Rutkow/Robbins which have popularized the use of prosthetic mesh by an open anterior approach in the USA. METHODS: Since January 1997 we have prospectively evaluated the open mesh plug repair described by Rutkow/Robbins in Basel and Lugano. We have operated on 110 patients (103 male, 7 female). All patients were interviewed 4 weeks postoperatively at our clinic. RESULTS: There were no major complications. Two patients underwent reoperation for drainage of a haematoma. There was no early recurrence or infection. After 4 weeks 82% of all patients were back to normal activity. An early return to work has been noted (10 days on average for sedentary workers). CONCLUSION: The main advantages of this technique are simplicity, low cost, reduced post-operative disability and early return to work. It is much too early to say anything concerning recurrence in this series.

Adult↗
PubMed1998

[Hemorrhagic pseudocysts and pseudoaneurysms in pancreatitis. Diagnosis and therapy].

Acute hemorrhage from pseudocysts and pseudoaneurysms is a threatening complication of chronic pancreatitis. Whilst surgical intervention still has high perioperative mortality (16.8%), transcatheter arterial embolization is becoming more frequently used for suitable cases and appears to have lower mortality (6.1%). We report on six patients treated in our unit. Four of them underwent primary surgical treatment, the other two were treated by embolisation. One of the latter patients subsequently required laparotomy for further treatment. All six patients survived. Comparing the literature covering the periods between 1951 and 1981 and between 1982 and 1996, transcatheter embolisation seems to be valuable in controlling this type of bleeding, thereby reducing mortality.

Adult↗
PubMed1998

[A new anal retractor for hand-sutured colo-anal anastomoses].

The hand-sutured coloanal anastomosis requires adequate and atraumatic exposure of the anal canal in order to avoid sphincter damage. We evaluated a new modified anal retractor to improve exposure of the anal canal and thread handling during construction of hand-sutured coloanal anastomosis. This new device was used during all coloanal and transperineal procedures performed in 1997 in our hospital. This new device is safe and extremely comfortable for the surgeon. It speeds up the procedure and keeps sutures out of the way when completing a coloanal anastomosis.

Anal Canal↗
PubMed1998

[Ileo-cecal segment as stomach substitute].

In clinical practice a long Roux-en-Y reconstruction is most often used for gastric replacement. Among various postgastrectomy symptoms, alcaline reflux is the most disturbing. A great variety of different pouch reconstructions with or without duodenal bypass only control reflux in part. The ileocoecal interposition has been placed between the oesophagus and the duodenum as a gastric substitute in 14 patients without postoperative mortality. This preliminary series demonstrates an excellent control of alcaline reflux and a good quality of life, according to the Eypasch score. Dysphagia or stasis in the distal oesophagus are absent as is gas bloating. This type of reconstruction, which is simpler than some of the pouch reconstructions, probably deserves more attention and may perhaps be perfected by varying the length of ileum and volume of ascending colon to be interposed.

Cecum↗
PubMed1997

Ileocecal interpositional graft as gastric replacement after total gastrectomy and distal esophagectomy.

The ileocecal interpositional graft is an alternative method for replacing the distal esophagus and the stomach. A pedunculated ileocecal interpositional graft rotated 180 degrees clock-wise and placed across the hiatus between the proximal esophagus and the duodenum could act as a reservoir and protect against reflux (ileocecal valve) while preserving the duodenal passage. Two patients underwent this operation (the first patient has been observed for 12 postoperative months). We also used this technique to replace the stomach alone below the diaphragm, a technique that had been abandoned in the surgical literature since 1952, although the concept and initial experiences were already promising at that time. In favor of these attractive features of the ileocecal interpositional graft as gastric replacement, we have begun a controlled examination of this method.

Adenocarcinoma↗
PubMed1997

[Agenesis of the gallbladder in adults: a laparoscopic diagnosis].

Failure to find the gallbladder at the usual or most common atypical sites during surgery for cholecystolithiasis is a rare but known problem. Although ultrasonography has 95% sensitivity for the diagnosis of cholelithiasis, occasionally a small contracted gallbladder with stones and chronic cholecystitis will be difficult to visualize and can lead to erroneous interpretation. We report on the case of a patient presenting with abdominal colic and ultrasonographically confirmed cholecystolithiasis. During laparoscopic cholecystectomy, the gallbladder could not be detected. After laparoscopic staging followed by endoscopic retrograde cholangiopancreatography and abdominal computed tomography, agenesis of the gallbladder was confirmed. This method can be considered for diagnosis of gallbladder agenesis without the need for laparotomy and thorough exploration.

Adult↗
PubMed1997

Ileocecal interposition--functional outcome.

Surgery of rectal cancer aims at providing satisfactory quality of life early postoperatively. Low postoperative morbidity and good defecation quality early after rectal reconstruction by means of a reservoir construction are essential conditions for a good quality of life. The clinical results show, that the ileocecal interposition is feasible with a low morbidity and that the majority of patients experience good to excellent defecation quality.

Aged↗
PubMed1996

[Mesenteric venous thrombosis (MVT): a problem in diagnosis and management].

The mesenterial venous thrombosis is a rare and independent cause of intestinal ischemia. 5 to 15% of all intestinal ischemias are due to venous problems. The lack of specific clinical symptoms and laboratory data often leads to a delayed diagnosis with irreversible intestinal infarction. Only by thorough searching by means of modern diagnostic devices is it possible to make an early diagnosis and treat the ischemic situation timely. Several therapeutical options are at hand. A timely and adequate application of these aids mostly depends on the clinical experience of the medical team as well as on an optimal interdisciplinary collaboration (radiology, hematology, angiology, gastroenterology, surgery). We want to analyze the problems related to diagnostics and management on the basis of 2 cases with different manifestations of a mesenterial venous thrombosis. We ascertain that: (1) the enhanced-CT analysis and/or the duplex-sonography mostly lead to a diagnosis, (2) the prognosis benefits from an immediate heparinization, (3) the request for large-scale intestinal resection, keeping a safety-space, has been replaced by the technique of limited resection, followed by earlier second-look-operations.

Adult↗
PubMed1995

[Laparoscopic adrenalectomy in pheochromocytoma].

Standard adrenalectomy for pheochromocytoma was until recently performed via the transperitoneal open approach. The disadvantage of the open procedure is a more painful and longer recovery. With good surgical experience in laparoscopic techniques and in endocrine surgery, laparoscopic adrenalectomy can be performed safely without complications. The advantage of the laparoscopic technique is excellent vision of the operative field with magnification even of very small vessels. The first two cases of laparoscopic right adrenalectomy at our institution are described.

Adrenal Gland Neoplasms↗
PubMed1995

[Sphincter-conserving surgery in tumors of the middle and distal rectum: methods, indications and limitations].

The purpose of this review is to summarize new developments in the surgical treatment of benign and malignant tumors of the rectum, focusing on oncological requirements and postoperative functional aspects which affect the quality of life. One of the developments is the transanal endoscopic microsurgical (TEM) approach to resection of adenomas and low risk early cancers in the rectum. Another focus is total rectum resection with colo-anal reconstruction with a colon pouch. This procedure reconstructs anorectal anatomy and provides nearly normal function. The reconstruction exists in two forms, (a) the colon-J-pouch and (b) the ileocecal interposition pouch (cecum pouch), which was developed at our institution. The review includes 33 consecutive patients with a rectum tumor. Standardized tumor-specific and functional staging determines which technique is used. 12 patients were operated on using the transanal endoscopic approach, 3 patients had a posterior proctotomy, another patient a transanal local excision and 17 patients total rectum resection with colon pouch reconstruction as described above.

Aged↗
PubMed1995

[Small bowel injuries in blunt abdominal trauma--a diagnostic problem!].

AIMS: Injuries of the small bowel following a blunt abdominal trauma are rare (incidence 6%). The diagnosis is difficult and therefore often missed. The aim of this paper is to acquire an useful diagnostic sequence of our own results in comparison to the literature. METHODS: The diagnostic procedures and the time of the final diagnosis of 13 patients with this rare injury have been retrospectively analysed. RESULTS: Two of these 13 patients died in the emergency room. Five of the remaining 11 patients had signs of peritonitis at the first examination. These were confirmed by findings either in peritoneal lavage (3), ultrasound (1) or X-ray (1). Patients without signs of peritonitis revealed no pathological signs at the first examination with these diagnostic tools. Correct diagnosis was achieved on 7/11 patients within 24 hours. The diagnosis of small bowel injury was confirmed by the rest of the patients (n = 4) after an average of 11 days after trauma. DISCUSSION/CONCLUSION: Initial assessment with diagnostic tools as ultrasound, peritoneal lavage or X-ray is poor. Therefore repetitive controls (Nowadays by ultrasound) are indicated. The CT is a valuable tool to detect an organ lesion in hemodynamic stable patients with positive proof of liquid in the ultrasound. Today the value of the diagnostic laparoscopy is not established. It should be considered that a local ischemia due to the blunt trauma can cause a delayed perforation.

Abdomen↗
PubMed1994

[Perianal extramammary Paget's disease].

Extramammary perianal morbus Paget is a rare disease; so far, only a few more than 100 cases have been reported on or described worldwide. Diagnosis, differential diagnosis, therapy, and prognosis of intra-epidermally growing adenocarcinoma are explained and discussed by means of a well-documented case.

Anus Neoplasms↗