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Biomedical subjects

P Schrenk

Publications and source records attributed to P Schrenk.

15 recordsLinked to original sources
PubMed1996

Metabolic responses after laparoscopic or open hernia repair.

BACKGROUND: The purpose of a prospective randomized study was to compare the surgical trauma in patients undergoing laparoscopic or open hernia repair. METHODS: Postoperative pain, analgesic consumption, and metabolic response to surgery were assessed in 30 patients undergoing laparoscopic (group 1; n = 15) or open (group II; n = 15; Shouldice repair) unilateral inguinal hernia repair. Both groups were comparable with respect to age, sex, and type and size of inguinal hernia. RESULTS: Postoperative visual analogue scales (VAS) for pain were reduced on mobilization for patients of group I with a significant difference (P = 0.02) on the operative day, whereas pain scores at rest and analgesic requirements were similar for both groups. No differences between groups I and II were found in postoperative levels of interleukin-1, interleukin-6, tumor necrosis factor alpha, C-reactive protein, fibrinogen, transferrin, alpha-1-antitrypsin, and white blood cells. Postoperative polymorphonuclear (PMN) elastase concentrations remained within normal range in group II but showed a significant increase in patients operated laparoscopically for postoperative days 1 and 2. CONCLUSIONS: No major surgical trauma was found after herniorraphy compared to open hernia repair.

Acute-Phase Proteins↗
PubMed1996

Videothoracoscopy for the management of mediastinal mass lesions.

BACKGROUND: The indications for video-assisted thoracoscopy have steadily expanded during recent years and include now the management of various mediastinal disorders. METHODS: Until now we have used videothoracoscopy for the diagnosis or treatment of mediastinal mass lesions in 28 patients. The indication for the procedure was bilateral or unilateral mediastinal adenopathy in 16, a suspected malignant anterior mediastinal mass lesion in six, and a presumable benign tumor of the posterior or anterior mediastinum in six patients. RESULTS: Video-assisted thoracoscopy provided an accurate tissue diagnosis in all patients with adenopathy and in all but one patient with a malignant mass lesion of the anterior mediastinum. It further allowed complete excision of all benign tumors of the anterior or posterior mediastinum. There were no intra- or postoperative complications, but conversion to open thoracotomy was necessary in one patient. CONCLUSIONS: Video-assisted thoracoscopy is a valuable adjunct to traditional surgical techniques for the diagnosis of malignant mediastinal disease and may overcome some of the limitations of mediastinoscopy and mediastinotomy. In the future, it may become the procedure of choice for the resection of small benign tumors of the anterior or posterior mediastinum.

Adult↗
PubMed1996

Mechanism, management, and prevention of laparoscopic bowel injuries.

BACKGROUND: Inadvertent injury to the bowel is a rare but potentially fatal complication of laparoscopy. Such injury often goes unrecognized at the time of the procedure and only later is manifest by high morbidity and mortality. METHODS: We reviewed the mechanism and management of 10 instances of bowel injury known to have been encountered in a series of 4672 laparoscopic procedures performed at our hospital over the past 5 years. RESULTS: The usual causes of injury to the bowel wall were thermal burns, sharp dissection, and needle punctures. Six of the injuries were readily evident and treated immediately; four were unrecognized until 2 to 14 days after the procedure. One patient died of multiple organ failure on the third day after laparoscopy. Operative management in nine cases required simple closure or segmental resection. A high index of suspicion and vigilant physical examination were the keys to early recognition of bowel injury; laboratory and radiographic findings were nonspecific. CONCLUSIONS: Suspected bowel injury following laparoscopy mandates early laparotomy to avoid life-threatening complications.

Adult↗
PubMed1995

Laparoscopic cholecystectomy. Cause of conversions in 1,300 patients and analysis of risk factors.

In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 patients (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic regression analysis of 23 parameters identified the following data as associated with a higher risk for conversion: pain or rigidity in the right upper abdomen (P < 0.01), thickening of the gallbladder wall on preoperative ultrasound (P < 0.05), intraoperatively found dense adhesions to the gallbladder or in Calot's triangle (P < 0.001), and intraoperatively found acute inflammation of the gallbladder (P < 0.01). Clinical findings of an acute cholecystitis associated with intraoperative dense scarring in Calot's triangle were the best factors predicting conversion from LC to OC. As a result of the study we preoperatively select our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complications low.

Adult↗
PubMed1994

Laparoscopic removal of dislocated ventriculoperitoneal shunts. Report of two cases.

In two patients the dislocated abdominal catheter of a ventriculoperitoneal (VP) shunt was successfully removed from the abdominal cavity by laparoscopy. Avoiding laparotomy, only two small abdominal incisions were necessary to insert the laparoscope and the grasping forceps. Postoperative course was uncomplicated except for protrusion of a part of the greater omentum through the umbilical incision in one patient. Both patients were mobilized on the operative day. Surgery required only 10 min, provided an excellent view of the entire abdomen, and led to prompt identification and removal of the lost catheter.

Abdomen↗
PubMed1994

Diagnostic laparoscopy: a survey of 92 patients.

From January 1991 to June 1993 the authors performed 92 diagnostic laparoscopies when physical examination, laboratory tests, and noninvasive imaging techniques failed to provide accurate diagnoses. Thirty-three patients (36%) underwent laparoscopy to ensure or exclude diagnosis in suspected intra-abdominal malignancy or to assess the operability in the cases of known cancer; 31 patients (34%) were evaluated for chronic abdominal pain; 15 patients (16%) were evaluated for acute abdominal pain; 9 trauma patients (10%) were evaluated to exclude or confirm penetration of the peritoneum or laceration of intra-abdominal organs; and 4 patients (4%) were operated on for miscellaneous conditions. Of the 92 patients, laparoscopy led to diagnosis in 80 patients (87%), a laparotomy was avoided in 78 patients (85%), and operative treatment was done laparoscopically in 65 patients (71%). Diagnostic laparoscopy will not replace laparotomy in every instance. However, in selected groups of patients, it may be used to yield diagnosis and help to avoid unnecessary laparotomy.

Abdomen↗
PubMed1994

Hemodynamic changes during prolonged laparoscopic surgery.

7 healthy pigs, anesthetized with ketamine/azaperon/thiopentone and ventilated with O2/N2O by volume control, underwent anterior resection of the descending colon by laparoscopic view. During operation of pneumoperitoneum by inflating CO2 to an abdominal pressure of 14 mm Hg was installed. Immediately (+2 min) after the onset of insufflation, both systemic and pulmonary arterial pressure increased. However, pulmonary artery pressure started to decrease after 10 min, whereas systemic arterial pressure remained elevated until the end of the experimental protocol. Left ventricular (LV) pressure and LV dp/dt increased in parallel with the systemic arterial pressure. Peak inspiratory pressure and central venous pressure increased in parallel with the abdominal pressure. Blood gas analysis of arterial and pulmonary blood demonstrated increased pCO2 associated with mild acidosis. Arterial pO2 did not change significantly indicating that the decreased pulmonary distensibility did not endanger the oxygenation. Pulmonary pO2 and pulmonary O2 saturation increased early (+10 min) after start of insufflation and were stable during the 2 h of observation indicating either increased cardiac output or decreased O2 extraction. We conclude that the sharp initial rise of both arterial pressures could be the effect of a mechanical action, whereas sustained hemodynamic alterations would involve complex regulatory mechanisms like an increase of sympathetic activity, baroreceptor control, or a response to acidosis. The acute and, in the systemic circulation, stable increase of ventricular afterload should be considered in patients with underlying cardiac diseases such as ischemic heart disease or valvular dysfunction or in patients taking drugs which interfere with normal compensatory processes.

Animals↗
PubMed1994

[Thoracoscopic therapy of iatrogenic hemothorax].

Video-assisted thoracoscopy is an innovative technique which now allows the surgeon to approach various intrathoracic pathologic conditions without thoracotomy. In a 20-year-old male with pneumothorax urgent surgical intervention was necessary because of severe hemothorax following chest tube placement. The successful management of this patient by video-assisted thoracoscopy is presented.

Adult↗
PubMed1993

[Laparoscopic hernia repair].

From January 1992 to February 1993 a total of 361 inguinal hernia repairs were performed in our unit. We routinely performed the Shouldice repair. In 60 patients, 46 men and 14 women, 19-82 year old, we closed the inguinal defect with a patch, performing a "tension-free" repair by a laparoscopic technique. In 26 patients we found a left-sided hernia, in 21 patients a right-sided, and in 13 bilateral hernias. We found 29 direct hernias, 26 indirect hernias and 18 combined hernias. There were no intraoperative complications. Postoperatively, 1 patient suffered from epididymitis, and 5 patients reported disturbed sensibility of the skin at the medial proximal thigh for some weeks. One patient had an inguinal seroma postoperatively. In this patient we had not removed the hernia sac. There was no recurrence. Long time results are not available until now.

Adult↗
PubMed1993

[Laparoscopic cholecystectomy--advantages and disadvantages].

From march 1990 to february 1992 we performed 600 laparoscopic cholecystectomies. In 18 cases we had to change to a laparotomy because of intraoperative problems, in 3 cases we had to laparotomise patients because of postoperative complications. 9 patients (1.5%) had a wound infection. In two prospective studies we could prove that patients after laparoscopic cholecystectomy have less pain and are in a better respiratory condition than after open cholecystectomy.

Adolescent↗
PubMed1987

Fibrin glue coating of e-PTFE prostheses enhances seeding of human endothelial cells.

A laboratory study was undertaken to improve the initial count of endothelial cells (EC) adhering to the wall of e-PTFE prostheses when seeding of human EC is attempted. In our experiments pretreatment of the prosthetic wall with commercially available fibrin glue (Tissucol) improved the reliability of the seeding procedure. The number and the distribution of EC seeded onto fibrin glue presealed e-PTFE prostheses was compared to the number and distribution of EC adhering to blood preclotted grafts 24 hours following the initial seeding procedure. Fibrin glue presealed grafts showed a higher number of initially adhering EC and a more equal distribution over the graft surface when compared to blood pretreated grafts. Our results suggest that the use of fibrin glue enhances the seeding of human EC on e-PTFE grafts.

Antigens↗
PubMedDate not supplied

Selective use of ERCP in patients undergoing laparoscopic cholecystectomy.

With the advent of laparoscopic cholecystectomy (LCH) various strategies have been proposed for the management of common bile duct (CBD) stones. In a consecutive series of 1140 patients subjected to LCH, preoperative endoscopic retrograde cholangiopancreatography (ERCP) was attempted in 128 patients (11.2%) and successfully accomplished in 121 (94.5%). Based on the prediction of CBD stones by laboratory tests, ultrasonography, and intravenous cholangiography, prelaparoscopic ERCP was performed in 106 patients (9.3%). CBD stones were identified in 56 patients and benign papillary stenosis in 5 patients (57.5%). Of these 61 patients, 58 (95%) were treated by endoscopic sphincterotomy (ES) and stone extraction followed by LCH after a mean interval of 1.6 days. Three patients with failure of endoscopic ductal stone extraction required open CBD exploration. In 39 of the 106 patients (36.8%) ERCP was negative for ductal stones but revealed unexpected ampullary and pancreatic cancer in two cases. Six patients (of the 106) with preoperative ERCP cannulation failure (5.7%) were managed either by LCH and intraoperative cholangiography or by open CBD exploration. In 22 of the 1140 total patients (1.9%) ERCP was performed at various intervals after LCH. Retained CBD stones were found in eight patients, and ES and ductal clearance was achieved in all eight. There was no mortality among the entire surgical group who underwent perioperative ERCP/ES. Including two cases of ES-related pancreatitis, the overall morbidity was 5.5% (7 of 128). Perioperative ERCP/ES in conjunction with LCH is an attractive approach for patients with cholecystocholedocholithiasis, at least until laparoscopic ductal clearance becomes a standard procedure.

Adolescent↗
PubMedDate not supplied

Value of diagnostic laparoscopy in abdominal malignancies.

Diagnostic laparoscopy was performed in 72 patients for diagnosis of suspected cancer or staging of intraabdominal malignancies. In 66 of 72 patients (91.7%) a diagnosis was possible laparoscopically and in 53 patients (73.6%) a laparotomy was avoided. In 19 of 72 patients (26.4%) laparoscopy changed staging of preoperative non-invasive test and helped to plan proper surgical management. Laparoscopy has proved to be an effective diagnostic tool in abdominal malignancies and should help to avoid unnecessary laparotomies in case of incurable disease. It should be used complementary to non-invasive imaging methods and the addition of laparoscopic ultrasonography will improve the accuracy of examination.

Abdominal Neoplasms↗