PubMed Health⌕ Search

Biomedical subjects

R Pointner

Publications and source records attributed to R Pointner.

At least 19 recordsLinked to original sources
PubMed2000

[Health-related and disease-specific quality of life assessment after laparoscopic repeated fundoplication].

PURPOSE: In recent years, the efficacy of laparoscopic antireflux surgery has been well-documented with quality-of-life data. The aim of the present study was to describe the efficacy of laparoscopic redo-surgery using health-related and disease-specific quality-of-life data. METHODS: A sample of 30 patients with mean age of 56 years underwent laparoscopic refundoplication. In 18 patients the primary antireflux procedure was performed by the open technique. In 12 cases the primary intervention was performed laparoscopically. To evaluate quality-of-life the German SF-36 Health Survey and the Gastrointestinal Quality of Life Index (GIQLI) were used and given to all patients before and 3 months and 1 year after redo-surgery. RESULTS: Before surgery, in two (physical functioning, role physical) out of 8 dimensions of SF-36 the values have not decreased significantly (P < 0.05) compared to healthy individuals. Three months after laparoscopic redo-surgery all reduced dimensions improved significantly (P < 0.05). One year after surgery all dimensions are stable and comparable to a healthy population. Prior to redo-surgery, the mean GIQLI was 86.7 points and improved significantly (P < 0.05) to 121.6 and 123.8 points (3 months and 1 year after refundoplication) and reached an equivalent level of comparable healthy individuals (122.6 points). There are no significant differences between patients with an open and laparoscopic initial antireflux procedure at all times of measurement. Postoperative data of only 28 patients were included because in two patients conversion was necessary due to operative problems. CONCLUSION: Because of these results laparoscopic refundoplication can be discussed as an effective method of treatment after failed primary antireflux procedure. Laparoscopic redo-surgery normalizes objective outcome criteria and also improves quality of life.

Adult↗
PubMed2000

Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up.

BACKGROUND AND STUDY AIMS: Quality of life data are becoming widely accepted as a measure of surgical outcome, but the multifaceted symptoms in patients with gastrointestinal disorders are a challenge for this type of evaluation. The aim of the present study was to determine any potential differences in quality of life, specifically in patients undergoing either laparoscopic "floppy" Nissen fundoplication or Toupet fundoplication. PATIENTS AND METHODS: Using the Gastrointestinal Quality of Life Index (GIQLI), the quality of life data for 175 consecutive patients undergoing laparoscopic "floppy" Nissen (n=107) or Toupet (n=68) fundoplication at our department of surgery over a period of 30 months were evaluated prospectively. The patients included 97 men and 78 women, with a mean age of 52 years. The GIQLI creates a general score for quality of life by classifying five different subscales: gastrointestinal symptoms, emotional status, physical and social functions, and stress of medical treatment. This questionnaire was given to the patients preoperatively, and on three occasions after surgery -- at six weeks, three months, and one year. RESULTS: The analysis showed that the patients had a low GIQLI preoperatively in comparison with healthy individuals (mean 90.4 vs. 122.6 points), with all subscales being affected. The general score improved significantly six weeks postoperatively (mean: 118.2 points; P<0.05), showed further improvement at three months (mean: 124.2 points), and remained stable at one year (mean: 123.1 points; P<0.01) postoperatively. There were no differences in the quality of life or side effects between patients with a Nissen or Toupet fundoplication, except regarding the frequency of mild, transient dysphagia. CONCLUSIONS: Patients with gastroesophageal reflux disease suffer from a poor quality of life. After laparoscopic fundoplication, the quality of life improves and becomes comparable to that of healthy individuals. In our view, quality of life data should be evaluated as a major factor in determining the role of surgical interventions. Patients should receive consultation and advice regarding quality of life questions prior to surgery.

Female↗
PubMed2000

Predictability of dysphagia after laparoscopic nissen fundoplication.

OBJECTIVE: Dysphagia is the most common complication of antireflux surgery. Temporary dysphagia occurs in addition to persistent dysphagia because of technical or physiological problems. Temporary dysphagia may be due to the patient's personal perception or faulty eating habits. The aim of this study was to investigate the impact of the patient's personality as it relates to temporary dysphagia and individual impairment. METHODS: Several studies have used the construct of personality known as "health locus of control" to predict health-related behavior and convalescence after medical or surgical treatments. This study investigates the predictability of the subjective degree of dysphagia and its perceived degree of impairment in relation to the health locus of control after laparoscopic so-called "floppy" Nissen fundoplication in 90 patients. Several questionnaires and single-item questions were given to the patients preoperatively, and 1 wk, 6 wk, and 3 months after surgery. The answers to the questions provided the data for this study. RESULTS: Preoperatively, 92% of the patients had no dysphagia and 8% had a mild subjective degree of dysphagia. Temporary postoperative dysphagia was found in approximately 50% of the patients 1 wk after surgery. The intensity of the dysphagia ranged among mild (18%), moderate (15%), and severe (16%). Three months postoperatively about 80% had no dysphagia and only 2% severe dysphagia. Correlations between the construct of personality and the intensity of postoperative dysphagia and its impairment revealed a significant relationship at all times. Patients with high expectations for their own health-related abilities (internal control) had less dysphagia (r = -0.78 after 1 wk [p<0.001], r = -0.71 after 6 wk [p<0.001], and r = -0.64 after 3 months [p<0.001]), compared with patients who believed that their convalescence depended more on luck, chance, or fate (external control) (r = 0.67 after 1 wk [p<0.01], r = 0.72 after 6 wk [p<0.001], and r = 0.63 after 3 months [p<0.01]). These results are highly significant. The correlation between health locus of control the degree of a subjective impairment from perceived dysphagia showed similar results (p<0.01). CONCLUSIONS: The subjective degree of dysphagia and the perceived impairment as a result of laparoscopic antireflux surgery can be predicted according to the personality of the patient. Those patients with low expectations for their own abilities can be identified before surgery, thereby allowing adaptation techniques to be applied that could improve the results and well-being of patients after antireflux surgery.

Attitude↗
PubMed1999

Laparoscopic refundoplications after failed antireflux surgery.

BACKGROUND: Open and laparoscopic antireflux procedures may require reoperation for failures of the initial procedure in about 3% to 6% of cases. The purpose of this study is to describe our operative experiences, postoperative results, and patients' view of outcome following laparoscopic refundoplication. METHODS: Thirty patients (18 men, 12 women), mean age 56 years (range 37 to 77) underwent laparoscopic redo surgery. In 18 patients the initial surgery was done by the open technique, and 3 had surgery twice previously. Twelve patients had previous laparoscopic antireflux surgery. Indications for redo surgery were recurrent reflux (n = 17), dysphagia (n = 6), and the combination of both (n = 7). RESULTS: Twenty-eight patients were completed laparoscopically, 21 with a floppy Nissen and 7 with a Toupet fundoplication. Two patients were converted to the open procedure because of intraoperative technical problems. In 5 cases there was an injury to the stomach wall, successfully managed laparoscopically. Postoperatively 1 patient had dysphagia and required pneumatic dilatation, another had gas bloat. There was a significant increase in lower esophageal sphincter pressure at 3 months (12.4+/-4.8 mm Hg; n = 30) and 1 year (12.3+/-4.5 mm Hg; n = 30). Twenty-four hour pH monitoring showed a decrease of the DeMeester Score at 3 months after surgery from 14.7+/-10.6 (n = 30) and 1 year after surgery from 12.1+/-8.7 (n = 30). Gastrointestinal quality of life index increased from 87 points preoperatively to 121 at 3 months and 123 at 1 year, which is comparable with a healthy population (123 points). CONCLUSIONS: Laparoscopic refundoplication is a feasible and effective procedure with excellent postoperative results, independent of whether the primary procedure was done by the open or laparoscopic technique.

Esophagogastric Junction↗
PubMed1999

[Coping with stress and personality structure in patients with and without stress-associated symptoms of gastroesophageal reflux].

BACKGROUND: Psychological aspects like stress, emotions or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate differences in coping with stress, structure of personality and also objective and subjective parameters of patients with or without a stress-related perception of symptoms in GERD. METHODS: 100 patients which underwent laparoscopic antireflux surgery at our department of surgery were included in this study. All patients answered questionnaires to evaluate their coping with stress (SVF), structure of personality (FPI-R) and quality of life (GILQI) pre- and postoperatively. Also data of physiological parameters like manometry, 24-hours pH monitoring, endoscopy and clinical history were included. Patients were divided into two groups: one with and one without a stress-related perception of symptoms. RESULTS: 46 out of 100 patients declared stress-related symptoms of reflux (group 1) and 54 out of 100 had no influence of stress to their reflux disease (group two). Those two groups showed significant differences (p < .05) in some coping strategies and their personality: Coping with stress (SVF): Trial to control the situations (18.3 vs. 13.1), trial to control reactions (18.2 vs. 13.3), requirement of social support (9.7 vs. 14.8), tendency to escape (7.7 vs. 13.9) and aggression (13.1 vs. 7.6); structure of personality (FPI-R): Standard of performance (10.8 vs. 7.2), stress (9.8 vs. 4.7) and physical discomfort (7.6 vs. 4.6). We also found significant (p < .05) differences in pre- and postoperative quality of life (GILQI: preoperative 86.3 vs. 98.5 points; postoperative 117.9 vs. 128.2 points) and the day-time of reflux perception. There were no differences in physiological parameters. CONCLUSION: These findings point out that there are no physiological differences between the two groups with or without stress-related symptoms in GERD. But we found significant differences in psychological factors. Therefore we suggest that preoperative psychological interventions may optimize the subjective outcome after antireflux surgery in patients with a stress-related perception of symptoms.

Adaptation, Psychological↗
PubMed1998

[Quality of life after laparoscopic antireflux surgery--Nissen fundoplication].

PURPOSE: During the last few years there has been an increasing interest in evaluating quality of life (QOL) data regarding surgical treatment. METHODS: The present study comments the efficacy of laparoscopic antireflux surgery after required Nissen fundoplication of 70 patients. Therefore, the German Gastrointestinal Quality of Life Index (GIQLI) was used to query the patients preoperatively and three times after surgery up to 1 year. RESULTS: Preoperatively, we found a low general GIQLI score (mean 92.7 points), which increased 6 weeks postoperatively (116.8 points), 3 months (124.8) and 1 year (mean 123.9 points) significantly and is now comparable to the healthy population (122.6 points). CONCLUSION: It is our opinion that the efficacy of the treatment of gastroesophageal reflux disease with required Nissen fundoplication can also be documented and discussed by using QOL.

Adult↗
PubMed1998

Dieulafoy's disease of the large and small bowel.

The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. We describe four patients with extragastric Dieulafoy's disease, in the duodenum (one), the proximal jejunum (two), and the left hemicolon (one). Diagnosis was made by endoscopy in all four and confirmed by histology in three. The pathology of the Dieulafoy lesion is essentially the same throughout the gastrointestinal tract. Endoscopic treatment by sclerotherapy combined with electrocoagulation was successful in the duodenal and colonic Dieulafoy lesions, but not in the jejunal lesions.

Adult↗
PubMed1997

Respiratory symptoms in patients with gastroesophageal reflux disease following medical therapy and following antireflux surgery.

BACKGROUND: It is not known whether antireflux surgery is more effective than medical therapy to control respiratory symptoms (RS) in gastroesophageal reflux disease (GERD). METHODS: In 21 GERD patients with RS, reflux was assessed by endoscopy, manometry, and pH monitoring. Patients had proton pump inhibitor therapy and cisapride for 6 months. After GERD relapsed following withdrawal of medical therapy, 7 patients with normal esophageal peristalsis had a laparoscopic Nissen fundoplication and 14 with impaired peristalsis a Toupet fundoplication. Respiratory symptoms were scored prior to treatment, at 6 months following medical therapy, and at 6 months after surgery. RESULTS: Heartburn and esophagitis were effectively treated by medical and surgical therapy. Only surgery improved regurgitation. Respiratory symptoms improved in 18 patients (85.7%) following surgery and in only 3 patients (14.3%) following medical therapy (P <0.05). Esophageal peristalsis improved following the Toupet fundoplication. CONCLUSION: Medical therapy fails to control reflux since it does not inhibit regurgitation. Surgery controls reflux and improves esophageal peristalsis, which contributes to its superiority over medical therapy in the treatment of RS associated with GERD.

Adult↗
PubMed1996

Laparoscopic technique of proximal selective vagotomy.

Proximal selective vagotomy (PSV) is an effective, definitive therapy for peptic ulcer disease of the duodenum. Long-term studies have shown that ulcer recurrence occurs in less than 10% of patients if the operation is performed by an experienced surgeon. Since PSV does not influence gastric emptying, side effects such as diarrhea, gastric stasis or the dumping syndrome are rare. Due to this favorable experience, PSV is our preferred technique for the laparoscopic approach to peptic ulcer disease. We have performed this operation in 13 patients. Indications were chronic duodenal ulceration unresponsive to medical therapy, chronic duodenal ulceration combined with reflux esophagitis, and reflux esophagitis due to gastric acid hypersecretion. In patients with reflux esophagitis PSV was performed in addition to an antireflux procedure. Laparoscopic PSV can be performed more accurately than the open procedure since it allows for better visualization with less possibility of missing small vagal connections to the parietal cells such as the 'criminal nerve'. The median duration of operation was 3 hours. There were no serious peri- or postoperative complications. The median time of postoperative hospital stay was 3 days. During the median follow-up of 27 months no recurrence of duodenal or esophageal ulceration was encountered and none of the patients complained of epigastric pain, diarrhea or dumping symptoms.

Adult↗
PubMed1994

Gastric remnant cancer has a better prognosis than primary gastric cancer.

OBJECTIVE: To study the prognosis of gastric remnant cancer following radical resection (group 1) compared with that of primary gastric cancer of the upper third of the stomach following radical resection (group 2). DESIGN: Cohort study with a 5-year follow-up. SETTING: A university hospital in Austria. PATIENTS: Group 1 consisted of 43 patients, and group 2, of 61. Postoperative deaths and deaths during the follow-up period that were not related to gastric cancer were excluded. Fifteen patients in group 1 (34.9%) presented with stage I cancer; 10 (23.3%), stage II; 13 (30.2%), stage III; and five (11.6%), stage IV. Twenty patients in group 2 (32.8%) presented with stage I cancer; 12 (19.7%), stage II; 15 (24.6%), stage III; and 14 (22.9%), stage IV (Union Internationale Contre le Cancer staging classification, 1987). MAIN OUTCOME MEASURES: Overall and stage-related 5-year survival rates. RESULTS: The overall 5-year survival rate was 53.5% in group 1 and 32.8% in group 2 (P < .05). The stage-related 5-year survival rate in group 1 was 100% for stage I and 80% for stage II. In group 2, the stage-related 5-year survival rate was 65% for stage I and 25% for stage II (both, P < .01). No significant difference was noted for stages III and IV. CONCLUSIONS: The prognosis of cancer of the gastric remnant presenting as stage I or II is good and is significantly better than that of the equivalent stages of primary cancer of the upper third of the stomach.

Adolescent↗
PubMed1994

Bone disorders following total gastrectomy.

Bone disorders following gastrectomy were studied by measuring absolute and relative bone mineral density of the Wards triangle, serum 1,25-(OH)2-D, alkaline phosphatase, and total serum calcium. The subjects were 20 males who had undergone total gastrectomy not more than three months previously (group A1). Seventeen of these patients were reviewed three years later (group A2). Absolute and relative bone density were significantly lower in group A2 than in A1 (0.52 +/- 0.011 g/cm2 versus 0.6 +/- 0.014 g/cm2, P < 0.01 and 85.5 +/- 1.4% age-matched control versus 95 +/- 1.3%, P < 0.01). 1,25-(OH)2-D was significantly lower in group A2 than in group A1 (14.3 +/- 0.97 pg/ml versus 20.6 +/- 1.02 pg/ml, P < 0.01). There was no difference in alkaline phosphatase and calcium serum concentration. The mean weight loss was 6.26 +/- 0.57% over the follow-up period, and weight loss correlated with absolute and relative bone density (r = -0.74, P < 0.01). There was a positive correlation between 1,25-(OH)2-D and absolute or relative bone density (r = 0.67, r = 0.62 and P < 0.01). These data suggest that bone density decrease has already occurred three years after total gastrectomy and is positively correlated to 1,25-(OH)2-D deficiency. As no differences in serum alkaline phosphatase and serum calcium concentration were found, these factors are of little value for the early detection of postgastrectomy bone disorders, whereas weight loss is a valuable screening parameter.

Aged↗
PubMed1994

Lymphangitis carcinomatosis of the lesser omentum: a prognostic factor in gastric cancer.

A series of 126 patients with gastric cancer who underwent radical gastrectomy with systemic lymph node dissection revealed 9 patients who survived for a median time of only 3 months. Of these 9 patients, 4 were classified by the UICC system as stage II and 5 as stage III, all of whom had lymphangitis carcinomatosis of the lesser omentum. These data suggest that although lymphangitis carcinomatosis of the lesser omentum is an uncommon finding, if it is present, curative surgery is impossible and an operation should therefore be limited to tumor palliation.

Adult↗
PubMed1994

Traumatic bilhemia.

BACKGROUND: Retrospective analysis was done of three cases with severe liver trauma and excessive serum bilirubin levels caused by a traumatic biliovenous fistula. The literature is reviewed. METHODS: Diagnostic measures included laboratory findings, computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The biliovenous fistula was detected by ERCP in two cases. In one case a left hemihepatectomy was carried out, and the patient was cured. The other patient received drainage of a huge necrotic cavity in the center of the liver. Ten months later the patient underwent reoperation, and left hepatic resection was performed. The patient died of liver function failure on postoperative day 7. In the third case the fistula subsided spontaneously. CONCLUSIONS: An excessively high serum level of direct bilirubin and only moderately elevated liver enzymes indicate bilhemia in trauma patients. ERCP is most reliable in localizing the fistula; computed tomography/ultrasonography are valuable in detecting the extension and localization of the parenchymal destruction. Conservative therapy is justified if the patient is in good condition or if the localization of the fistula is unclear. Spontaneous closure of the fistula may occur. Surgical treatment options are partial liver resection and suture of the fistula and T-tube drainage of the common bile duct and drainage of the rupture site.

Adolescent↗