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R Raakow

Publications and source records attributed to R Raakow.

At least 19 recordsLinked to original sources
PubMed2004

Computed tomography-guided pulmonary nodule localization before thoracoscopic resection.

PURPOSE: To assess the success rate and complication rate of a CT-guided pulmonary nodule-marker system before thoracoscopic resection. MATERIAL AND METHODS: In 24 patients (15 M, 9 F; age range, 18-71 years) a total of 25 pulmonary nodules (in 1 patient 2 lesions simultaneously) were marked with a special wire under CT-guidance and then thoracoscopically resected. We evaluated lesion size, lesion distance to the pleura, the time of intervention, complications, and thoracoscopic success rate. RESULTS: Mean lesion size was 7 mm (range 4-15 mm) and mean lesional distance to the pleura was 13 mm (range 2-31 mm). The pulmonary nodule-marker system was positioned successfully in all 25 pulmonary nodules within 5-11 min (mean 7.5 min). Minimal pneumothoraces were observed in five patients with no requirements of chest drains. In addition, no bleeding complications or hematothorax were observed. All 25 pulmonary nodules could be resected thoracoscopically. However, in one patient (4%), the guide-wire dislocated during thoracoscopy, but the lesion could be successfully resected during thoracoscopy. CONCLUSION: The CT-guided placement of the pulmonary nodule-marker system used here offers a safe and accurate guide for the localization of small pulmonary nodules during thoracoscopic resection.

Adolescent↗
PubMed2002

Right hepatic lobectomy for recurrent cholangitis after combined bile duct and right hepatic artery injury during laparoscopic cholecystectomy: a report of two cases.

BACKGROUND: Bile duct injuries in combination with major vascular injuries may cause serious morbidity and may even require liver resection in some cases. We present two case studies of patients requiring right hepatic lobectomy after bile duct and right hepatic artery injury during laparoscopic cholecystectomy. PATIENTS: Two patients sustained combined major bile duct and hepatic artery injury during laparoscopic cholecystectomy. Surgical management consisted of immediate hepaticojejunostomy with reconstruction of the artery in one patient and hepaticojejunostomy alone in the other patient. In both cases the initial postoperative course was uncomplicated. RESULTS: After 4 and 6 months both patients suffered recurrent cholangitis due to anastomotic stricture. Both developed secondary biliary cirrhosis and required right hepatic lobectomy with left hepaticojejunostomy. The patients remain well 31 months and 4.5 years after surgery. CONCLUSIONS: The outcome of bile duct reconstruction may be worse in the presence of combined biliary and vascular injuries than in patients with an intact blood supply of the bile ducts. We recommend arterial reconstruction when possible in early recognized injuries to prevent late strictures. Short-term follow-up is most important for early recognition of postoperative strictures and to avoid further complications such as secondary biliary cirrhosis.

Adult↗
PubMed2002

[Laparoscopic transhiatal approach to epiphrenic esophageal diverticula].

INTRODUCTION: The operative treatment for epiphrenic diverticula is usually performed via thoracotomy or laparotomy. PATIENTS AND METHODS: Alternatively we describe the feasibility of a laparoscopic transhiatal approach in three consecutive symptomatic patients with four epiphrenic diverticula. In all cases, the diverticula were completely resected laparoscopically in combination with an esophagomyotomy and a posterior partial fundoplication. RESULTS: The three patients showed uneventful postoperative courses with a speedy recovery and are symptom-free after a follow-up of 22-41 months. CONCLUSION: Our results demonstrate that laparoscopic transhiatal procedure in patients with symptomatic epiphrenic diverticula can be performed safely, effectively, and gently.

Aged↗
PubMed2001

The laparoscopic Janeway gastrostomy. An alternative technique when percutaneous endoscopic gastrostomy is impractical.

BACKGROUND AND STUDY AIMS: Today, percutaneous endoscopic gastrostomy (PEG) is the standard procedure for ensuring safe feeding access. In the case of advanced hypopharyngeal and esophageal carcinomas, it may not be feasible to pass an existing stenosis by endoscopy. The aim of this prospective study was to investigate the laparoscopic Janeway gastrostomy as an alternative technique for guaranteeing feeding access in these instances. PATIENTS AND METHODS: Between May 1993 and December 1999, 21 patients underwent laparoscopic Janeway gastrostomies. Indications were extended incurable tumors of the hypopharnyx (n = 12) and esophagus (n = 9) which rendered oral nutrition impossible and did not allow passage by the endoscope. RESULTS: The mean operative time was 38 minutes (range 24-50). No procedure-related intraoperative or postoperative complications were observed. All patients recovered quickly from surgery and the gastrostomies functioned well in all cases until the death of the patients. CONCLUSION: The laparoscopic Janeway gastrostomy is a safe and simple technique for palliative feeding access, avoiding a laparotomy in patients in whom percutaneous endoscopic placement is impractical.

Aged↗
PubMed2000

[Classification and treatment of bile duct injuries after laparoscopic cholecystectomy].

Iatrogenic bile duct lesions are serious complications during laparoscopic cholecystectomy and include biliary leakage and major bile duct injury. The incidence of biliary lesions following laparoscopic cholecystectomy is up to threefold higher than that of the open procedure. A total of 108 patients with bile duct lesions after laparoscopic cholecystectomy were treated at our institution. Endoscopic treatment was successful in 68 cases, 6 patients were treated by external drainage, and 34 patients required surgical therapy. Selection criteria for the type of treatment included the etiology, anatomical situation, and diagnostic interval of the biliary lesion. We suggest a classification of bile duct injury and a proposal for diagnosis and treatment of these complications.

Adult↗
PubMed1999

[Motherhood and fatherhood after liver transplantation].

BACKGROUND AND OBJECTIVE: Liver transplantation for terminal liver failure enables patients to look forward to many years of good quality life. As a result, more and more of the often still relatively young transplant recipients inquire about the possible risks to a child procreated after transplantation. PATIENTS AND METHODS: During 9.5 years (between September 1988 and April 1998) 1000 liver transplantations were performed on 911 patients (374 females, 537 males) at our hospital. The potential for parenthood existed for 163 women (aged between 16 an 46 years) and 520 men. 14 children were born of 14 women, six pregnancies ended in spontaneous abortion or miscarriage and three other women are now pregnant. Seven men reported paternity of eight children after transplantation. All data were collected prospectively. RESULTS: Six of the 14 births (42.9%) proceeded normally, but up to three complications developed in the other eight (57.1%). Six women (35.7%) developed hypertension during the pregnancy. There was no case of transplant dysfunction or toxaemia of pregnancy. Half the births were by caesarean section. Premature births occurred in two women (14.3%); four children were underweight (< 2500 g) at birth (28.6%). The seven men, at a mean age of 44 (7-75) months after transplantation, fathered eight children, at present aged between 11 months and 6 years, all of whom have developed normally. The 13 children of the post-transplantation mothers are also without malformation or abnormal development. One child's development is retarded due to a fetal alcohol syndrome resulting from the mother's post-transplantation alcohol abuse during pregnancy. All the patients are well at present and live with their children. CONCLUSIONS: Both men and women can procreate at a relatively low risk to the off-spring. But for this to happen, an informed decision for parenthood must be made by the prospective parent together with her/his partner and the doctor in charge, she/he must be in good physical condition with stable transplant function, and there must be frequent interdisciplinary monitoring during any post-transplantation pregnancy.

Abortion, Spontaneous↗
PubMed1999

[Laparoscopic therapy of diaphragmatic rupture on both sides].

The usual treatment for operative repair of diaphragmatic injuries is laparotomy or thoracotomy. We report on a 26-year-old patient, who was treated by laparoscopic surgery for a rupture on both sides of the diaphragm. The operation was without complications and the advantages of minimally invasive laparoscopic surgery were clearly evident. There was much less strain on the patient and the postoperative recovery period was short. In addition, for unclear findings there is a high diagnostic potential in laparoscopy. The rupture on the right side of the diaphragm was not diagnosed until laparoscopy, although our patient underwent extensive diagnostics prior to the intervention.

Adult↗