Biomedical subjects

Th Böttger

Publications and source records attributed to Th Böttger.

3 recordsLinked to original sources

PubMed2006

[Laparoscopic pancreatic resection].

UNLABELLED: Over a long time laparascopy for pancreatic diseases was performed only as staging laparoscopy in order to find hidden metastasis. The laparoscopic pyloric preserving duodeno-pancreatectomy showed many problems and could not establish. Laparoscopic distal resection of pancreas is much more feasible due to lack of intestinal anastomoses. Anyway there is only few literature about laparoscopic left pancreatic resection found. We demonstrate our experiences in four cases of the last months. RESULTS: In all four cases laparoscopic distal pancreatic resection was performed for tumor. In three cases the resection of the spleen was necessary. In another case we performed a laparoscopic hemifundoplicaton (DOR) for GERD in the same session. Histologic examination showed a neuroendocrine carcinoma, a serous-microcystic adenoma, a low differentiated ductal adenocarcinoma and an intraductal papillary-mucinous tumor of borderline type. Postoperative stay was between eight and ten days. There was no patient suffering from intra- or postoperative complications. CONCLUSION: Laparoscopic resection of distal pancreas shows the common benefit of minimal invasive surgery for the early postoperative period and is an attractive alternative for treatment of benign and semimalign pancreatic tumors.

Adenoma↗

PubMed2006

[Laparoscopic Dor-hemifundoplication for therapy of gastroesophageal reflux disease].

INTRODUCTION: Gastroesophageal reflux disease is a major health problem in western industrial nations. Several prospective randomized studies showed the operative therapy of GERD superior to a steady medication with omeprazole regarding recurrence rate as well as rate of side effects. The today most performed 360 degrees fundoplication (Nissen-Rossetti) leads in 10-30% to a persisting postoperative dysphagia. We prefer the anterior semifundoplication by Dor. Aim of our study is to find out if our results are comparable to current literature and to open procedure. PATIENTS: Between 1.1.03 and 30.6.05 one operator performed on 100 consecutive patients (57 female, 43 male) between 29 and 86 years of age an anterior Dor-semifundoplication with posterior hiatal repair. In 37 cases we performed a cholecystectomy simultaneously, on two patients a sigmoid resection and in one case a left pancreatic resection. 52 Patients were re-evaluated after six months (median follow up nine months). RESULTS: Median operation time was 71 min (30-250 min). The learning curve showed a time reduction of initially 102 to 40 min in the last 10 cases. Blood loss was between 10 and 300 ml (median 40 ml). No conversion was necessary). As intraoperative complication in one case the right pleural cavity was opened. Postoperative complications were found to be wound infection in one case and urinary tract infection in another. Postoperative stay was four days (2-19 d) and eight days respectively for patients after sigmoid resection or left pancreatic resection. After median follow up of nine months 45 of 52 re-evaluated patients (86%) were free of reflux symptoms, 47 (90%) were pleased or very pleased with the result of the operation. Four patients felt at least a reduction of preoperative symptoms. CONCLUSION: The anterior Dor semifundoplication is a technically easy and low risk procedure, which has a lower side effect rate than the 360 degrees operation and will heal 90% of the patients from their reflux disease.

Adult↗

PubMed2006

[Extent of lymphnode dissection with minimally invasive esophageal resection].

UNLABELLED: Esophageal resection is still today associated with a high morbidity and mortality. Minimally invasive procedures show a significantly lower rate of such complications and therefore might also be associated with a lower surgical risk. However, publications till date contain little or no data on the extent of lymph node dissection. The aim of our study was to evaluate the morbidity and mortality rate of minimally invasive esophageal resection. MATERIAL AND METHODS: In the last two years, we carried out 25 minimally invasive esophageal resections on five women and 20 men with a median age of 63 years (range 41-74 years). All data were accrued prospectively. RESULTS: Nine patients were operated upon transhiatally and 12 combined laparocopic-thoracoscopic. On four patients, a thoracotomy was necessary. The average surgical time for the transhiatal approach was calculated at 164 minutes (range 150-180 min) and for the combined laparoscopic-thoracoscopic procedure 285 minutes (240-360 min). The thoracoscopic esophageal resection itself lasted 105 minutes on average; the last five resections each lasting 70 minutes. A median of 24,5 lymph nodes (19-26) was calculated in the laparoscopic-thoracoscopic technique. The transhiatal procedure revealed a median of 14 lymph nodes (12-17). Postoperatively, we had three cases of anastomotic and two cases of bronchial leakages, most probably associated with the use of monopolar current; complications no longer seen since usage of the HARMONIC ACE for surgical preparation. There was no 30 day letality. CONCLUSION: Our experience with 25 successful minimally invasive esophageal resections shows that with increasing experience and better surgical equipment, the extent of lymph node dissection does not differ from open procedure.

Adenocarcinoma↗