PubMed Health⌕ Search

Biomedical subjects

U Hildebrandt

Publications and source records attributed to U Hildebrandt.

At least 19 recordsLinked to original sources
PubMed1996

Biomechanical stabilization of the nipple valve in continent ileostomy.

Despite stapler stabilization, sliding complication of nipple valve function occur in 19 per cent of continent ileostomies. Because the tendency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of contacting intestinal walls was removed by selective ultrasonic fragmentation. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a median time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch. All are functioning well after a median of 4.6 (range 3.0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm2 was shown by endosonography. This procedure may provide long-term prevention of sliding complications in continent ileostomies.

Adenomatous Polyposis Coli↗
PubMed1996

First experience with laparoscopic spine fusion in an experimental model in the pig.

BACKGROUND: We elucidated whether anterior lumbar spine fusion with interbody implants (BAK) can be performed in an experimental model in the pig using a transperitoneal laporoscopic approach. METHODS: In seven animals, a pneumoperitoneum with an intraabdominal pressure of 12 mmHg was induced, and five trocars were placed in the middle, as well as in the left and right lateral aspect of the abdomen. With the use of specially designed instruments, the bifurcations of the aorta and vena cava were prepared. The sacral artery, overlying the anterior aspect of the L5/S1 disc space, was retracted, allowing the exposure of the disc space. A working trocar was then fixed to the spine bodies above (L6) and below (S1) the disc, and instrumentation was completed by destruction of the disc, insertion of distraction plug, and implantation of the BAK cage. X-ray control allowed exact positioning of the cage. RESULTS: There were no major complications during the operative procedure, in particular no bleeding from major blood vessels and no injury to intraperitoneal organs. Cages were implanted in all animals in correct position, as indicated by postoperative X-ray control. CONCLUSIONS: We conclude from our experiments that in the pig model implants for anterior interbody lumbar spine fusion can be inserted successfully using the laparoscopic approach. We propose that the pig model represents an ideal tool for training before applying this operative procedure in men.

Animals↗
PubMed1996

[Laparoscopic 2-level fusion of the lumbar spine with Bagby and Kuslich implants].

In a 50-year-old female patient, presenting with permanent low lumbar back pain and intermittent neurological alterations due to degenerative disc disease L4-5 and L5-/S1 we demonstrate that two-level anterior interbody fusion can be performed via laparoscopic transabdominal instrumentation using BAK interbody implants. Intervertebral disc space L5-/S1 was stabilized approaching the spine caudally of the aortic bifurcation, while disc space L4-L5 required an approach from the left lateral aspect, mobilizing the aorta and vena cava to the right. The postoperative course was without complications and allowed discharge from the hospital on day 8. X-ray control 4 months later demonstrated restoration of adequate disc space at L4-L5 and L5-/S1 and appropriate positioning of the implants.

Female↗
PubMed1996

[Surgical treatment concept in traumatic sphincter lesions].

The surgical problems of traumatic sphincter lesions are reported comparing early and late repair. In 11 acute injuries the surgical concept consisted generally of proximal fecal deviation, distal washout, reconstruction of the muscular defects and presacral drainage. In soft tissue injuries (grade I, n = 2) complete healing without functional deficiencies was obtained inspite of renouncing fecal diversion. In isolated ruptures of the rectum or the sphincter (grade II, n = 3) and in complete disruption of both components (grade III, n = 4) after healing and closure of the temporary colostomy continence was estimated subjectively as being sufficient. Patients' overall-appraisal was not correlated to the preoperative degree of destruction not the postoperative measurement of continence. Only when devascularisation of the anorectum with severe bleeding had occurred (grade IV, n = 2) proctectomy was necessitated resulting in one death. In none of 5 patients operated on elsewhere there was a chance of secondary sphincteric reconstruction. During operation or endosonographically and electromyographically the sphincter musculature could not be detected. Obviously renouncing of anatomical reconstruction leads not only to retraction but also to secondary degeneration of the sphincter muscles.

Adolescent↗
PubMed1996

[Laparoscopic resections in colon carcinoma].

Since 1992 laparoscopic-assisted resections have been performed in 43 patients with tumors of the right or left colon. Excluding one patient with anastomotic leak there were no harvest complications. After a mean follow-up of 25 months 26/39 patients are living without tumor progress or recurrence, none of the 39 patients have abdominal wall metastases as yet; nine patients died due to tumor progress.

Adult↗
PubMed1995

[Laparoscopic resections in Crohn disease].

39 patients with Crohn's disease underwent laparoscopic bowel resections during January 1993 to May 1995 (16 female, 23 male, with an average age of 33 years). The duration of the disease ranged from one to 18 years. 21 of the 39 patients were under steroid therapy at the time of operation. Seven patients have had ileocaecal resection for Crohn's disease. The operative technique is laparoscopically assisted. We performed: small bowel resections (8), ileocaecal resections (16), hemicolectomies (11), subtotal colectomies (2), colectomies (2). Operative time ranged from 90 to 280 min for ileocaecal resections and from 330 to 420 min for colectomies. Intraoperative complications were not encountered. Postoperatively one patient developed a subhepatic abscess which was drained under sonographic guidance on day 6. One patient was reoperated for a different disease on postoperative day 2. Two patients had fever till day 9 and 13 without clinical relevance. Two patients had delayed incision site healing. Postoperative clinical stay was 11 days. The main benefit for the patients was early mobilisation due to reduced pain. Patients experienced the small abdominal incision as a ray of hope in their chronic disease.

Adolescent↗
PubMed1995

[Experimental approach to left laparoscopic pancreas resection preserving the spleen].

The pancreas has been excluded from laparoscopic surgery ever since. The technical possibilities of laparoscopic left resection of the pancreas in pigs are examined in this study. Mobilization of the left pancreatic segment up to the confluence area (splenic vein and upper mesenteric vein) was possible preserving the spleen. Sectioning of the organ was performed by ultrasound dissector and selective clipping of the pancreatic duct in 4 animals, in 2 animals this was achieved by Endo-GIA. The size of resected segments was 10-15 cm in length, 2-4 cm in width and the segments weighed 30 gr. Laparoscopic left resection of the pancreas with preservation of the spleen is technically possible in pigs. Postoperative complications have to be further examined in survival studies.

Animals↗
PubMed1995

[Technique and quality of laparoscopic hand-sewn intestinal anastomoses in an experimental procedure].

In conventional surgery running suture of all intestine layers is used commonly. Therefore we have tested the following manual running suture technics for laparoscopic surgery using animal experiments. 1. Turnover technic: suture of front and back-wall from outside by using holding sutures. 2. Non-turnover-technic: special holding sutures to fix the back-wall and sewing from the inside followed by the front-wall from outside. 3. Clamp-technic: By using two special parallel closing clamps (Endo-Gauge) with a suture from inside and outside. The ends of the anastomosis are well fixed without additional suture. All animals (n = 15) survived without complications, without leakage of the anastomosis and only one third developed intraabdominal fusions. The main difference was in time performing the anastomosis: 64 min. for the turnover technic, 52 min. for the non-turnover technic and only 25 min for the clamp technic without holding sutures. According to this results, we start to design a new bowel-clamp for sewing laparoscopic anastomosis. Therefore it is possible to perform a laparoscopic manual running suture in a reasonable amount of time. Furthermore the laparoscopic manual suture is a good alternative to the stapler technic because it is much less expensive and leaves no foreign materials.

Anastomosis, Surgical↗
PubMed1995

[Intersphincteric rectum resection with colosphincter pouch].

In rectal cancer the emphasis has moved towards sphincter saving resection. Tumor site and penetration depth decide the operative technique in low rectal cancer. 1) Resection at the upper confinement of the anal canal. 2) Intersphincteric resection at the level of the dentate line. Reconstruction is achieved by a colonic J-pouch. From 1991 to 1994 we operated on 35 patients with an average age of 58.1 years. An intersphincteric resection was performed in 11 patients whose tumor was situated between 0 and 2 cm upwards the dentate line. 24 cancers were situated between 2 and 6 cm of the dentate line and were resected at the upper confinement of the anal canal with a linear stapler. Tumor penetration depth was determined endosonographically (ES). Four patients had tumor stage ES T1, 13 ES T2 and 18 ES T3. A J-pouch of 7-9 cm size was sutured (11) or stapled (24) to the anal canal. In 10 patients who underwent intersphincteric resection the pre- and post-operative anal pressures were determined. We did not encounter major complications. In three patients a leakage at the colonal anastomosis postponed closure of the diverting colostomy. We had no anastomotic recurrence but one pelvic side recurrence. Four patients developed liver metastases; in one case resectable. Postoperative anal sphincter pressure was reduced in all cases but clinically relevant only in one. This patient has frequent major soiling, three patients have occasional minor leak. Two patients are incontinent of gas, 26 are perfect continent. One patient has bowel movements every two days, 15 one per day, 12 two per day and 3 three per day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Pseudo-aneurysm of the hepatic artery. A rare complication after laparoscopic cholecystectomy].

With the spread of laparoscopic cholecystectomy more and more complications are being reported. For the first time in this paper a pseudoaneurysm of the right hepatic artery as a complication of laparoscopic cholecystectomy in a 55 year old patient is described. During embolization the aneurysm ruptured and an emergency laparotomy was performed. The right hepatic artery was ligated. The postoperative course up to follow-up at 6 months was uncomplicated.

Aneurysm, False↗
PubMed1994

Preoperative staging of rectal and colonic cancer.

In rectal cancer, endosonography assesses the tumor penetration depth, EUS T1 to EUS T3, with a sensitivity of 96% and a specificity of 89%. The evaluation of lymph nodes is less accurate, at 79%. The surgical strategy is different in the three parts of the rectum, and depends on the endosonographic tumor stage: upper third of the rectum--anterior resection for all tumor stages; middle third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior resection; EUS T3: anterior resection with complete excision of the mesorectum, reconstruction with coloanal pouch; lower third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior or intersphincteric resection with complete excision of the mesorectum, reconstruction with colon pouch; EUS T3: abdominoperineal excision. With the impact of endosonography, the proportion of abdominoperineal excisions has dropped from 46% to 15% during the last five years. Laparoscopic technology is likely to have an increasing impact on surgical procedures that have previously required an open approach. The following treatment policy derived from the endosonographic staging of colon tumors is proposed: EUS T1, laparoscopic segmental resection; EUS T2, laparoscopic oncological resection; EUS T3, conventional open surgery.

Colonic Neoplasms↗