Biomedical subjects

W Raue

Publications and source records attributed to W Raue.

At least 19 recordsLinked to original sources

PubMed2006

[The role of anesthesiology in fast track concepts in colonic surgery].

In the present study the "fast-track rehabilitation" protocol of the Charité university hospital for patients undergoing elective colonic resection is described. The underlying principles, clinical pathways and outcome data from 208 patients are shown. Particularly anesthesiological aspects of this multimodal approach, such as modified preoperative and postoperative fluid management, changed guidelines for preoperative fasting, effective analgetic therapy using epidural analgesia and avoiding high systemic doses of opioids, use of short-acting anesthetic agents, and maintenance of normothermia as well as normovolemia are presented and discussed. In comparison to outcome data before "fast-track rehabilitation" was established, the duration of postoperative hospital stay has been reduced from 12 to 5 days, the number of general complications (pneumonia, duodenal ulcer bleeding, urinary tract infection, cerebral, cardiac and renal dysfunction) decreased from 20% to 7%, whereas surgical complications remained constant at 17% (8% wound infections, 3% anastomotic insufficiency).

Analgesia, Epidural↗

PubMed2006

[Value of laparoscopic surgery in elective colorectal surgery with "fast-track"-rehabilitation].

INTRODUCTION: Laparoscopic (LAP) versus open (CON) colonic resection with traditional perioperative care has some short term benefits postoperatively regarding functional recovery. Whether these benefits may also occur when all patients are treated with multimodal "fast-track"-rehabilitation programs is questionable. METHODS: Patients undergoing elective left sided colonic surgery were prospectively non randomised observed. The "fast-track" program included patient information, thoracic peridural analgesia, forced mobilisation and oral intake, and stress reduction. Endpoints were duration of postoperative ileus and hospital stay, general- and local complication, and pulmonary function. RESULTS: 147 consecutive patients were operated on, 47 open and 100 laparoscopically. The time until oral intake was completed seemed to be shorter in the LAP-group (p=0.07) followed by a shorter hospital stay (p<0.01). The pulmonary function was postoperatively improved in the LAP-group compared to the CON-group (p<0,01). General complications (LAP 9% vs. CON 17%) were non significantly increased in the CON-group. Local complications increased in the CON-group (LAP 13% vs. CON 28%, p<0,05). CONCLUSION: Even with perioperative "fast-track"-rehabilitation programs short term advantages were found in laparoscopic compared with open colonic surgery in a non randomised population. The clinical relevance should be examined in controlled randomised trials.

Adult↗

PubMed2005

"Fast-track" rehabilitation after rectal cancer resection.

BACKGROUND AND AIMS: After rectal cancer surgery, postoperative general complications occur in 25-35% of all patients and postoperative hospital stay is 14-21 days. "Fast-track" rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Because the feasibility of "fast-track" rehabilitation in patients undergoing rectal cancer surgery has not been demonstrated yet, we demonstrate our initial results of "fast-track" rectal cancer surgery. PATIENTS AND METHODS: Seventy consecutive unselected patients undergoing rectal cancer resection by one surgeon underwent a perioperative "fast-track" rehabilitation. Demographic and operative data, pulmonary function, pain and fatigue, local and general complications and mortality were assessed prospectively. RESULTS AND FINDINGS: Thirty-six female and 34 male patients aged 65 (34-77) years underwent open (n=31) or laparoscopic (n=39) anterior resection with partial mesorectal excision (PME 27), anterior resection with total mesorectal excision and protective loop ileostomy (TME 29) or abdominoperineal excision with colostomy (APR 14). Overall, pulmonary function returned to >80% of preoperative value on day 2 (1-4) and the first bowel movement occurred on day 1 (0-3) after surgery. The incidence of local and general complications was 27 and 18%, respectively. Postoperative hospital stay was 8 (3-50) days overall, but shorter after PME [5 (3-47)] than TME [10 (5-42)] or APR [9 (5-50)] (p<0.01). INTERPRETATION AND CONCLUSION: "Fast-track" rehabilitation was feasible in patients undergoing rectal cancer resection. Local morbidity was not increased, while general morbidity and postoperative hospital stay compared favourably to other series with "traditional" perioperative care.

Adult↗

PubMed2005

Fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resection: data from a randomized controlled trial.

BACKGROUND: A reduced peritoneal fibrinolytic capacity after surgery is currently accepted to be the main cause for postoperative adhesions. The aim of this prospective randomized trial was to determine the fibrinolytic activity in peritoneal fluid after laparoscopic as compared to conventional colorectal resection. METHODS: A randomized controlled trial in parallel with the multicenter trial Lapkon II was conducted. Peritoneal fluid was sampled via drain at 2, 8, and 24 h after elective laparoscopic (n=14; LAP) and conventional (n=16; CON) colorectal resections. Activities and concentrations of tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and t-PA/PAI complex were determined in all specimen by ELISA kits. RESULTS: There was no difference in age, sex or body mass index between both groups. Postoperatively, t-PA activity decreased in both groups and was lower 2 h after closing the abdomen in the laparoscopic group (p<0.05). PAI-1 activity and concentration increased in both groups. Difference between the groups was measured for PAI-1 concentration after 24 h (p<0.05). There were no differences between the groups regarding t-PA concentrations, PAI-1 activity and t-PA/PAI complex. CONCLUSIONS: After closing the abdominal cavity, postoperative changes in fibrinolytic capacity of peritoneal fluid can be determined in samples collected by a drain. However, there were no major differences in the postoperative course of fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resections.

Aged↗

PubMed2005

[Fast track rehabilitation in colonic surgery: results of a prospective trial].

OBJECTIVE: In elective large bowel surgery the incidence of general complications with standard perioperative care is up to 27%. Hospital discharge occurs 10 to 15 days after a conventional or laparoscopic colonic resection. The aim of a fast track management is to reduce the number of general complications and the length of hospital stay. MATERIAL AND METHODS: We prospectively evaluated a multimodal protocol in our service utilizing a combined thoracic epidural analgesia, an early mobilization and oral nutrition to accelerate postoperative recovery after elective colonic surgery. RESULTS: One hundred thirty-two consecutive patients aged an average of 66 years (range 22-88) were operated by laparotomy (n =71) or laparoscopy (n =61) and treated with the fast track rehabilitation protocol. Surgical complications occurred in 15 patients (11 %), four of these had an anastomotique leakage (3%). General complications occurred in 11 patients (8 %), the mortality was 1 %. The median length of hospital stay was four days (range 3-77) and 14 patients (11%) had to be readmitted. CONCLUSION: Application of a fast track rehabilitation protocol lowered the number of general complications and reduced the duration of hospital stay in our study.

Adult↗

PubMed2005

Subcutaneous gentamycin implant to reduce wound infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: After loop-ileostomy closure subcutaneous wound infection is the most frequent postoperative complication. Implantation of local antibiotics has been shown to reduce the incidence of wound infection after different surgical procedures, therefore, a subcutaneous application of a gentamycin implant may also decrease infection rate after ileostomy-closure. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effectiveness of a subcutaneous gentamycin-collagen implant to reduce wound infection after loop-ileostomy closure. Patients had the same perioperative treatment and standardized anastomotic and closure technique. A collagen sponge with gentamycin was used in the treatment group and an identical collagen implant without antibiotics was used in the placebo group. RESULTS: Eighty patients (40 per group) were included. There was no difference between the groups with respect to demographics or in the postoperative course. The total wound infection rate was 10 percent with no difference between the gentamycin (n=4) and the collagen group (n=4) (P = 1.0). CONCLUSION: Subcutaneous implantation of a gentamycin sponge yields no clinically relevant reduction of the wound infection rate after loop-ileostomy closure so that routine use is not recommended in this procedure.

Aged↗

PubMed2004

'Fast-track' multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation.

BACKGROUND: Laparoscopic colorectal resection improves patient outcome by reducing pain, postoperative pulmonary dysfunction, gastrointestinal paralysis, and fatigue. A multimodal rehabilitation program ("fast-track") with epidural analgesia, early oral feeding, and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection, enabling early ambulation of these patients. METHODS: Fifty two consecutive patients underwent laparoscopic sigmoidectomy with standardized regular perioperative treatment (standard) or multimodal rehabilitation program ("fast-track"). Outcome measures included pulmonary function, duration of postoperative ileus, pain perception, fatigue, morbidity, and mortality. RESULTS: Twenty nine standard-care patients (19 men and 10 women) and 23 fast-track patients (15 men and eight women) were evaluated. Demographic and operative data were similar for the two groups. On the 1st postoperative day, pulmonary function was improved (p = 0.01) in fast-track patients. Oral feeding was achieved earlier (p < 0.01) and defecation occurred earlier (p < 0.01) in the fast-track group. Visual analogue scale scores for pain were similar for the two groups (p > 0.05), but fatigue was increased in the standard-care group on the 1st (p = 0.06) and 2nd (p < 0.05) postoperative days. Morbidity was not different for the two groups. Fast-track patients were discharged on day 4 (range, 3-6) and standard-care patients on day 7 (range, 4-14) (p < 0.001). CONCLUSION: Multimodal rehabilitation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay.

Adult↗

PubMed2004

Comparison of EORTC quality of life core questionnaire (EORTC-QLQ-C30) and gastrointestinal quality of life index (GIQLI) in patients undergoing elective colorectal cancer resection.

BACKGROUND: EORTC-QLQ-C30 questionnaires and GIQLI questionnaires are used to evaluate post-operative quality of life (QoL). It was not clear whether results of both instruments are comparable. Therefore, the level of agreement between both QoL questionnaires was evaluated in patients undergoing elective colorectal cancer resection. METHODS: Pre-operatively, 7 and 30 days after surgery 116 patients answered the EORTC-QLQ-C-30 and the GIQLI questionnaires in random order. Individual questions with similar content from each questionnaire were compared. Data for global QoL, physical (PF), emotional (EF) and social function (SF) were linearly transformed to fit a scale from 0 to 100. Data from the two instruments were correlated and the level of agreement between them was calculated according to the method of Bland and Altman. RESULTS: A total of 308 data sets [(pre-op. n=116; 7th pod n=101; 30th post-operative day (pod) n=91)] were evaluated. Both instruments detected a reversible reduction of QoL after surgery and gave inferior results for patients with conditions known to impair QoL. EORTC-QLQ-C30 was more sensitive than GIQLI. The correlation between the two questionnaires for global QoL, PF and EF was good ( r=0.53-0.66, p<0.01), but no correlation for SF was detected ( r=-0.44, p=0.44). Linearly transformed scores from the two instruments differed considerably from -13 (95%CI -51 to 24) points (QoL) to 10 (-38 to 58) points (PF). CONCLUSION: Although EORTC-QLQ-C30 scores and GIQLI scores from patients undergoing elective colorectal cancer surgery did correlate well, the level of agreement between the two instruments was quite low. Perioperative QoL data from the two instruments cannot be compared with each other.

Aged↗

PubMed2004

["Fast-track" colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery].

OBJECT: The aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and "traditional" perioperative therapy and to allow hospital discharge only a few days following the operation. MATERIALS AND METHODS: In this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called "fast-track" program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic. RESULTS: Sixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66 years (range 54-71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2nd day (range 2-3). The patients could be released on the 4th postresection day (range 4-5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency. CONCLUSION: In colonic surgery, the "fast-track" method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of "fast-track" concepts is warranted in other types of elective abdominal surgery.

Aged↗

PubMed2004

[Establishing "fast-track"-colonic surgery in the clinical routine].

OBJECTIVE: A multimodal perioperative concept ("fast-track"-surgery) may decrease the incidence of general complications following elective colonic resections, accelerate rehabilitation and shorten postoperative hospital stay. During the introduction of this new "clinical pathway" several obstacles have to be overcome. This manuscript describes a practical way to establish "fast-track"-colonic surgery in the clinical routine. MATERIAL AND METHODS: After discussion of the many aspects of perioperative pathophysiology following abdominal surgery a "fast-track"-concept for colonic surgery was defined. Since 11.10.2001 the "fast-track" concept was applied to all patients treated by one attending surgeon. Experience with establishing this concept in the clinical routine was analysed. RESULTS: "Fast-track"-colonic surgery was established in close cooperation between surgeons, anesthesiologists and nurses. A written-down concept, the use of checklists and letters of information for patients, their relatives and general practicioners will simplify the introduction of the new perioperative treatment. Traditional practice (i. e. types of incisions, use of drainage, postoperative oral feeding) have to be modified. In 74 "fast-track"-colonic resections postoperative hospital stay was reduced to a median of 4 days, regardless of the way of access to the abominal cavity (laparoscopic or conventional). Postoperative morbidity was acceptable (local complications: 7 %; general complications: 7 %, but only 1 % without local complication). CONCLUSION: Establishing "fast-track"-colonic surgery requires close cooperation between surgery, anestehsiology and nursing personal. Most important is a surgeon prepared to overcome traditional concepts of perioperative care.

Colon↗

PubMed2002

Prospective randomized trial to determine the influence of laparoscopic and conventional colorectal resection on intravasal fibrinolytic capacity.

BACKGROUND: Although the pneumoperitoneum decreases venous reflux from the lower extremities, the rate of thromboembolic complcations seems to be lower after laparoscopic than after conventional procedures. Therefore, it has been assumed that laparoscopic surgery better preserves the intravasal fibrinolytic capacity. The aim of this study was to determine the influence of the operative technique on intravasal fibrinolytic capacity in colorectal resection. METHODS: Randomized controlled trial conducted in parallel with the multicenter trial LAPKON II comparing the long-term effects of elective laparoscopic (group I) and conventional (group II) resections for colorectal cancer. Blood samples were taken from 30 patients preoperatively, at the beginning and end of surgery as well as 2, 8, and 24 hr postoperatively. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), tPA/PAI complex, fibrinogen, and D-dimers were determined in all specimen with ELISA tests. Area under the curve values (AUC) were calculated for all parameters. RESULTS: Patient characteristics and indication for surgery were not different between both groups. Preoperative values of fibrinolytic parameters were similar in both groups. Postoperatively, tPA activity decreased significantly in both groups, but AUC values for tPA and PAI-1 activity (p = 0.23; p = 0.68); concentration of tPA, PAI-1, and tPA/PAI complex (p = 0.52; p = 0.78; p = 0.95); and concentration of fibrinogen and D-dimers (p = 0.67; p = 0.71) did not differ between the groups. CONCLUSIONS: An intravasal fibrinolytic "shutdown" occurs not only after conventional but also after laparoscopic colorectal resection. Both operative techniques had similar effects on postoperative intravasal fibrinolytic capacity. Therefore, the lower incidence of thromboembolic complications after laparoscopic colorectal resections does not seem to be caused by a lesser depression of the intravasal fibrinolytic capacity.

Aged↗

PubMed2002

Effect of laparoscopic and conventional colorectal resection on peritoneal fibrinolytic capacity: a prospective randomized clinical trial.

BACKGROUND AND AIMS: Reduced fibrinolytic activity of the peritoneum seems to be the main cause of postoperative adhesions. This prospective randomized trial compared the peritoneal fibrinolytic activity between laparoscopic and conventional colorectal resection. METHODS: Parietal peritoneal biopsy specimens were taken in standardized elective laparoscopic ( n=14) and conventional ( n=16) colorectal resections at the beginning and at the end of surgery. Activities and concentrations of tissue-plasminogen activator (tPA), plasminogen activator (PAI) type 1, and tPA/PAI complex were determined by ELISA kits. RESULTS: There was no difference in age, sex, or body mass index between the two groups. Perioperative tPA activity decreased in both groups without differences between the groups. Concentrations and activities of tPA, PAI-1, and tPA/PAI complex did not differ between the groups at any time. CONCLUSION: Peritoneal concentrations and activities of tPA, PAI-1, and tPA/PAI complex are similar during laparoscopic and conventional colorectal resections. A capnoperitoneum of 12 mmHg over 3 h did not affect the peritoneal fibrinolytic activity

Aged↗

PubMed2002

Influence of the sampling technique on the measurement of peritoneal fibrinolytic activity.

OBJECTIVE: To establish the influence of the peritoneal sampling technique on the measurement of fibrinolytic capacity. DESIGN: Clinical study. SETTING: University hospital, Germany. SUBJECTS: 40 peritoneal biopsy specimens were taken from 10 patients who were having elective colorectal resections. INTERVENTIONS: Peritoneal biopsy specimens were taken either with a biopsy punch (n = 20) or manually with forceps and scissors (n = 20). MAIN OUTCOME MEASURES: Extent of agreement in fibrinolytic activities between specimens taken with biopsy punch and manually. Major endpoint-peritoneal tissue plasminogen activator (t-PA) activity. Minor endpoints-peritoneal tissue plasminogen activator concentration, and concentration and activity of plasminogen activator inhibitior type 1 (PAT-1). RESULTS: Intra-assay agreement and the extent of agreement between the groups were evaluated by the method of Bland and Altman. Correlation of repeated measurements of t-PA and PAI-1 concentrations and activities from the same sample using the same ELISA kit was high (r = 0.93-0.99, p < 0.01). t-PA activities and concentrations between the groups correlated poorly (r= 0.60 and 0.66, p < 0.01) while no correlation at all was seen for PAI-1 concentration and activity between the groups (r = 0.6 and 0.1, p = 0.2 and 0.9). The mean differences between the groups ranged from -27% to -4.8%. CONCLUSION: The sampling technique considerably affects the measurement of peritoneal fibrinolytic activity.

Biopsy↗

PubMed1996