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W Wayand

Publications and source records attributed to W Wayand.

At least 37 records · Page 2Linked to original sources
PubMed1996

EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management.

BACKGROUND: The current management of patients with ductal calculi and gallstone disease consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). The advent of techniques of laparoscopic ductal stone clearance has introduced an alternative single stage laparoscopic treatment for these patients. The EAES ductal stone trial was set up to compare the relative efficacy and outcome of these two management options. METHODS: The study consists of a prospective randomized controlled clinical trial comparing two management options of patients undergoing LC and suspected of harbouring common duct stones. Patients registered into the trial are randomized to one of two arms: (i) Group A-preoperative ERC with ESE followed by LC during the same hospital admission. (ii) Group B-single stage laparoscopic management consisting of LC and laparoscopic stone extraction either by the trans-cystic duct route or by direct supraduodenal common duct exploration. RESULTS: This preliminary analysis was carried out on 207 randomized patients with comparisons being made on the intention to treat principle. The two groups (A = 106, B = 101) were comparable with respect to clinical features. ASA grade, serum biochemistry and ultrasound findings. CONCLUSIONS: These preliminary findings indicate equivalent success rates and patient morbidity between the two management options but a shorter hospital stay (cost benefit) with the single stage laparoscopic treatment. Trans-cystic duct extraction is a more benign procedure than laparoscopic supraduodenal CBD exploration and is accompanied by a significantly shorter hospital stay. The higher incidence of conversion in the single stage laparoscopic group compared to the two-stage arm is due to the preference for open common duct exploration when the laparoscopic attempt failed by the majority of participating surgeons. The results to-date suggest that in fit patients, single stage laparoscopic treatment is the better option and the role of ESE should change to selective use in those patients in whom laparoscopic ductal stone extraction has failed.

Adolescent↗
PubMed1996

Mechanism, management, and prevention of laparoscopic bowel injuries.

BACKGROUND: Inadvertent injury to the bowel is a rare but potentially fatal complication of laparoscopy. Such injury often goes unrecognized at the time of the procedure and only later is manifest by high morbidity and mortality. METHODS: We reviewed the mechanism and management of 10 instances of bowel injury known to have been encountered in a series of 4672 laparoscopic procedures performed at our hospital over the past 5 years. RESULTS: The usual causes of injury to the bowel wall were thermal burns, sharp dissection, and needle punctures. Six of the injuries were readily evident and treated immediately; four were unrecognized until 2 to 14 days after the procedure. One patient died of multiple organ failure on the third day after laparoscopy. Operative management in nine cases required simple closure or segmental resection. A high index of suspicion and vigilant physical examination were the keys to early recognition of bowel injury; laboratory and radiographic findings were nonspecific. CONCLUSIONS: Suspected bowel injury following laparoscopy mandates early laparotomy to avoid life-threatening complications.

Adult↗
PubMed1995

Yield of prospective, noninvasive evaluation of the common bile duct combined with selective ERCP/sphincterotomy in 1390 consecutive laparoscopic cholecystectomy patients.

The role of noninvasive evaluation of the common bile duct combined with selective preoperative endoscopic retrograde cholangiography and sphincterotomy was prospectively evaluated in 1390 consecutive patients subjected to laparoscopic cholecystectomy. Preoperative common bile duct testing included liver chemistries, transcutaneous ultrasonography, and intravenous cholangiography. When indicated by various sets of abnormal studies, prelaparoscopic endoscopic retrograde cholangiography was attempted in 129 patients (9.3%) and successfully accomplished in 122 (94.6%). Seventy-six patients (62.3%) had duct stones or a papillary stenosis, and 73 of them (96%) were treated successfully by endoscopic duct clearance and subsequent laparoscopic cholecystectomy. No deaths occurred, and the morbidity rate was 6.2% (8/129), including 2 cases of pancreatitis and 1 case of a retained duct stone after sphincterotomy. Predicting the presence of common duct pathology was 60% accurate when based on abnormal laboratory test results alone, 69% when based on abnormal laboratory test results and concomitant radiologic abnormalities, and 42% when based on radiologic criteria alone (p < .05). We conclude that patients with altered serum liver chemistries with or without concomitant positive radiologic criteria should undergo endoscopic cholangiography before laparoscopic cholecystectomy. However, in patients with radiologic duct dilatation as the sole indicator for duct stones, the frequency of normal findings in endoscopic examinations is high. This latter group is probably better managed with intraoperative cholangiography and postlaparoscopic sphincterotomy if needed.

Case-Control Studies↗
PubMed1995

[CT-guided wire marking of peripheral pulmonary coin lesions--value for thoracoscopic resection].

Thoracoscopic identification of small and deep seated peripheral lung lesions may be difficult. To facilitate resection in such cases, a technique of CT-guided transthoracic hook wire localisation has been developed. We used this technique for localization of 12 peripheral lung lesions in 11 patients. In all cases the hook wire was correctly placed within or just beside the nodule and subsequent thoracoscopic resection was fast and easily accomplished in all. The described localization technique has a low complication rate and can be recommended for patients with small peripheral lung nodules subjected to thoracoscopic surgery.

Adenocarcinoma↗
PubMed1995

[The status of laparoscopic cholecystectomy in Austria. AMIC--Study Group for Minimally Invasive Surgery].

The complete 1992 register of minimal invasive operations at all surgical departments in Austria has been compiled for the third year running, representing questionnaires returned from 107 departments reporting a total of 11,591 laparoscopic cholecystectomies (LC). Evaluation of the data from the 81 departments with a least 2 years' experience showed an increase of 56.60% in the number of LCs and an overall increase in cholecystectomies of 18.50% in comparison with 1991. Sonography and/or intravenous cholangiography remain the standard procedures for the pre-operative diagnosis of bile-duct concrements, undertaken in 98.05% and 71.70%, respectively, of all cases in 1992. Intra-operative cholangiography has been implemented with increasing frequency (17.56% of all cases in 1992), especially in those departments with longer experience on LC. The conversion rate to open cholecystectomy was 6.09%, and the incidence of secondary cholecystectomy was 1.26%. The mortality rate was 0.11%. Our register now contains the data on 19,872 LCs. Our evaluation of the multicentric data aims at a complete documentation of the frequency of this surgical procedure and the incidence of complications in Austria with a view to establishing guidelines for the indications for LC and planning of this operation, as well as following up current trends in the regional implementation of LC in Austria.

Austria↗
PubMed1995

[Pancreas resection with the surgical stapler. Technique and results].

In a consecutive series of 42 pancreatoduodenectomies and 17 distal pancreatectomies we evaluated the applicability of the stapler TA-55 for transecting the pancreas parenchyma. In 90% of Whipple's operations and in 88% of distal pancreatectomies the transection of the pancreas was successfully accomplished by using the TA-55. The two rows of steel staples lead to a uniform closure of the pancreatic tissue and thus provided an excellent precondition for pancreatic stump healing and creation of a pancreaticojejunal anastomosis. Pancreatic fistulas occurred in 3 cases (5%) and were all successfully treated conservatively. Summarizing our experience, the stapler TA-55 can be recommended particularly for the transection of normal and fragile pancreatic tissue.

Adult↗
PubMed1994

[Thoracoscopic therapy of iatrogenic hemothorax].

Video-assisted thoracoscopy is an innovative technique which now allows the surgeon to approach various intrathoracic pathologic conditions without thoracotomy. In a 20-year-old male with pneumothorax urgent surgical intervention was necessary because of severe hemothorax following chest tube placement. The successful management of this patient by video-assisted thoracoscopy is presented.

Adult↗
PubMed1993

[Laparoscopic hernia repair].

From January 1992 to February 1993 a total of 361 inguinal hernia repairs were performed in our unit. We routinely performed the Shouldice repair. In 60 patients, 46 men and 14 women, 19-82 year old, we closed the inguinal defect with a patch, performing a "tension-free" repair by a laparoscopic technique. In 26 patients we found a left-sided hernia, in 21 patients a right-sided, and in 13 bilateral hernias. We found 29 direct hernias, 26 indirect hernias and 18 combined hernias. There were no intraoperative complications. Postoperatively, 1 patient suffered from epididymitis, and 5 patients reported disturbed sensibility of the skin at the medial proximal thigh for some weeks. One patient had an inguinal seroma postoperatively. In this patient we had not removed the hernia sac. There was no recurrence. Long time results are not available until now.

Adult↗
PubMed1993

Thoracoscopic wedge resection of peripheral lung lesions.

The increasing experience with minimally invasive surgery and advances in endoscopic equipment have expanded the role of thoracoscopy to include thoracoscopic pulmonary resections. In 11 patients we have evaluated the technical feasibility of thoracoscopic wedge resection of single peripheral lung lesions. In 8 patients the lesion could be exactly identified by thoracoscopy and be effectively resected using an automatic endoscopic stapler. All lesions were located within the outer third of the lung parenchyma with a maximum distance of 1.4 cm between lesion and visceral pleura. Mean diameter of the nodules was 1.9 cm and ranged from 1.0 to 4.1 cm. Histological analysis revealed completely excised tuberculomas in 4, carcinomas in 2, hamartoma in 1, and localised fibrosis in one patient. In 3 patients the thoracoscopic approach was unsuccessful because of difficulty in identifying the lesion or impossibility of achieving a reliable assessment of the intraparenchymal extension of the tumor. In conclusion, thoracoscopic wedge resection is helpful for the diagnostic and therapeutic management of peripheral lung lesions in carefully selected patients. Continued experience is necessary to be able to establish reliable criteria to assess which types of lung lesion can be excised safely and effectively by videothoracoscopy.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1993

[Laparoscopic resection of liver metastasis].

Six weeks after a partial colon resection because of an adenocarcinoma of the sigmoid we removed a solitary liver metastasis (6th segment) by laparoscopic technique in a 63-year-old patient. Operation time was 95 min, the postoperative course was uneventful and the patient was discharged at day 6 postoperatively.

Adenocarcinoma↗
PubMed1993

[Laparoscopic cholecystectomy in Austria. The Austrian 1991 register].

The number of surgical units, performing laparoscopic cholecystectomies (LC) in Austria increased from 24 hospitals (20%) in 1990 to 85 hospitals (70%) in 1991, performing 7351 LCs. In 97% the outcome was uneventful, the conversion rate was 2.1%; 0.85% required secondary laparotomy. Common bile duct lesion occurred in 0.5%, lethality was 0.1% (n = 4). Because of the cooperation of all surgeons Austria is the only country to present actual numbers concerning acceptance and penetration rate of LC.

Austria↗
PubMed1993

[Laparoscopic cholecystectomy--advantages and disadvantages].

From march 1990 to february 1992 we performed 600 laparoscopic cholecystectomies. In 18 cases we had to change to a laparotomy because of intraoperative problems, in 3 cases we had to laparotomise patients because of postoperative complications. 9 patients (1.5%) had a wound infection. In two prospective studies we could prove that patients after laparoscopic cholecystectomy have less pain and are in a better respiratory condition than after open cholecystectomy.

Adolescent↗
PubMed1992

[Laparoscopic surgery--the revolution in gallstone treatment].

The treatment of gallbladder disease is revolutionized by laparoscopic cholecystectomy (LCHE). Less pain postoperatively, earlier mobilization and a fascinating cosmetic result as well as a definitive cure of the disease have led to a fast acceptance by patients and doctors. From March 1990 to March 1991 we have performed 250 LCHE. Only 5 times we had to switch to the conventional procedure. 5 complications (1 lesion of the common bile duct, 2 biliary effusion, 1 abscess formation, 1 bleeding) were treated by laparotomy without further morbidity or lethality. Our rate of gallbladders operated by laparoscopy has increased from 35% in 1990 to 75% in 1991.

Cholangiopancreatography, Endoscopic Retrograde↗