1,720,965 research outputs found
Laparoscopy in acute small-bowel obstruction
No full textToday laparoscopic procedures are routinely performed in patients with intestinal adhesions from previous abdominal surgery. Does laparoscopy have a potential benefit in acute small-bowel obstruction? Theoretically, a lower rate of wound complications and incisional hernias. as well as less subsequent adhesions with a lower incidence of recurrent intestinal obstruction, can be expected. However, laparoscopy is successful in only 50-70 % of selected patients, thereby representing the highest rate of conversion in minimally invasive surgery. Laparoscopic management of severe abdominal distension with massively dilated and fragile small-bowel or dense adhesions is extremely difficult even when performed by experienced surgeons. Significantly prolonged operating time, the high risk of bowel injury ( > 6-10 %) and an increased frequency of early reoperations jeopardize the patient's safe outcome. However. in strictly selected patients the laparoscopic approach may be promising. In acute intestinal obstruction without a history of previous abdominal surgery, laparoscopy is - in the absence of adhesions - an excellent diagnostic tool and may also be a successful therapeutic modality in a variety of bowel-obstruction etiologies. Furthermore, the laparoscopic option should be considered in patients who previously had undergone small laparotomies (e.g., appendectomy) or laparoscopic surgery. We recommend "postlaparoscopic" intestinal obstruction as the ideal case for laparoscopic reexploration. Incarcerated hernias at the site of trocar insertion or adhesions due to peritoneal tears are easily identified as the cause of obstruction and successfully cured with the laparoscope. In conclusion, we advocate the laparoscopic approach in acute small-bowel obstruction exclusively for selected patients. Clinical studies are required to define appropriate surgical indications objectively
Incisional hernia recurrence after mesh repair of the abdominal wall
No full textIntroduction: Depending on the surgical technique, mesh material and follow-up, the figures for recurrences of incisional hernia vary from 0 to 31 %. What are the reasons for recurrences, and which options exist for more successful therapy? Methods: Fourteen operations for recurrences after mesh repair of incisional hernias were analyzed retrospectively and correlated with a literature review of the years 1990-2000. Results: An inadequate surgical technique is the main reason for recurrences after the use of polypropylene or polyester, but with PTFE, it is instead the properties of the material. In our patients we found central mesh recurrences. The first results with laparoscopic technique are very promising. Conclusions: Open incisional hernia mesh repair should be performed with the sublay technique, preferably with polypropylene; the use of polyester can be recommended only with reservations and the use of PTFE ought to be limited to very few indications. The entire incision should always be prepared with safe fixation of the mesh and wide overlap of the hernia. Recurrences after polypropylene implantation can be treated with additional mesh; concerning PTFE, a different material is recommended. A final evaluation of laparoscopic mesh repair cannot be assessed yet
Central mesh recurrence after incisional hernia repair with Marlex - are the meshes strong enough?
No full textCarbon dioxide absorption during extraperitoneal and transperitoneal endoscopic hernioplasty
No full textTransabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) hernioplasty are probably associated with differing degrees of CO2 absorption which can influence anesthetic management and perioperative morbidity. We studied 20 patients with either TAPP or TEP for perioperative CO2 absorption (calculated from CO2 elimination and metabolic CO2 production) and ventilatory changes required to maintain normocapnia (blood gas analyses). CO2 absorption reached plateau values in the TAPP group, but increased over time in the TEP group. Median CO2 absorption during insufflation was 61 mL/min (range 43-78) for TAPP and 114 mL/min (range 75-178) for TEP, with a maximum of 114 mL/min (range 75-178) for TAPP and 258 mL/min (range 112-585) for TEP. Median minute ventilation ((V) over dot (E)) required for maintaining normocapnia was 9.5 L/min (range 7.7-11.5) for TAPP and 12.9 L/min (range 9.0-22.6) for TEP (P < 0.01). Seven patients in the TEP group required over 18 L/min (V) over dot (E), although no patient in the TAPP group required more than 14 L/min (V) over dot (E). All patients in the TEP group had significant subcutaneous emphysema resulting in one case of delayed tracheal extubation. We conclude that CO2 absorption is consistently less with TAPP
Standard polypropylene-mesh repair of incisional hernia using the sublay technique
No full textIntroduction: With the introduction of meshes to support hernia repairs the recurrence rates were reduced from 50% to less than 10%. Special complications such as scar plates with restriction of the mobility of the abdominal wall, pain and fistula formation are described. Methods: In a prospective study trial 38 patients with incisional hernia were treated with Marlex (R) mesh repair in the standard sublay technique. Results: Within a mean follow-up period of 3 years most of the patients were free from pain and very satisfied. Two recurrences (5.2 %) occurred and 2 hematomas (5.2 %) had to be removed surgically. Conclusions: Using a standard operation technique with the mesh in sublay position, even with heavy-weight Marlex mesh, good clinical results can be achieved compared to published findings. To our surprise we found two central recurrences through the mesh
A new abdominal cavity chamber to study the impact of increased intra-abdominal pressure on micro circulation of gut mucosa by using video microscopy in rats
No full textObjective: In experimental studies of capillary blood flow that use intravital video microscopy, organs are exposed in observation chambers implanted into the animal. In this article we describe an abdominal cavity chamber for intravital video microscopy of gut mucosa microcirculation during increased intra-abdominal pressure. Design: Prospective, experimental animal study. Setting: Research laboratory at a university hospital. Subjects: Male Wistar rats. Interventions: The abdominal cavity chamber was designed for implantation into the abdominal wall of rats after laparotomy, thus creating an expanded hermetic, abdominal cavity volume. Animals were assigned to three levels of intra-abdominal pressure: controls (group 1), 10 mm Hg (group 2), and 15 mm Hg (group 3). Intra-abdominal pressure was increased by intra-abdominal insufflation of gas. By using a fluorescent marker, we quantitatively assessed mucosa perfusion index, functional capillary density, red blood cell velocity, capillary diameters, and flow motion during increased intra-abdominal pressure by intravital video microscopy. Results were expressed as mean SEM. Significance of differences was determined by analysis of variance and multiple comparison of means with post hoc test ( p < .05 groups vs. control; daggerp < .05 group 3 vs. group 2). Measurements and Main Results: When compared with controls, animals subjected to an intra-abdominal pressure of 10 and 15 mm Hg showed a significant stepwise decrease in mucosa perfusion index (88%, 71% , 22% dagger), functional capillary density (665.4 +/- 71.7, 461.6 +/- 71.9 , 375.1 +/- 2.0 dagger cm(-1)), and red blood cell velocity (0.50 +/- 0.04, 0.33 +/- 0.03 , 0.04 +/- 0.06 dagger mm/sec), indicating a stepwise impairment of mucosal microcirculation. Capillary diameters and flow motion did not change with respect to intra-abdominal pressure. Conclusions: This novel animal model of intravital intestinal video microscopy that uses an abdominal cavity chamber is a feasible and sensitive experimental tool to study intestinal microcirculation during increased intra-abdominal pressure. Intra-abdominal pressure likely results in a severe impairment of mucosal microcirculation
Carbon dioxide absorption during extraperitoneal and transperitoneal endoscopic hernioplasty
No full textTransabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) hernioplasty are probably associated with differing degrees of CO2 absorption which can influence anesthetic management and perioperative morbidity. We studied 20 patients with either TAPP or TEP for perioperative CO2 absorption (calculated from CO2 elimination and metabolic CO2 production) and ventilatory changes required to maintain normocapnia (blood gas analyses). CO2 absorption reached plateau values in the TAPP group, but increased over time in the TEP group. Median CO2 absorption during insufflation was 61 mL/min (range 43-78) for TAPP and 114 mL/min (range 75-178) for TEP, with a maximum of 114 mL/min (range 75-178) for TAPP and 258 mL/min (range 112-585) for TEP. Median minute ventilation ((V) over dot (E)) required for maintaining normocapnia was 9.5 L/min (range 7.7-11.5) for TAPP and 12.9 L/min (range 9.0-22.6) for TEP (P < 0.01). Seven patients in the TEP group required over 18 L/min (V) over dot (E), although no patient in the TAPP group required more than 14 L/min (V) over dot (E). All patients in the TEP group had significant subcutaneous emphysema resulting in one case of delayed tracheal extubation. We conclude that CO2 absorption is consistently less with TAPP
Laparoscopic fundoplication - Is there a correlation between pH studies and the patient's quality of life?
No full textBackground: The effectiveness of laparoscopic Nissen fundoplication (LNF) was assessed in patients with chronic gastroesophageal reflux disease (GERD) using pH study and different quality-of-life indexes. We correlated both types of data and hypothesised that improvement in quality of life following LNF does not necessarily correlate with improvement in pH values. Methods: Seventy patients presenting with typical symptoms of GERD (14 with Barrett's esophagus) underwent LNF between May 1997 and December 2000. All patients were evaluated both prior to and 3 months after surgery using 24-h pH study, endoscopy, and a validated quality-of-life questionnaire. Results: Following LNF. reflux was reduced to normal in all but six patients. Howevers despite persistent reflux, the Gastrointestinal Quality of Life Index (GQLI), of these six patients improved postoperatively from 79.5 +/- 2.2 to 111.7 +/- 8.3. These results correlate with those of patients who had normal postoperative pH studies-namely, 88.5 +/- 19.3 to 112 +/- 16.7. There was no difference in quality-of-life improvement between patients with Barrett's esophagus and those without it. Conclusion: There is only a weak correlation between quality-of-life assessment and pH study. Because the patient's quality of life is likely to improve following LNF, an objective means parameter of assessing the effectiveness of antireflux surgery, such as pH study or endoscopy, is recommended
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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