Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia.

Background: Pneumatic dilation and laparoscopic Heller's myotomy (LHM) are established treatments for idiopathic achalasia. Peroral endoscopic myotomy (POEM) is a less invasive therapy with promising early study results.

Methods: In a multicenter, randomized trial, we compared POEM with LHM plus Dor's fundoplication in patients with symptomatic achalasia.

[Individualization of guidelines. Approach for rectal cancer in UICC stages II and III].

Background: The German guidelines for the therapy of rectal carcinoma in Union Internationale Contre le Cancer (UICC) stages II and III raise questions of overtherapy. This is why we have individualized the therapy in suitable isolated cases (localization in the upper third of the rectum and wider safety margins in cases of small T3).

Material And Methods: All 131 patients with rectal cancer stages II and III, who were operated on within a time period of 4 years were retrospectively included in the study.

Transvaginal specimen removal after laparoscopic distal pancreatic resection.

Purpose: Transvaginal specimen removal has been introduced 20 years ago but then abandoned. With the advent of transvaginal interventions following the introduction of natural orifice transluminal endoscopic surgery, renewed interest was generated for hybrid procedures with minimal access for the intervention and use of transvaginal (TV) specimen removal. We present the first such series after laparoscopic distal pancreatectomy.

NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients.

Background: Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for both gastroenterologists and surgeons. We have developed a technique of transvaginal hybrid NOTES cholecystectomy (TVC) that leaves no visible scar and is applicable to daily use. This technique is compared to the conventional laparoscopic cholecystectomy (CLC) in a matched-pair analysis.

Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up.

Background And Study Aims: Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used.

[Combined transvaginal and transumbilical approach for cholecystectomy with no visible scarring].

The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus.

Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients.

Background: Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall and might further improve minimal invasive surgery of patients, but might also increase surgical risk when used by a transgastric or transcolonic approach with flexible endoscopes. Therefore we decided to use a transvaginal approach using rigid laparoscopic instruments for cholecystectomies.

Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility.

Objective: To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360 degrees ) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility.

Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach.

Laparoscopic surgery has decreased trauma and improved results and natural orifice transluminal endoscopic surgery (NOTES) should be a further step in this direction. However the use of flexible gastroscopes in the abdomen is difficult and the generally chosen transgastric approach is not without risk. Therefore we have carried out a cholecystectomy with a combined transvaginal and transumbilical approach, using laparoscopic instruments.

[Leiomyomatosis of the colon: case report and literature review].

We present the findings of a 67 year old male patient with an intestinal leiomyomatosis localized in the rectum. To our knowledge, this is the fifth case of intestinal leiomyomatosis reported so far. The most characteristic findings of this rare disease include a cuff-like tumorous proliferation of smooth muscle within the bowel wall which may extend into extramural tissue and result in a stenosis of a longer bowel segment.

[Effect of pneumoperitoneum on ultrastructure of parietal peritoneum in experimentally induced peritonitis in the rat].

Aim of this study was to analyse the effect of gastric perforation induced peritonitis and a pneumoperitoneum (PP) on the ultrastructure of the parietal peritoneum. After randomisation rats allocated to groups I and II were subjected to standardized gastrotomy simulating gastric perforation. After a 12-h-interval a PP was induced in groups I and III.

[Prognostic value of gastric tonometry in peritonitis due to intestinal perforation and laparoscopic versus conventional management in the swine model].

After a 12 hour period of experimental peritonitis induced by gastric perforation mortality was significantly higher in the laparoscopically treated group of pigs when compared to the open procedure. In both groups the treatment was simple oversowing of the defect plus peritoneal lavage. Septic shock associated with peritonitis and subsequent "multi organ failure syndrome" could accurately be predicted with gastric tonometry.

Nissen vs Toupet laparoscopic fundoplication.

Background: Nissen fundoplication (360 degrees ) is the standard operation for the surgical management of gastroesophageal reflux disease (GERD). To avoid postoperative dysphagia, it has been proposed that antireflux surgery be tailored according to the degree of preexisting esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and the Toupet procedure (270 degrees ) has been recommended for these patients.

Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study.

Background And Aims: The purpose of this study was to determine whether esophageal dysmotility affects symptoms of gastroesophageal reflux disease or clinical outcome after laparoscopic fundoplication and whether esophagus motor function changes postoperatively.

Methods: Two hundred patients with a history of long-standing gastroesophageal reflux disease were investigated by clinical assessment, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH monitoring between May 1999 and May 2000. Patients were stratified according to presence or absence of esophageal dysmotility (each n = 100) and randomized to either 360 degrees (Nissen) or 270 degrees (Toupet) fundoplication.

[Parathyroid gland carcinoma with postoperative encephalopathy].

We present a 78-year-old patient who suffered from symptomatic transitory psychotic syndrome after laparotomy. Persisting somnolence appeared with cardiopulmonary decompensation and gastrointestinal atony. Due to prolonged hypercalcemia primary hyperparathyreoidism was diagnosed.

[Laparoscopic splenectomy for idiopathic thrombocytopenia].

Background And Objective: Splenectomy is of great benefit for patients with idiopathic thrombocytopenia (ITP), when medical therapy has failed. It was the aim of this retrospective study to evaluate the results of laparoscopic splenectomy.

Patients And Methods: All patients with ITP, who had a laparoscopic splenectomy between 1992 and 1999, were included in this study.

Effective treatment of symptomatic gastroesophageal reflux disease by laparoscopic fundoplication.

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A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats.

Background: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis-e.g., peptic ulcer perforation.

Gastric tonometry accurately predicts mortality in experimental peritonitis in both laparoscopic and conventional surgery.

Objectives: Tonometry is widely used in the diagnosis of sepsis and splanchnic ischemia. This study was devised to analyze the predictive value of gastric tonometry for outcome of experimental viscus perforation-induced peritonitis. The impact of conventional and laparoscopic intervention on tonometric measurements was the main scope.

[Laparoscopic 2/3 resection of the stomach with intracorporal Roux-en-Y anastomosis].

In a patient with recurrent ulcer disease under medication, which was complicated by episodes of bleeding, a laparoscopic partial gastric resection with intracorporal Roux-en-Y anastomosis was performed. The operation was completed within 3 h with blood loss < 10 ml. The postoperative hospital stay of 6 days was uncomplicated as was the further follow-up (2 months so far).

Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs.

Background: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation.

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap.

Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition.

Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself.

[Laparoscopic cardiomyotomy in achalasia].

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the conventional operation, the laparoscopic approach promised to have advantages concerning postoperative convalescence.