Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases.

Background: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional laparoscopic and open surgery. As compared with conventional laparoscopic surgery, it offers the advantages of tactile feedback, better exposure, and a shorter learning curve. There is increasing evidence that HALS retains the advantages of minimal-access surgery.

Evaluation of MR-angiography for pre-operative assessment of living kidney donors.

Introduction: Pre-operative magnetic resonance tomography (MR) and MR-angiography (MRA) have rendered favorable results for the assessment of renal anatomy preceding living-related kidney transplantation. However, limited value of MRA in the detection of accessory renal vasculature is reported.

Methods: We compared the results of pre-operative contrast-medium-enhanced MRA of the last 30 consecutively performed nephrectomies in living kidney donors with the intraoperative findings of vascular, parenchymal, and ureteral anatomy.

Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair.

Background: Almost half the patients who undergo hernia repair with mesh report a feeling of stiffness and a foreign body in the groin. This study evaluated whether patients noticed any difference between lightweight and standard polypropylene mesh for the repair of inguinal hernia.

Methods: Patients scheduled for elective repair of unilateral or bilateral, primary or recurrent inguinal hernia by the Lichtenstein technique were randomized to receive either a conventional densely woven polypropylene mesh (100-110 g/m(2)) or a lightweight composite multifilament mesh (polypropylene 27-30 g/m(2)).

A new abdominal cavity chamber to study the impact of increased intra-abdominal pressure on microcirculation of gut mucosa by using video microscopy in rats.

Objective: 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.

Laparoscopic fundoplication.

Background: 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.

Central mesh recurrence after incisional hernia repair with Marlex--are the meshes strong enough?

The use of biomaterial meshes in the repair of incisional abdominal wall hernias is now widely accepted internationally. The introduction of synthetic meshes to achieve tension-free repair has led to a satisfactory reduction in the recurrence rate to less than 10%. However, the use of such biomaterials can result in the occurrence of undesirable complications such as increased risk of infection, seromas, restriction of the abdominal wall and failure caused by mesh shrinkage.

[Standardized sublay technique in polypropylene mesh repair of incisional hernia. A prospective clinical study].

Introduction: 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 mesh repair in the standard sublay technique.

[Problem of recurrent incisional hernia after mesh repair of the abdominal wall].

Introduction: 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.

[Hand-assisted, laparoscopic nephrectomy for live donor organ harvesting. Initial results].

We report technique and preliminary results with a new, laparoscopic hand-assisted, technique for live donor nephrectomy. A special device (Pneumo-Sleeve, Handport) in a short (7.5-8 cm) Pfannenstiel incision allows the surgeon to insert his or her hand into the insufflated abdominal cavity and to use it as a "multifunctional instrument" while pneumoperitoneum is preserved.

Carbon dioxide absorption during extraperitoneal and transperitoneal endoscopic hernioplasty.

Unlabelled: Transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) hernioplasty are probably associated with differing degrees of CO(2) absorption which can influence anesthetic management and perioperative morbidity. We studied 20 patients with either TAPP or TEP for perioperative CO(2) absorption (calculated from CO(2) elimination and metabolic CO(2) production) and ventilatory changes required to maintain normocapnia (blood gas analyses). CO(2) absorption reached plateau values in the TAPP group, but increased over time in the TEP group.

[Laparoscopy in small bowel ileus].

Today 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.

Neurotensin-related regulation of the postprandial lower-oesophageal-sphincter pressure.

Background: Ingestion of food has been shown to modulate the lower-oesophageal-sphincter pressure (LESP). Fat is especially effective in decreasing the postprandial LESP. As there is good evidence that neurotensin (NT) is able to decrease the LESP, we conducted the present trial to determine whether NT could possibly be a mediator of the fat-induced decrease of the LESP.

[Laparoscopic stoma technique].

Laparoscopic stoma creation may be performed as an independent intervention, in combination with local anorectal procedures or as a part of complex laparoscopic intestinal operations. With the exception of specialized methods to preserve continence, every type of stoma formation can be performed laparoscopically. Indications for laparoscopic fecal diversion do not differ from open surgery.

[Effect of ultrasonic diagnosis and incidence of appendectomy and laparoscopy].

A total of 330 of 409 patients with suspected acute appendicitis were examined by ultrasound, and an appendectomy was performed in 146 patients. The negative appendectomy rate was 7% with preoperative ultrasound (n = 72) compared with 31% without (n = 74). Laparoscopy did not reduce the negative appendectomy rate, but was useful in patients with opposing clinical and sonographical findings.

[Appendectomy 1997--open or closed?].

Unlike laparoscopic cholecystectomy, laparoscopic appendectomy (LAE) has not yet become popular. Are there no significant advantages? Or is the poor acceptance of LAE related to its longer learning curve, longer operative times and the need for additional equipment, which lead to some inconvenience when the procedure is done on an emergency basis? LAE may be performed as safely as open appendectomy (OAE) with fewer wound complications. Superior laparoscopic exploration allows an accurate diagnosis and reduces the rate of negative appendectomies.

[Manually assisted laparoscopic surgery--realistic evolution of the minimally invasive therapy concept? Initial experiences with the "Endohand"].

The essential limitations of laparoscopic procedures--lack of palpation, problematic retrieval of specimen and anastomosis, etc.--are abolished by the hand of the surgeon, which is inserted into the peritoneal cavity through a mini-laparotomy. While holding the pneumoperitoneum, the hand acts as an intelligent instrument performing surgical exploration, exposition of the field of operation, blunt dissection or intracorporal knot-tying.

[Laparoscopic diagnosis and therapy of closed traumatic diaphragmatic rupture].

Diagnosis of blunt diaphragmatic rupture is still a challenging problem. This injury is generally treated by direct closure of the defect via a laparotomy or a thoracotomy. As it occurs frequently in severely traumatized patients, we wondered whether those patients could benefit from the well-known advantages of minimally invasive surgery.

Laparoscopic resection of pheochromocytoma.

The following case report presents the diagnostic procedures, laparoscopic therapy, and postoperative course of a 48-year-old patient with pheochromocytoma. During the previous 15 years, he had occasionally presented with hypertension, intermittent attacks of severe perspiration, and tachycardia; no diagnostic measures were performed at the time. During an ultrasound examination of the abdomen performed due to gastrointestinal complaints, a 5-cm adrenal tumor was discovered incidentally.

[Laparoscopic hernioplasty].

We report our experience with laparoscopic repair of inguinal hernias since Dec. 1990. The initially used "plug & patch-technique" was abandoned because of high recurrence rates for primary hernias and other disadvantages.

[Initial experiences with laparoscopic fundoplication].

Over the past decade decreasing numbers of anti-reflux surgical procedures have been performed. The two main reasons are improved pharmacotherapeutics and the complication rate associated with anti-reflux surgery. But in patients who are medically refractory or in those requiring long-term medications the Nissen-Rossetti fundoplication still has its place in the therapy of reflux disease.

[Intraoperative cholangiography and anterograde bile duct exploration in laparoscopic cholecystectomy--technique, results, perspectives].

The avoidance of (unrecognized) bile duct injuries (1) and the management of bile duct stones (pre-, intra- or postoperatively?) (2) are believed to be the main problems in laparoscopic cholecystectomy (LCE) at present. They must be a challenge for surgery to develop and improve the concepts of minimally invasive therapy for treatment of cholelithiasis. Intraoperative cholangiography (IOC) plays a very important role and is the basis of innovative, laparoscopically assisted procedures (3) for single session therapy of gallbladder and bile duct stones.

[New trends in biliary surgery].

On the basis of the experience gained in 893 laparoscopic procedures performed on the gallbladder, and with increasing frequency on the bile-ducts, and on the basis of a comprehensive review of the literature from 1992 and 1993 pertaining to this subject, a critical analysis of laparoscopic gallbladder surgery has been accomplished. As substantiated by recent publications, laparoscopic cholecystectomy has achieved wide acceptance in surgical practice. Over the course of the last two years, discussion has focussed on the avoidance of injury caused by Veress needle and trocar puncture and specific pneumoperitoneum-associated complications, as well as the minimisation of overlooked and/or spilled bile-duct calculi and the avoidance of iatrogenic bile-duct injuries.

[Specifics of anesthesiology in the operative phase of laparoscopic surgery].

Aim Of Investigation: The present investigation was initiated to quantify the effect of a CO2-peritoneum on CO2-absorption (VCO2res) and other respiratory variables during laparoscopic surgical procedures.

Methods: Gas exchange and endtidal pCO2 (petCO2) were measured continuously. Ventilation was adjusted to maintain preoperative petCO2 mainly by increasing the tidal volume.

[Critical evaluation of laparoscopic hernia surgery].

The success of the laparoscopic cholecystectomy was remarkable and well-founded, thus it seems necessary to examine whether this procedure could be also used for other general surgical operations. Since Dec. 29th, 1990 the transperitoneal repair of hernias by laparoscopy has been performed in 177 patients.