Quality of Life After Total Mesorectal Excision and Rectal Replacement: Comparing Side-to-End, Colon J-Pouch and Straight Colorectal Reconstruction in a Randomized, Phase III Trial (SAKK 40/04).

Background: Functional outcomes of different reconstruction techniques have an impact on patients' quality of life (QoL), but information on long-term QoL is lacking. We compared QoL among three reconstruction techniques after total mesorectal excision (TME).

Methods: Quality of life was assessed within a randomized, multicenter trial comparing rectal surgery using side-to-end anastomosis (SEA), colon J-pouch (CJP), and straight colorectal anastomosis (SCA) by the Functional Assessment of Cancer Therapy-Colorectal scale (FACT-C) before randomization and every 6 months up to 2 years post-TME.

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision: A Swiss Prospective, Randomized, Multicenter Trial (SAKK 40/04).

Objective: To compare, in a phase 3, prospective, randomized, multi-center clinical trial functional outcome of reconstruction procedures following total mesorectal excision (TME).

Summary Background Data: Intestinal continuity reconstruction following TME is accompanied by postoperative defecation dysfunctions known as "anterior resection syndrome." Commonly used reconstruction techniques are straight colorectal anastomosis (SCA), colon J -pouch (CJP), and side-to-end anastomosis (SEA).

[Hypnotic communication and hypnosis in clinical practice].

In addition to usual medical care it is often critical to consider the patient's inner world in order to sensitively differentiate between harmful and helpful suggestive elements. The respective abilities in terms of hypnotic communication can be easily learned. Confident, empathic attention and a calm, understanding and figurative language narrowing the focus on positive emotions and positive change, which have been shown to improve the patient's chances of healing, are of particular importance.

[Laparoscopic fundoplication for gastroesophageal reflux disease (GERD)].

Laparoscopic fundoplication became the gold standard in the surgical therapy of GERD. In comparison with open procedures, laparoscopic antireflux surgery has a lower morbidity rate, a better early and late postoperative outcome and is more cost-effective. Antireflux surgery can be performed after a critical evalutation of the patient including gastroscopy, biopsy, 24h-pH-manometry and after a long lasting conservative medical treatment.

Selective enhancement of gene transfer by steroid-mediated gene delivery.

The incorporation of transgenes into the host cells' nuclei is problematic using conventional nonviral gene delivery technologies. Here we describe a strategy called steroid-mediated gene delivery (SMGD), which uses steroid receptors as shuttles to facilitate the uptake of transfected DNA into the nucleus. We use glucocorticoid receptors (GRs) as a model system with which to test the principle of SMGD.

[Laparoscopic fundoplication for gastroesophageal reflux: experience with 49 surgical patients (1994-1999)].

Introduction: Chronic gastrooesophageal reflux disease (GERD) is the most common benign pathology of the upper gastrointestinal tract in the western world. We report our experience of laparoscopic antireflux surgery.

Patients And Methods: 49 patients underwent laparoscopic antireflux surgery at our clinic between 1994 and 1999.

[Extraovarian peritoneal serous papillary carcinoma: an unusual surgical case].

The extraovarian peritoneal serous papillary carcinoma (EPSPC) is a multicentric peritoneal tumor with minimal or absent involvement of the ovaries. The actual treatment regimen consists of a cytoreductive surgery followed by a combination chemotherapy. Few studies have compared outcome of EPSPC to papillary serous ovarian cancer (PSOC).

Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma.

Background: We sought to determine the incidence of recurrence of carcinoma at the port site and the outcome of patients with such recurrences after exploratory laparoscopy/laparoscopic cholecystectomy for unsuspected gallbladder carcinoma and analyzed aspects of the laparoscopic procedure associated with recurrences at the port site.

Methods: Thirty-seven patients with preoperatively unknown adenocarcinoma of the gallbladder were analyzed. The patients were part of a large prospective study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery including 10,925 patients undergoing laparoscopic cholecystectomy.

Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery.

Background: We set out to analyze the technical aspects, intraoperative complications, morbidity, and mortality of laparoscopic cholecystectomy in a multi-institutional study representative of Switzerland.

Methods: Data were collected from 10,174 patients from 82 surgical services. A total of 353 different parameters per patient were included.

Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies.

Background: Spilled gallstones after laparoscopic cholecystectomy may cause abscess formation, but the exact extent of this problem remains unclear.

Method: The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) on 10,174 patients undergoing laparoscopic cholecystectomy at 82 surgical institutions in Switzerland between January 1992 and April 1995 were retrospectively analyzed with special interest in spilled gallstones and their complications.

Results: In 581 cases (5.

[Laparoscopic colon surgery in the regional hospital: initial experiences after 65 interventions].

321 colorectal operations have been performed in our institution in a 4-year period from 1992 to 1996. They included 65 laparoscopic interventions for benign disease or for palliative treatment of malignancy. 40 patients underwent low anterior resections, mostly for diverticular disease.

[Etiology, pathogenesis and classification of anal fissure].

Anal fissure is one of the most common causes of anal pain but its etiology and pathophysiology remain obscure. Many theories have been advanced to explain the origin of anal fissures but trauma of faecal mass and hypertonicity of the internal sphincter seem to be the most important factors. The initial lesion in anal fissure is a tear in the anoderm mostly in its posterior midline caused by overstretching of the anal canal.

[The clinic as profit center and management with reference figures].

Financial responsibility is one of the important aspects of hospital management. At the hospital of Uster a trial with a profit center concept was started in October 1991. This concept included development of management tools such as reference figures to check costs, returns and performance.

A nation's experience in laparoscopic cholecystectomy. Prospective multicenter analysis of 3722 cases.

In a national prospective multicenter study 3,722 laparoscopic cholecystectomies (LC) performed by 179 surgeons in 50 institutions were analyzed with special regard to technique and complications. Conversion to open cholecystectomy was necessary in 259 patients (7.0%), either without intraoperative complications (4.

[Laparoscopic appendectomy: techniques and results in Switzerland].

We have tried to assess the actual attitude towards laparoscopic appendectomy in Switzerland. An inquiry on preoperative investigations, operative approach and results in cases of suspected appendicitis in 26 surgical Institutions affiliated to the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) was performed. In a 20 month period a total of 3665 laparoscopic procedures were performed.

[Significance of laparoscopic surgery in the treatment of cholecysto- and choledocholithiasis].

The management of common bile duct stones during laparoscopic cholecystectomy contains some controversy. Our first aim is to detect choledocholithiasis preoperatively making use of a preoperative ultrasound and cholangiogram routinely. Laparoscopic cholecystectomy will follow a preoperative ERCP with endoscopic sphincterotomy and stone extraction in this desirable situation.

Upper gastrointestinal hemorrhage preceding development of Bouveret's syndrome.

Gastric outlet obstruction by a gallstone is a very uncommon clinical entity; it was first reported by Bouveret in 1896. In the patient presented, we were able to show the development of formation of the bilioenteric fistula with massive arterial bleeding from the eroded cystic artery until duodenal occlusion. The process was endoscopically and radiologically observed and documented.

[Laparoscopic cholecystectomy in Switzerland. Critical retrospective evaluation of the first 3,722 cases. Swiss Professional Society of Laparoscopic and Thoracoscopic Surgery].

In a national prospective multicenter study 3722 laparoscopic cholecystectomies (LC) performed by 179 surgeons in 50 Swiss institutions were analysed with special regard to technique and complications. Conversion to open cholecystectomy was necessary in 259 patients (7.0%), either expectively without intraoperative complications (4.

Differential inhibition of human secretory and cytosolic phospholipase A2.

The roles and relative contributions of secretory and cytosolic phospholipases A2 in physiology and pathology are not precisely known. In a search for differential inhibitors of these enzymes, which could serve as tools to clarify this issue, we evaluated the potencies of reference compounds and three series of new compounds, viz. substrate analogues, 1,2-amino alcohols and enolized beta-tricarbonyl derivatives, as inhibitors of secretory phospholipase A2 from human polymorphonuclear leukocytes (sPLA2) and of cytosolic phospholipase A2 from human U937 cells (cPLA2).

[Surgical therapy of diverticular disease at the Waid City Hospital, Zurich, 1980-1990].

Our experience with 431 patients suffering from diverticular disease is presented. Indications for emergency (severe bleeding, bowel obstruction, sigmoid perforation with peritonitis) and elective surgery (recurrent attacks of diverticulitis or bleeding, painful or obstructing diverticular disease, fistula, impossibility to exclude a cancer) are given. Resection of the perforated sigmoid by the Hartmann procedure helps to reduce mortality markedly for diffuse purulent and fecal peritonitis.

[Laparoscopic cholecystectomy. Results and experiences 1 year following introduction of a new surgical technique (139 cases)].

Laparoscopic cholecystectomy is on the way to become the procedure of choice for treatment of uncomplicated cholelithiasis. First experiences are summarized: Within the first year after introduction 139 patients, 100 women and 39 men, have been treated by this novel technique. 33 open cholecystectomies were carried out in the same period.

[Diverticular disease: When to operate?].

We present our experience with 431 patients suffering from diverticular disease. Indications for emergency and elective surgery are given. Immediate laparatomy is mandatory for severe diverticular bleeding, bowel obstruction and sigmoid perforation.

[Surgical therapy of severe idiopathic constipation].

Because surgery for severe idiopathic constipation is seldom indicated, careful preoperative evaluation is mandatory (colonoscopy with biopsy, whole gut transit study, evacuation proctography, electromyography, anorectal manometry) in order to classify chronic idiopathic constipation into two broad functional groups: "outlet obstruction" and "colonic inertia". Subtotal colectomy with ileorectal anastomosis yields a good outcome in 70-100% of cases with slow transit constipation. In contrast, there is a broad spectrum of surgical techniques in the treatment of outlet obstruction, among which anorectal myectomy seems to be appropriate for selected patients with good results in 54-92%.

[100 consecutive cases of surgical esophagus-cardia carcinoma].

100 esophagectomies were performed at the Waid Hospital in Zürich between 1981-1988. 55 patients underwent blunt esophagectomy without thoracotomy, 34 abdomino-thoracic resection with intrathoracic anastomosis, and 11 abdomino-thoracic resection with lymphadenectomy and cervical anastomosis. In 80% the tumor had spread through the esophageal wall or there were already regional lymph node metastases.