[Laparoscopic treatment of small bowel obstruction with intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum]. / Laparoskopische Behandlung eines Dünndarmileus mit mehrfacher Invagination, Volvulus und Appendizitis bei Meckel'schem Divertikel.

Indications and contraindications for diagnostic laparoscopy in cases of intestinal obstructions are discussed in connection with a 16-year-old patient's case report with small bowel obstruction including intussusception, volvulus and appendicitis caused by an inflammatory Meckel's diverticulum. The use of diagnostic laparoscopy in cases of intestinal obstructions is controversial. In the described case we performed completely laparoscopically the derevolving and desusception of the volvulus and intussusception, the appendectomy and resection of the diverticulum. The procedure itself and the postoperative course were uneventful.

Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study.

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

[Value and technique of laparoscopic choledochus revision in choledocholithiasis]. / Stellenwert und Technik der laparoskopischen Choledochusrevision bei der Choledocholithiasis.

Despite a large scale indication to ERCP, 5% of unsuspected stones are shown by principally intraoperative cholangiography in our patients. Praeoperative diagnostic makes it possible to select the individual optimal therapy for each patient, the possibility of saving the Papilla vateri gives the large scale indication to laparoscopic common bile duct exploration. Also suspected stones gets a one-time cure therapy by complete laparoscopic operation. After balloon-dilatation of cysticus duct to 6 mm, the laparoscopic choledochoscopy is possible through the cysticus duct. Little stones are flushed into the duodenum or extracted by Segura-basket through the cysticus duct. Big stones needs a Laser- or electrohydraulic lithotripsy, the stonefragments can be flushed into the duodenum or aspirated through the cysticus duct. Multiple big or proximal incarcerated stones gives the indication for laparoscopic choledochotomy. Effective extraction is possible by big Segura-basket, residual stones are taken out under choledochoscopic control by little Segura-basket. Incarcerated stones needs the lithotripsy. Microdrainage of the common bile duct and only in special indication the T-tube saves the gall-flow to restitution of papilla function, the common bile duct is closed by running suture in Lahodny-technique. After the regular postoperative cholangiography on third day after operation, the microdrainage can be taken out. In 96% of all laparoscopic cholecystectomies the intraoperative cholangiography was successful. Only 3 of 103 patients needs a postoperative EPT because of residual fragments after trans cystic duct exploration. 8 laparoscopic choledochotomies shows the successness of endoscopic techniques, the postoperative complications can be the same then in conventional operation.

[Minimal invasive lumbar sympathectomy--technique and outcome, retroperitoneoscopic approach]]. / Die minimal-invasive lumbale Sympathektomie--Technik und Ergebnisse, retroperitoneoskopischer Zugang.

Peripheral vascular obliteration of the leg provides an indication for a retroperitoneoscopic lumbal sympathectomy initially using a balloon dilator to create a transitional retroperitoneal cavity. After introducing carbon dioxide and two 5-mm instruments, we perform the resection and extirpation of the lumbal sympathetic nerve from L 2 to L 4. No complications occurred in 29 patients except conversion to open surgery in two cases because of gas loss into the peritoneum after causing peritoneal lesions.

Laparoscopic cholecystectomy in a young girl.

Laparoscopic cholecystectomy is now a widely used procedure in adults. However, reports on this procedure in infants and young children are rare. This paper reports a successful laparoscopic cholecystectomy in a young girl.

Laparoscopic proximal gastric vagotomy--neuralgic points of technique.

Laparoscopic proximal gastric vagotomy is a valuable therapeutic tool in the management of patients suffering from recurrent duodenal ulcer disease, the therapeutic principle being the effective reduction of gastric acid output without gastrotomy or gastric resection. The method is based on the well-documented conventional technique, which has been evaluated for over 15 years. The division of all vagal fibres to the gastric fundus and body is essential for complete vagotomy in order to ensure a sufficient reduction in gastric acid. The operation time is between 2 and 3 hours. Eighteen patients have been treated successfully with this minimally invasive and safe procedure in our unit. The functional and cosmetic results are excellent. The comparatively lower costs are, last but not least, an important advantage.

Strategy and technique of laparoscopic common bile duct exploration.

The laparoscopic approach to common bile duct exploration enables the complete clearance of stones from the bile duct without damage to structures of physiological importance such as the ampulla of Vater. Despite preoperative endoscopic retrograde cannulation of the biliary tree (ERCP) in patients with suspected stones, routine intraoperative cholangiography reveals a further 6% with unsuspected common bile duct stones. Both the preoperative suspected stone and the stone found on intraoperative cholangiography can be adequately managed by the laparoscopic method. The approach to the common bile duct via the cystic duct avoids incising the common duct or the sphincter of Oddi. The common bile duct can be approached satisfactorily by balloon dilatation of the cystic duct to 5 mm so enabling the choledochoscope to be inserted into the common bile duct. Small stones are washed into the duodenum or extracted by the Segura basket retrogradely through the cystic duct. Larger stones can be disintegrated by laser or electrohydraulic lithotripsy; the fragments can either be washed into the duodenum or sucked out via the cystic duct. Laparoscopic choledochotomy is indicated for multiple big or proximally located stones. The larger sized Segura basket can be used effectively for these large stones. Residual stones are extracted under cholangioscopic control and any incarcerated stone disintegrated by lithotripsy. A small catheter placed in the common bile duct or a standard T-tube completes the exploration and avoids disordered function of the sphincter of Oddi.(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopic operations of the bile duct]. / Laparoskopische Operationen am Gallengang.

Laparoscopic common bile duct exploration offers the possibility of complete minimal invasive therapy of biliary stone disease with respect to the anatomical structures of the papilla Vateri. In spite of generously indicated preoperative ERC, we found in 23 of 376 laparoscopic cholecystectomies unsuspected common bile duct stones by intraoperative in principle cholangiography. 8 patients with known common bile duct stones got a complete laparoscopic therapy. Balloon-dilatation of the ductus cysticus up to 5 mm is followed by laparoscopic choledochoscopy via the cystic duct. Small stones are washed into the duodenum or extraced retrogradely via the cystic duct. For bigger stones the intracorporeal lithotripsy is available, the stone scrap is washed either into the duodenum or is sucked off via the cystic duct. Laparoscopic choledochotomy is indicated for multiple big or proximally fixed stones. In this way stone extraction can be effectively performed, incarcerated stones are treated by additional lithotripsy. A microdrainage of the common bile duct or a T-tube drainage secures the bile flow until restitution of papillary function. The common bile duct is sewn by running suture. In the case of regular cholangiography the microdrainage can be removed on the third postoperative day. In 96% of the laparoscopic cholecystectomies intraoperative cholangiography was possible. 3 of 21 patients with transductus cysticus-exploration had to undergo postoperative EPT due to residual stone fragments. 6 laparoscopic choledochotomies showed the efficacy of the endoscopic operation technique, demonstrating the probability of complications in the postoperative period to be equivalent to that of conventional operations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reservoir capacity of esophagojejunostomy following gastrectomy determined by the radioisotope method]. / Die Reservoirleistung der Osophagojejunostomie nach Gastrektomie, bestimmt mit der Radioisotopenmethode.

The substitute reservoir emptying was determined quantitatively in 16 patients with total gastrectomy by means of the radio-isotope method. The continuity was restored in 15 patients by an entero-anastomosis in modification according to Graham and in one patient by esophagoduodenostomy. The investigation was carried out in 11 patients with total gastrectomy in upright position and in 4 patients in lying position. As control group there were used 14 normal subjects. The emptying traces, the radioactive half-life, and the emptying rate show a clear acceleration of the emptying. The behaviour of the emptying returns to normal in lying position. A constant relation of these findings could not be found out compared with the nutritional state or the postprandial complaints.

[Current surgical management of reflux disease]. / Aktueller Stand der chirurgischen Behandlung der Refluxkrankheit.

This disease has not been fully clarified yet. In our opinion, surgery should only be performed in cases of stage IV because of ulcers, irreversible scar formation, metaplasia of the epithelium, endobrachyoesophagus, stenoses or malignant degeneration. 11 patients suffering from severe reflux oesophagitis (stage IV) underwent a combination of supraselective vagotomy (to lower gastric acidity) fundoplication according to Nissen and intraoperative dilatation of the stenosis or stricture. This procedure was effective. Resection of the cardia is a difficult operation full of possible complications and should be reserved only to cases with malignant degeneration (adenocarcinoma).

[Hepatocellular adenoma following long-term intake of ovulation inhibitors]. / Hepatozelluläres Adenom nach langjähriger Einnahme von Ovulationshemmern.

PIP: A 32-year-old woman with a contraceptive history of use of combination contraceptives (Oviston, Non-Ovlon) between 1966 and 1979 (with a 1-year interruption), followed by radical hysterectomy in 1979, complained of dull right upper quadrant pain, nausea, vomiting, and fatigue in 1980. Among various diagnostic studies performed only cholecystography and cholangiography demonstrated clear areas in the gallbladder assumed to be stones. Cholecystectomy performed in 1981 showed chronic inflammation of the gallbladder without stones. The undersurface of the liver revealed a greyish tumor (3 cm in diameter). Frozen section demonstrated mature hepatocellular adenoma. Wedge excision of the tumor and cholecystectomy were performed without complications. CAT-scan follow-up showed no residual pathology. Additional literature search reports 58 cases in western European and American journals. Diagnosis of these benign tumors is difficult because the symptoms are vague. The main complication is intraabdominal hemorrhage necessitating emergency lobectomy. Ligation of a branch of the hepatic artery is done in case of inoperability. CAT-scan and ultrasonography with selective angiography are the best procedures to ascertain the diagnosis. Needle biopsy is contraindicated because of the risk of hemorrhage.^ieng

[Amino acid resorption and protein metabolism following total gastrectomy in the rat]. / Untersuchungen der Aminosäureresorption und des Eiweissstoffwechsels nach totaler Gastrektomie bei der Ratte.

The investigations were carried out in rats by means of the amino acid 15N-glycinee 6 to 12 weeks after the gastrectomy. 10 rats were operated by Graham and 9 by Longmire, Gütgemann. 12 rats as a control group were not operated. The animals got a single dose 15N-glycin with the food in the beginning of the experiment. The excretion of the isotope was measured every twelve hours for 5 days. All rats had a positive nitrogen balance. The rats operated by Graham excreted with the urine significantly less 15N than the rats of the other two groups. These differences were caused by different fast adsorption of the amino acids likely, at this the rats operated by Graham absorbed retardingly evident qualified by the absent duodenal passage. These disturbances of the amino acid absorption are not aggravating, because the nitrogen balance and the protein synthesis rate of the animals were normal.

[Malabsorption from the surgical viewpoint]. / Malabsorption aus chirurgischer Sicht.

Malabsorption following surgical procedures on the GI-tract happens only in rare cases, such as blindloop-syndrome, short gut-syndrome, internal fistulae and dumping syndrome after partial gastric resection. Pathophysiological background and therapeutical possibilities as well as parenteral nutrition are discussed in detail.

[Current state and perspectives of the use of the 15N-tracer technic in gastroenterologic studies]. / Gegenwärtiger Stand und Perspektiven des Einsatzes der 15N-Tracertechnik in der gastroenterologischen Forschung.

The importance of 15N as tracer in medical research is increasing. Since 1965 many results were obtained in cooperation of surgeons (Surgical clinic of Karl-Marx-University; Bezirkskrankenhaus St. Georg, Leipzig) and coworkers of Central Institute of Isotope and Radiation research. Using 3 test models (15N-labelled amino acid solution, permanent infused; 15N-labelled glycine, given as one single dose; 15N-labelled casein, oral given) healthy persons, patients in stress condition and after gastric operations and rats after performing several types of gastric operations were studied. Possibilities of calculations with mathematical models are shown.

[Preoperative phase of colonic surgery (author's transl)]. / Die präoperative Phase in der Kolonchirurgie.

The existing possibilities to prepare colon and rectum for surgery are discussed, optimal nutrition just before operation is particularly stressed. The efficiency of oral and parenteral antimicrobial prophylaxis ist pointed out. Apart from contra-indications, orthograde lavage of the bowel is the method of choice.

[Absorption of amino acids in patients after partial gastrectomy (B II) and truncal vagotomy with pyloroplasty or antrectomy (author's transl)]. / Die Anderung der Aminosäurenresorptionsdynamik nach resezierenden, bionomen und kombinierten Magenoperationsmethoden.

After surgery for gastric or duodenal ulcer the resorption of amino acids is changed due to alteration of morphology and function of stomach, bile system, pancreas and small bowel. We used the stable isotope labelled amino acid 15N-glycine in patients after partial gastrectomy (B II), truncal vagotomy with pylorplasty as well as antrectomy and in healthy persons. It could be shown that in contrast to the control group the absorption of the amino acid in the surgical group took place more rapid and more intensive.