ABSTRACT
Laparoscopic colorectal surgery not only presupposes knowledge in conventional surgery of the large bowel but also requires extensive experience in laparoscopic techniques. Furthermore every individual of the operating team should have suitable experience to guarantee effective co-operation. The presented study reports on 41 laparoscopic resections of sigmoid colon and upper rectum. The operations were carried out on 31 patients with benign and 10 patients with malignant diseases. In 1 case we had to change to an open procedure. Postoperative complications were seen in 10 patients, one of whom died (secondary haemorrhage 2; anastomotic leakage 1, Douglas haematoma 1, inflammation of the drainage tract 6). Preoperative management, intraoperative procedures and postoperative results are described and discussed.
Subject(s)
Laparoscopes , Rectal Diseases/surgery , Rectal Neoplasms/surgery , Sigmoid Diseases/surgery , Sigmoid Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/instrumentation , Cause of Death , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/etiology , Rectal Diseases/mortality , Rectal Neoplasms/mortality , Reoperation , Sigmoid Diseases/mortality , Sigmoid Neoplasms/mortality , Surgical Equipment , Surgical Instruments , Survival RateABSTRACT
Oesophageal pressure swings were analysed during complete occlusion of the upper airways in 8 patients with obstructive sleep apnoea. We hypothesed that in dependence of the apnoea type, there is a significant decrease in oesophageal inspiratory effort in REM vs. NREM that is caused by a decrease of the respiratory drive. We analysed in each patient 40 apnoeas in which the respiratory timing (Ti) and the inspiratory effort (Pin) were calculated and compared with the type of apnoea and the degree of oxygen desaturation. A significant decrease in inspiratory effort in REM vs NREM occurred only in mixed apnoeas but not in patients with mainly obstructive apnoeas. Additionally, all apnoeas with a decrease of inspiratory effort at the end of apnoea during NREM were seen in obstructive apnoeas only, whereas none occurred in mixed apnoeas. Due to the significant lower inspiratory timing during obstructive apnoeas vs mixed apnoeas we assume a decrease in respiratory drive in the patients suffering mainly from obstructive apnoeas.
