[Is the thyroidectomy a surgical standard procedure for therapy of Graves' disease?]. / Stellt die Thyreoidektomie ein Standardverfahren zur Behandlung des Morbus Basedow dar?

Surgery is an important therapeutic option in the treatment of Graves' disease. Nevertheless it is still controversial discussed wether the extent of resection correlates with the rate of surgical complications and the therapeutic success. Therefore we performed a retrospective analysis on 75 surgically treated patients. 58 of these 75 patients were examined after a median interval of 34.2 months. The examination focussed on the appearance of temporary and permanent palsy of the recurrent laryngeal nerve, hypoparathyroidism, recurrences, and on the postoperative course of thyroid-stimulating-hormone-receptor antibody (TSH-ab) titers. Total thyroidectomy has been performed in 51 and bilateral resection with a remnant thyroid volume less than 2 ml each side in 24 patients. We could not confirm a significant difference concerning the postoperative complication rates between both groups. In the bilateral resection group we saw 3 cases of recurrent goitre and a more unfavourable course of TSH-ab titers than in the thyroidectomy group. For these reasons we propose the total thyroidectomy as surgical standard procedure for therapy of Graves' disease.

[Laparoscopic heller cardiomyotomy either combined with a Dor or Toupet procedure in the treatment of achalasia]. / Die laparoskopische Heller-Dor-/Heller-Toupet-Prozedur in der Therapie der Achalasie.

INTRODUCTION: The treatment of achalasia has undergone a dramatic evolution over the past ten years with the introduction of advanced laparoscopic techniques beside the use of balloon dilatation and injections of botulinumtoxin. With the introduction of the laparoscopic Heller cardiomyotomy the question was raised again whether and if so which antireflux measures are meaningful in combination with the cardiomyotomy. PATIENTS AND METHOD: Since 1998, 51 patients underwent laparoscopic cardiomyotomy in the surgical department of the Marienhospital Herne, Ruhr University Bochum. To prevent postoperative gastroesophageal reflux we performed a Dor fundoplication in 13 patients and a Toupet fundoplication in 38 patients. The mean period of observations was 17 months (3-45 months). All patients were evaluated through a symptoms score. 16 patients could be clinically and objectively followed-up. RESULTS: The mean operation time was 170 min. (80-290 min). The intraoperative complications were 8 mucosal disruptions without further morbidity and 1 pneumothorax. Postoperative complications were 1 scarring restenosis and 1 wrap dislocation. Improvement of symptoms was reported in 94.2 % of patients with good or excellent results. In 5.8 % of patients symptoms of reflux were claimed. There was no significant difference in results between Dor- and Toupet-fundoplication. CONCLUSION: Laparoscopic Heller cardiomyotomy with either a Dor or Toupet fundoplication are equivalent with respect to short- and middle-term outcome and efficient procedures with low rate of morbidity and mortality in the treatment of achalasia. A long-term observation period is necessary for determining which type of fundoplication has to be performed particularly regarding restenosis and reflux rate.

[Implantation of oxidized, regenerated cellulose for prevention of recurrence in surgical therapy of carpal tunnel syndrome]. / Einsatz von oxidierter, regenerierter Zellulose zur Rezidivprophylaxe bei der chirurgischen Therapie des Karpaltunnelsyndroms.

Recurrences and persistent symptoms of carpal tunnel syndrome after its surgical treatment is most commonly due to inadequacies of the first procedure, recurrent tenosynovialitis and in particular adhesion formation between the median nerve and its surrounding tissue and scars. Because of the encouraging experiences with oxidized regenerated cellulose (INTERCEED) as an absorbable adhesion-barrier in abdominal surgery, we began using INTERCEED in carpal tunnel surgery. In nine patients who underwent division of the flexor retinaculum combined with epineurotomy or synovialectomy, we covered the median nerve with a monolayer of INTERCEED. According to our good experiences concerning handling, compatibility and recovery, the application of INTERCEED might potentially reduce the recurrence rate in carpal tunnel surgery.

[Necrotizing fasciitis of the lower extremity]. / Die Fasciitis necroticans im Bereich der unteren Extremität.

Three cases of a necrotizing fasciitis, a rare but life- and limb-threatening infection, were treated in the Department of Surgery at the University Hospital of the Ruhr University Bochum (MHH) between October 1992 and January 1994. We compare our experiences with regard to bacteriological etiology, risk factors, localization, and place of entry, course, therapy and mortality with those in the literature.