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Rau B, Lang H, Koenigsrainer A, Gockel I, Rau HG, Seeliger H, Lerchenmueller C, Reim D, Wahba R, Angele M, Heeg S, Keck T, Weimann A, Topp S, Piso P, Brandl A, Schuele S, Jo P, Pratschke J, Wegel S, Rehders A, Moosmann N, Gaedcke J, Heinemann V, Trips E, Loeffler M, Schlag PM, Thuss-Patience P. Effect of Hyperthermic Intraperitoneal Chemotherapy on Cytoreductive Surgery in Gastric Cancer With Synchronous Peritoneal Metastases: The Phase III GASTRIPEC-I Trial. J Clin Oncol 2024; 42:146-156. [PMID: 37906724 PMCID: PMC10824373 DOI: 10.1200/jco.22.02867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/27/2023] [Accepted: 08/30/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE In patients with peritoneal metastasis (PM) from gastric cancer (GC), chemotherapy is the treatment of choice. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are still being debated. This randomized, controlled, open-label, multicenter phase III trial (EudraCT 2006-006088-22; ClinicalTrials.gov identifier: NCT02158988) explored the impact on overall survival (OS) of HIPEC after CRS. PATIENTS AND METHODS Adult patients with GC and histologically proven PM were randomly assigned (1:1) to perioperative chemotherapy and CRS alone (CRS-A) or CRS plus HIPEC (CRS + H). HIPEC comprised mitomycin C 15 mg/m2 and cisplatin 75 mg/m2 in 5 L of saline perfused for 60 minutes at 42°C. The primary end point was OS; secondary endpoints included progression-free survival (PFS), other distant metastasis-free survival (MFS), and safety. Analyses followed the intention-to-treat principle. RESULTS Between March 2014 and June 2018, 105 patients were randomly assigned (53 patients to CRS-A and 52 patients to CRS + H). The trial stopped prematurely because of slow recruitment. In 55 patients, treatment stopped before CRS mainly due to disease progression/death. Median OS was the same for both groups (CRS + H, 14.9 [97.2% CI, 8.7 to 17.7] months v CRS-A, 14.9 [97.2% CI, 7.0 to 19.4] months; P = .1647). The PFS was 3.5 months (95% CI, 3.0 to 7.0) in the CRS-A group and 7.1 months (95% CI, 3.7 to 10.5; P = .047) in the CRS + H group. The CRS + H group showed better MFS (10.2 months [95% CI, 7.7 to 14.7] v CRS-A, 9.2 months [95% CI, 6.8 to 11.5]; P = .0286). The incidence of grade ≥3 adverse events (AEs) was similar between groups (CRS-A, 38.1% v CRS + H, 43.6%; P = .79). CONCLUSION This study showed no OS difference between CRS + H and CRS-A. PFS and MFS were significantly better in the CRS + H group, which needs further exploration. HIPEC did not increase AEs.
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Affiliation(s)
- Beate Rau
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Hauke Lang
- Department of Surgery, Johannes Gutenberg Universität Mainz Klinikum, Mainz, Germany
| | | | - Ines Gockel
- Department of Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Hendrik Seeliger
- Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Lerchenmueller
- Department of Medical Oncology, Gemeinschaftspraxis für Hämatologie und Onkologie-Münster, Münster, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roger Wahba
- Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Martin Angele
- Department of Surgery, Klinikum der Universität München-Großhadern, München, Germany
| | - Steffen Heeg
- Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Keck
- Department of Surgery, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Arved Weimann
- Department of Surgery, St Georg-Krankenhaus Leipzig, Leipzig, Germany
| | - Stefan Topp
- Department of Surgery, Bonifatius Hospital Lingen (für Düsseldorf), Lingen, Germany
| | - Pompiliu Piso
- Department of Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Andreas Brandl
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Silke Schuele
- Department of Surgery, Universitätsklinikum Jena, Jena, Germany
| | - Peter Jo
- Department of Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Johann Pratschke
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Sandra Wegel
- Department of Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Alexander Rehders
- Department of Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Nicolas Moosmann
- Department of Medical Oncology, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Jochen Gaedcke
- Department of Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Volker Heinemann
- Department of Medical Oncology, Klinikum der Universität München-Großhadern, München, Germany
| | - Evelyn Trips
- Zentrum für Klinische Studien (ZKS) Leipzig, Medizinische Fakultät, Universität Leipzig, Leipzig, Germany
- Coordination Centre for Clinical Trials Dresden, Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Markus Loeffler
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Medizinische Fakultät, Universität Leipzig, Leipzig, Germany
| | - Peter Michael Schlag
- Department of Surgery and Surgical Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Abstract
Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38–101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was associated with faster recovery, no need for hospitalization and overall low complication rates. In summary, the main advantages of the pit-picking operation lie in its’ outpatient character, the simplicity of the procedure, low complication rates, short recovery time, and predictably good results.
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Affiliation(s)
- Denis Ehrl
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Cornelia Choplain
- Department of Visceral and Thoracic Surgery, Helios Amper-Clinic of Dachau, Dachau, Germany
| | - Paul Heidekrueger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Holger C. Erne
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
| | - Horst-Guenter Rau
- Department of Visceral and Thoracic Surgery, Helios Amper-Clinic of Dachau, Dachau, Germany
| | - P. Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Technical University Munich, Munich, Germany
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Ehrl D, Choplain C, Heidekrueger P, Erne HC, Rau HG, Broer PN. Treatment Options for Pilonidal Disease. Am Surg 2017; 83:453-457. [PMID: 28541853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pilonidal disease can be treated medically; however, surgical excision remains the gold standard. Nonetheless, all current surgical approaches are still associated with potential for tissue loss, wound healing disorders, and high rates of recurrence. Aim of this study is to assess the long-term outcomes of the minimal-invasive pit-picking operation in comparison to the well-established technique of Karydakis flap-closure. Medical records of all patients undergoing either Karydakis flap-closure or the pit-picking operation for pilonidal disease at our department were reviewed retrospectively. A total of 101 patients were treated either by excision and Karydakis flap-closure (n = 62) or by the pit-picking operation (n = 39). Mean follow-up time was 65.5 (range: 38-101) months, including data collection using a standardized questionnaire. Analysis of the outcomes revealed no significant differences between the Karydakis flap-closure- and the pit-picking groups; however, the latter was associated with faster recovery, no need for hospitalization and overall low complication rates. In summary, the main advantages of the pit-picking operation lie in its' outpatient character, the simplicity of the procedure, low complication rates, short recovery time, and predictably good results.
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May F, Schlenker B, Hofer B, Stief CG, Rau HG. Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review. Indian J Urol 2013; 29:61-3. [PMID: 23671369 PMCID: PMC3649604 DOI: 10.4103/0970-1591.109988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.
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Affiliation(s)
- Florian May
- Department of Urology, Amper-Klinikum, Dachau, Germany ; Department of Urology, Ludwig Maximilians-University, Munich, Germany
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Petridis C, Klein B, Parzhuber A, Rau HG. [TULC - total umbilical laparoscopic cholecystectomy]. Zentralbl Chir 2011; 137:43-7. [PMID: 21360429 DOI: 10.1055/s-0030-1262610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Except for some few cases only symptomatic cholecystolithiasis constitutes an indication for operative treatment. The gold standard meanwhile has been the laparoscopic cholecystectomy, because the method shows good results with short hospital stay. Recently there has been an intensive discussion about combination of laparoscopic techniques with natural body orifice using surgery (NOTES). These techniques permit further reduction of surgical trauma and enhancing of cosmetic results. However, the technical effort is significant and most of the times a combination (hybrid procedure) of NOTES with standard laparoscopic procedure is performed, so that we concentrated on performing a laparoscopic cholecystectomy using a single incision through the umbilicus. METHODS A 5-mm incision left deep in the umbilicus and a 10-mm incision directly below were used for creating a pneumoperitoneum and for inserting the ports for the optic and the dissector. Exposition of the gallbladder was carried out by sutures, that were penetrated from outside through the abdominal wall into the abdominal cavity and transfixed through the gallbladder in order to hang up the gallbladder like a puppet by penetrating the abdominal wall again to the outside. Removal occurred through the umbilical incision. RESULTS We successfully operated on 90 patients in a 12-month period. Mean operating time was 48 (39-71) min whereby no conversion to open surgery was necessary. No intra- or postoperative complications occurred in any patient. Average hospital stay was 2.5 (2-4) days, postoperative examination showed no differences to the usual laparoscopic cholecystectomy with a good cosmetic result and no visible scars. CONCLUSION The purpose of our study was to further improve the cosmetic results of minimally invasive surgery of the gallbladder by operating totally through the umbilicus, using 2 ports deep in the umbilicus. We thereby avoid further surgical trauma due to creating an access through another organ as is done in the NOTES technique. For this operation no special equipment like flexible endoscopes was needed as common laparoscopic instruments were used.
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Affiliation(s)
- C Petridis
- Amper Klinik Dachau, Abteilung für Viszeral-, Thorax- und Gefäßchirurgie, Dachau, Deutschland.
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Choukèr A, Martignoni A, Schauer RJ, Rau HG, Volk A, Heizmann O, Dugas M, Messmer K, Peter K, Thiel M. Ischemic preconditioning attenuates portal venous plasma concentrations of purines following warm liver ischemia in man. Eur Surg Res 2005; 37:144-52. [PMID: 16088179 DOI: 10.1159/000085961] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 03/15/2005] [Indexed: 01/12/2023]
Abstract
BACKGROUND/AIMS Degradation of adenine nucleotides to adenosine has been suggested to play a critical role in ischemic preconditioning (IPC). Thus, we questioned in patients undergoing partial hepatectomy whether (i) IPC will increase plasma purine catabolites and whether (ii) formation of purines in response to vascular clamping (Pringle maneuver) can be attenuated by prior IPC. METHODS 75 patients were randomly assigned to three groups: group I underwent hepatectomy without vascular clamping; group II was subjected to the Pringle maneuver during resection, and group III was preconditioned (10 min ischemia and 10 min reperfusion) prior to the Pringle maneuver for resection. Central, portal venous and arterial plasma concentrations of adenosine, inosine, hypoxanthine and xanthine were determined by high-performance liquid chromatography. RESULTS Duration of the Pringle maneuver did not differ between patients with or without IPC. Surgery without vascular clamping had only a minor effect on plasma purine concentrations. After IPC, plasma concentrations of purines transiently increased. After the Pringle maneuver alone, purine plasma concentrations were most increased. This strong rise in plasma purines caused by the Pringle maneuver, however, was significantly attenuated by IPC. When portal venous minus arterial concentration difference was calculated for inosine or hypoxanthine, the respective differences became positive in patients subjected to the Pringle maneuver and were completely prevented by preconditioning. CONCLUSION These data demonstrate that (i) IPC increases formation of adenosine, and that (ii) the unwanted degradation of adenine nucleotides to purines caused by the Pringle maneuver can be attenuated by IPC. Because IPC also induces a decrease of portal venous minus arterial purine plasma concentration differences, IPC might possibly decrease disturbances in the energy metabolism in the intestine as well.
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Affiliation(s)
- A Choukèr
- Clinic of Anesthesiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
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Choukèr A, Schachtner T, Schauer R, Dugas M, Löhe F, Martignoni A, Pollwein B, Niklas M, Rau HG, Jauch KW, Peter K, Thiel M. Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial. Br J Anaesth 2004; 93:204-11. [PMID: 15194628 DOI: 10.1093/bja/aeh195] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Pringle manoeuvre and ischaemic preconditioning are applied to prevent blood loss and ischaemia-reperfusion injury, respectively, during liver surgery. In this prospective clinical trial we report on the intraoperative haemodynamic effects of the Pringle manoeuvre alone or in combination with ischaemic preconditioning. METHODS Patients (n=68) were assigned randomly to three groups: (i) resection with the Pringle manoeuvre; (ii) with ischaemic preconditioning before the Pringle manoeuvre for resection; (iii) without pedicle clamping. RESULTS Following the Pringle manoeuvre the mean arterial pressure increased transiently, but significantly decreased after unclamping as a result of peripheral vasodilation. Ischaemic preconditioning improved cardiovascular stability by lowering the need for catecholamines after liver reperfusion without affecting the blood sparing benefits of the Pringle manoeuvre. In addition, ischaemic preconditioning protected against reperfusion-induced tissue injury. CONCLUSIONS Ischaemic preconditioning provides both better intraoperative haemodynamic stability and anti-ischaemic effects thereby allowing us to take full advantage of blood loss reduction by the Pringle manoeuvre.
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Affiliation(s)
- A Choukèr
- Clinic of Anaesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University, D-81377 Munich, Germany
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8
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Schirren CA, Zachoval R, Gerlach JT, Ulsenheimer A, Gruener NH, Diepolder HM, Baretton G, Schraut W, Rau HG, Nitschko H, Pape GR, Jung MC. Antiviral treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation: association of a strong, multispecific, and long-lasting CD4+ T cell response with HCV-elimination. J Hepatol 2003; 39:397-404. [PMID: 12927926 DOI: 10.1016/s0168-8278(03)00266-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Patients with recurrent hepatitis C virus (HCV)-infection after liver transplantation (OLTx) could develop an early, multispecific, preferentially intrahepatic CD4+ T cell response. We asked now whether there is a correlation between the HCV-specific CD4+ T cell response and treatment outcome in patients who receive interferon (IFN)-alpha/ribavirin. METHODS Liver- and blood-derived T cell lines of 20 patients were studied in parallel before, under, at the end and after antiviral treatment. Virus-specific IFN-gamma production at a single cell level to HCV-proteins (core, non-structural protein (NS)3/4, NS5) was determined by enzyme-linked immunospot assay. RESULTS In 6/7 non-responders a weak HCV-specific CD4+ T cell response was detectable. All six sustained responders developed a strong, at NS3/4 and NS5 directed and long-lasting CD4+ T cell response which was mainly detected in peripheral blood mononuclear cells. This reaction was significantly stronger: (1) in the responders than in the non-responders; and (2) within the responders at the end of treatment than before (P<0.03). Seven transient-responders showed a weak and/or transient HCV-specific CD4+ T cell response. CONCLUSIONS In patients with recurrent HCV-infection after OLTx, who receive antiviral treatment, a strong, at NS3/4 and NS5 directed and long-lasting CD4+ T cell response is associated with HCV-elimination whereas no or a weak/transient response is associated with treatment failure.
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Affiliation(s)
- Carl Albrecht Schirren
- Department of Medicine II, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany.
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Penovici M, Zachoval R, Schauer R, Rau HG, Roth U, Hiller E. [Phenotypic healing of factor II deficiency by liver transplantation]. Internist (Berl) 2002; 43:1125-8. [PMID: 12426720 DOI: 10.1007/s00108-002-0634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Penovici
- Medizinische Klinik III, Klinikum Grosshadern, Ludwig-Maximilians-Universität München
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Abstract
Laparoscopy has improved surgical treatment of various diseases due to its limited surgical trauma and has developed as an interesting therapeutic alternative for the resection of colorectal cancer. Despite numerous clinical advantages (faster recovery, less pain, fewer wound and systemic complications, faster return to work) the laparoscopic approach to colorectal cancer therapy has also resulted in unusual complications, i.e. ureteral and bladder injury which are rarely observed with open laparotomy. Moreover, pneumothorax, cardiac arrhythmia, impaired venous return, venous thrombosis as well as peripheral nerve injury have been associated with the increased intraabdominal pressure as well as patient's positioning during surgery. Furthermore, undetected small bowel injury caused by the grasping or cauterizing instruments may occur with laparoscopic surgery. In contrast to procedures performed for nonmalignant conditions, the benefits of laparoscopic resection of colorectal cancer must be weighed against the potential for poorer long-term outcomes of cancer patients that still has not been completely ruled out. In laparoscopic colorectal cancer surgery, several important cancer control issues still are being evaluated, i.e. the extent of lymph node dissection, tumor implantation at port sites, adequacy of intraperitoneal staging as well as the distance between tumor site and resection margins. For the time being it can be assumed that there is no significant difference in lymph node harvest between laparoscopic and open colorectal cancer surgery if oncological principles of resection are followed. As far as the issue of port site recurrence is concerned, it appears to be less prevalent than first thought (range 0-2.5%), and the incidence apparently corresponds with wound recurrence rates observed after open procedures. Short-term (3-5 years) survival rates have been published by a number of investigators, and survival rates after laparoscopic surgery appears to compare well with data collected after conventional surgery for colorectal cancer. However, long-term results of prospective randomized trials are not available. The data published so far indicate that the oncological results of laparoscopic surgery compare well with the results of the conventional open approach. Nonetheless, the limited information available from prospective studies leads us to propose that minimally invasive surgery for colorectal cancer surgery should only be performed within prospective trials.
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Affiliation(s)
- M W Wichmann
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München, Germany
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Ehrentraut S, Rothenhäusler HB, Gerbes AL, Rau HG, Thiel M, Schirren CA, Kapfhammer HP. [Acute liver failure in nefazodone therapy? A case report]. Nervenarzt 2002; 73:686-9. [PMID: 12212533 DOI: 10.1007/s00115-002-1350-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antidepressant-induced hepatotoxicity is generally considered of minimal clinical importance and is not well recognized. We report on a patient with recurrent major depression who was treated with nefazodone. Six weeks after initiation of therapy with nefazodone, he developed fatal liver failure. After cessation of the drug, the patient did not recover. He underwent liver transplantation but unfortunately died.
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Affiliation(s)
- S Ehrentraut
- Psychiatrische Klinik und Poliklinik der LMU München, Nussbaumstrasse 7, 80336 München.
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Rau HG, Wichmann MW, Wilkowski R, Heinemann V, Sackmann M, Helmberger T, Dühmke E, Schildberg FW. [Surgical therapy of locally advanced and primary inoperable pancreatic carcinoma after neoadjuvant preoperative radiochemotherapy]. Chirurg 2002; 73:132-7. [PMID: 11974476 DOI: 10.1007/s00104-001-0363-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION So far, surgery represents the only prospect for cure in patients with pancreatic cancer. Most patients, however, present with locally advanced pancreatic cancer at primary diagnosis. Recently, novel therapeutic regimens with preoperative radiochemotherapy have been developed that may improve long-term survival and resectability rates of patients with locally advanced pancreatic cancer. METHODS This feasibility study evaluates the preliminary results of neoadjuvant therapy with gemcitabine and 5-fluorouracil (5-FU) or cisplatin. Twenty-six patients suffering from locally advanced pancreatic cancer were considered for preoperative radiochemotherapy. They received radiation (45 Gy) and chemotherapy with simultaneous or sequential gemcitabine and 5-FU (n = 15) or gemcitabine and cisplatin (n = 11) administration prior to surgical resection. RESULTS Mean patient age was 62.4 +/- 2.6 years and 62% (n = 16) were male. The response rate was 69%, and 11 patients underwent curative surgical resection of the pancreatic cancer. Nine Whipple procedures and two complete pancreatectomies were carried out. In five patients a total of eight surgical complications were observed. Median overall survival was 9.8 months after primary cancer diagnosis (mean 12.0 +/- 1.2). During follow-up no local recurrent disease was detected. CONCLUSIONS Our findings lead us to conclude that preoperative chemoradiation with 45 Gy, gemcitabine and 5-FU or cisplatin is a powerful therapeutic tool in patients with locally advanced non-resectable pancreatic cancer. Major resections, including vascular reconstructions, are nonetheless associated with increased mortality. Preoperative chemoradiation contributes to improved survival in patients with primary non-resectable pancreatic cancer.
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Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universität, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
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Schauer RJ, Meyer G, Baretton G, Schildberg FW, Rau HG. Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients. Langenbecks Arch Surg 2001; 386:110-7. [PMID: 11374043 DOI: 10.1007/s004230000189] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The surgical management of gallbladder cancer is controversial, especially as to the indications for reoperation, extended resection, and aggressive treatment in advanced tumor stages. METHODS Records and follow-ups of 127 patients with gallbladder carcinoma who underwent surgery between 1980 and 1997 were examined according to the pTNM and Nevin staging systems. Factors predictive for survival were obtained from histopathologic staging and surgical procedures. RESULTS Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 6.6%. Curative resection was possible in 35.5% of cases, which resulted in 5-year survival rates of 20%. Noncurative surgery revealed poor prognosis, with median survival time limited to 3.2 months, independently of macroscopic or microscopic tumor residues. None of the latter patients survived longer than 24 months. Surgery of stage I/II cancer showed a 5-year survival rate of 64.5%. In stage III/IV tumors, resectability was only 20.4%. However, curative surgery in advanced stages significantly increased median survival from 3.2 to 19.4 months. CONCLUSIONS Only complete tumor resection can provide long-term survival, even in advanced stages. Because negative surgical margins and UICC stage are the strongest predictors for survival, reoperation is required with all incidental findings above the T1b stage.
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Affiliation(s)
- R J Schauer
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University, 81377 Munich, Germany
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14
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Mittelkötter U, Rau HG, Thiede A, Schildberg FW, Kullmann KH. [Perioperative antimicrobial prophylaxis for colonic surgery: Present status in Germany. A prospective multicenter study with and without Metronidazole]. Zentralbl Chir 2001; 126:799-804. [PMID: 11727192 DOI: 10.1055/s-2001-18261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The objective of a multicentric observational study, that was performed in Germany between 1(st) September 1996 and 30(th) September 1997, was to assess postoperative infections as a function of risk factors and antibiotic prophylaxis under everyday clinical conditions. 2 481 patients from 114 centres who received infection prophylaxis prior to elective colonic resection were included. In the descriptive analysis of the study it was noted that 36.1 % of the patients had received no prophylaxis with metronidazole despite the fact that the study protocol recommended the use of this drug in preoperative antibiotic combinations. The present analysis therefore considers the influence of metronidazole on the postoperative infection rate. METHODS In order to exclude any bias due to intergroup differences in risk profile, the groups with and without metronidazole were subjected to a matched-pair analysis. Matching parameters were: duration of operation, blood loss, age, diabetes mellitus, hepatic, renal, or chronic airways disease, immunosuppressive therapy, and rectal resection. This led to the formation of 800 pairs that were matched with respect to these parameters. The 800 pairs were then stratified into the following treatment groups: Group 1 a and b: long-acting cephalosporine (ceftriaxone) with or without metronidazole (n = 2 x 491); Group 2 a and b: short-acting cephalosporines with or without metronidazole (n = 2 x 133); Group 3 a and b: broad-spectrum penicillines with or without metronidazole (n = 2 x 176). RESULTS In all three treatment groups combination therapy with metronidazole was found to be significantly superior. Postoperative infection rates were 9.4 % and 18.7 % (p = 0.000) respectively in Group 1 a and b, 12.0 % and 25.6 % (p = 0.008) respectively in Group 2 a and b, and 19.9 % and 29.0 % (p = 0.009) respectively in Group 3 a and b. CONCLUSION Preoperative administration of metronidazole in addition to an effective beta-lactam antibiotic is strongly advised in elective colonic surgery, as absence of antibiotic cover against anaerobic colonic flora leads to a significantly higher postoperative infection rate.
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Affiliation(s)
- U Mittelkötter
- Chirurgische Klinik und Poliklinik der Universität Würzburg
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15
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Rau HG, Wichmann MW, Schinkel S, Buttler E, Pickelmann S, Schauer R, Schildberg FW. [Surgical techniques in hepatic resections: Ultrasonic aspirator versus Jet-Cutter. A prospective randomized clinical trial]. Zentralbl Chir 2001; 126:586-90. [PMID: 11518996 DOI: 10.1055/s-2001-16573] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM OF THE STUDY For all resection-techniques of liver tissue intra- and post-operative blood-loss remains an important problem. Two novel resection-techniques the ultrasound-aspirator (CUSA) and the water-jet dissector (Jet-Cutter) appear to offer significant advantages regarding this problem. Aim of the present prospective clinical study was the comparison of these dissection techniques. MATERIAL AND METHODS Prospective randomized study with the end points blood-loss, length of surgery, tissue trauma and long-term survival. FINDINGS Significant differences between both procedures with Jet-Cutter (n = 31) versus ultrasonic surgical aspirator CUSA (n = 30) were observed regarding length of resection and complete liver ischemia time (Pringle-time). Here significant advantages of the jet-cutter-technique were observed with 28 +/- 11 minutes length of resection versus 46 +/- 19 minutes and 29 +/- 12 minutes Pringle-time versus 39 +/- 16 minutes. Furthermore, significant fewer blood transfusions were required following jet-cutter-resection with a mean of 1.5 blood units vs. 2.5 blood units using the CUSA. No differences were observed regarding postoperative long-term survival. CONCLUSIONS The jet-cutter-technique is a fast and safe surgical procedure for liver resections and offers an attractive therapeutic alternative for various indications in liver surgery.
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Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Germany
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16
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Schirren CA, Jung MC, Worzfeld T, Mamin M, Baretton G, Gerlach JT, Gruener NH, Zachoval R, Houghton M, Rau HG, Pape GR. Hepatitis C virus-specific CD4+ T cell response after liver transplantation occurs early, is multispecific, compartmentalizes to the liver, and does not correlate with recurrent disease. J Infect Dis 2001; 183:1187-94. [PMID: 11262200 DOI: 10.1086/319692] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2000] [Revised: 01/17/2001] [Indexed: 01/11/2023] Open
Abstract
The role of hepatitis C virus (HCV)-specific CD4+ T cells in recurrent HCV infection after orthotopic liver transplantation (OLTx) is unclear. In parallel, 73 intrahepatic and 73 blood-derived T cell lines were established from 34 patients. At a single cell level, virus-specific interferon (IFN)-gamma production to various HCV proteins was determined by ELISPOT assay: 45 (62%) of 73 liver- or blood-derived T cell lines produced IFN-gamma in response to one of the HCV antigens. HCV specificity was detected mainly in the liver (47% vs. 23% in the blood; P<.05, chi(2) test) and was detectable earlier (< or =6 months) significantly more often than later (>6 months) after OLTx (78% vs 49%; P<.05, chi(2) test). Histology, histologic activity index, liver enzymes, and virus load did not correlate with the occurrence of HCV-specific CD4+ T cells. Despite strong immunosuppressive treatment, OLTx recipients can develop an early, multispecific, preferentially intrahepatic CD4+ T cell response that decreases over time, making it a potential candidate target for novel therapeutic approaches in the transplant setting.
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Affiliation(s)
- C A Schirren
- Department of Medicine II, Klinikum Grosshadern, University of Munich, Marchioninstrasse 15, D-81377 Munich, Germany.
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17
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Rau HG, Schauer R, Pickelmann S, Beyer BC, Angele MK, Zimmermann A, Meimarakis G, Heizmann O, Schildberg FW. [Dissection techniques in liver surgery]. Chirurg 2001; 72:105-12. [PMID: 11253668 DOI: 10.1007/s001040051277] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The first liver resection was performed in 1888. Since then a wide variety of dissection techniques have been introduced. The blunt dissection was replaced by novel methods, i.e. the CUSA technique and the Jet Cutter for major liver resections. These methods represent selective dissection techniques; whereas non-selective methods include the scalpel, scissors, linear stapling cutter, high-frequency coagulation, and the laser technique. The aim of this review article is the comparison of the different resection techniques in liver surgery, focussing on blood loss and resection time.
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Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität, München
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18
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Abstract
Thoracic paragangliomas are a rare cause of hypertension. We report the occurrence of a sporadic benign norepinephrine-producing branchiomeric paraganglioma in a 32-year-old man with paroxysms of hypertension. After localization by iodine 123-metaiodobenzyl-guanidine scintigraphy and magnetic resonance imaging, the paraganglioma was resected successfully below the right pulmonary artery through a right-sided posterolateral thoracotomy. The particular location was consistent with a branchiomeric paraganglioma in an extremely rare extrapulmonary location.
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Affiliation(s)
- B Szukics
- Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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19
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Rau HG, Mittelkötter U, Zimmermann A, Lachmann A, Köhler L, Kullmann KH. Perioperative infection prophylaxis and risk factor impact in colon surgery. Chemotherapy 2000; 46:353-63. [PMID: 10965101 DOI: 10.1159/000007309] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A prospective observational study was undertaken in 2, 481 patients undergoing elective colon resection in 114 German centers to identify optimal drug and dosing modalities and risk factors for postoperative infection. METHODS Patients were pair matched using six risk factors and divided into 672 pairs (ceftriaxone vs. other cephalosporins, group A) and 400 pairs (ceftriaxone vs. penicillins, group B). End points were local and systemic postoperative infection and cost effectiveness. RESULTS Local infection rates were 6.0 versus 6.5% (group A) and 4.0 versus 10.5% (group B); systemic infection rates in groups A and B were 4.9 versus 6.3% and 3.3 versus 10.5%, respectively. Ceftriaxone was more effective than penicillins overall (6.8 vs. 17.8%, p < 0.001). Length of postoperative hospital stay was 16.2 versus 16.9 days (group A) and 15.8 versus 17.6 days (group B). Of the six risk factors, age and concomitant disease were significant for systemic infection, and blood loss, rectum resection and immunosuppressive therapy were significant for local infection. Penicillin was a risk factor compared to ceftriaxone (p < 0.0001). Ceftriaxone saved 160.7 EUR versus other cephalosporins and 416.2 EUR versus penicillins. CONCLUSION Clinical and microbiological efficacy are responsible for the cost effectiveness of ceftriaxone for perioperative prophylaxis in colorectal surgery.
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Affiliation(s)
- H G Rau
- Department of Surgery, Grosshadern Hospital, Ludwig Maximilian University, Munich, Germany.
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20
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Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G. The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP). Surg Endosc 2000; 14:736-40. [PMID: 10954820 DOI: 10.1007/s004640000108] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We designed a study to determine the rate of intra- and postoperative complications as well as the rate of recurrences in elective operated femoral hernias treated via the laparoscopic technique. METHODS Between 1993 and 1998, we performed 1,097 operations in our department using the laparoscopic transabdominal preperitoneal (TAPP) technique. Femoral hernias amounted to only 4.6% (51 cases) of these patients. The male/female ratio was 1:2. The data concerning the operations and pre- and postoperative treatment were recorded prospectively. The patients were followed up at 2 weeks and 1 year after the operation. RESULTS We encountered one intraoperative bladder lesion, one subcutaneous port site infection, two postoperative hematomas that required reoperation, and two nerve irritation syndromes, which disappeared spontaneously after 6 months. Two patients developed an ileus; one required laparoscopic reintervention, and the other was treated with conventional open reoperation and intestinal resection. There were no recurrences. CONCLUSIONS The application of the laparoscopic approach to the treatment of femoral hernias using the TAPP technique in nonemergency situations is highly effective. To date, we have seen no recurrences. Although the rate of major complications is low, current surgical techniques need to be perfected to avoid the type of complication recognized in this study.
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Affiliation(s)
- T Hernandez-Richter
- Department of Surgery, University Hospital Grosshadern, Ludwig Maximilians University, Marchioninistrasse 15, D-81377 Munich, Germany
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21
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Stangl MJ, Beuers U, Schauer R, Lang T, Gerbes A, Briegel J, Da Silva L, Schildberg FW, Rau HG. [Allogenic liver transplantation: a form of "gene therapy" in metabolic diseases. Munich results and a review]. Chirurg 2000; 71:808-19. [PMID: 10986603 DOI: 10.1007/s001040051140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Liver transplantation is the method of choice for metabolic diseases and end-stage liver failure. METHODS At the Klinikum Grosshadern we have performed liver transplantation for inborn errors of metabolism in 24 patients (5.3% of all transplantations, 16 adults, age 39 +/- 13 years; 8 children, age 9 +/- 3 years); 19 patients received a transplant for end-stage liver disease, and in 5 cases because of fulminant hepatic failure. RESULTS Twenty-four patients received 27 transplants. In 3 cases, a split-liver transplantation was performed; one patient received a combined lung-liver graft. The 5-year survival rate for children is 100% and for adults 68%. CONCLUSIONS Liver transplantation for inborn errors of metabolism not only replaces the diseased organ, but also leads to complete reversal of the metabolic defect.
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Affiliation(s)
- M J Stangl
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, Klinikum Grosshadern, München.
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22
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Rau HG, Schauer R, Helmberger T, Holzknecht N, von Rückmann B, Meyer L, Buttler E, Kessler M, Zahlmann G, Schuhmann D, Schildberg FW. Impact of virtual reality imaging on hepatic liver tumor resection: calculation of risk. Langenbecks Arch Surg 2000; 385:162-70. [PMID: 10857486 DOI: 10.1007/s004230050260] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The risk involved in partial liver resections depends mainly on tumor localization, invasion of central vascular structures, and parenchymal function. The imaging techniques available today (computed tomography, magnetic resonance imaging) allow us to detect precisely the extent of tumor invasion and their relationship to central vessels. The various three-dimensional reconstruction techniques are helpful with regard to a virtual planning of liver resections. The calculation of remaining liver volumes subsequent to partial hepatectomies are considered to be an essential predictive parameter in terms for the development of postoperative liver failure. In a retrospective and a later consecutive, prospective clinical study we analyzed the postoperative risk in a series of 570 patients. In an univariate analysis 13 of 31 parameters showed significant values. In multivariate analysis only three parameters (partial hepatic resection rate, PHRR), gamma-glutamyltranspeptidase, and prothrombin activity) were independent parameters for predicting liver failure, generating the most significant values for the PHRR. In our experience the most comfortable and precise technique for evaluating PHRR is the b-spline technique.
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Affiliation(s)
- H G Rau
- Surgical Department, Ludwig Maximilian University of Munich, Klinikum Grosshadern, Germany.
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23
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Kenngott S, Gerbes AL, Rau HG, Hoelzl J, Paumgartner G, Bilzer M. [Sixteen year old girl with acute liver failure after tonsillectomy]. Internist (Berl) 2000; 41:376-80. [PMID: 10798186 DOI: 10.1007/s001080050520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Kenngott
- Medizinische Klinik II, Klinikum Grosshadern, Ludwig Maximilians Universität München
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24
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Michl P, Bilzer M, Waggershauser T, Gülberg V, Rau HG, Reiser M, Gerbes AL. Successful treatment of chronic Budd-Chiari syndrome with a transjugular intrahepatic portosystemic shunt. J Hepatol 2000; 32:516-20. [PMID: 10735624 DOI: 10.1016/s0168-8278(00)80405-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Budd-Chiari syndrome is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for chronic Budd-Chiari syndrome are limited. We report the case of a 28-year-old woman who presented with recurrence of chronic Budd-Chiari syndrome with total obstruction of all major hepatic veins. Due to worsening liver function over the course of 1 year, she had to be listed for liver transplantation. Because of therapy-refractory ascites, declining renal function and severe esophageal varices, a transjugular intrahepatic portosystemic shunt (TIPS) was placed, planned as a bridge to transplantation. Following TIPS, a marked recovery of liver function could be observed, accompanied by disappearance of ascites, esophageal varices, and normalization of kidney function. Therefore, the patient could be removed from the waiting list for liver transplantation. This case demonstrates for the first time that the use of TIPS in chronic Budd-Chiari syndrome may result in marked recovery of liver function.
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Affiliation(s)
- P Michl
- Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany.
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25
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Hernandez-Richter T, Meyer G, Schardey HM, Rau HG, Schildberg FW. [Transabdominal preperitoneal hernia repair (TAPP). Results of 1,000 completed operations]. Zentralbl Chir 1999; 124:657-63. [PMID: 10474882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
It was the aim of this report to evaluate the laparoscopic transabdominal preperitoneal hernia repair (TAPP) which has been standardized at our department. Along with the demographic characterisation of 795 patients with 1000 inguinal hernia repairs we report about complications and early recurrences. The patient data were collected prospectively. The rate of follow-up amounted to 79.9% with an average follow-up of 1 year. The complications were divided into intraoperative, minor, major, as well as severe ones. In 30 repairs minor complications (3%) were detected. Major (n = 28) and severe (n = 9) complications were detected in 3.7% of the cases. There were two deaths, 3 patients with an intestinal obstruction due to adhesions (2 segmental small bowel resections), two patients with testicular atrophy, two mesh infections, two trocar hernias, 6 surgical revisions for removal of hematomas, one exploration of a testicle, 4 diagnostic laparoscopies for suspected recurrences with a negative result, and 15 patients with a nerve irritation syndrome. The early rate of recurrence was 0.7%. In 6 cases primary hernias had been repaired and in one case a recurrent hernia. The recurrent hernias became apparent in an average of 2 years (minimum 2.5 months, maximum 36 months) after surgery. The results of the clinical study demonstrate an acceptable rate of complications and a low rate of early recurrences. Based on these data we recommend the laparoscopic transabdominal preperitoneal technique and see an ideal indication in the case of bilateral, recurrent and femoral hernias.
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Affiliation(s)
- T Hernandez-Richter
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Universität München
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26
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Hernandez-Richter T, Meyer G, Schardey HM, Rau HG, Schildberg FW. [Experience with the transabdominal preperitoneal (TAPP) technique regarding recurrent hernia]. Chirurg 1999; 70:1020-4. [PMID: 10501667 DOI: 10.1007/s001040050760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION It was our aim to evaluate the results of laparoscopic transabdominal preperitoneal hernia repair (TAPP) with regard to recurrent hernias treated in our department. METHODS Included were 276 operations for first or subsequent recurrence of inguinal hernia previously treated with suture repair. All final repairs were carried out using the TAPP technique. The data were collected prospectively. The patients were examined 2 weeks and 1 year postoperatively. The rate of follow-up amounted to 78.1 % at 1 year after operation. RESULTS Perioperative complications were monitored prospectively and divided into intraoperative, minor and major. The overall complication rate amounted to 9 %, major complications 5.3 %. The re-recurrence rate was 0.4 %. CONCLUSIONS Because of the general advantages of laparoscopic surgery and the low recurrence rate we prefer laparoscopic hernioplasty using the TAPP technique.
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Affiliation(s)
- T Hernandez-Richter
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Universität München
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27
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Schauer R, Rau HG, Grundner H, Schildberg FW. [Operation or intervention in advanced gallbladder carcinoma?]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:348-51. [PMID: 9931638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In a retrospective study of patients with locally advanced or metastatic gallbladder cancer, we tried to define patient groups, that profit either from extended resection, palliative surgery or intervention. 102 out of 160 operative treated patients (73.8%) had UICC-tumor stages III and IV. Depending on the T-stage, resection rates were 31% for T3-stage and 12.5% for T4-stage tumors. Corresponding median survival times were 20.2 and 18.1 month, respectively. Patients with T3/T4-tumor stages, where only palliative surgery was possible, had median survival times of 2.5 to 4.5 month. So, only radical tumor resection can result in better survival times and should be performed even in elderly patients in good condition. Palliative surgery does not improve survival and, moreover, often not life quality.
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Affiliation(s)
- R Schauer
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, LMU München
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28
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Strauss T, Meyer G, Rau HG, Schardey HM, Schildberg FW. [The Janeway laparoscopic gastrostomy in palliative surgery]. Zentralbl Chir 1998; 123:1160-3. [PMID: 9848256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
For the creation of a gastrostomy percutaneous endoscopic technique should be the method of first choice. If impossible a laparoscopic procedure should be preferred to a conventional one. Laparoscopic Janeway-gastrostomy might have some advantages compared to Kader-Stamm-Fistulas. We present the results with this method which we have used since 1993 in 12 patients. The postoperative course of these patients with mainly malignant diseases of ENT (n = 4), esophagus (n = 3) and thyroid gland (n = 3) as well as two non-malignant underlying diseases is presented and discussed in the light of recent publications. The Janeway-gastrostomy is an effective, easily feasable and safe procedure that ensures a good palliation also due to easy handling and care.
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Affiliation(s)
- T Strauss
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Universität München
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Lorenz M, Müller HH, Schramm H, Gassel HJ, Rau HG, Ridwelski K, Hauss J, Stieger R, Jauch KW, Bechstein WO, Encke A. Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases (Arbeitsgruppe Lebermetastasen). Ann Surg 1998; 228:756-62. [PMID: 9860474 PMCID: PMC1191593 DOI: 10.1097/00000658-199812000-00006] [Citation(s) in RCA: 245] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the impact of adjuvant hepatic arterial infusion (HAI) on survival relative to resection alone in patients with radical resection of colorectal liver metastases. SUMMARY BACKGROUND DATA Nearly 40% to 50% of all patients with colorectal carcinoma develop liver metastases. Curative resection results in a 5-year survival rate of 25% to 30%. Intrahepatic recurrence occurs after a median of 9 to 12 months in up to 60% of patients. The authors hypothesized that adjuvant intraarterial infusion of 5-fluorouracil (5-FU) might decrease the rate of intrahepatic recurrence and improve survival in patients with radical resection of colorectal liver metastases. METHODS Between April 5, 1991, and December 31, 1996, patients with colorectal liver metastases from 26 hospitals were stratified by the number of metastases and the site of the primary tumor and randomized to resection of the liver metastases followed by adjuvant HAI of 5-FU (1000 mg/m2 per day for 5 days as a continuous 24-hour infusion) plus folinic acid (200 mg/m2 per day for 5 days as a short infusion), or liver resection only. RESULTS The first planned intention-to-treat interim analysis after inclusion of 226 patients and 91 events (deaths) showed a median survival of 34.5 months for patients with adjuvant therapy versus 40.8 months for control patients. The median time to progression was 14.2 months for the chemotherapy group versus 13.7 months for the control group. Grade 3 and 4 toxicities (World Health Organization), mainly stomatitis (57.6%) and nausea (55.4%), occurred in 25.6% of cycles and 62.9% of patients. CONCLUSION According to this planned interim analysis, adjuvant HAI, when used in this dose and schedule in patients with resection of colorectal liver metastases, reduced the risk of death at best by 15%, but at worst the risk of death was doubled. Thus, the chance of detecting an expected 50% improvement in survival by the use of HAI was only 5%. Patient accrual was therefore terminated.
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Rau HG, Buttler E, Meyer G, Schardey HM, Schildberg FW. Laparoscopic liver resection compared with conventional partial hepatectomy--a prospective analysis. Hepatogastroenterology 1998; 45:2333-8. [PMID: 9951918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND/AIMS Tumor size and location are the major influences on the practicality of a laparoscopic operation. Visual control of the operating field is important for isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques such as the water-jet dissector. METHODOLOGY We carried out laparoscopic liver resections with the Jet-Cutter in 17 patients. The results were compared to a control group of 17 closely matched patients undergoing conventional hepatic resection during the period of the study. In 1 patient, conversion of laparoscopic to an open operation was required. RESULTS Early in our learning curve, the duration of operation and time for resection were significantly longer in the laparoscopic group. Following laparoscopic operation, patients were discharged from the hospital after a mean of 7.8+/-8.2 days; patients having undergone conventional operation were discharged after a mean of 11.6+/-12.8 days. CONCLUSIONS Laparoscopic liver resection is technically feasible, but, at present, careful patient selection is required.
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Affiliation(s)
- H G Rau
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Meyer G, Wichmann MW, Rau HG, Hiller E, Schildberg FW. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. A 1-year follow-up study. Surg Endosc 1998; 12:1348-52. [PMID: 9788860 DOI: 10.1007/s004649900854] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. METHODS Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n = 14) to determine the short- and long-term results of the procedure. RESULTS Mean operation time was 123.4 +/- 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 +/- 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 +/- 47.3 g. Mean postoperative hospital stay was 4.6 +/- 0. 4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). CONCLUSIONS Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.
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Affiliation(s)
- G Meyer
- Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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Cohnert TU, Rau HG, Buttler E, Hernandez-Richter T, Sauter G, Reuter C, Schildberg FW. Preoperative risk assessment of hepatic resection for malignant disease. World J Surg 1997; 21:396-400; discussion 401. [PMID: 9143571 DOI: 10.1007/pl00012260] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Clinical, laboratory, functional, and volumetric data of 340 consecutive patients undergoing hepatic resection for malignant disease between November 1990 and June 1995 were analyzed. The operative mortality was 3.3% (8/244 patients). Among 178 patients with liver metastases and 66 with primary hepatobiliary tumors the hospital mortality was 4.1% (10/244 patients) and morbidity 22.0% (54/244 patients). Survival after hepatectomy was strongly influenced by the extent of resection quantified by the parenchymal hepatic resection rate. The prediction of fatal postoperative complications can be improved for patients with hepatic metastases by calculating the liver resection index (sensitivity 75%, specificity 83%).
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Affiliation(s)
- T U Cohnert
- Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
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Rau HG, Buttler ER, Baretton G, Schardey HM, Schildberg FW. Jet-cutting supported by high frequency current: new technique for hepatic surgery. World J Surg 1997; 21:254-9; discussion 259-60. [PMID: 9015167 DOI: 10.1007/s002689900225] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To reduce blood loss incurred during liver resection, techniques that separate vessels from liver parenchyma, such as the CUSA or the jet-cutter, are in clinical use. By conducting high frequency current through the jet beam using hypertonic NaCl cutting solution, we developed a new method enabling simultaneous coagulation during selective cutting. In this study we examined the effects of this method on liver resection in a rabbit model. With the three techniques-jet-cutting, CUSA, and high frequency-supported jet-cutting (HF-jet)-we performed liver resection of the ventral lobe in six animals per group. We compared velocity of resection, blood loss, tissue trauma, selectivity (number of isolated vessels per area), electrolytes, and vital signs. Histopathology was carried out with the resectate and after 7 days with the remaining liver. Velocity of resection procedure and selectivity were significantly reduced in the HF-jet group. Histopathology showed coagulated vessels and a deeper zone of necrosis. Accordingly, the liver enzymes transiently showed distinctly higher values in the HF-jet group. Electrolyte disturbances or differences of vital signs could not be detected. Transferring our results to patient care we expect that with major resections the hilus clamping time, blood loss, and number of blood transfusions can be reduced. In our opinion the additional application of high frequency through the jet beam is a helpful improvement of the jet-cutter.
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Affiliation(s)
- H G Rau
- Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Marchionisistrasse 15, 81366 Munich, Germany
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Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, Kooistra A, Rau HG, Nibler R, Lüdeling S, Unertl K, Ruckdeschel G, Exner H, Schildberg FW. The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg 1997; 225:172-80. [PMID: 9065294 PMCID: PMC1190646 DOI: 10.1097/00000658-199702000-00005] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A prospective, randomized, double-blind, placebo controlled multicenter trial was undertaken in 205 patients treated with total gastrectomy for gastric malignancies to evaluate whether local antimicrobial measures reduce the incidence of esophagojejunal anastomotic leakage. SUMMARY BACKGROUND DATA Anastomotic leakage of the esophagojejunostomy is always a septic complication of total gastrectomy for gastric malignancies, but it never has been attempted to prevent this complication with the administration of topical antimicrobial agents during the critical phase of anastomotic wound healing. METHODS To evaluate the efficacy and safety of topical decontamination, the study was carried out as a prospective, randomized, double-blind and placebo-controlled clinical multicenter trial in patients with total gastrectomy for gastric cancer. Patients received either placebo or decontamination with polymyxin B (100 mg), tobramycin (80 mg), vancomycin (125 mg), and amphotericin B (500 mg) four times per day orally from the day before the operation until the seventh postoperative day. All patients received a perioperative intravenous prophylaxis with cefotaxime 2 x 2 g. Other interventions including the administration of antibiotics and fluids, were not affected by the study protocol. RESULTS Of 260 patients who were randomized, total gastrectomy was not carried out in 55 patients. They dropped out of the study. Patients receiving an esophagojejunostomy were observed until day 42, when they were discharged from the clinic or died. An intention-to-treat analysis of the data was carried out. Among the 103 recipients of placebo, there were 11 (10.6%) with an anastomotic leakage of the esophagojejunostomy, and among the 102 recipients of decontamination, there were 3 (2.9%) with an anastomotic leakage of the esophagojejunostomy (p = 0.0492). Pulmonary infections were observed in 23 patients (22.3%) receiving placebo and in 9 patients (8.8%) who were decontaminated (p = 0.02). There were 11 deaths (10.6%) among the recipients of placebo and 5 deaths (4.9%) among the recipients of decontamination (p = 0.1). CONCLUSIONS Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy.
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Affiliation(s)
- H M Schardey
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Schardey HM, Meyer G, Rau HG, Gradl G, Jauch KW, Lauterjung L. Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. Eur J Vasc Endovasc Surg 1996; 12:431-6. [PMID: 8980432 DOI: 10.1016/s1078-5884(96)80009-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyse the clinical results and long-term patency rates of 108 patients with subclavian carotid transposition (SCT) and compare the outcomes to other clinical series using the same technique, as well as to those reported for other surgical procedures and PTA in the treatment of proximal subclavian artery disease. METHODS The hospital records of 108 patients with carotid subclavian transposition were retrospectively reviewed for preoperative symptoms, Doppler examination, arteriography, blood pressure differentials and postoperative complications. Long-term patency and symptoms were determined during a follow-up examination including a history, physical examination, blood pressure differentials, Doppler examinations and arteriography in selected cases. RESULTS The indication for SCT were subclavian steal (78%), upper extremity ischaemia (59%), rest pain or acral necrosis (5%), vertigo (6%). There was no mortality, blood pressure differentials were equalised in all patients without any early reocclusions. The complication rate was 15% with a permanent morbidity of 3%. Eighty-four patients (77%) could be re-examined during follow-up. For them the overall patency after a mean observation period of 70 months (1-144 months) was 100%. CONCLUSIONS Subclavian carotid transposition is an excellent method for the treatment of proximal subclavian occlusive disease because of its exceptional long-term patency and low morbidity.
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Affiliation(s)
- H M Schardey
- Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
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Rau HG, Meyer G, Jauch KW, Cohnert TU, Buttler E, Schildberg FW. [Liver resection with the water jet: conventional and laparoscopic surgery]. Chirurg 1996; 67:546-51. [PMID: 8777886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In a prospective study 60 patients underwent liver resection. Two different resection techniques, ultrasonic aspirator (CUSA, n = 30) and Jet-Cutter (n = 30), were compared, Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of the area of transsected liver. Liver resection with the Jet-Cutter was significantly faster with a resection time of 0.35 min/cm2 in comparison to the CUSA (0.77 min/cm2, p < 0.001) and associated with less blood loss of 18.4 ml/cm2 (p < 0.05) than the CUSA technique (34.4 ml/cm2). Tissue damage in respect to levels of transaminases SGOT and SGPT was comparable with both techniques. The Jet-Cutter is a promising new instrument in liver surgery, and challenged by these results we used the Jet-Cutter in 7 patients performing laparoscopic liver resections.
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Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München
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Abstract
Laparoscopic liver resection requires careful patient selection. Tumor size and location have a major influence on the feasibility of a laparoscopic operation. Isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques are important for visual control of the operating field. Since the Jet-Cutter has proven to give excellent clinical results in conventional liver surgery, we carried out laparoscopic liver resections with the Jet-Cutter in six patients. Five tumors were located in the left liver lobe; the fifth was in segment 6. There were no intra- or postoperative complications. The patients were discharged from the hospital after a mean of 5.4 +/- 2.1 days.
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Affiliation(s)
- H G Rau
- Department of Surgery, Ludwig-Maximilians-Universität Munich, Klinikum Grosshadern, München, Germany
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Rau HG, Schardey HM, Buttler E, Reuter C, Cohnert TU, Schildberg FW. A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter. Eur J Surg Oncol 1995; 21:183-7. [PMID: 7720893 DOI: 10.1016/s0748-7983(95)90435-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a prospective study 116 patients underwent liver resection. Three different resection techniques, blunt dissection (n = 61), ultrasonic aspirator (CUSA) (n = 27) and jet-cutter (n = 28) were compared. Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of area of transected liver surface. Liver resection with the jet-cutter was significantly faster with a resection time of 0.33 min/cm2 in comparison to blunt dissection (0.57 min/cm2) and CUSA (0.50 min/cm2) (P < 0.01) and associated with lower blood loss of 17.7 ml/cm2 (P < 0.01) than the other techniques (blunt dissection 32.5 ml/cm2, CUSA 24.3 ml/cm2). Tissue damage with respect to transaminases SGOT and SGPT was comparable to the other techniques. The jet-cutter is a promising new instrument in liver surgery.
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Affiliation(s)
- H G Rau
- Surgical Department, University Hospital Grosshadern, Munich, Germany
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Rau HG, Meyer G, Maiwald G, Schardey M, Merkle R, Lange V, Schildberg FW. [Conventional or laparoscopic cholecystectomy in treatment of acute cholecystitis?]. Chirurg 1994; 65:1121-5. [PMID: 7851146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Elective laparoscopic cholecystectomy has become established as the procedure of choice for the treatment of symptomatic cholecystolithiasis while the application of this method for acute cholecystitis has been propagated with restrainment. In a prospective study 114 conventional (right subcostal incision) and 102 laparoscopic cholecystectomies for this indication were compared. The overall complication rate amounted 10.7% for conventional cholecystectomy and 8.9% for laparoscopic cholecystectomy. The rate of conversion was 9.2%. Due to the fact that intraoperative cholangiography was carried out in 60% of conventional cholecystectomies and in only one of laparoscopic procedures the arithmetic advantage of minimally invasive technique with respect to blood loss and operating time does not allow final conclusions. These patients however recovered clearly faster and could be discharged after an average of 5.2 +/- 4.2 postoperative days, while the hospitalisation after conventional operations amounted to 7.6 +/- 3.8 days (p < 0.001).
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Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern
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Abstract
Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.
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Affiliation(s)
- H G Rau
- Department of Surgery, University Hospital Grosshadern, Ludwig-Maximillians University, Munich, Germany
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Schardey HM, Kamps T, Rau HG, Gatermann S, Baretton G, Schildberg FW. Bacteria: a major pathogenic factor for anastomotic insufficiency. Antimicrob Agents Chemother 1994; 38:2564-7. [PMID: 7872748 PMCID: PMC188242 DOI: 10.1128/aac.38.11.2564] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to determine the influence of bacteria on the development of anastomotic insufficiency following gastrectomy in the rat. Fifty-seven male Wistar rats were randomly assigned to three groups and subjected to gastrectomy. Group I (n = 20) was orally inoculated with 10(9) Pseudomonas aeroginosa organisms on postoperative day 1. Group II (n = 20) served as the control group. Group III (n = 17) was decontaminated with 320 mg of tobramycin, 400 mg of polymyxin B, and 500 mg of vancomycin per liter of fluid administered from preoperative day 7 to postoperative day 10. Swabs from the oropharynx and rectum were cultured and analyzed daily for gram-positive and gram-negative bacteria. Surviving animals were sacrificed on postoperative day 10. All animals were autopsied immediately following death. Anastomotic insufficiency was defined as a histologically proven transmural defect at the suture line. Along with an effective reduction of pathogenic bacteria colonizing the oropharynx, the rate of anastomotic insufficiency could be reduced significantly, to 6% in decontaminated animals compared with 80% in controls (P < 0.001 by Fisher's exact test). Inoculation of group I animals with P. aeruginosa led to an increase of anastomotic insufficiency up to 95% and a significant increase in mortality (P < 0.05). We conclude that bacteria play a major role in the pathogenesis of anastomotic insufficiency following gastrectomy in the rat.
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Affiliation(s)
- H M Schardey
- Department of Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Hofmann TU, Rau HG, Reuter C, Fürst H. [Leiomyosarcoma of the inferior vena cava--diagnosis and therapy]. Chirurg 1994; 65:702-8. [PMID: 7956536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report four patients with primary vascular leiomyosarcoma of the inferior vena cava. Even after radical surgery the prognosis is serious because of local tumor recurrence and distant metastases. Although controlled studies are difficult because of the small number of patients, a multimodal therapeutic approach needs to be developed.
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Affiliation(s)
- T U Hofmann
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern
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Meyer G, Lange V, Rau HG, Schardey HM, Schildberg FW. [Laparoscopic single staple suture--initial clinical experiences]. Chirurg 1994; 65:361-6. [PMID: 8020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Based on the results of our own animal experimental investigations, the first clinical employment of single titanium staples in the creation of suture lines on the gastrointestinal tract was carried out. These staple lines are most favorably adapted for laparoscopic use. First experiences with 10 staple lines, 6 of which were anastomoses, are reported. Neither insufficiencies nor stenoses were detected. Until now there are no long-term observations. The technique seems to allow open or laparoscopically the creation of standardized suture lines in any segment of the gastrointestinal tract.
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Affiliation(s)
- G Meyer
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München
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Lange V, Rau HG, Schardey HM, Meyer G. Laparoscopic stenting for protection of common bile duct sutures. Surg Laparosc Endosc Percutan Tech 1993; 3:466-9. [PMID: 8269266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Laparoscopic common bile duct exploration is comparable with the open operation and it is usually finished with the insertion of external bile drainage such as a T-tube. We performed an antegrade placement of a biliary stent with primary suture of the common bile duct following common bile duct exploration. We thereby avoided the acquisition of the additional expensive equipment required for the transcystic approach and the placement of a T-tube, which in our eyes contradicts the idea of minimized discomfort in minimally invasive surgery.
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Affiliation(s)
- V Lange
- Surgical Clinic Grosshadern, Ludwigs Maximilian University, Munich, Germany
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Rau HG, Schardey HM, Lange V. [A cerebrospinal fluid fistula as a rare complication of anterior lobe-chest wall resection for squamous epithelial cancer of the lung]. Chirurg 1993; 64:73-5. [PMID: 8436056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität München
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Rau HG, Arnold H, Schildberg FW. [Cutting with a water jet (jet cutting)--an alternative to the ultrasound aspirator?]. Chirurg 1990; 61:735-8. [PMID: 2276306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- H G Rau
- Chirurgische Klinik und Poliklinik, Universität München
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Rau HG. Johann Kunckel, Geheimer Kammerdiener des Grossen Kurfürsten, und sein Glaslaboratorium auf der Pfaueninsel in Berlin. Medizinhist J 1976; 11:129-156. [PMID: 11609941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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