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Hubens G, Ysebaert D, Vaneerdeweg W, Chapelle T, Eyskens E, Houben JJ, Lipkind R, Meurisse M. Laparoscopic Adrenalectomy with the Aid of the AESOP 2000 Robot/Invited comment. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1999.12098462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Hubens
- Department of Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - D. Ysebaert
- Department of Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - W. Vaneerdeweg
- Department of Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - T. Chapelle
- Department of Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - E. Eyskens
- Department of Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - J. J. Houben
- Service de chirurgie digestive, Hôpital Erasme, Brussels, Belgium
| | - R. Lipkind
- Jackson Memorial Hospital, Miami, FL, USA
| | - M. Meurisse
- Service de Chirurgie des Glandes Endocrines et Transplantation, CHU-Sart-Tilman — Liège
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Giuliani D, Hoenjet K, Vaneerdeweg W, Tjalma W, Hubens G, Chapelle T, Eyskens E, Backer AD. Congenital Right-Sided Diaphragmatic Hernia in an Elderly Patient A Case Report. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Giuliani
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - K. Hoenjet
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - W. Vaneerdeweg
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - W. Tjalma
- Departments of Gynaecology-Obstetrics, University Hospital of Antwerp, Edegem, Belgium
| | - G. Hubens
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - T. Chapelle
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - E. Eyskens
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - A. De Backer
- Departments of Radiology, University Hospital of Antwerp, Edegem, Belgium
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Vaneerdeweg W, Hubens G, Chapelle T, Eyskens E. Rectovaginal Fistulas. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vaneerdeweg W. In memoriam Prof. dr. A. Hubens, past president RBSS 1988. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2004.11679627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hee RV, Vaneerdeweg W. In Memoriam Prof. Dr. Eric Eyskens (1935–2008). Acta Chir Belg 2016. [DOI: 10.1080/00015458.2008.11680272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Balduyck B, Vansteenkiste S, Ruppert M, Balliu L, Vaneerdeweg W, Hubens G. The Evaluation of Pyrosis and Long-term Satisfaction after Gastric Restrictive Procedures: a Retrospective Study. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2005.11679691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Balduyck
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
| | - S. Vansteenkiste
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
| | - M. Ruppert
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
| | - L. Balliu
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
| | - W. Vaneerdeweg
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
| | - G. Hubens
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
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Abdelgabar A, Wojciechowski M, Van de Vijver E, Ruppert M, Hubens G, Balliu L, Creytens D, Vaneerdeweg W. Ectopic pancreatic tissue at the umbilicus in childhood: a case report and review of the literature. Acta Chir Belg 2013; 113:452-454. [PMID: 24494475] [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: 06/03/2023]
Abstract
Ectopic pancreatic tissue at the umbilicus is very rare. To our best knowledge, only fourteen cases of ectopic pancreatic tissue at the umbilicus are reported. In this paper we present the case of a two-year-old boy with an abrasion at the umbilicus. He had a poorly healing scar that started bleeding after recurrent injuries. Abdominal ultrasound revealed an unclear cystic structure with no communication to intra-abdominal structures. Surgical resection was performed without complications. Histology diagnosed an ectopic pancreatic tissue with reactive epidermal changes. We present a review of the literature and the clinical manifestations and treatment of the previously reported fourteen cases.
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Affiliation(s)
- A Abdelgabar
- Department of General Surgery, University Hospital, Antwerp, Belgium.
| | - M Wojciechowski
- Department of Paediatrics, University Hospital, Antwerp, Belgium
| | - E Van de Vijver
- Department of Paediatrics, University Hospital, Antwerp, Belgium
| | - M Ruppert
- Department of General Surgery, University Hospital, Antwerp, Belgium
| | - G Hubens
- Department of General Surgery, University Hospital, Antwerp, Belgium
| | - L Balliu
- Department of General Surgery, University Hospital, Antwerp, Belgium
| | - D Creytens
- Department of Pathology, University Hospital, Antwerp, Belgium
| | - W Vaneerdeweg
- Department of General Surgery, University Hospital, Antwerp, Belgium
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Haenen F, Hubens G, Creytens D, Vaneerdeweg W. Multiple abdominal cysts in a patient with Gorlin-Goltz syndrome: a case report. Acta Chir Belg 2013; 113:217-9. [PMID: 24941720 DOI: 10.1080/00015458.2013.11680915] [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: 10/21/2022]
Abstract
A rare case of symptomatic mesenteric cysts in a patient with Gorlin-Goltz syndrome, associated with various neoplasms, is presented. The patient, known with Gorlin-Goltz syndrome, consulted with increasingly severe abdominal pain and large abdominal cysts. At surgery, the cysts were excised and the postoperative course was uneventful. In conclusion, this case reminds clinicians to always maintain a wide differential diagnosis when dealing with patients known with Gorlin-Goltz syndrome.
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Affiliation(s)
- F. Haenen
- Department of Abdominal Surgery,University of Antwerp, Edegem, Belgium
| | - G. Hubens
- Department of Abdominal Surgery,University of Antwerp, Edegem, Belgium
| | - D. Creytens
- Department of Pathology,Antwerp University Hospital,University of Antwerp, Edegem, Belgium
| | - W. Vaneerdeweg
- Department of Abdominal Surgery,University of Antwerp, Edegem, Belgium
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Abstract
Adrenal myelolipomas are rare, benign, hormonally inactive tumours composed of mature adipose tissue and haematopoietic elements. Currently, most diagnosed tumours are discovered incidentally because of modern imaging. Myelolipomas are usually asymptomatic, but symptoms such as abdominal pain, haematuria and abdominal mass are described as the result of tumour bulk, haemorrhage or tumour necrosis. Myelolipomas are usually small, although there are descriptions of giant myelolipomas in the literature. We report the case of a giant adrenal myelolipoma in a 79-year-old female who presented with epigastric pain and discomfort. The resected tumour weighed 1777 g and measured 20.5 x 18 x 9.0 cm.
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Affiliation(s)
- S. Heylen
- Department of Abdominal Surgery, University Hospital Antwerp, Belgium
| | - G. Hubens
- Department of Abdominal Surgery, University Hospital Antwerp, Belgium
| | - W. Vaneerdeweg
- Department of Abdominal Surgery, University Hospital Antwerp, Belgium
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Geurts N, Hubens G, Wojciechowski M, Vaneerdeweg W. Encapsulating peritoneal sclerosis in a peritoneal dialysis patient with prune-belly syndrome: a case report. Acta Chir Belg 2010; 110:354-6. [PMID: 20690523 DOI: 10.1080/00015458.2010.11680633] [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: 10/21/2022]
Abstract
This case describes a prune-belly syndrome patient who had a kidney transplantation and was diagnosed with Encapsulating Peritoneal Sclerosis (EPS), a rare but potentially fatal condition, mostly associated with Peritoneal Dialysis (PD). The definition of EPS is based on the clinical findings linked to bowel obstruction and on the demonstration of peritoneal thickening. Surgical treatment is the only established basic treatment for the condition. Prune-belly syndrome is characterized by the triad of deficient abdominal musculature, urinary tract abnormality and cryptorchidism. Because it is often associated with end-stage renal disease, PD is essential in the treatment of patients with prune-belly syndrome. The aetiology of EPS follows a 'two-hit theory': the first 'hit' is peritoneal deterioration, caused by long-time exposure to PD. This causes peritoneal disruption which predisposes the patient to a second hit. In our patient, PD discontinuation and renal transplantation are possible 'second hits' that triggered the development of EPS. This case of prune-belly syndrome has all the necessary elements for the development of EPS, and we felt we should report it as the peroperative diagnosis was unexpected.
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Affiliation(s)
| | - G. Hubens
- Universitary Hospital Antwerp: Abdominal, Reconstructive and Paediatric Surgery
| | | | - W. Vaneerdeweg
- Universitary Hospital Antwerp: Abdominal, Reconstructive and Paediatric Surgery
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Vergauwen W, Op de Beeck B, Hagendorens M, Wojciechowski M, Vaneerdeweg W, Ramet J. A solid pseudopapillary tumour of the pancreas presenting after an abdominal trauma. Acta Chir Belg 2010; 110:390-3. [PMID: 20690532 DOI: 10.1080/00015458.2010.11680642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of 12-year-old girl who was referred with persistent abdominal pain and a palpable mass after blunt trauma and whose final diagnosis was a solid pseudopapillary tumour of the pancreas. This is the second case in our hospital of a solid pseudopapillary tumour of the pancreas presenting after a blunt abdominal trauma. Solid pseudopapillary tumour of the pancreas is a rare neoplasm. It comprises 2 to 3% of primary pancreatic tumours occurring at all ages. It was first described in 1959 by Frantz. The presenting symptoms are usually a slow growing abdominal mass with vague abdominal discomfort. Sometimes they are discovered after a trauma. Solid pseudopapillary tumours of the pancreas have a fairly characteristic appearance on imaging but the final diagnosis depends on histological confirmation. After resection the prognosis is excellent.
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Affiliation(s)
- W. Vergauwen
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - B. Op de Beeck
- Department of Radiology, Antwerp University Hospital, University of Antwerp
| | - M. Hagendorens
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - M. Wojciechowski
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
| | - W. Vaneerdeweg
- Department of Paediatric Surgery, Antwerp University Hospital, University of Antwerp
| | - J. Ramet
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp
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Abstract
There is still an important controversy about the optimal management of colonic diverticular disease, complicated by peritonitis. Most surgeons have always been reluctant to perform a primary anastomosis in the presence of diffuse peritonitis, and were mostly in favour of the Hartmann's procedure. Some even preferred the three stage procedure. However for some considerable time feasibility studies about primary resection with primary anastomosis were published. Those studies demonstrated that this technique was safe. The last years some authors tried to compare the primary anastomosis with the Hartmann's procedure, by reviewing the literature. It is obvious that their conclusions are debatable because of the selection bias, but nevertheless there is evidence that in selected patients primary anastomosis is at least as good as the Hartmann's procedure if the surgeon is experienced enough. By doing so, a risky restoring of the continuity after Hartmann's procedure can be avoided. Actually, there is a tendency to advocate the primary anastomosis, covered by a defunctioning ileostoma for patients with Hinchey stages I to III (abscess or purulent but not faecal peritonitis). However nothing is really proven and a randomized, controlled trial is required to show if primary anastomosis is as safe or even superior compared to Hartmann's procedure.
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Hubens G, Balliu L, Ruppert M, Gypen B, Van Tu T, Vaneerdeweg W. Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc 2007; 22:1690-6. [DOI: 10.1007/s00464-007-9698-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 06/27/2007] [Accepted: 07/26/2007] [Indexed: 11/28/2022]
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Abstract
A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient consulted with epigastric pain. MRI showed a giant tumour of the stomach wall, invading the surrounding organs, as well as the mediastinal region. After surgical 'en-bloc' resection of the tumour, histopathologic examination yielded a diagnosis of pleiomorphic liposarcoma. Because of the bad prognosis of this histologic type, the patient received adjuvant chemotherapy: a combination of doxorubicin and ifosfamide (MAI). Nine months after surgery, she represented with a relapse of the tumour that had become inoperable. Palliative chemotherapy was started with the intent to prolong the young patient's life. However 6 months later, the patient died of the recurrent disease. Although liposarcoma is a very common soft tissue sarcoma, it is rarely seen in the stomach. The standard therapy is surgical excision. Over the last years, adjuvant therapy became more accepted. Drugs of choice are doxorubicin and ifosfamide, although the benefits of this therapy are still largely unknown and doubtful.
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Affiliation(s)
- A. Michiels
- Department of Abdominal Surgery, University Hospital Antwerp
| | - G. Hubens
- Department of Abdominal Surgery, University Hospital Antwerp
| | - M. Ruppert
- Department of Abdominal Surgery, University Hospital Antwerp
| | - L. Balliu
- Department of Abdominal Surgery, University Hospital Antwerp
| | - W. Vaneerdeweg
- Department of Abdominal Surgery, University Hospital Antwerp
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Abstract
Primary retroperitoneal mucinous cystadenocarcinomas are rare tumors with a controversial pathogenesis. Present report describes a 74-year-old woman with a retroperitoneal cystic pelvic mass. Her past medical history included appendectomy, bilateral salpingo-oophorectomy, and a hysterectomy. An explorative laparotomy was performed and the mass was completely excised. Definitive pathology revealed a primary retroperitoneal mucinous cystadenocarcinoma of the ovarian type. Further management consisted of four cycles carboplatin. She had a recurrence after 8 months and died 31 months after the initial diagnosis. Primary retroperitoneal mucinous cystadenocarcinomas are distinct entity, with the same poor prognosis as their ovarian counterpart.
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Affiliation(s)
- W A A Tjalma
- Department of Gynecological Oncology, University Hospital Antwerp, Antwerp, Belgium.
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Ruppert M, De Clerck L, van Offel J, Hubens G, Balliu L, Vaneerdeweg W. Intestinal necrosis in a patient with rheumatoid arthritis receiving anti-TNF treatment. Acta Chir Belg 2006; 106:225-7. [PMID: 16761484 DOI: 10.1080/00015458.2006.11679877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/21/2022]
Abstract
Vasculitis leading to intestinal necrosis is a rare complication of rheumatoid arthritis. The introduction of anti-TNF treatment for methotrexate-resistant cases improved disease-control substantially in these often more aggresive forms of rheumatoid arthritis. As far as we know only two cases of severe vasculitis following anti-TNF treatment have been reported. We describe a 45-year old female patient with severe rheumatoid arthritis, who presented with an epileptic insult, renal failure and a quickly deteriorating general condition due to intestinal vasculitis, while she had been receiving anti-TNF treatment for 6 months.
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Affiliation(s)
- M Ruppert
- Department of Abdominal Surgery, University of Antwerp, Antwerp, Belgium
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Lauwers P, Moens E, Wustenberghs K, Deprettere A, Ruppert M, Balliu L, Hubens G, Vaneerdeweg W. Association of colonic atresia and Hirschsprung's disease in the newborn: report of a new case and review of the literature. Pediatr Surg Int 2006; 22:277-81. [PMID: 16021458 DOI: 10.1007/s00383-005-1456-z] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2004] [Indexed: 10/25/2022]
Abstract
Colonic atresia (CA) is an infrequent cause of lower gastrointestinal obstruction in the neonate. Coexistence with aganglionosis of the colon (Hirschsprung's disease) has been reported but is generally not recognized in the neonatal period. We report another case and present a review of the literature. A boy with a lower gastrointestinal obstruction, caused by a CA type III, had creation of a proximal colostomy and a distal mucous fistula on the 1st day of life. In the preoperative work-up before restoring the continuity, rectal suction biopsies revealed the presence of Hirschsprung's disease. When the boy was 6 months old, a distal colectomy and reanastomosis were done. Creation of a colostomy and reanastomosis in a second procedure is recommended for treating a type III CA unless distal aganglionosis has been ruled out.
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Affiliation(s)
- P Lauwers
- Department of Abdominal and Pediatric Surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
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Balduyck B, Vansteenkiste S, Ruppert M, Balliu L, Vaneerdeweg W, Hubens G. The evaluation of pyrosis and long-term satisfaction after gastric restrictive procedures: a retrospective study. Acta Chir Belg 2005; 105:161-7. [PMID: 15906907] [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: 05/02/2023]
Abstract
OBJECTIVE To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to the evolution of pyrosis and patient satisfaction. SUMMARY BACKGROUND DATA Although weight loss is the most immediate end-point in the evaluation of surgical treatment of obesity, the demonstration of changes in long-term patient satisfaction and in co-morbidity, like reflux, is an essential outcome measure. MATERIAL AND METHODS Retrospective study of 243 morbidly obese patients. All patients received a questionnaire regarding the evolution of pyrosis and their satisfaction after surgery. The evolution of pyrosis was compared between 2 patient groups who had different oesophagitis stages. Group A had oesophagitis I, or no oesophagitis, and group B had oesophagitis II, III or IV. RESULTS In group A of the GB group 57.8% had no complaints, 11.1% had improvement and 22.2% had aggravation of the pyrosis. In group B of the GB group 50.0% had improvement. In group A of the VBG group 51.4% had no complaints, 11.1% improvement and 23.6% aggravation of the pyrosis. In group B of the VBG group 16.7% had no complaints, 66.6% had improvement and 16.7% had aggravation of the pyrosis complaints. Statistically there is no significant difference between GB and VBG. The experience after GB is good with 67.9%, mediocre with 25.0% and bad with 7.1% of the patients ; 60.7% is pleased with the weight loss. The experience after VBG is good with 47.4%, mediocre with 29.5% and bad with 23.1% of the patients. 52.6% is satisfied with the weight loss. CONCLUSION VBG and GB have a similar effect on pyrosis. From our point of view it has been evidenced that the presence or absence of pyrosis before the operation is a possible predictor of the evolution afterwards. Long-term patient satisfaction is the same after GB and VBG. Other factors influence the satisfaction.
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Affiliation(s)
- B Balduyck
- Department of abdominal surgery, University Hospital of Antwerp, Belgium
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Abstract
Robotic- assisted surgery has been introduced recently in order to overcome some of the difficulties surgeons encounter during advanced laparoscopic surgery. Due to the 3D vision equipment, higher number of degrees of freedom in manipulating instruments and better ergonomics it is hoped that by using robot techniques the indications of minimally invasive surgery in the field of digestive surgery can be broadened or that difficult procedures will be easier to perform. Since the introduction of the system in our hospital now almost two years ago 70 procedures have been performed with the aid of the da Vinci system covering the whole spectrum of GI surgery. Conversion took place in 2.5% and peroperative morbidity related to the use of robotic techniques was 10%. Although we had the subjective feeling that the procedures were indeed easier to perform and more relaxing for the surgeon, some major problems still exist as the complete lack of tactile feedback and the cost effectiveness of these procedures. Before robotics can be introduced in the every day clinical practice of the surgeon, its true benefit still needs to be established. This can only be done by well randomised prospective studies comparing one technique with the other.
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Affiliation(s)
- G Hubens
- Dept of Abdominal Surgery, University Hospital Antwerp.
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Thijssens K, Vaneerdeweg W, Schrijvers D, Eyskens E, Van Oosterom A. Retroperitoneal lymph node dissection as adjuvant therapy in the treatment of non-seminomatous testicular cancer. Acta Chir Belg 2003; 103:599-602. [PMID: 14743567 DOI: 10.1080/00015458.2003.11679500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 10/21/2022]
Abstract
OBJECTIVE To assess the results of retroperitoneal lymph node dissection (RPLND) of residual masses in patients with disseminated non-seminomatous germ cell tumour treated with cisplatin-based chemotherapy, both in terms of extension of surgery, morbidity and survival. PATIENTS AND METHODS Retrospectively, all patients treated for non-seminomatous germ cell tumour at the University Hospital of Antwerp were studied from January 1987 till December 1997. In patients with non-seminomatous testicular cancer more than stage I, the 'wait and see' strategy changed and patients were treated with chemotherapy. Patients were assessed at the end of chemotherapy and if a residual masses persisted, a RPLND was performed. If possible, a nerve-sparing lymphadenectomy was performed. Extension of surgery, morbidity and survival were analysed. RESULTS Sixty patients had a non-seminomatous germ cell tumor of the testis and were analysed. The median follow-up was 78 months (range: 13-144 months). Thirteen patients with stage I disease were treated with orchiectomy only and none of these patients had recurrent disease. Forty-seven patients were treated with cisplatin-based chemotherapy. A complete response was observed in sixteen patients (34%), while 31 patients (66%) achieved a partial response and were treated with a RPLND. Fifteen patients underwent RPLND above the level of the renal trunk. In two patients malignant cells or fibrotic tissue were found above the renal trunk and bilateral. In five patients viable tumour cells were found in the region below the renal trunk. Sixteen patients underwent RPLND below the level of the renal trunk, of which nine had a unilateral resection, containing viable tumour in two patients. Operative mortality was 0%. One patient died six months after RPLND due to metastatic disease. In two patients, an important retroperitoneal bleeding occurred. Resection of adherent organs was performed in two patients. Long term sexual problems were reported by thirteen patients (65%) with bilateral lymphadenectomy versus two patients (18%) in the unilateral group. The survival of the patients treated with a RPLND was 97% and in the whole group of patients with a non-seminomatous testicular cancer 98%. CONCLUSION RPLND has a place in the treatment of patients with non-seminomatous testicular cancer after chemotherapy in case of residual masses. Although mortality is low, morbidity is acceptable. In a limited number of patients there was a need of resection of adherent organs when a resection above the renal trunk was performed.
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Affiliation(s)
- K Thijssens
- Department of Surgery, University Hospital of Antwerp, Edegem, Belgium
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Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdeweg W. A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system. Surg Endosc 2003; 17:1595-9. [PMID: 12874678 DOI: 10.1007/s00464-002-9248-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.1] [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: 11/11/2002] [Accepted: 03/21/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to compare the efficacy of the da Vinci robotic system using both the three-dimensional view (3D) and two-dimensional (2D) view options with traditional manually assisted laparoscopic techniques in performing standardized exercises. METHODS To evaluate surgical efficiency in the use of robotically assisted and manual laparoscopic surgery for standardized exercises six, last-year medical students without any surgical experience were selected. The exercises consisted of placing rings over receptacles, grasping a free hanging suture and cutting three pieces of it, running a suture, and performing a surgical knot. Each student performed the exercise twice. The median times needed for completion of the exercises and the median number of errors in performing the tasks were noted. RESULTS The unexperienced students performed the standardized tasks significantly quicker and with fewer errors when assisted by the da Vinci robot in the 3D optical display mode, as compared with traditional manually assisted laparoscopic surgery. Even when the 2D mode was selected, a significant advantage favoring the da Vinci robotic system was seen both in time and efficacy for most exercises. When the 3D and 2D modes were compared, time differences in favor of the 3D mode remained, but a significant difference in efficacy favoring the 3D mode was seen only in one exercise (exercise 2: suture cutting). CONCLUSIONS The da Vinci robotic system permits standardized minimal invasive surgical exercises to be performed quicker and more efficiently than traditional minimally invasive techniques. Therefore, with the aid of this robotic system, difficult laparoscopic interventions may become easier to perform, and indications for minimal invasive surgery may be expanded.
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Affiliation(s)
- G Hubens
- Department of Abdominal Surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2560 Edegem, Belgium.
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Abstract
More and more prosthetic materials are being used in the treatment of inguinal hernia. This report deals with some unusual but devastating complications, occurring after preperitoneal mesh implantation. A 56-year old male patient underwent a Stoppa-repair for a bilateral inguinal hernia. Two years postoperatively, a localized abdominal wall abscess was treated with antibiotics and drainage. A barium enema and a CT-scan of the abdomen were performed to rule out an enteric fistula; the CT-scan unexpectedly revealed a tumoral mass involving the sigmoid colon, and an explorative laparotomy was done. Peroperatively, part of the mesh was found to penetrate the bowel wall and a sigmoidectomy with removal of the mesh was performed. Two years later, ingrowth of the urinary bladder by the remains of the mesh was the unfortunate peroperative finding when the patient was operated on for an inflammatory mass, involving the bladder wall. The patient needed two more interventions for persisting wound fistulas. All the remains of the mesh have been removed and all fistulas have been widely excised. Nowadays, the patient is recovering well with complete healing of all wounds. Although infection of prostheses used in the treatment of hernias has been described, late and serious complications related to mesh implantation, such as perforation of the colon and the bladder, have seldom been reported.
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Affiliation(s)
- P Lauwers
- University Hospital of Antwerp, Department of Abdominal Surgery, Antwerp, Belgium
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23
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Hansson B, Hubens G, Vaneerdeweg W. Benign mucinous cystadenoma of the appendix. Report of 3 cases. Review of the literature. Acta Chir Belg 2002; 102:63-5. [PMID: 11925744 DOI: 10.1080/00015458.2002.11681161] [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: 10/21/2022]
Affiliation(s)
- B Hansson
- Department of Surgery, Groningen University Hospital, The Netherlands.
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24
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Giuliani D, Hoenjet K, Vaneerdeweg W, Tjalma W, Hubens G, Chapelle T, Eyskens E, De Backer A. Congenital right-sided diaphragmatic hernia in an elderly patient. A case report. Acta Chir Belg 2001; 101:141-4. [PMID: 11501391] [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: 02/21/2023]
Abstract
Congenital diaphragmatic hernia is a rare condition in adulthood. It is even more exceptional when located on the right side. We describe a case of right-sided congenital diaphragmatic hernia in a 74-year old woman. The diagnosis was only made when the patient developed an acute intestinal obstruction after a laparotomy for a gynaecological benign tumour. The treatment of this condition is discussed. In our opinion, in elderly, the advantages of an elective operation in asymptomatic congenital diaphragmatic hernia have to outweigh the risks of the operation. However, if the patient shows symptoms of pulmonary dysfunction or motility disorders of the gut, or even when he has to undergo a laparotomy for a different reason, we advise to repair the hernia in order to prevent complications.
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Affiliation(s)
- D Giuliani
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
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25
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De Backer AI, Mortelé KJ, Vaneerdeweg W, Ros PR. Pancreatocolonic fistula due to severe acute pancreatitis: imaging findings. JBR-BTR 2001; 84:45-7. [PMID: 11374629] [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: 04/16/2023]
Abstract
Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis. The spectrum of colonic complications includes localized ileus with "pseudo-obstruction", obstruction, necrosis, hemorrhage, fistula, and ischemic colitis. We report on a patient who developed pancreatocolonic fistulization in the course of protracted severe acute pancreatitis. Emphasis is made on the computed tomographic and water soluble contrast enema findings.
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Affiliation(s)
- A I De Backer
- Department of Radiology, Algemeen Centrumziekenhuis Antwerpen, Belgium
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26
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Vaneerdeweg W, Hendriks JM, Lauwers PR, Ieven M, Eyskens EJ. Effect of gentamicin-containing sponges on the healing of colonic anastomoses in a rat model of peritonitis. Eur J Surg 2000; 166:959-62. [PMID: 11152258 DOI: 10.1080/110241500447137] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the influence of gentamicin-containing sponges on the healing of colonic anastomoses in a rat model of peritonitis. DESIGN Controlled laboratory study. SETTING University hospital, Belgium. MATERIALS 40 male Wistar rats. INTERVENTIONS Peritonitis was caused by implantation of a gelatin capsule containing faeces and barium sulphate. The rats then had a colonic anastomosis. They were divided into 4 groups (n = 10 in each). The control group (no additional treatment); a second group in which a plain collagen sponge was wrapped around the anastomosis; a third group in which a gentamicin-containing collagen sponge was wrapped around the anastomosis; the last group in which the animals were given an intramuscular dose of gentamicin. MAIN OUTCOME MEASURES Operative mortality, weight loss and anastomotic bursting pressure four days after the anastomosis. RESULTS Seven rats died before necropsy but none in the last group. Peritonitis developed in all rats Weight loss was significantly higher in the plain collagen group. Bursting pressures were similar in the control and two gentamicin groups. In the plain collagen group all the anastomoses but one had broken down. CONCLUSION There was no difference in bursting pressure between rats treated with gentamicin sponges or systemically, and controls. Healing was severely compromised when a plain collagen sponge was used.
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Affiliation(s)
- W Vaneerdeweg
- Laboratory of Experimental Surgery, University Hospital Antwerp, Edegem, Belgium
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27
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Abstract
Intragastric erosion of the adjustable silicone gastric band (ASGB) is a rare but severe complication of gastric banding, often leading to reoperation. We describe our experience with 4 cases referred to us. The best timing of removal and the choice of another bariatric procedure is still controversial. We advise to wait until migration of the band into the lumen is complete. With removal of the ASGB if another weight reduction procedure is advisable, conversion to a biliopancreatic diversion is possible.
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Affiliation(s)
- B Ventienen
- Department of Surgery, University Hospital of Antwerp, Belgium
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28
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De Backer AI, De Schepper AM, Michielsen PP, De Maeyer M, Bogers JJ, Vaneerdeweg W. Hepatobiliary cystadenoma with mesenchymal stroma mimicking hydatid cyst. Report of a case. Acta Gastroenterol Belg 2000; 63:317-20. [PMID: 11190002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We report on a case of hepatobiliary cystadenoma with mesenchymal stroma in a 44-year-old Caucasian woman who presented with upper abdominal discomfort. Ultrasound (US) and computed tomography (CT) showed a cystic mass resembling hydatid cyst. Endoscopic retrograde cholangiography (ERC) demonstrated communication with the left hepatic duct. At surgery, a cystic mass with communication to the left hepatic duct was found and resected en bloc with a margin of normal liver tissue. Histological examination showed a hepatobiliary cystadenoma with mesenchymal stroma.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium
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29
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Abstract
BACKGROUND In vertical banded gastroplasty (VBG), a small proximal gastric pouch is created, which is believed to fill rapidly and to empty slowly. METHODS In 13 patients who underwent VBG, gastric emptying rate was measured. A radiolabelled solid test meal was used before and 2 weeks after operation. From a region of interest above the whole stomach, the proximal pouch and the distal stomach, half emptying time as well as retention percentage were derived. RESULTS All patients experienced early satiety and gastric fullness after ingestion of a small test meal. The proximal pouch emptied rapidly. The evacuation of the test meal from the whole gastric region as well as the distal stomach were not altered significantly by the operation. CONCLUSION VBG is a safe operation which reduced weight significantly. Early satiety, however, induced by this technique, cannot be explained alone by slow emptying of the proximal pouch. The nature of the outlet of the pouch as well as the behavior of its wall must be considered.
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Affiliation(s)
- W Mistiaen
- Laboratory of Human Anatomy, University of Antwerp, Belgium.
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30
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Vaneerdeweg W, Hubens G, Chapelle T, Eyskens E. Rectovaginal fistulas. Acta Chir Belg 2000; 100:128-31. [PMID: 11280177] [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: 02/19/2023]
Abstract
The treatment of rectovaginal fistulas is controversial. The choice of the technique used for repair depends on many factors. Therefore the classification, etiology and treatment are discussed, in order to help decision making in the management of this troublesome disease.
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31
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Abstract
Gastrobronchial fistula is a rare complication of antireflux surgery, whereas esophagobronchial fistula as a complication of Nissen fundoplication has, to the best of our knowledge, not been reported previously. We report on a case of esophagobronchial fistula in a patient with left subphrenic abscess following redo Nissen fundoplication. Chest radiographs suggested an unresponsive pneumonia of the left lower lobe. Computed tomography (CT) of the abdomen showed partial consolidation of the left lower lobe and contrast filling of the left bronchial tree from a left subphrenic abscess. CT diagnosis of fistula originating from the region of fundoplication was confirmed by Gastrografin follow-through.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University of Antwerp, Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, B-2650 Edegem, Belgium
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32
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Abstract
We report a case in which blunt abdominal trauma resulted in injury to the mesentery with subsequent ischemic stricture of the adjacent small bowel. We present CT images at the time of trauma and 5 weeks later when clinical signs of intestinal obstruction occurred. We include images of enteroclysis and angiography of this uncommon sequela of blunt abdominal trauma. At surgery, a stenotic small bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the resected segment showed mucosal and submucosal ischemia with mucosal ulceration, mural inflammation, and fibrosis. Posttraumatic intestinal stenosis subsequent to a mesenteric tear should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University of Antwerp, Universitair Ziekenhuis Antwerpen, Wilrijkstraat 10, B-2650 Edegem, Belgium
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33
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De Backer AI, De Schepper AM, Deprettere A, Van Reempts P, Vaneerdeweg W. Radiographic manifestations of intestinal obstruction in the newborn. JBR-BTR 1999; 82:159-66. [PMID: 10555422] [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: 02/14/2023]
Abstract
Intestinal obstruction in the newborn infant may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, and Hirschsprung's disease. Neonates with unrecognised intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings by the radiologist. Plain film of the abdomen is often helpful in determining the level of obstruction and usually dictates, together with clinical symptoms, the choice of the contrast study firstly to perform. In this article we will review the clinical and radiological signs of different pathological conditions causing intestinal obstruction in the newborn.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University of Antwerp, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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34
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Hubens G, Ysebaert D, Vaneerdeweg W, Chapelle T, Eyskens E. Laparoscopic adrenalectomy with the aid of the AESOP 2000 robot. Acta Chir Belg 1999; 99:125-7; discussion 127-9. [PMID: 10427347] [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
The authors describe a left adrenalectomy for Cushing's disease with the aid of an AESOP (Automated Endoscopic System for Optimal Positioning) 2000 voice controlled robot. This device facilitated the procedure by producing a constant, stable picture allowing the operative team to concentrate principally on the dissection.
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Affiliation(s)
- G Hubens
- Department of Surgery, University Hospital of Antwerp, Belgium
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35
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Roeyen G, Jansen M, Hubens G, Vaneerdeweg W, Eyskens E. Intussusception in infants: an emergency in diagnosis and treatment. Eur J Emerg Med 1999; 6:73-6. [PMID: 10340739] [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: 02/12/2023]
Abstract
Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.
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Affiliation(s)
- G Roeyen
- Department of Surgery, University Hospital Antwerp, Edegem, Belgium
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36
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De Backer A, Fierens H, De Schepper A, Pelckmans P, Jorens PG, Vaneerdeweg W. Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases. Eur Radiol 1998; 8:1619-22. [PMID: 9866773 DOI: 10.1007/s003300050598] [Citation(s) in RCA: 35] [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] [Indexed: 10/28/2022]
Abstract
We report on two patients with biliary tract injury and associated biloma following blunt abdominal trauma. Both patients underwent emergency surgery because of hemodynamic instability and bloody peritoneal aspiration. Computed tomography in the postoperative days showed severe hepatic parenchymal injury and the presence of hypodense collections with intraparenchymal and subcapsular extension, suggestive for biloma, but otherwise failed to demonstrate the exact location of the bile duct injury. One of them underwent temporary percutaneous drainage. Bile duct injury was well demonstrated on endoscopic retrograde cholangiography (ERCP) and treated by endobiliary stent placement. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma.
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Affiliation(s)
- A De Backer
- Department of Radiology, University Hospital of Antwerp, Edegem, Belgium
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37
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Vaneerdeweg W, Bresseleers T, Du Jardin P, Lauwers P, Pauli S, Thyssens K, Van Marck E, Elseviers M, Eyskens E. Comparison between plain and gentamicin containing collagen sponges in infected peritoneal cavity in rats. Eur J Surg 1998; 164:617-21. [PMID: 9720939 DOI: 10.1080/110241598750005723] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To study the usefulness of gentamicin-containing sponges in the infected peritoneal cavity in rats. DESIGN Controlled study. MATERIAL 83 Male Wistar rats, 36 of which were treated by plain sponge, 36 by gentamicin-impregnated sponge, and 11 acted as controls. INTERVENTIONS A standard model of intraperitoneal infection was developed by making a 1 cm long incision in the caecum. MAIN OUTCOME MEASURES Postoperative mortality, macroscopic and microscopic features of infection, and bacterial concentrations in the abdomen on days 3, 6, and 9. RESULTS In the respective groups 2, 3 and 2 animals died during operation and 4/34 (11%), 3/33 (9%); and 0/9 died before day 3. There were appreciable reductions in the number of animals with features of infection after 3 days but these were not significant at 6 or 9 days. CONCLUSION Gentamicin-containing collagen sponges placed on a septic focus in the abdomen reduce local infection for at least 3 days.
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Affiliation(s)
- W Vaneerdeweg
- Department of Surgery, University of Antwerp, Edegem, Belgium
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38
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De Backer AI, De Schepper AM, Hubens G, Vaneerdeweg W. Shock bowel following massive pulmonary embolism. J Belge Radiol 1997; 80:231-2. [PMID: 9400055] [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: 02/05/2023]
Abstract
Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acute hemodynamic collapse are described. These small bowel abnormalities are secondary to hypotension with prolonged hypoperfusion. They consist of diffuse thickening of the small-bowel wall, fluid-filled, dilated loops and increased contrast enhancement of the small-bowel wall (shock bowel). These abnormalities are reversible and should be distinguished from acute vascular occlusion.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University Hospital of Antwerp, Edegem, Belgium
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39
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Vaneerdeweg W. Restorative proctocolectomy for ulcerative colitis. Acta Chir Belg 1997; 97:157-62. [PMID: 9381896] [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: 02/05/2023]
Affiliation(s)
- W Vaneerdeweg
- Department of Surgery, University Hospital, Antwerp, Belgium
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40
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De Backer AI, Parizel PM, De Schepper A, Vaneerdeweg W. A patient with congenital short small bowel associated with malrotation. J Belge Radiol 1997; 80:71-2. [PMID: 9237417] [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: 02/04/2023]
Abstract
A case of congenital short small bowel associated with malrotation and malabsorption in a baby girl is presented. Clinical manifestations developed in the first days after birth and consisted of diarrhea, vomiting and poor weight increase. Congenital short small bowel was suspected on radiological examination, which showed an associated malrotation. The diagnosis was confirmed by exploratory laparotomy. The length of the small intestine was only 50 cm. The intensive work of maintaining nutrition and controlling infection is described.
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Affiliation(s)
- A I De Backer
- Department of Radiology, University Hospital of Antwerp, Edegem, Belgium
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41
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Roeyen G, Hubens G, Vaneerdeweg W, Mahieu L, Eyskens E. Scheduled relaparotomies using a zipper system for the treatment of diffuse generalized peritonitis in children. Acta Chir Belg 1996; 96:201-5. [PMID: 8950380] [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: 02/03/2023]
Abstract
In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.
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Affiliation(s)
- G Roeyen
- Department of Surgery, University Hospital, Antwerp, Belgium
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42
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Abstract
Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed. Therefore it seems logical to preserve those structures unaltered during surgical therapy. Mucosal proctectomy and colo-anal anastomosis is a safe, technically well known technique that achieves this goal.
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Affiliation(s)
- W Vaneerdeweg
- Department of Surgery, Antwerp University Hospital and Medical School, Edegem, Belgium
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43
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Hubens G, De Vries D, Hauben E, Van Marck E, Corthouts B, Michielsen P, Vaneerdeweg W, Eyskens E. Laparoscopic resection of an adenoma of the urachus in combination with a laparoscopic cholecystectomy. Surg Endosc 1995; 9:914-6. [PMID: 8525448 DOI: 10.1007/bf00768892] [Citation(s) in RCA: 8] [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: 01/31/2023]
Abstract
In a 40-year-old male patient with symptomatic cholecystolithiasis, ultrasound examination disclosed a large cystic mass on the dome of the bladder. Laparoscopic resection of this mass was carried out in combination with a laparoscopic cholecystectomy. Histology disclosed an urachal adenoma. Postoperative recovery was uneventful. We conclude that urachal adenomas can be managed safely by laparoscopic means.
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Affiliation(s)
- G Hubens
- Department of Surgery, University Hospital University of Antwerp, Belgium
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44
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Kamper AD, Van Outryve M, De Backer A, Vaneerdeweg W, Pelckmans P. Meckle's diverticulum in association with Crohn's disease. Acta Gastroenterol Belg 1995; 58:318-20. [PMID: 7491845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Although it is not uncommon to encounter a Mecklel's diverticulum in a patient with Crohn's disease, the involvement of this diverticulum by Crohn's disease is less common. A well performed radiological small intestinal study strongly suggests the diagnosis, which is definite after histologic examination of the reported.
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Affiliation(s)
- A D Kamper
- Universitair Ziekenhuis Antwerpen, Department of Gastroenterology, Edegem, Belgium
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45
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Vaneerdeweg W, Hubens G, Van Gaal L, Eyskens E. Operations for failed vertical banded gastroplasty. Acta Chir Belg 1994; 94:203-6. [PMID: 8053290] [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
Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.
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Affiliation(s)
- W Vaneerdeweg
- Department of Surgery, University Hospital Antwerp (U.I.A.), Belgium
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46
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Hubens G, Lafaire C, De Praeter M, Ysebaert D, Vaneerdeweg W, Heytens L, Eyskens E. Staged peritoneal lavages with the aid of a Zipper system in the treatment of diffuse peritonitis. Acta Chir Belg 1994; 94:176-9. [PMID: 8067167] [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
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
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Affiliation(s)
- G Hubens
- Dept. of Surgery, Academic Hospital University of Antwerp, Belgium
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47
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Abstract
BACKGROUND The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and promoting spontaneous closure of postoperative digestive fistulas. METHODS In a consecutive series of 23 patients, closure was achieved in 83% of patients after a mean fistula duration of 11.0 +/- 7.9 days and a mean of 13.2 +/- 7.0 days of drug treatment, and without mortality. RESULTS A marked first-day effect (output drop > 50%) was noted in 60% of patients and had a good prognosis. Infection of the fistula markedly prolonged fistula closure time, but did not affect total outcome. CONCLUSION Somatostatin has been shown to be very useful in the conservative treatment of digestive fistulas because of its ability to reduce output significantly and to accelerate spontaneous closure.
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Affiliation(s)
- D Ysebaert
- Dept. of Surgery, University Hospital Antwerp, Belgium
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48
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D'Haese PC, Lamberts LV, Verpooten GA, Vaneerdeweg W, Jurgens A, Arakelian S, Babloyan A, Digenis P, Tjalma W, De Broe ME. Urinary and biliary excretion of aluminoxamine and ferrioxamine in dogs with various renal function. Kidney Int 1994; 45:76-84. [PMID: 8127024 DOI: 10.1038/ki.1994.9] [Citation(s) in RCA: 6] [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: 01/28/2023]
Abstract
We assessed the pharmacokinetics of aluminoxamine and ferrioxamine in dogs with sustained intermittent bile duct ligation and either normal renal function or stable chronic renal failure. A first group of male beagle dogs were given aluminoxamine and ferrioxamine, while a second group received desferrioxamine after loading them with iron and aluminum. Only minute amounts of ferrioxamine and aluminoxamine were found in the bile after administration of these compounds. The distribution volume of aluminoxamine and ferrioxamine appeared to be confined to the extracellular space and their renal excretion correlated with renal function. Administration of desferrioxamine to iron and aluminum-loaded dogs resulted in an increased biliary ferrioxamine but negligible aluminoxamine excretion. Renal clearance of the in vivo formed ferrioxamine and aluminoxamine in this group strongly correlated with renal function. Our observations indicate that biliary excretion of intravenously administered ferrioxamine and aluminoxamine is negligible even in renal failure. The data presented in this study provide indirect evidence that desferrioxamine administration to iron- and aluminum-loaded dogs results in the intra-hepatic formation of ferrioxamine which is partly excreted in the bile. Biliary excretion of aluminoxamine after desferrioxamine administration remained negligible.
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Affiliation(s)
- P C D'Haese
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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49
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Zhu MQ, Vaneerdeweg W, Buyssens N, De Broe ME. Quantitative relationships between body weight, kidney weight and nephron size in mongrel dogs. Nephron Clin Pract 1992; 62:187-91. [PMID: 1436312 DOI: 10.1159/000187031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 12/27/2022] Open
Abstract
Mammalian species of large stature have larger kidneys with larger nephrons than smaller animals, although this relationship is not linear. In order to investigate whether in animals of different sizes within the same species similar differences exist, a study in mongrel dogs was undertaken. In animals weighing between 9 and 42 kg with kidney weights from 25 to 79 g the area and perimeter of the glomeruli and the cortical width were measured. The number of glomeruli per unit area was counted and corrected for the size of the glomeruli. The results show that larger dogs have larger kidneys and that this enlargement is due to the increase in size of the nephrons and not in their number.
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Affiliation(s)
- M Q Zhu
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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50
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Vaneerdeweg W, Buyssens N, De Winne T, Sebrechts M, Babloyan A, Arakelian S, De Broe ME. A standardized surgical technique to obtain a stable and reproducible chronic renal failure model in dogs. Eur Surg Res 1992; 24:273-82. [PMID: 1425824 DOI: 10.1159/000129216] [Citation(s) in RCA: 18] [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: 12/27/2022]
Abstract
The remnant kidney, a model of chronic renal failure in animals, can be obtained by two techniques: either surgical removal of tissue of one kidney, combined with contralateral nephrectomy or inducing necrosis of kidney tissue by ligation of branches of the renal artery of one kidney combined with contralateral nephrectomy. In the literature, most reports concern the ligation technique. The technique is safe and simple but the results in dogs are unpredictable. In this paper, both techniques were compared. We could demonstrate that the unpredictable result of the ligation technique is due to the formation of collateral vessels bypassing the ligated branches and to the inconstant ramification pattern of the renal artery. In this study, a standardized technique consisting of the resection of 16-18 g of tissue of one beagle kidney and removal of the other one is described. This method results in a stable chronic renal failure until the dogs are sacrificed at 9-12 months.
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Affiliation(s)
- W Vaneerdeweg
- Department of Surgery, University of Antwerp, Belgium
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