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  • Laparoscopy
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  • 1
    Language: English
    In: Langenbeck's archives of surgery, January 2012, Vol.397(1), pp.69-74
    Description: The efficacy of Heller myotomy in patients 〉40 years-a significant predictor suggesting a favorable response to pneumatic dilation-has been questioned. The aim of our study was to evaluate the results obtained in patients aged 40 years undergoing minimally invasive surgery (MIS) for achalasia. In January 2008, we established the MIS technique for achalasia in our clinic. In the following period from January 2008 to March 2011, 74 patients underwent primary laparoscopic myotomy for achalasia. The procedure was accomplished with an anterior 180° semifundoplication according to Dor in all patients. The Eckardt score and the Gastrointestinal Quality of Life Index (GQLI) served as outcome measures. The median age of patients was 45.5 years (range, 18-85 years) with a median duration of preoperative achalasia symptoms of 57 months (range, 2-468 months). There were no conversions to open surgery and-except for one patient with a sterile pleural effusion-no postoperative complications. At a median follow-up of 12 months, the preoperative Eckardt score of 7.0 (range, 3-12) was found to be significantly decreased to a median of 2 (range, 0-6; P 40 years, the postoperative Eckardt score obtained in the older patient population was not significantly lower (P = 0.074). There was no statistically significant difference between the two groups with respect to the postoperative GQLI (P = 0.860). Neither gender nor preoperative Botox injection or pneumatic dilation inserted a significant influence on the postoperative clinical outcome (P 〉 0.05). Laparoscopic Heller myotomy for achalasia is associated with a high success rate as the primary therapeutic option and after failure of endoscopic therapy. It can be performed safely and with favorable outcomes also in patients 〉40 years. However, the long-term durability of the procedure remains to be established.
    Keywords: Esophageal Achalasia -- Surgery ; Esophagus -- Surgery ; Laparoscopy -- Methods
    ISSN: 14352443
    E-ISSN: 1435-2451
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  • 2
    Language: English
    In: The American Journal of Surgery, 2010, Vol.200(2), pp.291-297
    Description: The objective of this study was to examine the outcomes of comparisons between laparoscopic and open mesh repairs in the setting of recurrent inguinal hernia. The electronic databases MEDLINE, Embase, Pubmed, and the Cochrane Library were used to search for articles from 1990 to 2008. The present meta-analysis pooled the effects of outcomes of a total of 1,542 patients enrolled into 5 randomized controlled trials and 7 comparative studies, using classic and modern meta-analytic methods. Significantly fewer cases of hematoma/seroma formation were observed in the laparoscopic group in comparison with the Lichtenstein group (odds ratio, .38; .15–.96; = .04). A matter of great importance is the higher relative risk of overall recurrence in the transabdominal preperitoneal group compared with the totally extraperitoneal group (relative risk, 3.25; 1.32–7.9; = .01). Laparoscopic versus open mesh repair for recurrent inguinal hernia was equivalent in most of the analyzed outcomes.
    Keywords: Meta-Analysis ; Evidence Based ; Publication Bias ; Recurrent Inguinal Hernia ; Totally Extraperitoneal ; Transabdominal Preperitoneal ; OPM ; Open Preperitoneal Mesh ; Stoppa ; Giant Prosthetic Reinforcement of the Visceral Sac ; Lichtenstein Procedure
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 3
    Language: English
    In: Digestive Diseases and Sciences, 2009, Vol.54(12), pp.2763-2764
    Description: Byline: Ines Gockel (1), Hauke Lang (1) Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany Article History: Registration Date: 25/06/2009 Received Date: 07/06/2009 Accepted Date: 25/06/2009 Online Date: 23/07/2009
    Keywords: Surgery;
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 4
    Language: English
    In: BMC Surgery, 01 July 2017, Vol.17(1), pp.1-8
    Description: Abstract Background Cost reduction measures in medicine are gaining greater importance nowadays, especially in high-volume procedures such as laparoscopic appendectomy (LAE). Currently there are two common methods of dissecting the appendix...
    Keywords: Laparoscopic Appendectomy ; Endoloop ; Stapling Device ; Cost-Reduction
    E-ISSN: 1471-2482
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  • 5
    Language: English
    In: Deutsches Arzteblatt international, March 2012, Vol.109(12), pp.209-14
    Description: Many physicians are inadequately familiar with the clinical features of achalasia. Often, it is not diagnosed until years after the symptoms arise. This is unfortunate, because a delay in diagnosis worsens the prognosis. Selective review of the literature. Achalasia has a lifetime prevalence of 1:10 000. It is a neurodegenerative disorder in which the neurons of the myenteric plexus are lost, leading to dysfunction of the lower esophageal sphincter and to a derangement of esophageal peristalsis. In the final stage of achalasia, esophageal motility is irreversibly impaired, and complications ensue because of the retention of food that is no longer transported into the stomach. Aspiration causes pulmonary disturbances in up to half of all patients with achalasia. There may also be inflammation of the esophageal mucosa (retention esophagitis); this, in turn, is a risk factor for esophageal cancer, which arises in 4% to 6% of patients. The cause of achalasia is not fully known, but autoimmune processes appear to be involved in patients with a genetic susceptibility to the disease. Achalasia should be diagnosed as early as possible, so that complications can be prevented. In addition, guidelines should be established for cancer prevention in achalasia patients. Currently ongoing studies of the molecular causes of achalasia will probably help us understand its pathophysiology.
    Keywords: Catheterization -- Methods ; Delayed Diagnosis -- Prevention & Control ; Diagnostic Imaging -- Methods ; Endoscopy, Gastrointestinal -- Methods ; Esophageal Achalasia -- Diagnosis ; Laparoscopy -- Methods
    E-ISSN: 1866-0452
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  • 6
    Language: English
    In: Surgical endoscopy, July 2013, Vol.27(7), pp.2526-41
    Description: The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved. A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses. The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center's rates of recurrence and morbidity as disclosed by three-way sensitivity analysis. Nyhus and TEP repairs are possible optimal choices depending primarily on the institution's rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical "fixed budget trade-off" suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor).
    Keywords: Decision Trees ; Surgical Mesh ; Hernia, Inguinal -- Economics ; Laparoscopy -- Economics
    ISSN: 09302794
    E-ISSN: 1432-2218
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  • 7
    Language: English
    In: BMC Surgery, 01 May 2017, Vol.17(1), pp.1-10
    Description: Abstract Background Transabdominal Preperitoneal (TAPP) and Lichtenstein operation are established methods for inguinal hernia repair in clinical practice. Meta-analyses of randomized controlled studies, comparing those two methods for repair of primary inguinal hernia, are still missing. In...
    Keywords: Tapp ; Lichtenstein Repair ; Inguinal Hernia ; Outcome ; Meta-Analysis
    E-ISSN: 1471-2482
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  • 8
    In: Zeitschrift für Gastroenterologie, 2017, Vol.55(08)
    In: Zeitschrift für Gastroenterologie, 2017, Vol.55(08), pp.761-765
    Description: Schwannome sind benigne Tumoren der Schwann-Zellen und manifestieren sich hauptsächlich am Körperstamm und im Bereich der Extremitäten. Gastrointestinale Schwannome sind extrem selten, treten am häufigsten im Magen auf und verlaufen meist asymptomatisch. Wir berichten über ein Schwannom des Magens, das sich durch Hämatemesis auf dem Boden einer akuten oberen GI-Blutung bei einem 51-jährigen Mann klinisch manifestierte. Die Endoskopie des oberen Gastrointestinaltrakts erbrachte eine submuköse Raumforderung des Magenfundus von ca. 7 cm Durchmesser. Die anschließende Endosonografie des Magens zeigte den Ursprung der Raumforderung in der 4. Wandschicht (Muscularis propria) bei klar abgrenzbaren Rändern. Der Ursprung in der 4. Schicht sowie die im Vergleich mit der Echogenität der regulären Muskelschichten bestehende Isoechogenität finden sich signifikant häufiger beim Schwannom des Magens als beim gastrointestinalen Stromatumor. Endoskopisch-bioptisch konnte präoperativ keine klare Diagnose erzielt werden. Wir führten die endoskopisch-laparoskopische Magen-Wedge-Resektion des Fundus durch (in Rendezvous-Technik). Die Diagnose eines Schwannoms erfolgte nach histopathologischer Untersuchung mit Immunhistochemie mit typischer Positivität für das S100-Antigen, ohne Zeichen der Malignität. Der postoperative Verlauf war unauffällig. Die Erstmanifestation eines Schwannoms des Magens mit gastrointestinaler Blutung ist in der Literatur mit ca. 14 % der Fälle eher selten und wird überwiegend mit okkultem Blut im Stuhl bzw. Meläna angegeben – im Gegensatz zu unserem Patienten mit akuter oberer gastrointestinaler Blutung.
    Keywords: Schwannom ; Magen ; Obere gastrointestinale blutung ; Gastric schwannoma ; Upper gi-bleeding ; Stomach
    ISSN: 0044-2771
    E-ISSN: 1439-7803
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  • 9
    Language: English
    In: Digestive Diseases and Sciences, 2010, Vol.55(11), pp.3031-3040
    Description: Byline: George Sgourakis (1,2), Ines Gockel (1), Arnold Radtke (1), Thomas J. Musholt (1), Stephan Timm (1), Andreas Rink (1), Achilleas Tsiamis (3), Constantine Karaliotas (2), Hauke Lang (1) Keywords: Minimally invasive esophagectomy; Open esophagectomy; Meta-analysis; Evidence based medicine; Publication bias; Barrett's esophagus Abstract: Background A meta-analysis of the current literature was performed to compare the perioperative outcome measures and oncological impact between minimally invasive and open esophagectomy. Methods Using the electronic databases Medline, Embase, Pubmed and the Cochrane Library, we performed a meta-analysis pooling the effects of outcomes of 1,008 patients enrolled into eight comparative studies, using classic and modern meta-analytic methods. Results Two comparisons were considered for this systematic review: (I) open thoracotomy vs. VATS/laparoscopy esophagectomy and (II) open thoracotomy vs. VATS esophagectomy. In comparison I: both procedures report equally comparable outcomes (removed lymph nodes, 30-day mortality, 3-year survival) with the exception of overall morbidity (P = 0.038 in favor of the MIE arm) and anastomotic stricture (P 〈 0.001 in favor of the open thoracotomy arm). In comparison II: No differences were noted between treatment arms concerning postoperative outcomes and survival. Conclusions In summary, both arms were comparable with regard to perioperative results and prognosis. Further prospective comparative or randomized-controlled trials focusing on the oncological impact of MIE are needed. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany (2) 2nd Surgical Department and Surgical Oncology Unit, Korgialenio--Benakio Red Cross Hospital, 11 Mantzarou St., Neo Psychiko, 15451, Athens, Greece (3) Department of Colorectal and Laparoscopic Surgery, James Paget University Hospital, Norfolk, UK Article History: Registration Date: 03/02/2010 Received Date: 15/11/2009 Accepted Date: 03/02/2010 Online Date: 26/02/2010
    Keywords: Minimally invasive esophagectomy ; Open esophagectomy ; Meta-analysis ; Evidence based medicine ; Publication bias ; Barrett’s esophagus
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 10
    Language: English
    In: Gastric Cancer, 2015, Vol.18(3), pp.550-563
    Description: Byline: Markus Moehler (1,17), Christoph T. H. Baltin (5), Matthias Ebert (2), Wolfgang Fischbach (3), Ines Gockel (1), Lars Grenacher (4), Arnulf H. Holscher (5), Florian Lordick (6), Peter Malfertheiner (7), Helmut Messmann (8), Hans-Joachim Meyer (9), Anne Palmqvist (1), Christoph Rocken (10), Christoph Schuhmacher (11), Michael Stahl (12), Martin Stuschke (13), Michael Vieth (14), Christian Wittekind (15), Dorothea Wagner (16), Stefan P. Monig (5) Keywords: Guidelines; Esophageal cancer; Gastric cancer; Perioperative therapy; Diagnosis Abstract: Background Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature. Methods The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations. Results In the German S3 and other Western guidelines, adenocarcinomas of the esophagogastric junction (AEG) are classified according to formerly defined AEG I--III subgroups due to the high surgical impact. To stage local disease, computed tomography of the chest and abdomen and endosonography are reinforced. In contrast, laparoscopy is optional for staging. Mucosal cancers (T1a) should be endoscopically resected "en-bloc" to allow complete histological evaluation of lateral and basal margins. For locally advanced cancers of the stomach or esophagogastric junction (a[yen]T3N+), preferred treatment is preoperative and postoperative chemotherapy. Preoperative radiochemotherapy is an evidence-based alternative for large AEG type I--II tumors (a[yen]T3N+). Additionally, some experts recommend treating T2 tumors with a similar approach, mainly because pretherapeutic staging is often considered to be unreliable. Conclusions The German S3 guideline represents an up-to-date European position with regard to diagnosis, staging, and treatment recommendations for patients with locally advanced esophagogastric cancer. Effects of perioperative chemotherapy versus chemoradiotherapy are still to be investigated for adenocarcinoma of the cardia and the lower esophagus. Author Affiliation: (1) University Medical Center Mainz, Mainz, Germany (2) University Medical Center Mannheim, Mannheim, Germany (3) Klinikum Aschaffenburg, Aschaffenburg, Germany (4) Heidelberg University Hospital, Heidelberg, Germany (5) University Hospital of Cologne, Cologne, Germany (6) Klinikum Braunschweig, Braunschweig, Germany (7) University Clinic Magdeburg, Magdeburg, Germany (8) Klinikum Augsburg, Augsburg, Germany (9) Stadtisches Klinikum Solingen, Solingen, Germany (10) Charite Universitatsmedizin Berlin, Berlin, Germany (11) University Hospital Klinikum Rechts der Isar, Munich, Germany (12) Kliniken Essen-Mitte, Essen, Germany (13) Essen University Hospital, Essen, Germany (14) Klinikum Bayreuth, Bayreuth, Germany (15) Universitatsmedizin Leipzig, Leipzig, Germany (16) Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland (17) Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universitat, Langenbeckstra[sz]e, 155101, Mainz, Germany Article History: Registration Date: 16/07/2014 Received Date: 07/10/2013 Accepted Date: 13/07/2014 Online Date: 07/09/2014 Article note: M. Moehler and C.T.H. Baltin contributed equally. Electronic supplementary material The online version of this article (doi: 10.1007/s10120-014-0403-x) contains supplementary material, which is available to authorized users.
    Keywords: Guidelines ; Esophageal cancer ; Gastric cancer ; Perioperative therapy ; Diagnosis
    ISSN: 1436-3291
    E-ISSN: 1436-3305
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