Langenbeck's archives of surgery
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Langenbecks Arch Surg · Apr 2005
Comparative StudyNissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?
In patients with gastroesophageal reflux disease (GERD) it is still controversial as to which type of antireflux procedure-the Nissen or the partial posterior fundoplication-offers the lower rate of side effects in the long term. ⋯ Partial posterior fundoplication is a more physiological antireflux procedure than the Nissen fundoplication, and, therefore, this operation has now become our preferred technique for all GERD patients.
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Langenbecks Arch Surg · Nov 2004
ReviewSurgical trauma: hyperinflammation versus immunosuppression?
Experimental and clinical studies have brought evidence that surgical trauma markedly affects the immune system, including both the specific and the non-specific immune response. ⋯ When drawing up the therapeutic regimen the physician should not consider hyperinflammation versus immunosuppression, but hyperinflammation and immunosuppression, aiming at restoring an appropriate mediator- and immune cell-associated balance.
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Langenbecks Arch Surg · Nov 2004
ReviewVolume replacement and microhemodynamic changes in polytrauma.
Though fluid administration is one of the most basic concepts in resuscitation, there is ongoing controversy and continuing research on the definition of the ideal fluid for resuscitation of trauma and hemorrhage and for intraoperative volume support. In general, crystalloids and colloids, as well as blood, blood substitutes and oxygen therapeutics, are available. This report briefly revisits the physiological mechanisms underlying resuscitation with crystalloids and colloids, emphasizing colloid-supplemented resuscitation with hypertonic saline. Finally, potential applications of oxygen therapeutics are briefly considered.
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Langenbecks Arch Surg · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialChronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP.
Chronic pain after hernia repair is common, and it is unclear to what extent the different operation techniques influence its incidence. The aim of the present study was to compare the three major standardized techniques of hernia repair with regard to postoperative pain. ⋯ Chronic pain after hernia surgery is significantly more common with the open approach to the groin by Shouldice and Lichtenstein methods. The presence of the prosthetic mesh was not associated with significant postoperative complaints. The TAPP repair represents the most effective approach of the three techniques in the hands of an experienced surgeon.
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Langenbecks Arch Surg · Aug 2004
Postoperative recovery of microcirculation after gastric tube formation.
The formation of a gastric tube is associated with partial devascularisation of the stomach and impaired tissue perfusion in the anastomotic region. The aim of the study was to gain data on the time interval of microcirculatory recovery of the normal gastric conduit. ⋯ High levels of pCO(2)I indicate an impaired postoperative microcirculation in normal gastric tubes. After initial deterioration, gastric microcirculation takes approximately 4 days to recovery. These data are important for the implementation of ischaemic conditioning prior to gastric tube formation and gastric pull-up.