Esther C. J. Consten
NewYork–Presbyterian Hospital
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Featured researches published by Esther C. J. Consten.
Obesity Surgery | 2004
Esther C. J. Consten; Michel Gagner; Alfons Pomp; William B. Inabnet
Background: Laparoscopically performed sleeve gastrectomy may be employed as an adjunct to biliopancreatic diversion with duodenal switch (BPD-DS), to induce early satiety and weight loss in morbidly obese patients. Complications from this gastric procedure include staple-line leakage or hemorrhage. The efficacy of a staple-line buttressing material, an absorbable polymer membrane (Seamguard®, Gore), in reducing these complications, was investigated. Methods: A prospective consecutive series of 20 patients who underwent a laparoscopic sleeve gastrectomy in conjunction with BPD-DS were studied. In 10 patients, the absorbable polymer membrane was integrated into the gastric linear staple-line (group A). In a control group of 10 patients, a conventional linear stapling system was used (group B). The following data were recorded: demographics, intraoperative blood loss, staple-line leakage and hospital stay. Results: Demographic profile was similar in both groups. Operative data, including type, duration and strategy of operation as well as surgeons experience were well matched. Peroperative blood loss (120 ml vs 210 ml) was significantly higher in group B (P <0.05). Median length of hospital stay was 3.8 days (range 2-8 days) in group A and 4.6 days (range 4-12 days) in group B. There was no mortality. Morbidity was encountered in 3 patients (all group B), including 2 staple-line hemorrhages (10%) and 1 subphrenic abscess (5%). Conclusion: These early results may show that Seamguard® reduces staple-line hemorrhage and leakage. This may have contributed to shorter hospital stay, decreased costs and lower morbidity after laparoscopic bariatric surgery.
The Lancet | 2015
Sandra Vennix; Gijsbert D. Musters; Irene M. Mulder; Hilko A Swank; Esther C. J. Consten; Eric H J Belgers; Anna A. W. van Geloven; Michael F. Gerhards; Marc J.P.M. Govaert; Wilhelmina M.U. van Grevenstein; Anton G M Hoofwijk; Philip M Kruyt; Simon W. Nienhuijs; Marja A. Boermeester; J. Vermeulen; Susan van Dieren; Johan F. Lange; Willem A. Bemelman
BACKGROUND Case series suggest that laparoscopic peritoneal lavage might be a promising alternative to sigmoidectomy in patients with perforated diverticulitis. We aimed to assess the superiority of laparoscopic lavage compared with sigmoidectomy in patients with purulent perforated diverticulitis, with respect to overall long-term morbidity and mortality. METHODS We did a multicentre, parallel-group, randomised, open-label trial in 34 teaching hospitals and eight academic hospitals in Belgium, Italy, and the Netherlands (the Ladies trial). The Ladies trial is split into two groups: the LOLA group comparing laparoscopic lavage with sigmoidectomy and the DIVA group comparing Hartmanns procedure with sigmoidectomy plus primary anastomosis. The DIVA section of this trial is still underway but here we report the results of the LOLA section. Patients with purulent perforated diverticulitis were enrolled for LOLA, excluding patients with faecal peritonitis, aged older than 85 years, with high-dose steroid use (≥20 mg daily), and haemodynamic instability. Patients were randomly assigned (2:1:1; stratified by age [<60 years vs ≥60 years]) using secure online computer randomisation to laparoscopic lavage, Hartmanns procedure, or primary anastomosis in a parallel design after diagnostic laparoscopy. Patients were analysed according to a modified intention-to-treat principle and were followed up after the index operation at least once in the outpatient setting and after sigmoidoscopy and stoma reversal, according to local protocols. The primary endpoint was a composite endpoint of major morbidity and mortality within 12 months. This trial is registered with ClinicalTrials.gov, number NCT01317485. FINDINGS Between July 1, 2010, and Feb 22, 2013, 90 patients were randomly assigned in the LOLA section of the Ladies trial when the study was terminated by the data and safety monitoring board because of an increased event rate in the lavage group. Two patients were excluded for protocol violations. The primary endpoint occurred in 30 (67%) of 45 patients in the lavage group and 25 (60%) of 42 patients in the sigmoidectomy group (odds ratio 1·28, 95% CI 0·54-3·03, p=0·58). By 12 months, four patients had died after lavage and six patients had died after sigmoidectomy (p=0·43). INTERPRETATION Laparoscopic lavage is not superior to sigmoidectomy for the treatment of purulent perforated diverticulitis. FUNDING Netherlands Organisation for Health Research and Development.
The Lancet | 2015
David da Costa; Stefan A.W. Bouwense; Nicolien J. Schepers; Marc G. Besselink; Hjalmar C. van Santvoort; Sandra van Brunschot; Olaf J. Bakker; Thomas L. Bollen; Cornelis H.C. Dejong; Harry van Goor; Marja A. Boermeester; Marco J. Bruno; Casper H.J. van Eijck; Robin Timmer; Bas L. Weusten; Esther C. J. Consten; Menno A. Brink; B.W. Marcel Spanier; Ernst Jan Spillenaar Bilgen; Vincent B. Nieuwenhuijs; H. Sijbrand Hofker; Camiel Rosman; Annet Voorburg; K. Bosscha; Peter van Duijvendijk; Jos J. G. M. Gerritsen; Joos Heisterkamp; Ignace H. de Hingh; Ben J. Witteman; Philip M Kruyt
BACKGROUND In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission cholecystectomy is poor, and concerns exist about an increased risk of cholecystectomy-related complications with this approach. In this study, we aimed to compare same-admission and interval cholecystectomy, with the hypothesis that same-admission cholecystectomy would reduce the risk of recurrent gallstone-related complications without increasing the difficulty of surgery. METHODS For this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, inpatients recovering from mild gallstone pancreatitis at 23 hospitals in the Netherlands (with hospital discharge foreseen within 48 h) were assessed for eligibility. Adult patients (aged ≥18 years) were eligible for randomisation if they had a serum C-reactive protein concentration less than 100 mg/L, no need for opioid analgesics, and could tolerate a normal oral diet. Patients with American Society of Anesthesiologists (ASA) class III physical status who were older than 75 years of age, all ASA class IV patients, those with chronic pancreatitis, and those with ongoing alcohol misuse were excluded. A central study coordinator randomly assigned eligible patients (1:1) by computer-based randomisation, with varying block sizes of two and four patients, to cholecystectomy within 3 days of randomisation (same-admission cholecystectomy) or to discharge and cholecystectomy 25-30 days after randomisation (interval cholecystectomy). Randomisation was stratified by centre and by whether or not endoscopic sphincterotomy had been done. Neither investigators nor participants were masked to group assignment. The primary endpoint was a composite of readmission for recurrent gallstone-related complications (pancreatitis, cholangitis, cholecystitis, choledocholithiasis needing endoscopic intervention, or gallstone colic) or mortality within 6 months after randomisation, analysed by intention to treat. The trial was designed to reduce the incidence of the primary endpoint from 8% in the interval group to 1% in the same-admission group. Safety endpoints included bile duct leakage and other complications necessitating re-intervention. This trial is registered with Current Controlled Trials, number ISRCTN72764151, and is complete. FINDINGS Between Dec 22, 2010, and Aug 19, 2013, 266 inpatients from 23 hospitals in the Netherlands were randomly assigned to interval cholecystectomy (n=137) or same-admission cholecystectomy (n=129). One patient from each group was excluded from the final analyses, because of an incorrect diagnosis of pancreatitis in one patient (in the interval group) and discontinued follow-up in the other (in the same-admission group). The primary endpoint occurred in 23 (17%) of 136 patients in the interval group and in six (5%) of 128 patients in the same-admission group (risk ratio 0·28, 95% CI 0·12-0·66; p=0·002). Safety endpoints occurred in four patients: one case of bile duct leakage and one case of postoperative bleeding in each group. All of these were serious adverse events and were judged to be treatment related, but none led to death. INTERPRETATION Compared with interval cholecystectomy, same-admission cholecystectomy reduced the rate of recurrent gallstone-related complications in patients with mild gallstone pancreatitis, with a very low risk of cholecystectomy-related complications. FUNDING Dutch Digestive Disease Foundation.
Obesity Surgery | 2004
Esther C. J. Consten; Gregory Dakin; Michel Gagner
A 41-year-old morbidly obese woman (BMI 40.8) underwent elective laparoscopic biliopancreatic diversion with duodenal switch. The operation involved: sleeve gastrectomy, division of duodenum, creation of a duodenoenterostomy, and creation of a distal ileoenteric anastomosis. With laparoscopic stapling, bleeding is often a problem along the sleeve gastrectomy staple-line. To reduce this risk, we used bovine pericardial strips to reinforce the staple-line throughout its length. 4 weeks postoperatively, the patient was found to have fragments of pericardium in her vomitus, indicating intraluminal migration of the reinforcing strips. Her subsequent course has been uneventful. This represents the first report of such migration. Indications, benefits, complications and risks of using bovine pericardium to reinforce gastric staple-lines in laparoscopic bariatric surgery are discussed.
Colorectal Disease | 2013
H. A. Formijne Jonkers; N. Poierrié; Werner A. Draaisma; Ivo A. M. J. Broeders; Esther C. J. Consten
This retrospective study aimed to determine functional results of laparoscopic ventral rectopexy (LVR) for rectal prolapse (RP) and symptomatic rectoceles in a large cohort of patients.
Colorectal Disease | 2013
H. A. Formijne Jonkers; Werner A. Draaisma; Steven D. Wexner; Ivo A. M. J. Broeders; W. A. Bemelman; I. Lindsey; Esther C. J. Consten
Aim Validated guidelines for the surgical and non‐surgical treatment of rectal prolapse (RP) do not exist. The aim of this international questionnaire survey was to provide an overview of the evaluation, follow‐up and treatment of patients with an internal or external RP.
International Journal of Medical Robotics and Computer Assisted Surgery | 2014
Paul M. Verheijen; Esther C. J. Consten; Ivo A. M. J. Broeders
A transanal approach for total mesorectal excision (TME) using a single incision port is feasible. The disadvantages are technical difficulties associated with limited manoeuvrability.
World Journal of Gastroenterology | 2016
Jan J. van Iersel; Tim J.C. Paulides; Paul M. Verheijen; John W Lumley; Ivo A. M. J. Broeders; Esther C. J. Consten
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
International Journal of Colorectal Disease | 2012
H. A. Formijne Jonkers; Werner A. Draaisma; A. M. Roskott; A. J. van Overbeeke; Ivo A. M. J. Broeders; Esther C. J. Consten
PurposeThis study aims to provide an overview of all complications that may occur after construction of an ileostomy or colostomy (loop or end) in daily practice.MethodsBetween July 2007 and April 2008, all adult patients who underwent any type of intestinal stoma formation were asked to participate in this prospective cohort study. All relevant patient characteristics were gathered. Patients were evaluated for complications eight times in a 1-year postoperative period. Enterostomal therapy nurses scored complications on specially designed forms.ResultsOne hundred patients were included; two patients were lost before initial follow-up (FU). During FU, 21% of the patients deceased, and 15% were lost, physically unable to visit the outpatient clinic or withdrew from FU. In 37% of the patients, bowel continuity was restored. Only 26% of the patients were able to complete FU. Overall, 82% of all the patients had one or more stoma-related complications. Most common complications were skin irritation (55%), fixation problems (46%) and leakage (40%). Superficial necrosis, bleeding and retraction occurred in 20%, 14% and 9% of patients, respectively. More stoma related complications were found in stoma’s on inappropriate locations.ConclusionsIn this heterogenic patient population with formation of different stoma types, a high complication rate was detected.
International Journal of Colorectal Disease | 2012
Bryan J. M. van de Wall; Ellen M. B. P. Reuling; Esther C. J. Consten; Janneke van Grinsven; Matthijs P. Schwartz; Ivo A. M. J. Broeders; Werner A. Draaisma
PurposeRoutine colonic evaluation is advised after an episode of diverticulitis to exclude colorectal cancer. In the recent years, the possible relation between diverticulitis and colorectal cancer has been subject of debate. The aim of this study is to evaluate the benefit of routine colonic endoscopy after an episode of diverticulitis.MethodsRecords of all consecutive patients presenting with a radiologically confirmed episode of diverticulitis between 2007 and 2010 were retrieved from an in-hospital database. Patients who subsequently underwent colonic evaluation were included. The endoscopic detection rate of hyperplastic polyps, adenomas and advanced colonic neoplasia was assessed. Findings were categorized on the basis of the most advanced lesion identified.ResultsThree hundred and seven patients presented with a radiologically confirmed primary episode of diverticulitis. Two hundred and five patients underwent colonic evaluation. Hyperplastic polyps were found in15 (6.8 %), adenomas in 18 (8.8 %) and advanced neoplastic lesions in 7 (3.4 %) patients. Only two patients had a colorectal malignancy.ConclusionThere appears to be no benefit in performing routine colonic evaluation after an episode of diverticulitis as the incidence of colorectal cancer is almost equal to that of the general population. A more selective approach might therefore be justified. Potentially, only patients with persisting abdominal complaints after an episode of diverticulitis should be offered colonic evaluation to definitively exclude causal pathology.