H. J. Schrag

Transanal endoscopic tube decompression of acute colonic obstruction : experience with 51 cases

BackgroundAcute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. To avoid major postoperative complications, most surgeons advocate two-step surgery despite the increase in patient discomfort and cost. Various methods for performing one-step surgery have been reported including intraoperative colonic lavage, decompression with self-expandable metal stents, and transanal tube decompression.MethodsThe authors present their experience performing transanal colonic decompression for 51 patients.ResultsEndoscopic tube placement was successful for 43 (84%) of the 51 patients. The emergency clinical situation could be converted to semielective treatment in 37 cases (73%) (30 operations and 6 nonoperative interventions), and to an elective operation in 1 case. After successful colonic decompression, the rate of one-stage operations was 93% (28/30), as compared with 40% (4/10) if the decompression failed.ConclusionEndoscopic tube decompression of acute colonic obstruction is an easy and cost-effective possibility for avoiding emergency operations with all their sequelae. Emergency surgery can be converted to semielective or elective surgery, markedly reducing the rate of staged operations.

Endoscopic bougienage of benign anastomotic strictures in patients after esophageal resection: the effect of the extent of stricture on bougienage results

SUMMARY The aim of our retrospective study was to determine the incidence of benign anastomotic strictures (BAS) in patients after esophageal resection and to examine the influence of the extent of BAS on the results of bougienage therapy. From January 2001 to July 2006, 79 patients at risk of BAS development were included in the study. BAS was diagnosed with a median delay of 8 weeks (4-26) postoperative in 23 patients (29%). A median of 4 bougienage sessions (2-20) was needed for success (success rate 100%). The mean follow-up time was 22 months [range 3-47]. There were no late recurrences of BAS. Five patients had an anastomosis diameter <5.5 mm and 14 patients >5.5 mm. There was no difference in median number of bougienage procedures in these subgroups (4.5 [2-9] vs. 4 [2-20]). Patients who presented with BAS earlier than 6 weeks postoperative had more procedures (median 8 [2-20] vs. 4 [2-9]) than those presenting later. Patients in whom first bougienage was possible to only 16 mm diameter needed more procedures than patients in whom first dilation was possible to more than 16 mm (median 5.5 [3-20] vs. 3 [2-9]). In conclusion, both early BAS development and the diameter of bougienage at first endoscopy, but not the extent of stricture, seem to be predictive factors for longer bougienage therapy. In order to influence the BAS formation early, we now routinely examine every patient after esophageal resection endoscopically in the 6th postoperative week.

German Artificial Sphincter System-GASS

No highly integrated sphincter prosthesis for therapy of anal incontinence exists. Therefore, this trial was performed to develope a novel artificial sphincter: the German Artificial Sphincter System „GASS“. This device combine the fluid reservoir, the occlusion cuff and micropump to a highly integrated device. The GASS is completely manufactured of polyurethane. The micropump is based on piezo-technology. Threshold of continence and the pressure-volume relationship of the cuff prosthesis were evaluated in an in vitro simulator using isolated porcine bowel segments and isolated anal canals. Minimal filling volumes between 6.5 and 7 cc could maintain continence for liquids against high luminal pressures. The high pressure zone of the occlusion cuffs reached only intraluminal pressure values between 36-76 mm Hg, indicating a little risk of ischaemie injury of the bowel respectively the anal canal. In summery, an integrated, patented and functionable sphincter device, easy to implant, could be realized.

German Artificial Sphincter System-GASS II: Erste in vivo Evaluation eines neuen hochintegrativen Neosphinkters zur Therapie der hochgradigen Stuhlinkontinenz / Short time in vivo evaluation of a novel and highly integrated sphincter prosthesis for therapy of major fecale incontinence

Abstract Zur Therapie der hochgradigen Stuhlinkontinenz integriert das German Artificial Sphincter System GASS erstmals alle wesentlichen Funktionsbausteine in einer Schließmuskelprothese. Ein bidirektional arbeitender und hochleistungsfähiger Piezoantrieb, kleinsten Ausmaßes, ermöglicht eine ferngesteuerte Bedienung. Diese Studie berichtet erstmals über die Optimierung der Leistungscharakteristik der Piezopumpe und Weiterentwicklung von GASS zu einem funktionsfähigen Vollimplantat. Am Großtiermodell wurde eine erste Kurzzeitevaluierung vorgenommen. Die Prothese zeichnet sich durch ein einfaches Handling, Betriebsstabilität und hohe Kontinenzeffektivität aus. The German Artificial Sphincter System GASS consists of a support ring which includes a fluid reservoir on the outer side and an occlusive cuff on the inner side. The cuffs are designed as polyurethane hollow bodies with a pre-determined inflation volume and are connected to an integrated piezo micropump/valve unit. To evaluate the threshold of continence, the GASS was placed around the anorectal junction via a perineal approach in one mini pig. The novel cuff design reduces the occlusion pressure and allows low compression volumes. Low operating pressures indicate a minor risk of ischemia injury of the bowel. The operation time is estimated at about 6 days with no recharging of the battery. The novel remote controlled GASS is a highly integrated prosthesis for placement around the anal canal or lower rectum and is effective in restoring continence for liquids and solids in vitro and in vivo.