phenylephrine-hydrochloride and Gallstones

Two different ways have been developed to perform endoscopic surgery. The standard way is multiport laparoscopic surgery. When entering through a natural orifice, we use single-port surgery for transanal work (transanal endoscopic microsurgery). In clinical routine, we moved from intralumenal surgery toward surgery in the perirectal area and finally the free abdomen. In the context of natural orifice translumenal endoscopic surgery, we have modified the length and diameter of optics and tube and developed new mechanisms for steering long curved instruments. This technology is then used for transvaginal cholecystectomy and transanal rectosigmoid resection. Global clinical application of transanal endoscopic microsurgery has proven superiority in preciseness and clinical results for adenomas and early cancer. The initial clinical study for transvaginal cholecystectomy is successfully performed in 6 female patients with an average operation time of 80 minutes and without major complication. Feasibility of transanal rectosigmoid resection is demonstrated in an ex vivo experimental model.

Topics: Adolescent; Adult; Cholecystectomy, Laparoscopic; Colectomy; Colon, Sigmoid; Equipment Design; Feasibility Studies; Female; Follow-Up Studies; Gallstones; Humans; Laparoscopes; Microsurgery; Middle Aged; Nose; Rectal Diseases; Rectum; Retrospective Studies; Sigmoid Diseases; Treatment Outcome; Vagina; Young Adult

Topics: Bile; Common Bile Duct Diseases; Constriction, Pathologic; Drainage; Gallstones; Humans; Nose

Alternating fluid rinsing with a modified glyceromono-octanoate (GMOC) and bile salt-EDTA (BA-EDTA) solution via an endoscopically placed indwelling nasal biliary catheter was performed on 15 patients (13 women, 2 men) with recurrent stones in the choledochal duct after cholecystectomy. Of 12 radiotranslucent and three radioopaque concrements with a mean diameter of 1.72 X 2.05 cm (largest concrement: 3.0 X 3.5, smallest 1.0 X 2.1 cm) 13 were dissolved (87% success rate). In one patient chemolitholysis had to be stopped because of electrolyte abnormalities, before treatment had been completed. After the end of treatment all patients were free of symptoms and during a fairly long follow-up period no stone recurrences were observed.

Topics: Aged; Bile Acids and Salts; Caprylates; Catheters, Indwelling; Cholecystectomy; Common Bile Duct; Drug Combinations; Edetic Acid; Female; Gallstones; Glycerides; Humans; Male; Middle Aged; Nose; Postoperative Complications; Recurrence; Solutions; Therapeutic Irrigation; Time Factors

Twenty patients with bile duct stones were treated via an indwelling nasobiliary tube with a modified Capmul 8210 preparation (GMOC) and alternating with a bile salt-EDTA (BA-EDTA) solution for an average of 12 days. In vitro the dissolution capacity of GMOC and BA-EDTA for cholesterol stones was higher than that of Capmul 8210. The nasobiliary tube was tolerated well for a maximum of 84 days; this renders us independent of the T-tube. The therapeutic success rate of GMOC was 64%, even though we treated mostly old and large concrements. Side effects occurred markedly less than with Capmul 8210. In patients with acute cholecystitis or cholangitis the clinical course improved under therapy, and there was no deterioration of a chronic condition.

Topics: Aged; Caprylates; Cholic Acids; Common Bile Duct; Deoxycholic Acid; Drug Combinations; Edetic Acid; Female; Gallstones; Glycerides; Humans; In Vitro Techniques; Infusions, Parenteral; Intubation; Male; Middle Aged; Nose; Solutions; Solvents; Ursodeoxycholic Acid