Zentralblatt fur Chirurgie最新文献

{"title":"[Planned Ventral Hernia After Open Abdomen Therapy: Complex Incisional Hernia Repair].","authors":"Angelina Klein, Arnulf Willms, Christoph Güsgen, Robert Schwab, Sebastian Schaaf","doi":"10.1055/a-2420-1303","DOIUrl":"https://doi.org/10.1055/a-2420-1303","url":null,"abstract":"<p><p>A planned ventral hernia after open abdomen therapy is a rare hernia entity because the fascial closure rate has been increased due to established concepts for open abdominal treatment. Nevertheless, fascial closure is not always successful, and a planned ventral hernia has to be treated later. Preoperative optimisation and planning are essential for such challenging abdominal wall repairs.In a single centre retrospective analysis, all incisional hernias from 2013 to 2023 (n = 632) were identified and planned hernias after a laparostomy were selected (n = 11). The data on surgical management were obtained from the patient files for the operation reports. Literature search was conducted with PubMed (Medline).In all cases a physical examination, abdominal sonography, CT abdomen and a colonoscopy were carried out preoperatively. The median size of the abdominal wall defects were horizontally 13 cm (6-35 cm) and vertically 18 cm (10-28 cm). Botulinum toxin A has been used preoperatively since 2018. Median fascial closure was successful intraoperatively in all 11 patients. The surgical techniques included sublay, IPOM, sandwich technique, intraoperative fascial traction, and component separation.Planned ventral hernias after open abdomen treatment should always be considered complex hernias for which the entire expertise in hernia surgery is required. Comprehensive preoperative optimisation with botulinum toxin A infiltration is essential to facilitate anatomically appropriate reconstruction through midline closure with mesh augmentation.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"149 6","pages":"516-521"},"PeriodicalIF":0.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Early Thoracic Endografting is Safe in Patients with Uncomplicated Type B Aortic Dissection].","authors":"Thomas Betz, Karin Pfister, Wilma Schierling, Georgios Sachsamanis, Piotr Kasprzak, Kyriakos Oikonomou","doi":"10.1055/a-2060-9864","DOIUrl":"10.1055/a-2060-9864","url":null,"abstract":"<p><p>There are many publications dealing with treatment options for uncomplicated type B aortic dissection (TBAD). Early TEVAR (Thoracic Endovascular Aortic Repair) may improve aortic-specific survival and delay disease progression in the long-term. Especially in patients with uncomplicated TBAD and additional high-risk features, preemptive TEVAR may improve late outcomes.We conducted a retrospective analysis of all patients treated for TBAD in our hospital between February 2017 and September 2021. Comorbidities, intraoperative data, 30-day mortality and postprocedural complications were analysed.During the above-mentioned period, 61 patients (38 males, median age 63 years) with TBAD were treated. Six patients received best medical treatment (BMT). 55 patients were treated by TEVAR and BMT. 11 patients (20%) had complicated TBAD, 12 patients (22%) had uncomplicated TBAD with high-risk features and 32 patients (58%) had uncomplicated TBAD. Technical success was 100%. No patient with uncomplicated TBAD died within the first 30 postoperative days. One patient with uncomplicated TBAD had a stroke after TEVAR. Two reinterventions were performed on day 7 and day 9 after TEVAR.Patients with uncomplicated TBAD could be treated by early TEVAR, with a low rate of perioperative complications. In patients with uncomplicated TEVAR and high-risk features, early TEVAR with BMT should be considered as the treatment of choice.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"428-434"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9551497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Outpatient and \"Admission-Substituting\" Interventions in Vascular Surgery - What is Feasible and Where are the Limits? Previous and New Legal Requirements and their Implementation in Practice].","authors":"Udo Barth, Martin Lehmann, Jörg Tautenhahn, Frank Meyer, Zuhir Halloul","doi":"10.1055/a-2100-1458","DOIUrl":"10.1055/a-2100-1458","url":null,"abstract":"<p><strong>Introduction: </strong>In vascular surgery too, more services and procedures will have to be shifted from the previous inpatient to the outpatient sector in the future. Therefore, the previous and new legal requirements as well as their implementation in vascular surgery will be explained and evaluated.</p><p><strong>Material and methods: </strong>Professional policy analysis from a perspective of medical vascular surgery.</p><p><strong>Results: </strong>The AOP catalog from 01.01.2023 was extended by 208 additional OPS codes. The inpatient performance of services which, according to the AOP contract, must be regularly performed on an outpatient basis, are now to be justified on the basis of context factors.A special sector-equivalent remuneration, which is independent of whether the remunerated service is performed on an outpatient or inpatient basis, is a prerequisite for a cost-covering expansion of outpatient operations and inpatient-replacing services. The rehabilitation of primary varicosis under outpatient conditions is undoubtedly the standard. The majority of AV shunt installations are performed as inpatient procedures. No new OPS codes were added to the 2023 AOP catalog for varicose vein, shunt and endovascular surgery.</p><p><strong>Discussion: </strong>The shift of inpatient services to the outpatient sector can be a feasible path, based on the experience of other European countries. However, the structures, economic conditions and incentives should first be created to successfully promote transfer to outpatients. Integrated care offers the possibility for the health insurance funds to conclude contracts with the service providers named in § 140a of the Social Code, paragraph 3, for special care. The use of telemedicine in the sense of tele-premedication or tele-monitoring can be a way to expand outpatient surgery, especially in rural regions. In order to enable therapy concepts from one expert in vascular medicine, the outpatient service billing of interventional procedures must also be demanded by vascular surgeons and specialists.</p><p><strong>Conclusion: </strong>The potential to transform inpatient services into the outpatient setting of service provision is realisable in vascular surgery in the core areas of varicose vein surgery, shunt surgery and peripheral interventional procedures under specific conditions.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"458-467"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"Tobias Keck","doi":"10.1055/a-2376-0727","DOIUrl":"10.1055/a-2376-0727","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"149 5","pages":"427"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: Reduced Amputation Rate in Patients with Diabetic Foot Syndrome Since the Introduction of a Minimal-invasive Concept].","authors":"Ahmed Algharib, Giel G Koning, Lourina M C van Dortmont, Sandra Riedel, Rüdiger Möller","doi":"10.1055/a-2218-6253","DOIUrl":"10.1055/a-2218-6253","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"478"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Schuster bleib bei deinem Leisten!","authors":"Albrecht Wienke","doi":"10.1055/a-2302-7248","DOIUrl":"https://doi.org/10.1055/a-2302-7248","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"149 5","pages":"421-422"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reduced Amputation Rate in Patients with Diabetic Foot Syndrome Since the Introduction of a Minimal-invasive Concept].","authors":"Ahmed Algharib, Giel G Koning, Lourina M C van Dortmont, Sandra Riedel, Rüdiger Möller","doi":"10.1055/a-2206-2353","DOIUrl":"10.1055/a-2206-2353","url":null,"abstract":"<p><p>Amputations are always considered \"the last option\" for patients with vascular diseases. Currently, in Germany, more than 4.5 million patients suffer from diabetes mellitus. Since we introduced the minimally invasive concept for the treatment of diabetic foot syndrome, we have observed, after careful evaluation, a decreasing trend in the rates of minor and major amputations.Ethics and informed consent were ensured in this retrospective evaluation. Approximately 150 patients with complex diabetic foot syndrome are treated annually. Since July 2021, we have been treating our patients with a minimally invasive concept as one of several multidisciplinary modalities. For evaluation, we included and analyzed our diabetic patients who underwent minor and major amputations within the defined time frames from 2018 to 2023 (including revision amputations). We compared the most recent 30 months (group 2) since the introduction of this concept with the preceding 30 months (group 1).A total of 810 patients with any form of diabetic foot syndrome presented at our clinic between 2018 and 2023, of which 242 patients required primary surgical treatment. Patients in group 1 exhibited a major amputation rate of 4%, a minor amputation rate of 13%, and an overall revision surgery rate of 4%. Patients in group 2 displayed a major amputation rate of 2%, a minor amputation rate of 10%, and an overall revision surgery rate of 2%.After the introduction of the minimally invasive concept as an adjustment to our multidisciplinary approach for treating patients with diabetic foot syndrome, we have observed, through our critical evaluation, a declining trend in both minor and major amputation rates. While further research is necessary to confirm or reject our results, the implementation of minimally invasive surgery into the toolkit of regional hospitals may significantly contribute to an improved health status for patients.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"475-478"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Malperfusion after Aortic Dissection - Management and Techniques].","authors":"Tugce Öz, Barbara Rantner, Jan Stana, Konstantinos Stavroulakis, Sven Peterß, Maximilian Pichlmaier, Carlota Fernandez Prendes, Nikolaos Tsilimparis","doi":"10.1055/a-2058-9080","DOIUrl":"10.1055/a-2058-9080","url":null,"abstract":"<p><p>Malperfusion is a common complication of aortic dissection and further increases this deadly disease's mortality. An effective treatment strategy requires a timely diagnosis based on the clinical findings and the available instruments, understanding the disease's pathomechanism, recognising the therapy options recommended by the guidelines, and the diagnostic and therapeutic innovations of the area of research. The final treatment decision should be patient- and case-specific. In this work, we have considered malperfusion after aortic dissection, not only as a complication of aortic dissection but as a separate disease and summarise important information that can contribute to efficient therapy decisions in everyday clinical practice.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"435-445"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9697138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vascularsurgical Long-term Outcome - Comparison of Orthotopic and Extraanatomic Reconstructions in Unilateral Occlusions of Iliac Artery over 10 Years].","authors":"Udo Barth, Jörg Tautenhahn, Philipp Klinsmann, Frank Meyer, Zuhir Halloul","doi":"10.1055/a-2324-1692","DOIUrl":"10.1055/a-2324-1692","url":null,"abstract":"<p><p>In PAOD, several vascular regions are usually affected, the pelvic axis in 35% of cases. Interventional-radiological/endovascular or hybrid interventions have been established for recanalization, so that bypass procedures are increasingly taking a back seat, but are not losing their importance.To study unilateral iliac artery occlusions (inclusion criterion) that were repaired either by implantation of an orthotopic or extraanatomic bypass (oBP/eaBP).Over a defined period of time, the rate of open vessel, complications (frequency, type, severity) to characterize morbidity and mortality as well as the extent of clinical improvement after BP implantation were analyzed in a clinical-systematic, single-center observational study (for vascular surgical quality assurance and contribution to vascular medical-clinical health care research). The study method was not explicitly based on the STROBE criteria, but essentially corresponds to them.Over 10 years, 122 PAOD patients (50% in stage IIb-stage III and IV equally distributed; mean age: 63 [range, 44-87] years; majority ASA III) were included with the same number of reconstructions: 71 patients received an eaBP (\"crossover\"), 51 patients an iliacofemoral (orthotopic - oBP) bypass (neither significant difference regarding frequency nor number of risk factors per patient).The oBP is not superior to eaBP with regard to the analysis parameters of openness, complication rate and mortality. Furthermore, extraanatomic revascularization does not have to be reserved for polymorbid patients only.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":"446-457"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update lokale Wundtherapie – was ist neu und was bleibt?","authors":"Ewa Klara Stürmer","doi":"10.1055/a-2338-1358","DOIUrl":"10.1055/a-2338-1358","url":null,"abstract":"","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":"149 5","pages":"413-417"},"PeriodicalIF":0.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}