Chirurg最新文献

{"title":"[Results of the Limberg flap procedure in acute and chronic pilonidal abscesses].","authors":"Jamal Driouch,&nbsp;C Braumann,&nbsp;J Dehnst,&nbsp;M Ikram,&nbsp;G Alnammous,&nbsp;D Bausch,&nbsp;T Glatz","doi":"10.1007/s00104-021-01439-0","DOIUrl":"https://doi.org/10.1007/s00104-021-01439-0","url":null,"abstract":"<p><strong>Background: </strong>A number of different treatment algorithms are recommended for the treatment of an acute pilonidal abscess and a chronic pilonidal sinus. While a 1-stage surgical procedure using excision or plastic reconstruction according to Limberg or Karydakis is suggested for chronic pilonidal sinus, a 2‑stage procedure is recommended for an acute pilonidal abscess. The aim of this study was to compare the results of the 1‑stage surgery with plastic reconstruction according to Limberg for acute pilonidal abscess and chronic pilonidal sinus in terms of recurrence, disorders of wound healing, inpatient length of stay and patient satisfaction.</p><p><strong>Methods: </strong>From 2009 to 2014 a total of 39 patients were included in this prospective observational study: 21 patients with acute pilonidal abscess and 18 patients with chronic pilonidal sinus. All patients were surgically treated with a 1‑stage procedure using the Limberg flap method. The groups were compared in terms of postoperative complication rates and frequency of recurrence.</p><p><strong>Results: </strong>Both groups were basically comparable with respect to demographic characteristics and risk factor profiles. Analysis of the postoperative results showed a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647). In the group with acute pilonidal abscesses there was no recurrence during the observational period, while in the chronic pilonidal sinus group there were 2 (11%) recurrences (p = 0.206).</p><p><strong>Conclusion: </strong>The results of the Limberg flap procedure regarding acute pilonidal abscesses were comparable to those of chronic pilonidal sinus. The results of this study show a trend to a lower risk of recurrence. The use of the Limberg flaps therefore also seems to be an adequate treatment option in an acute infection situation.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 2","pages":"182-189"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01439-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39237240","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":"[Definition and treatment of superior mesenteric artery revascularization and dissection-associated diarrhea (SMARD syndrome) in Germany].","authors":"Patrick Téoule,&nbsp;Katharina Tombers,&nbsp;Mohammad Rahbari,&nbsp;Flavius Sandra-Petrescu,&nbsp;Michael Keese,&nbsp;Nuh N Rahbari,&nbsp;Christoph Reißfelder,&nbsp;Felix Rückert","doi":"10.1007/s00104-021-01427-4","DOIUrl":"https://doi.org/10.1007/s00104-021-01427-4","url":null,"abstract":"<p><strong>Background: </strong>The superior mesenteric artery (SMA) is exposed and dissected during pancreatic resections (PR) and mesenteric vascular surgery (MVS). The resulting damage of the surrounding extrinsic and intrinsic vegetative nerve plexus can lead to a temporary or treatment refractory diarrhea.</p><p><strong>Objective: </strong>This study aimed to provide an overview of the current status of SMA revascularization and dissection-associated diarrhea (SMARD syndrome) in Germany.</p><p><strong>Material and methods: </strong>After a selective literature search (SLS) on the frequency of newly developed postoperative diarrhea after PR and MVS, an online survey was initiated.</p><p><strong>Results: </strong>The SLS (n = 4) confirmed that newly developed postoperative diarrhea is a frequent complication after preparation for revascularization (RV) or dissection (DIS) of the SMA (incidence approximately 62%). Treatment refractive courses were relatively uncommon with 14%. Out of 159 centers 54 took part in the survey and 63% stated that they carried out an SMA RV/DIS during PR or MVS. The average PR per center was 47 in 2018 and 49 in 2019. The average MVS was 5 per center in both years and on average 3 patients suffered from SMARD syndrome.</p><p><strong>Conclusion: </strong>This survey recorded the current status of the SMARD syndrome in Germany for the first time. So far there are no recommendations for the treatment of such a diarrhea. The results show that initially a symptomatic treatment should be carried out. Due to the complexity of the pathophysiology, causal treatment approaches have not yet been developed.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 2","pages":"173-181"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01427-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39072862","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":"[Complete response after neoadjuvant therapy].","authors":"C-T Germer","doi":"10.1007/s00104-021-01542-2","DOIUrl":"https://doi.org/10.1007/s00104-021-01542-2","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 2","pages":"113-114"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39773054","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":"[Complete response after neoadjuvant therapy for gastric cancer: implications for surgery].","authors":"Giovanni Capovilla,&nbsp;Caterina Froiio,&nbsp;Hauke Lang,&nbsp;Felix Berlth,&nbsp;Peter Philipp Grimminger","doi":"10.1007/s00104-021-01516-4","DOIUrl":"https://doi.org/10.1007/s00104-021-01516-4","url":null,"abstract":"<p><strong>Background: </strong>Perioperative or neoadjuvant therapy is the mainstay of treatment for locally advanced gastric cancer in Europe; however, data regarding possible modifications in the surgical strategy depending on the response to preoperative treatment are lacking.</p><p><strong>Methods: </strong>This review was carried out based on a search of the relevant contemporary literature regarding neoadjuvant or perioperative treatment for gastric adenocarcinoma and the implications of tumor response for the subsequent surgical treatment.</p><p><strong>Results: </strong>The most recent randomized trials showed a survival benefit after perioperative or neoadjuvant treatment for gastric cancer. Due to the variable response to the preoperatively administered part of the therapy, including complete response, it appears reasonable to develop an individualized surgical approach; however, scientific results supporting this approach are limited due to the variable quality of the surgical resection provided in these studies and the limited rate of complete response to preoperative treatment. Moreover, the reliability of clinical restaging after preoperative treatment is also limited. On the other hand, there is currently evidence that supports a re-evaluation of the necessary resection margins for partial gastrectomy in advanced gastric cancer with the help of intraoperative frozen sections and new reconstruction methods.</p><p><strong>Conclusion: </strong>The current evidence does not support the implementation of a complete organ-sparing strategy with active follow-up surveillance for gastric cancer.; however, stomach-preserving partial gastrectomy techniques could be applied for advanced disease more often in the future.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 2","pages":"138-143"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39496529","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":"[Chronic intestinal failure].","authors":"Jens G Brockmann,&nbsp;Anna Hüsing-Kabar,&nbsp;Katharina Bohlen,&nbsp;Caro Lin Höckelmann,&nbsp;Andreas Pascher","doi":"10.1007/s00104-021-01423-8","DOIUrl":"https://doi.org/10.1007/s00104-021-01423-8","url":null,"abstract":"<p><p>The term intestinal failure (IF) is understood as the transient or irreversible loss of the resorptive capacity of the bowels. This includes a multitude of diseases, some of which have anatomical causes and others functional causes. The functional capacity (absorption and motility) of the remaining digestive tract and the bacterial overgrowth and false colonization of the small bowel are of prognostic importance. After exclusion of pathological intestinal findings, such as stenosis and dilatation, initially conservative treatment is employed with the aim of intestinal adaptation. Before failure or complications, initially conservative surgery and then organ replacement by transplantation should be considered. The IF is a temporary or permanent condition. For adults a length of 100cm small bowel without the colon, 60cm still with continuity to the colon and 35cm small bowel with complete preservation of the colon including the ileocecal valve are potentially sufficient for intestinal autonomy.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 2","pages":"205-214"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01423-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39186791","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":"[Acute first manifestation of a congenital anomaly as a rare cause of acute abdomen].","authors":"T Hu,&nbsp;M Kakuan,&nbsp;E Kleimann,&nbsp;A Plamper","doi":"10.1007/s00104-021-01449-y","DOIUrl":"https://doi.org/10.1007/s00104-021-01449-y","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"89-91"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01449-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39050623","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":"[Locally advanced pancreatic cancer after FOLFIRINOX: surgical resection enhances survival].","authors":"Martin A Schneider,&nbsp;M W Büchler","doi":"10.1007/s00104-021-01558-8","DOIUrl":"https://doi.org/10.1007/s00104-021-01558-8","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"93-94"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39724866","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":"Klinische Studien","authors":"Ernesto Vilchis, B. Seitz, A. Langenbucher, M. Küchle, G. Naumann","doi":"10.1007/s00104-021-01555-x","DOIUrl":"https://doi.org/10.1007/s00104-021-01555-x","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47872906","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":"Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT).","authors":"K E Grund,&nbsp;U Schweizer,&nbsp;A Zipfel,&nbsp;B Duckworth-Mothes","doi":"10.1007/s00104-021-01497-4","DOIUrl":"https://doi.org/10.1007/s00104-021-01497-4","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative.</p><p><strong>Problem: </strong>The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here.</p><p><strong>Methods: </strong>Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT.</p><p><strong>Results: </strong>In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom (\"Tuebingen Orientophant\") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract (\"Tuebinger Spongiophant\"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom.</p><p><strong>Discussion: </strong>Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"56-63"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39454705","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":"[Surgical and interdisciplinary treatment of gastrointestinal stromal tumors].","authors":"Thomas Schmidt,&nbsp;Markus Ghadimi,&nbsp;Hans F Fuchs,&nbsp;Christiane J Bruns","doi":"10.1007/s00104-021-01527-1","DOIUrl":"https://doi.org/10.1007/s00104-021-01527-1","url":null,"abstract":"<p><p>Gastrointestinal stromal tumors (GISTs) are the most frequent potentially malignant mesenchymal tumors of the gastrointestinal tract. The treatment of GISTs has been revolutionized since imatinib and other tyrosine kinase inhibitors were introduced for the treatment of GISTs, which inhibit the tyrosine kinases c‑KIT and platelet-derived growth factor receptor (PDGFR) alpha. Even after the introduction of this targeted treatment GISTs can only be cured by surgical resection. With interdisciplinary multimodal treatment the prognosis of metastasized GIST can now be further improved by surgical resection of the primary tumor and the metastases, potentially leading to a cure. Neoadjuvant therapy can reduce the extent of surgical resection and hereby enable organ preservation and reduce surgical morbidity. To evaluate molecular and clinical predictors and to offer an optimal therapeutic plan, patients with GISTs and certainly patients with advanced GISTs should be evaluated by interdisciplinary sarcoma boards.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"27-33"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39565866","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}