ChirurgPub Date : 2022-01-01Epub Date: 2021-10-28DOI: 10.1007/s00104-021-01527-1
Thomas Schmidt, Markus Ghadimi, Hans F Fuchs, Christiane J Bruns
{"title":"[Surgical and interdisciplinary treatment of gastrointestinal stromal tumors].","authors":"Thomas Schmidt, Markus Ghadimi, Hans F Fuchs, 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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-04-20DOI: 10.1007/s00104-021-01399-5
Marco Sailer
{"title":"[Slow transit constipation].","authors":"Marco Sailer","doi":"10.1007/s00104-021-01399-5","DOIUrl":"https://doi.org/10.1007/s00104-021-01399-5","url":null,"abstract":"<p><p>Slow transit constipation (STC) is a rare condition almost exclusively encountered in middle-aged women. Pathophysiology and aetiology are poorly understood but a multi-factorial pathogenesis seems likely. With regard to differential diagnoses mechanical, drug induced, degenerative, metabolic, endocrinologic, neurologic, and psychiatric causes of constipation must be excluded by an interdisciplinary approach. Gastrointestinal physiologic investigations including colonic transit studies are mandatory. Furthermore, pangastrointestinal delay, pelvic floor dysfunction, and irritable bowel syndrome should be excluded. Initial treatment is strictly conservative. In cases of progression or persistence of symptoms surgical therapy should be discussed. Subtotal colectomy with ileorectal anastomosis is regarded as the standard operation for STC. Using strict selection criteria, overall success rates are reported in excess of 80%.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"103-112"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01399-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38898033","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-06-16DOI: 10.1007/s00104-021-01436-3
Hruy Menghesha, Michael Schroeter, Fabian Doerr, Georg Schlachtenberger, Matthias B Heldwein, Costanza Chiapponi, Thorsten Wahlers, Christiane Bruns, Khosro Hekmat
{"title":"[The value of thymectomy in the treatment of non-thymomatous myasthenia gravis].","authors":"Hruy Menghesha, Michael Schroeter, Fabian Doerr, Georg Schlachtenberger, Matthias B Heldwein, Costanza Chiapponi, Thorsten Wahlers, Christiane Bruns, Khosro Hekmat","doi":"10.1007/s00104-021-01436-3","DOIUrl":"https://doi.org/10.1007/s00104-021-01436-3","url":null,"abstract":"<p><p>The value of thymectomy in the treatment of non-thymomatous myasthenia gravis has been controversially discussed. The relatively low incidence and prevalence of this disease, the inconsistent documentation in various studies and the necessity of a long-term follow-up to assess the therapeutic effects has made the generation of valid data difficult. The publication in 2016 of the MGTX trial in the New England Journal of Medicine delivered the first randomized controlled data in which patients aged 18-65 years with generalized myasthenia gravis and positive for acetylcholine receptor antibodies showed a significant benefit after surgical resection of the thymus via median sternotomy. Despite a lack of validation of the advantages of thymectomy by minimally invasive surgery from randomized controlled studies, this technique seems to positively influence the outcome of certain patient groups in a similar way. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) using subxyphoidal and transcervical access routes showed not only esthetic advantages but also showed no relevant inferiority in the influence on clinical outcomes of myasthenia gravis compared to median sternotomy; however, not only the benefits and the esthetic results show differences but also the advantages in the various subtypes of myasthenia gravis show divergent prospects of success with respect to remission. The clinical spectrum of myasthenia is heterogeneous with respect to the occurrence of antibodies, the body region affected and the age of the patient at first diagnosis. Ultimately, thymectomy is an effective causal treatment of myasthenia gravis.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"48-55"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01436-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39237242","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-09-15DOI: 10.1007/s00104-021-01498-3
Alexander Nieto, Markus Albertsmeier, Jens Werner, Dorit Di Gioia, Lars H Lindner, Josefine Rauch, Silke Nachbichler, Claus Belka, Nina-Sophie Schmidt-Hegemann
{"title":"[Retroperitoneal soft tissue sarcoma: role of radiotherapy].","authors":"Alexander Nieto, Markus Albertsmeier, Jens Werner, Dorit Di Gioia, Lars H Lindner, Josefine Rauch, Silke Nachbichler, Claus Belka, Nina-Sophie Schmidt-Hegemann","doi":"10.1007/s00104-021-01498-3","DOIUrl":"https://doi.org/10.1007/s00104-021-01498-3","url":null,"abstract":"<p><strong>Background: </strong>Retroperitoneal soft tissue sarcomas (RPS) include tumors of mesenchymal origin with overall well-defined histological subtypes and heterogenic prognosis. For the first time with the publication of the STRASS study, which investigated the value of neoadjuvant radiotherapy in primary RPS, there is phase III evidence for the use of radiotherapy.</p><p><strong>Objective: </strong>The primary objective of the present article is to present the role of neoadjuvant radiotherapy in RPS since the publication of the STRASS study.</p><p><strong>Material and methods: </strong>We performed a non-systematic literature search. The results of retrospective and observational studies were compared to those of the STRASS study.</p><p><strong>Results: </strong>In the two of the largest analyses, the surveillance, epidemiology, and end results program (SEER) and the American National Cancer Database (NCDB), an improvement in overall survival due to radiotherapy in RPS could be shown. In contrast to these results, there was no significant improvement in 3‑year abdominal recurrence-free survival in the STRASS study. There was solely a trend to improved abdominal recurrence-free survival in initially unplanned subgroup analyses for patients with liposarcoma as well as low-grade sarcoma but not for leiomyosarcoma or high-grade sarcoma.</p><p><strong>Conclusion: </strong>Thanks to international collaboration an academic randomized trial was even feasible in such a rare disease as RPS. The results of the STRASS study have relativized the potential benefit of radiotherapy in RPS. A longer follow-up especially regarding the role of radiotherapy in liposarcomas is desirable.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39418979","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-12-07DOI: 10.1007/s00104-021-01539-x
Johanna Falkenhorst, Rainer Hamacher, Sebastian Bauer
{"title":"[Medicinal treatment of retroperitoneal soft tissue sarcomas].","authors":"Johanna Falkenhorst, Rainer Hamacher, Sebastian Bauer","doi":"10.1007/s00104-021-01539-x","DOIUrl":"https://doi.org/10.1007/s00104-021-01539-x","url":null,"abstract":"<p><p>Retroperitoneal soft tissue sarcomas represent extreme challenges for interdisciplinary treatment teams. The sarcoma-specific experience of surgeons has the greatest impact on the survival of patients; however, too many patients still die despite optimal local treatment. The role of chemotherapy is undisputed only for patients with highly malignant bone sarcomas or rhabdomyosarcomas. For soft tissue sarcomas in adult patients, especially liposarcomas and leiomyosarcomas, the evidence situation is very unsatisfactory. This overview article discusses the complex data situation and controversial aspects that are relevant for current treatment decisions in interdisciplinary treatment teams.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"40-47"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39698982","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}
ChirurgPub Date : 2022-01-01Epub Date: 2022-01-18DOI: 10.1007/s00104-021-01570-y
C-T Germer, S Hofmann
{"title":"[The editor Prof. Dr. med. Büchler takes his leave : He shaped the journal Der Chirurg for 20 years].","authors":"C-T Germer, S Hofmann","doi":"10.1007/s00104-021-01570-y","DOIUrl":"https://doi.org/10.1007/s00104-021-01570-y","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39829477","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-05-03DOI: 10.1007/s00104-021-01420-x
Sabine Kersting, Mara Götz, Faik Güntac Uzunoglu, Waldemar Uhl, Jakob Robert Izbicki, Niclas Christian Blessin, Monika Silvia Janot-Matuschek
{"title":"[Solid pseudopapillary neoplasms of the pancreas : Diagnostics, surgical treatment and postoperative outcome].","authors":"Sabine Kersting, Mara Götz, Faik Güntac Uzunoglu, Waldemar Uhl, Jakob Robert Izbicki, Niclas Christian Blessin, Monika Silvia Janot-Matuschek","doi":"10.1007/s00104-021-01420-x","DOIUrl":"https://doi.org/10.1007/s00104-021-01420-x","url":null,"abstract":"<p><strong>Background: </strong>Malignant solid pseudopapillary neoplasms (SPN) are rare tumor entities of the pancreas. The prognosis for SPN is generally excellent, although some tumors have malignant potential and tend to metastasize or relapse.</p><p><strong>Objective: </strong>The aim was to investigate whether there are histopathological or surgical risk factors that enable the biological potential of SPN to be estimated.</p><p><strong>Patients and methods: </strong>Data from patients with SPN treated in two large German pancreas centers from 2009 to 2018 were evaluated with respect to the occurrence of SPN, surgical management, histopathological tumor characteristics and the postoperative outcome.</p><p><strong>Results: </strong>A total of 22 patients with SPN (17 women, 5 men) were operated on. The median age of the patients was 37 years (range 19-69 years). At the time of surgery 20 patients showed tumor growth limited to the pancreas. A female patient with recurrence of an externally resected SPN had lymph node involvement. Another female patient had a hepatic metastatic recurrence (Union Internationale contre Cancer (UICC) stage IV) of an externally resected SPN. Although all patients survived recurrence-free during the follow-up, this patient developed liver metastases again. The survival rate up to the end of the follow-up (median 43 months; range 1-132 months) of this study was 100%.</p><p><strong>Conclusion: </strong>There is a lack of knowledge of the possible parameters that can be used to predict the biological behavior of SPN. Apart from an increased likelihood of recurrence after resection of an SPN recurrence, no clear risk factors could be identified in the examined patient collective that could indicate an increased malignant potential and a possibly poorer outcome. Only a radical surgical resection with lymphadenectomy enables a reliable assessment of the tumor stage and the removal of possibly affected lymph nodes, which could be the cause of a recurrence if left intact.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"72-81"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01420-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38862330","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-12-03DOI: 10.1007/s00104-021-01546-y
Khosro Hekmat, Christiane J Bruns
{"title":"[Dual antiplatelet therapy can be discontinued as early as 1 month after coronary stent implantation].","authors":"Khosro Hekmat, Christiane J Bruns","doi":"10.1007/s00104-021-01546-y","DOIUrl":"https://doi.org/10.1007/s00104-021-01546-y","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"95-96"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39689558","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-04-19DOI: 10.1007/s00104-021-01407-8
K Bauer, F Heinzelmann, P Büchler, B Mück
{"title":"[Current robotic ventral hernia surgery exemplified by 50 consecutive patients].","authors":"K Bauer, F Heinzelmann, P Büchler, B Mück","doi":"10.1007/s00104-021-01407-8","DOIUrl":"https://doi.org/10.1007/s00104-021-01407-8","url":null,"abstract":"<p><strong>Background: </strong>In recent years there has been a rise in robotic techniques and approaches regarding hernia repair with extraperitoneal mesh placement.</p><p><strong>Methods: </strong>A retrospective analysis of the first 50 patients who underwent robotic ventral hernia repair between May 2019 and November 2020 at the department of general surgery of the Kempten Clinic was performed.</p><p><strong>Results: </strong>This case series consisted of 36 incisional hernias, 12 primary hernias (8 umbilical and 3 epigastric hernias in combination with a diastasis recti abdominis as well as 1 Spigelian hernia) and 2 parastomal hernias. A complete closure of the hernia was achieved in all cases. Extraperitoneal mesh placement in the retromuscular or preperitoneal space was achieved in 98 % of the ventral procedures. We used an extraperitoneal approach with retromuscular mesh implantation (r-eTEP= robotic enhanced view total extraperitoneal plasty) in 22 cases, 3 of those along with a transversus abdominis release (r-eTAR= robotic extraperitoneal transversus abdominis release) and 26 operations were carried out transperitoneally. These included 11 preperitoneal (r-vTAPP= robotic ventral TAPP), 7 retrorectus (TARUP= robotic transabdominal retromuscular umbilical prosthetic hernia repair) and 1 intraperitoneal onlay mesh placements (r-IPOM= robotic intraperitoneal onlay mesh) as well as 7 transperitoneal transversus abdominis releases with retromuscular mesh placement. The 2 parastomal hernias were treated with an intraperitoneal 3D funnel mesh. After the initial treatment of smaller hernias the indications could be rapidly extended to complex hernias in 38 % of this case series. One conversion to an open operation was necessary due to technical problems in closing the posterior rectus sheath. The complication rate was 12 % and the reintervention rate 4 %.</p><p><strong>Conclusion: </strong>Robotic surgery of ventral hernia is safe and effective. Even complex hernias can be treated minimally invasively with closure of the hernia defect and extraperitoneal mesh placement.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"82-88"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01407-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38897147","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}
ChirurgPub Date : 2022-01-01Epub Date: 2021-12-10DOI: 10.1007/s00104-021-01547-x
H Kerndl, D Liebetrau, S Zerwes, C Römmele, A Hyhlik-Dürr
{"title":"[Resource requirements in the surgical treatment of COVID‑19 patients at a university clinic of maximum care].","authors":"H Kerndl, D Liebetrau, S Zerwes, C Römmele, A Hyhlik-Dürr","doi":"10.1007/s00104-021-01547-x","DOIUrl":"https://doi.org/10.1007/s00104-021-01547-x","url":null,"abstract":"<p><strong>Background: </strong>Surgical procedures in patients suffering from coronavirus disease 2019 (COVID‑19) are possible under strict hygiene and protective measures and are currently carried out regularly. This study examined how much additional work this involves.</p><p><strong>Material and methods: </strong>A structured evaluation of 71 surgical procedures performed at the Augsburg University Hospital between 1 November 2020 until 31 December 2020 was carried out. The operations on COVID‑19 patients were compared to procedures on non-COVID‑19 patients with respect to temporal, structural and staff resources, exemplified by four interventions: transbrachial embolectomy, total hip arthroplasty (H-TEP), proximal femoral nail antirotation (PFN-A) and new implantations of cardiac pacemakers.</p><p><strong>Results: </strong>The incision to suture times between the interventions in patients with COVID‑19 and non-COVID‑19 patients did not show any significant differences in any of the four interventions evaluated. The postoperative monitoring in the operating room, which is identified as time-consuming in many interventions, was often circumvented by postoperative transfer to the intensive care unit or by the use of local anesthetic procedures. For major operations, such as H‑TEP, the preparation time was shown to be significantly longer (p = 0.037). Furthermore, there was a significantly higher requirement for anesthesia nursing personnel of 1.5 vs. 1.0 (p = 0.02).</p><p><strong>Conclusion: </strong>A quantification of the additional effort of operative treatment is difficult due to the already complex care of COVID‑19 patients; however, it can be assumed that there is an increased need for additional human and structural resources due to the supply of material from outside the operating room, which is not documented in the standard recording.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"64-71"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8661830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39712287","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}