Chirurgie (Heidelberg, Germany)最新文献

[Postoperative long-term complications after intestinal bypass surgery : Internal hernia, anastomotic ulcer, choledocholithiasis]. 【肠搭桥术后长期并发症：内疝、吻合口溃疡、胆总管结石】。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-15 DOI: 10.1007/s00104-025-02389-7

Lars Kollmann, Jakob Lauerer, Miljana Vladimirov, Christoph-Thomas Germer, Florian Seyfried

{"title":"[Postoperative long-term complications after intestinal bypass surgery : Internal hernia, anastomotic ulcer, choledocholithiasis].","authors":"Lars Kollmann, Jakob Lauerer, Miljana Vladimirov, Christoph-Thomas Germer, Florian Seyfried","doi":"10.1007/s00104-025-02389-7","DOIUrl":"https://doi.org/10.1007/s00104-025-02389-7","url":null,"abstract":"The most frequent long-term complications following intestinal bypass procedures that require surgical treatment are internal hernia and treatment-refractory anastomotic ulcer. The risk of internal hernia after Roux-en‑Y gastric bypass ranges from 5-15% and, although it can be reduced by meticulous intraoperative closure of mesenteric defects, it cannot be entirely prevented. Internal hernia usually becomes clinically apparent after significant postoperative weight loss, typically within months to a few years and should ideally be managed by laparoscopic repositioning of the small bowel and closure of the mesenteric defect. Treatment-refractory anastomotic ulcer is most frequently associated with risk factors such as persistent nicotine use during a Helicobacter pylori infection and discontinuation of proton pump inhibitor (PPI) treatment. In addition, anatomical features such as a large gastric pouch or a circumferentially fashioned anastomosis predispose to ulcer formation. The reported incidence after gastric bypass varies considerably and ranges between 1% and 53%. Standard management consists of rigorous elimination of risk factors combined with PPI treatment. In cases of chronicity or (covered) perforation, surgical revision with resection and reconstruction of the anastomosis is required. Choledocholithiasis secondary to cholecystolithiasis represents a particular interdisciplinary challenge due to limited endoscopic access to the papilla of Vater. Established treatment options include endoscopic balloon enteroscopy, retrograde cholangiography via the gastric remnant, which is opened laparoscopically assisted, revision of the bile duct performed during laparoscopic cholecystectomy or percutaneous transhepatic cholangial drainage (PTCD). Management of these long-term complications should preferentially be carried out in certified centers for metabolic and bariatric surgery with appropriate specific expertise.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Orthopedic interventions after metabolic and bariatric surgery]. [代谢和减肥手术后的骨科干预]。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-15 DOI: 10.1007/s00104-025-02390-0

Felix Haussner, Thomas Caffard, Tobias Freitag, Heiko Reichel, Robert Zahn

{"title":"[Orthopedic interventions after metabolic and bariatric surgery].","authors":"Felix Haussner, Thomas Caffard, Tobias Freitag, Heiko Reichel, Robert Zahn","doi":"10.1007/s00104-025-02390-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02390-0","url":null,"abstract":"Overweight and obesity are among the leading causes of degenerative musculoskeletal disorders. As a consequence, the proportion of obese patients undergoing knee or hip joint arthroplasty or spinal surgery has significantly increased. In these interventions obese patients are at a higher risk for perioperative complications, including thromboembolic events, wound healing disorders, periprosthetic infections, implant failure and the need for revision surgery. A body mass index (BMI) >40 kg/m2 is considered a contraindication for many elective orthopedic procedures. Bariatric surgery can lead to rapid and sustained weight loss; however, the metabolic changes induced by these procedures can affect the absorption and bioavailability of nutrients and medications. At the same time, the altered metabolic state following bariatric surgery is associated with an increased risk of perioperative complications during orthopedic interventions. Furthermore, the efficacy of medications, such as analgesics, antimicrobial agents and oral anticoagulants can be significantly altered by metabolic and bariatric procedures. This article provides an overview of the specific considerations for orthopedic procedures following metabolic and bariatric surgery.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Comparison of the short-term and long-term results after pancreatic resection]. 【胰腺切除术后近期与远期疗效比较】。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-10 DOI: 10.1007/s00104-025-02396-8

Laura Schwenk, Michael Ardelt, Utz Settmacher

引用次数: 0

[The role of appendectomy in remission maintenance for ulcerative colitis: results of the randomized ACCURE study]. [阑尾切除术在溃疡性结肠炎缓解维持中的作用：ACCURE随机研究的结果]。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-08 DOI: 10.1007/s00104-025-02397-7

C T Germer, J Reibetanz

引用次数: 0

[Operating room management in a tertiary care center before and during the COVID-19 pandemic]. [COVID-19大流行之前和期间三级医疗中心的手术室管理]。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-07 DOI: 10.1007/s00104-025-02385-x

Vladan Tenic, Jörg Heckenkamp, Jelena Raskovic, Andreas Hoene, Reinhart T Grundmann

{"title":"[Operating room management in a tertiary care center before and during the COVID-19 pandemic].","authors":"Vladan Tenic, Jörg Heckenkamp, Jelena Raskovic, Andreas Hoene, Reinhart T Grundmann","doi":"10.1007/s00104-025-02385-x","DOIUrl":"https://doi.org/10.1007/s00104-025-02385-x","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19) pandemic led to significant restrictions in surgical services.Objective: To investigate the impact of the COVID-19 pandemic over 3 years on surgical case volume and operating room (OR) efficiency in a tertiary care hospital.Material and methods: From 1 January 2019 to 31 July 2022, the use of 6 ORs was analyzed for the first 7 months of each year (January-July), limited to regular daytime hours (8:00-16:00) from Monday to Friday. Key metrics included the number of surgeries, surgical utilization time, turnover time, start time and end time. Additionally, the number of inpatients with confirmed COVID-19 was documented. In total, 10,193 consecutive procedures were evaluated.Results: Compared to 2019, the number of surgeries decreased by 14.9% in 2020, 23.1% in 2021, and 16.7% in 2022. Surgical utilization time declined by 13.7% in 2020, 20.8% in 2021, and 13.5% in 2022. Turnover time and operating time per procedure significantly increased. The OR start times were significantly delayed, while end times occurred earlier. A significant inverse correlation was found between the number of hospitalized COVID-19 patients and surgical volume (p = 0.002). For each additional COVID-19 inpatient, surgical utilization time decreased by an average of 172.99 min (p < 0.001) and the delay in daily start time increased on average by 46.79 min per month (p = 0.000).Conclusion: The COVID-19 pandemic led to a sustained reduction in surgical case volume, decreased OR utilization and increased turnover times through 2022 in a tertiary care center, affecting vascular, visceral and trauma surgery.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Paravertebral block versus epidural catheter for perioperative analgesia in minimally invasive esophageal resection, results of the PEPMEN trial]. [椎旁阻滞与硬膜外导管在微创食管切除术围手术期镇痛的对比，PEPMEN试验的结果]。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-02 DOI: 10.1007/s00104-025-02394-w

L Schiffmann, C J Bruns

引用次数: 0

[The doctoral regulations of the medical faculties in Germany : What has changed in the last 9 years?] 德国医学院的博士制度：在过去的9年里发生了什么变化？]

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-02 DOI: 10.1007/s00104-025-02387-9

Tomico van Bergen, Christoph Paasch, Richard Hunger, René Mantke

{"title":"[The doctoral regulations of the medical faculties in Germany : What has changed in the last 9 years?]","authors":"Tomico van Bergen, Christoph Paasch, Richard Hunger, René Mantke","doi":"10.1007/s00104-025-02387-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02387-9","url":null,"abstract":"Background: The doctoral degree regulations at German faculties partially show fundamental differences. Against this background in 2016 the Medical Faculty Association (MFT) published a position paper on teaching scientific competence in medical studies. This study project aims to analyze the quality of doctoral degree regulations in Germany 9 years later.Methods: In this study 39 current doctoral degree regulations (PromO) from German medical faculties with the right to award doctorates were analyzed along with the supervision agreements, if available. The standard of the statutes was assessed according to the scoring system of Sorg et al.Results: The mean value of the total score of all doctoral regulations was 68.4 points (SD ± 8.4) and has increased compared to 2016 (57.5 points, SD ± 9.4, p < 0.001). Supervision agreements and cumulative doctorates have been strongly codified since 2016. Methodological training and plagiarism checks have become more mandatory compared to 2016 but are not widespread. The MFT requirement of at least 9 months of research activity was only addressed by 1 medical faculty. Not all doctorates have to be published.Conclusion: The key points of the MFT position paper have not been fully implemented; however, the quality of doctoral regulations in Germany has improved over the last 9 years.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Anatomical variations of vessels and bile ducts in hepatobiliary surgery : What must be considered in gallbladder and liver surgery?] 胆管手术中血管和胆管的解剖变异：胆囊和肝脏手术必须考虑什么？］

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-01 Epub Date: 2025-08-21 DOI: 10.1007/s00104-025-02360-6

Georg Wiltberger, Sebastian Cammann, Oliver Beetz, Felix Oldhafer, Thomas Vogel, Florian Vondran

{"title":"[Anatomical variations of vessels and bile ducts in hepatobiliary surgery : What must be considered in gallbladder and liver surgery?]","authors":"Georg Wiltberger, Sebastian Cammann, Oliver Beetz, Felix Oldhafer, Thomas Vogel, Florian Vondran","doi":"10.1007/s00104-025-02360-6","DOIUrl":"10.1007/s00104-025-02360-6","url":null,"abstract":"Anatomical variations of both the vascular structures of the liver and gallbladder as well as the bile ducts, are very common. Detailed knowledge of the different courses of these vessels and ducts as well as their topographical relationships to one another, is essential in hepatobiliary procedures and surgery involving the upper gastrointestinal tract. Whenever possible, these variations should be identified preoperatively. This is best achieved through contrast-enhanced computed tomography (CT) with both portal venous and arterial phases, and for bile ducts, additionally via magnetic resonance imaging (MRI)/MRCP with liver-specific contrast agents. In smaller procedures involving the hepatic hilum (such as lymph node dissection or cholecystectomy), cross-sectional imaging is not routinely available. In these cases, both the awareness of anatomical variations and the ability to use intraoperative tools (such as ICG fluorescence or cholangiography) are crucial. Although bile duct injuries during cholecystectomy are overall rare (0.2-0.8%), they are frequently associated with vascular damage (up to 61%) and have a significant impact on postoperative morbidity.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"799-807"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[DIVI recommendation: basic psychological care on the intensive care unit after severe injury and multiple trauma : A DIVI recommendation of the trauma and psychological care structures sections]. [DIVI建议：重症监护病房重型损伤和多重创伤后的基本心理护理：创伤和心理护理结构部分的DIVI建议]。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-01 Epub Date: 2025-08-12 DOI: 10.1007/s00104-025-02359-z

Katharina Hinrichs, Uwe Hamsen, Teresa Deffner, Agnes Nojack, Anke Hierundar

引用次数: 0

[Oncological operation reports: minimum requirements, legal aspects and future developments]. 【肿瘤手术报告：最低要求、法律方面和未来发展】。

Chirurgie (Heidelberg, Germany) Pub Date : 2025-10-01 Epub Date: 2025-06-16 DOI: 10.1007/s00104-025-02321-z

Johannes Klose, Sandra Böhm, Christiane J Bruns, Paul Chojecki, Lena-Christin Conradi, Stefan Fichtner-Feigl, Robert Grützmann, Jörg Heberer, Boris Jansen-Winkeln, Jens Jakob, Kay Kohlhaw, Astrid Oehme, Ulrich Ronellenfitsch, Susanne Roth, Christoph Rüger, Igor Sauer, Harald Schulz, Sven Zehnder, Jörg Kleeff

{"title":"[Oncological operation reports: minimum requirements, legal aspects and future developments].","authors":"Johannes Klose, Sandra Böhm, Christiane J Bruns, Paul Chojecki, Lena-Christin Conradi, Stefan Fichtner-Feigl, Robert Grützmann, Jörg Heberer, Boris Jansen-Winkeln, Jens Jakob, Kay Kohlhaw, Astrid Oehme, Ulrich Ronellenfitsch, Susanne Roth, Christoph Rüger, Igor Sauer, Harald Schulz, Sven Zehnder, Jörg Kleeff","doi":"10.1007/s00104-025-02321-z","DOIUrl":"10.1007/s00104-025-02321-z","url":null,"abstract":"The establishment of comprehensive oncological centers for the interdisciplinary care of cancer patients is based on defined criteria that must undergo regular external review to ensure a uniform quality standard of cancer care in Germany. The quality of surgical performance is defined, among other factors, by the number of cases treated or the experience of individual surgeons; however, the operation reports made are highly heterogeneous, as no specific requirements need to be met for certification as an oncological center. The German Association for Surgical Oncology (ACO) has therefore set the goal of proposing a minimum standard for oncological operation reports. In addition to the aspects to be included in the operation reports, exemplified with respect to individual organ systems, legal considerations and the use of artificial intelligence should also be examined in greater detail.","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"855-861"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0