Chirurgie (Heidelberg, Germany)最新文献

{"title":"[The \"simple\" laparoscopic cholecystectomy as a hybrid DRG in 2026 : Critical appraisal and practical orientation].","authors":"Colin M Krüger, Alexander Buia, Waldemar Uhl, Rolf Bartkowski, Helmut Witzigmann, Alexis Ulrich, Kai Nowak","doi":"10.1007/s00104-026-02593-z","DOIUrl":"https://doi.org/10.1007/s00104-026-02593-z","url":null,"abstract":"<p><strong>Background: </strong>With approximately 175,000 procedures per year (IQTIG, reporting year 2024), laparoscopic cholecystectomy is among the most common visceral surgical procedures in Germany. Since 2026, \"simple\" laparoscopic cholecystectomy (H08M) has been included in the cross-sectoral hybrid diagnosis-related groups (DRG) scheme under § 115f of the German Social Code Book V (SGB V).</p><p><strong>Objective: </strong>To critically analyze the hybrid DRG classification with respect to the underlying evidence, coding/grouping logic, real-world care patterns and economic implications, including a model calculation of the expected case distribution.</p><p><strong>Results: </strong>The current context factor logic does not consistently distinguish between hybrid and full inpatient DRG by severity: acute cholecystitis without gallstones (K81.0) is defined as a context factor (triggering the inpatient DRG H08C), whereas acute cholecystitis with gallstones (K80.00/K80.01) is not, despite comparable or greater treatment complexity. Based on a model calculation using routine data from the Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) for 2022-2024, an estimated 93,000-96,000 cases per year (≈ 60-65% of \"simple\" laparoscopic cholecystectomies) are likely to be uncomplicated and therefore eligible for the hybrid DRG, while approximately 52,000-55,000 cases per year (≈ 35-38%) involve acute cholecystitis, for which the classification is inconsistent and in some cases implausible. The actual outpatient share is likely to remain below 1%.</p><p><strong>Conclusion: </strong>Hybrid DRG eligibility is not equivalent to suitability for outpatient care. What is required are diagnosis-specific, more precisely defined context factors, a correct and sanction-free coding logic, and adequate reimbursement reflecting standby capacity costs and training obligations.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119280","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}

{"title":"[Analysis with propensity score matching to compare robotic and laparoscopic liver resections of the anterolateral segments].","authors":"Michael Ardelt, Falk Rauchfuß, Utz Settmacher","doi":"10.1007/s00104-026-02557-3","DOIUrl":"10.1007/s00104-026-02557-3","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"832-833"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725598","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}

{"title":"[The German Surgery Congress from the perspective of young surgeons; expectations and barriers : Results of a nationwide online survey].","authors":"Sebastian Schaaf, Stefanie Brunner, Frederik Schlottmann, Sabine Drossard, Benedikt J Braun, Louisa Schuffert, Dominik Adl Amini, Joscha Mulorz, Romina Rösch, Atrin Pezeshgi, Randa Haraki, Thomas Schmitz-Rixen","doi":"10.1007/s00104-026-02552-8","DOIUrl":"10.1007/s00104-026-02552-8","url":null,"abstract":"<p><strong>Background: </strong>The German Surgery Congress (DCK) represents a central platform for scientific exchange and continuing medical education in the surgical disciplines in Germany; however, participation rates among young surgeons appear disproportionately low relative to the target population.</p><p><strong>Objective: </strong>The study assessed the expectations, barriers to participation and potential areas for improvement of the DCK from the perspective of young surgeons.</p><p><strong>Material and methods: </strong>An anonymous web-based cross-sectional survey was conducted among young surgeons in Germany. The questionnaire included sociodemographic data, prior congress experience, barriers to participation, expectations regarding content and formats and open-ended responses to general perception of the DCK. The qualitatively and quantitatively collated data were exploratively analyzed.</p><p><strong>Results: </strong>A total of 226 responses were analyzed. The overall willingness to participate was high (90.3%). The main barriers identified were lack of institutional support/leave (38.1%), high costs (22.1%) and insufficient information about the congress (14.2%). Content-related factors played a minor role. Participants prioritized practice-oriented formats, particularly hands-on courses (50.9%), interactive sessions (33.6%), mentoring and networking opportunities (46.9%). Expectations were largely consistent across subgroups.</p><p><strong>Conclusion: </strong>Low participation of young surgeons in the DCK appears to be primarily driven by structural and organizational barriers rather than lack of interest. The findings highlight that the further development of the DCK does not primarily depend on expanding the program but on a targeted orientation toward the needs of young surgeons and a reduction In structural access barriers. A stronger emphasis on practice-oriented continuing education, mentoring, interactive formats and hybrid concepts could sustainably improve the attractiveness and accessibility of the DCK.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"819-828"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726930","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}

{"title":"[Open versus robotic-assisted repair of midline ventral hernias with a defect width 2-8 cm].","authors":"Mohamad El-Ahmar, Christoph Reißfelder","doi":"10.1007/s00104-026-02573-3","DOIUrl":"10.1007/s00104-026-02573-3","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"838-840"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892968","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}

{"title":"[Surgical teams in extraordinary stress environments : Education, mental resilience and simulation-based training].","authors":"Philipp Hube, Axel Franke, Christian Beltzer, Gerhard Achatz, Moritz Witzenhausen","doi":"10.1007/s00104-026-02556-4","DOIUrl":"10.1007/s00104-026-02556-4","url":null,"abstract":"<p><p>Extraordinary stress situations create a dual challenge for surgical teams: they must make technical decisions under time pressure while maintaining communication, leadership and situational awareness. In trauma rooms, intraoperative crises, mass casualty incidents, military deployments and resource-limited environments, risks arise due to stress, cognitive narrowing, unclear roles and impaired team coordination. The literature describes surgical skills, simulation-based education, structured debriefing and resilience training as relevant components to increase reliable team performance. This narrative review summarizes educational concepts, assessment tools and training approaches. A longitudinal curriculum should integrate technical procedures, team communication, crisis leadership and stress regulation. Repeated interprofessional scenarios with realistic stressors, explicit learning objectives and validated feedback are suitable. Resilience is understood as an individual, team-based and organizational capability.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"803-808"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889011","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}

{"title":"[Risk of bleeding-Strategies for prevention and treatment].","authors":"K Krötzsch, S Utzolino, S Fichtner-Feigl","doi":"10.1007/s00104-026-02570-6","DOIUrl":"10.1007/s00104-026-02570-6","url":null,"abstract":"<p><p>This article aims to provide an overview of the possibilities for prevention and treatment of one of the most common surgical complications, perioperative bleeding. In addition to careful patient selection for elective procedures, particular emphasis should be placed on obtaining a thorough medical history regarding pre-existing conditions and medications as well as addressing any preoperatively apparent anemia or coagulation disorder in a timely manner. In emergency situations, it is always necessary to balance the urgency of rapid treatment against the available time for preoperative preparation, especially with respect to the duration of action of commonly prescribed oral anticoagulants. From a therapeutic perspective, in addition to primary surgical hemostasis, there are several pharmacological optimization strategies, which are outlined.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"849-856"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946354","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}

{"title":"[Visceral surgery in mass casualty incidents due to disasters, crises and war].","authors":"Arnulf Gregor Willms, Sebastian Schaaf, Daniel Vallböhmer, Wolfgang E Thasler, Aliona Wöhler, Nina Kühler, Jürgen Tepel, Lena Heidelmann, Christoph Güsgen, Andreas Westerfeld, Axel Franke, Christian Beltzer","doi":"10.1007/s00104-026-02549-3","DOIUrl":"10.1007/s00104-026-02549-3","url":null,"abstract":"<p><strong>Background: </strong>Mass casualty incidents with a focus on visceral surgery pose major medical and organizational challenges for hospitals. They are characterized by a large number of simultaneously admitted patients, limited personnel and material resources as well as the necessity to make time-critical surgical decisions. From a visceral surgical perspective, abdominal injuries involving severe bleeding, contamination and multiorgan involvement are particularly demanding as they require rapid surgical intervention and close interdisciplinary cooperation. This injury pattern is typically encountered in current terror situations, conflicts and wars and is therefore the foundation of the preparations for national and alliance defence.</p><p><strong>Objective: </strong>The article outlines the surgical, ethical, organizational and structural requirements for visceral surgical care in mass casualty incidents.</p><p><strong>Material and methods: </strong>Based on a structured analysis of the literature, a narrative review was performed, focusing on disaster medicine, surgical triage, damage control surgery and organizational aspects of surgical crisis management.</p><p><strong>Results: </strong>Key prerequisites for successful management include a consistent and dynamic surgical triage, damage control-oriented surgical strategies, resilient clinical structures and transparent medical ethical decision-making processes. Furthermore, standardized leadership and communication structures, interdisciplinary collaboration and regular realistic training are essential.</p><p><strong>Conclusion: </strong>Effective visceral surgical mangement during mass casualty incidents or demanding situations over an indefinite time period due to conflicts or war requires not only surgical expertise but also crisis management skills, organizational resilience and structured decision-making processes. A systematic preparation through standardized concepts and regular training is essential for sustainable surgical disaster preparedness.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"777-785"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868173","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}

{"title":"[Randomized comparison of pyloroplasty vs. no pyloroplasty during minimally invasive esophagectomy].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-026-02551-9","DOIUrl":"10.1007/s00104-026-02551-9","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"836-837"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537077","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}

{"title":"[Neoadjuvant chemotherapy versus chemoradiotherapy for rectal cancer : Results of the CONVERT study].","authors":"J Reibetanz, C T Germer","doi":"10.1007/s00104-026-02569-z","DOIUrl":"10.1007/s00104-026-02569-z","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"834-835"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835254","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}

{"title":"[Adaptation of healthcare systems to disasters, crises and war : Resilient, robust and secure hospitals and dealing with medical standards].","authors":"T Wurmb, C Speicher, L Reese, P Meybohm, M Kippnich","doi":"10.1007/s00104-026-02525-x","DOIUrl":"10.1007/s00104-026-02525-x","url":null,"abstract":"<p><p>The resilience of healthcare systems is their ability to respond to disruptive crises by coping, maintaining key services and perseverance. After the crisis, it is a sign of resilience to evaluate the lessons identified and initiate improvement processes based on these lessons in order to emerge from the crisis with improved structures. An essential prerequisite for resilience is the robustness of hospitals and healthcare systems. This is decisively supported by the pillars of personnel, supplies and spatial/infrastructure. These are embedded in an overarching set of rules consisting of legal foundations, strategic principles and operational tools. It is crucial for the realization of resilience that the rules enable and do not hinder the action and the medical care. Reducing bureaucracy is of crucial importance here and can be put into practice in very concrete terms. A more resilient system that is capable of adequately responding to impending and already existing crises can only be achieved by noticeably reducing the complexity of the healthcare system.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"793-802"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044993","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}