Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Global surgery-Challenges in the treatment of children with cleft lip and palate].","authors":"Robert Sader, Axel Gils, Michelle Klos","doi":"10.1007/s00104-024-02208-5","DOIUrl":"10.1007/s00104-024-02208-5","url":null,"abstract":"<p><strong>Background: </strong>Cleft lip and palate is the most frequent malformation in humans that requires surgical correction but is not primarily life-threatening. That is why in many economically not very well developed countries, special surgical care, such as for cleft lip and palate, is not guaranteed at all or is not sufficiently guaranteed, so that numerous aid organizations have been founded for over 50 years to provide help by organizing surgical aid missions. Even if this help seems primarily ethically harmless and very laudable, the lack of rules and instructions unfortunately regularly leads to the fact that legal, ethical and even medical treatment standards are often not observed to the detriment of the affected children.</p><p><strong>Method: </strong>The necessary principles and prerequisites for surgical aid missions are described in an overview article and from these conceptual and strategic recommendations for the actions of the involved service disciplines are derived. Ultimately, the goal must be not only to surgically help the individual fate but also firstly to treat the functional aspects of the malformation holistically and secondly, to also prioritize the goal of achieving sustainability by competently training the local staff in order to be able to perform such surgery alone in the near future to make such aid missions unnecessary.</p><p><strong>Conclusion: </strong>Surgical aid missions in Third World countries are a model of success as many hundreds of thousands of children and adults with a cleft lip and palate have been successfully treated; however, unfortunately the sustainable further development of local structures and skills is often neglected. There is also an urgent need to establish general guidelines for surgical aid missions in Third World countries.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"184-193"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980840","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":"[A randomized clinical study of patients with soft tissue sarcoma of the extremities. Comparison of radiotherapy and surgery with vs. without additional administration of pembrolizumab].","authors":"Madelaine Hettler, J Jakob, C Reißfelder","doi":"10.1007/s00104-025-02247-6","DOIUrl":"10.1007/s00104-025-02247-6","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"245-247"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191304","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":"[Ultrafast intraoperative monitoring of parathyroid hormone-Results of a prospective multicenter validation study].","authors":"Elisabeth Maurer, Detlef K Bartsch","doi":"10.1007/s00104-025-02240-z","DOIUrl":"10.1007/s00104-025-02240-z","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"250-251"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415722","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":"[(No) Treatment for people without health insurance coverage : When access to inpatient surgical care is denied].","authors":"Sarah Alexandra Lang, Carolin Austermann-Grofer, Maria Siwek, Peter Tinnemann, Rebecca Zöllner","doi":"10.1007/s00104-024-02234-3","DOIUrl":"10.1007/s00104-024-02234-3","url":null,"abstract":"<p><strong>Background: </strong>For people without health insurance coverage access to healthcare is severely restricted. In large cities such as Frankfurt am Main, parallel structures have emerged to ensure free basic medical care for those affected; however, when inpatient treatment is required the medical infrastructure for people without health insurance is inadequate. This article outlines the importance of access to surgical treatment for people without health insurance and the serious consequences when this access is denied.</p><p><strong>Material and method: </strong>The Clearing Center 1.0 at the Public Health Authority of Frankfurt am Main and the Elisabeth Street Outpatient Department of the Caritas Association Frankfurt represent two low-threshold outpatient clinics that exist in the city of Frankfurt. The basic structure and function of each clinic are described along with a characterization of the patient populations, including a description of the sociodemographic characteristics. From the total patient collective, three case scenarios are selected as examples and are outlined with respect to (1) social history, (2) access barriers, (3) findings, (4) surgical indications and (5) treatment course.</p><p><strong>Results: </strong>Patients face complex barriers due to legal restrictions, financial hardships and precarious living conditions. The lack of a funding provider results in necessary surgery not being performed. The consequences are pain, functional limitations and worsening of life-threatening diseases.</p><p><strong>Conclusion: </strong>Timely surgical care for people without health insurance is essential to maintain health and avoid high follow-up costs. A treatment fund provides a solution. The combination of case management, secure accommodation and raising awareness among professionals helps close care gaps and develop solutions.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"205-212"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123992","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":"[Prognostic value of body composition in oncological visceral surgery].","authors":"Saleem Elhabash, Nils Langhammer, Ulrich Klaus Fetzner, Jan-Robert Kröger, Ioannis Dimopoulos, Nehara Begum, Jan Borggrefe, Berthold Gerdes, Alexey Surov","doi":"10.1007/s00104-024-02189-5","DOIUrl":"10.1007/s00104-024-02189-5","url":null,"abstract":"<p><p>Screening of nutritional status of cancer patients plays a crucial role in the perioperative management and is mandatory for the certification of oncological centers by the German Cancer Society (DKG). The available screening tools do not differentiate between muscle and adipose tissue. Recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) as well as the automatic picture archiving communication system (PACS) imaging analysis by high performance reconstruction systems have recently enabled a detailed analysis of adipose tissue and muscle quality. Rapidly growing evidence shows that body composition parameters, especially reduced muscle mass, are associated with adverse outcomes in cancer patients and have been reported to negatively affect overall survival (OS), disease-free survival (DFS), toxicity associated with chemotherapy and surgical complications. In this article, we summarize the recent literature and present the clinical influence of body composition in oncological visceral diseases.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"213-221"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549283","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":"[Patient safety in palliative surgery].","authors":"Felix O Hofmann, Simon Sirtl, Christian Heiliger, Jens Werner","doi":"10.1007/s00104-024-02202-x","DOIUrl":"10.1007/s00104-024-02202-x","url":null,"abstract":"<p><p>Palliative surgery aims to improve the quality of life for patients with incurable diseases. This patient group is vulnerable due to the underlying illness, prior treatment and comorbidities, which increase the risk of complications that can negatively impact the course of the disease and quality of life. Palliative surgical interventions often provide effective long-term symptom control but are more invasive than conservative, interventional endoscopic or interventional radiological alternatives. This article exemplary discusses frequent palliative visceral surgical procedures and less invasive alternatives. In practice, a close interdisciplinary collaboration, open and realistic communication, optimized perioperative care and in particular the minimization of cumulative invasiveness are crucial to maximize the quality of life and safety for oncological patients.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"179-183"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980851","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":"[Kasai-hepatoportoenterostomy for the treatment of biliary atresia - What is important?]","authors":"Omid Madadi-Sanjani, Uta Herden, Marie Uecker","doi":"10.1007/s00104-025-02259-2","DOIUrl":"https://doi.org/10.1007/s00104-025-02259-2","url":null,"abstract":"<p><p>Biliary atresia (BA) is a rare disease in neonates of unknown etiology. BA is defined by the extent of extra- and intrahepatic bile duct destruction, which results in liver deterioration and cirrhosis within the first years of life. Liver transplantation (LT) is the only curative treatment for BA, accompanied by LT-associated risks and complications; however, more than 60 years after it's first report, the Kasai hepatoportoenterostomy (KPE) is still an essential procedure in the sequential management of BA, as the primary surgical treatment option that can achieve long-term survival with a native liver. We highlight the key surgical steps of KPE and discuss relevant aspects.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525220","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":"[Is cytoreductive surgery with HIPEC adequately funded?]","authors":"Can Yurttas, Sarah Kalmbach, Emilia Ansorge, Mohamed Bezmawi, Gunnar Blumenstock, Markus W Löffler, André L Mihaljevic, Christian Ernst, Martin Holderried","doi":"10.1007/s00104-025-02246-7","DOIUrl":"https://doi.org/10.1007/s00104-025-02246-7","url":null,"abstract":"<p><strong>Background: </strong>Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment concept for highly selected patients with peritoneal metastases and primary tumors (PMT). A challenge from the perspective of hospitals is the cost intensity of this promising multimodal treatment option.</p><p><strong>Research question: </strong>Which factors influence the cost and revenue structure of CRS/HIPEC treatment in the current diagnosis-related group (DRG) system according to § 17b of the German Hospital Financing Act (KHG)?</p><p><strong>Material and methods: </strong>The database for this analysis was constituted by all patients treated with combined CRS/HIPEC at a certified tumor center between 2017 and 2021. The statistical analysis performed was descriptive, using two-sample and multisample comparisons (ANOVA) as well as linear correlation and regression analyses.</p><p><strong>Results: </strong>The total length of hospitalization for 173 patients was on average 16.1 days and the average length of stay in the intensive care unit was 2.2 days. Postoperative complications occurred in 110 (63.6%) patients. The average DRG revenue obtained was € 21,658.48. The total costs for the combined CRS/HIPC treatment amounted to an average of € 23,764.77 and were therefore on average € 2106.29 (8.86%) higher than the DRG revenue granted for the treatment. The length of stay in the intensive care unit and the total length of hospitalization correlated positively with the treatment costs and DRG revenue.</p><p><strong>Discussion: </strong>This study presents key factors influencing the cost and revenue structure of CRS/HIPEC and illustrates that this promising surgical treatment approach is relevantly underfunded by the German DRG system. A reform of the current DRG system with special consideration of highly complex oncological treatment concepts is therefore recommended.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460982","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":"[Long-term results of a pilot study on a two-stage procedure with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease].","authors":"Michael Ardelt, Falk Rauchfuss, Felix Dondorf, Aladdin Ali Deeb, Astrid Bauschke, Oliver Rohland, Laura Schwenk, Utz Settmacher","doi":"10.1007/s00104-025-02252-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02252-9","url":null,"abstract":"<p><strong>Background: </strong>The current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines recommend among others a Limberg flap for the treatment of pilonidal sinus disease. This article reports the long-term results of the pilot study: \"Results of a two-stage intervention with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease\", published in 2015.</p><p><strong>Method: </strong>From 2010 to 2013 a total of 50 patients with sacrococcygeal pilonidal sinus disease were treated. Following initial excision patients were offered plastic coverage in the presence of clean wound conditions according to the then relevant AWMF guidelines in primary cases and recommended in recurrent cases. Of the patients 22 opted for a Limberg flap. In 2022 recurrences were recorded via telephone interviews with patients. The groups with a Limberg flap were compared with the excision group.</p><p><strong>Results: </strong>There were no recurrences in the Limberg flap group (0%) while there were six recurrences in the excision group (23%) p = 0.028. In the Limberg group one patient and in the excision group two patients were lost to follow-up.</p><p><strong>Conclusion: </strong>With a two-stage technique a Limberg flap is obviously more effective under inflammation-free wound conditions. The Limberg flap is a simple plastic surgery procedure; however, one should remember that it is a transposition flap.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451130","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":"[What competences do medical students acquire in a surgical internship?-Curriculum mapping with the National Competence-based Catalogue of Learning Objectives in Medicine (NKLM) 1.0].","authors":"Vanessa Britz, A-M Lübbehüsen, J Sterz, M-C Stefanescu, H Sterz, M Rüsseler","doi":"10.1007/s00104-024-02238-z","DOIUrl":"https://doi.org/10.1007/s00104-024-02238-z","url":null,"abstract":"<p><strong>Background: </strong>Curriculum mapping describes the process indexing a curriculum to identify academic gaps. The first version of the National Competence-based Catalogue of Learning Objectives in Medicine (NKLM 1.0) was created to catalogue the content of medical studies and to promote the implementation of competence-oriented learning objectives. It is unclear and not transparent to what extent learning objectives are achieved in existing courses, particularly in clinical internships that cannot be standardized.</p><p><strong>Objective: </strong>The aim of the work was to map the achieved learning objectives of the NKLM 1.0. within a surgical internship from the students' perspectives.</p><p><strong>Material and methods: </strong>Medical students mapped their achieved learning objectives after a 2-week internship with an online questionnaire. In addition, sociodemographic data, the type of teaching hospital and the surgical specialty were recorded.</p><p><strong>Results: </strong>A total of 81 students participated in the mapping. After the internship 8.78 ± 5.10% (min. = 1.01%; max. = 29.84%) of all learning objectives were achieved by the students. Most of the learning objectives come from section 1 \"medical roles\" with 29.92 ± 15.22% (min. = 0.00%; max. = 63.10%). From section 2 \"medical knowledge, clinical skills and professional attitudes\", learning objectives from chapters 14b \"clinical practical skills\" (15.49 ± 7.78%, min. = 0.00%; max. = 41.30%) and 14c \"medical counseling technique\" (22.98 ± 16.47%, min. = 0.00%; max. = 70.69%) were primarily named. There were no significant differences between the sexes, the surgical specialty or the size of the teaching hospital.</p><p><strong>Conclusion: </strong>Students state that they mainly achieve learning objectives in the area of medical roles and clinical practical skills during an internship. Additional teaching formats seem to be necessary to teach specific surgical skills, diagnostics and treatment.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191307","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}