Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Digitally based clinically oriented anatomy: the future of teaching].","authors":"Esther C Maier, Veysel Ödemis, Anja U Bräuer","doi":"10.1007/s00104-024-02211-w","DOIUrl":"10.1007/s00104-024-02211-w","url":null,"abstract":"<p><p>University teaching is undergoing radical changes. Rising student numbers and the progressive digitalization of routine daily life are also leading to the testing of various new teaching and learning formats. This article provides an overview of the reasons for and approaches used to effectively and efficiently organize teaching of anatomy using digital learning methods and to fulfil the expectations of students.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959777","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":"[Prevalence and potential risk factors for nodal metastasis in early esophago-gastric adenocarcinoma-Results of the CONGRESS study].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-024-02199-3","DOIUrl":"10.1007/s00104-024-02199-3","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"69-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775459","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":"[Conversion to outpatient treatment beyond the hybrid DRG-A view abroad].","authors":"Franziska Peters, Jörg-Peter Ritz","doi":"10.1007/s00104-024-02166-y","DOIUrl":"10.1007/s00104-024-02166-y","url":null,"abstract":"<p><p>Outpatient visceral surgery is still in its infancy in Germany. While hernia repair that can be performed on an outpatient basis is still being discussed in this country, larger visceral surgery procedures such as thyroidectomy, fundoplication, bariatric procedures and colorectal resection are increasingly being performed abroad on an outpatient basis or in a short inpatient setting (< 24 h). The USA is the pioneer of outpatient care. Due to the private sector character of the American health insurance system, structures were created that ensure seamless care for patients. Overall, a look abroad shows that outpatient surgical procedures are a promising development that can also be further promoted in Germany through appropriate measures and strategies.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"984-989"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134651","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":"Secondary wound closure with a new transparent negative-pressure dressing.","authors":"Gunnar Loske","doi":"10.1007/s00104-023-01864-3","DOIUrl":"10.1007/s00104-023-01864-3","url":null,"abstract":"<p><p>Secondary healing surgical wounds can be treated with negative-pressure therapy. Dressing changes can be painful due to the strong adherence of the polyurethane foam placed in the wound. After debridement and conditioning of the wound bed, secondary surgical wound closure with a surgical suture can be performed. Cutaneous negative-pressure therapy is used preventively after primary surgical suturing. Descriptions for secondary wound closure without a surgical suture are not known to date. The preparation and handling of an innovative transparent dressing for the cutaneous application of negative-pressure therapy is demonstrated here. The dressing assembly consists of a transparent drainage film and a transparent occlusion film. Negative pressure is applied via a tubing connector using a negative pressure pump. A new method of secondary wound closure using the transparent negative-pressure dressing is presented based on a case example. The treatment cycle with instructions for making the dressing is shown in a video.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886457","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":"Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano : A single-center prospective cohort study.","authors":"Basma Hussein Abdelaziz Hassan, Philobater Bahgat Adly Awad, Mostafa Mohamed Abdelaziz, Mohammed Hossam, Mohamed Ali Mohamed Nada","doi":"10.1007/s00104-024-02134-6","DOIUrl":"10.1007/s00104-024-02134-6","url":null,"abstract":"<p><strong>Background: </strong>Supra-sphincteric and high trans-sphincteric fistula are very challenging procedures for both the patient and the surgeon. We aimed to evaluate the outcomes of anal sphincter repair in the management of supra-sphincteric and high trans-sphincteric fistula-in-ano in terms of postoperative wound infection, bleeding, incontinence to flatus or stool, and recurrence within 1 year.</p><p><strong>Patients and methods: </strong>This single-center prospective cohort trial conducted from June 2020 to December 2023 at the Ain Shams University Hospitals included 20 patients who presented with supra-sphincteric or high trans-sphincteric fistula. There were nine (45%) male and 11 (55%) female patients, with a mean age of 41.5 years postoperatively.</p><p><strong>Results: </strong>The mean duration of the procedure was 90.3 min (SD ± 11.9). During the first 2 weeks, ten (50%) patients scored their postoperative pain as mild, eight (40%) as moderate, and two (10%) as severe. Wound infection occurred in two (10%) patients and postoperative bleeding in three (15%) patients in the form of spotting after defecation. There were no cases of incontinence to stool. However, there were three (15%) cases of incontinence to gases. There were two cases (10%) of recurrence at the 1‑year follow-up. Postoperative patient satisfaction was assessed on a 5‑point Likert scale after 2 weeks: One patient (5%) was very dissatisfied, three (15%) patients were dissatisfied, and two (10%) patients were unsure, while five (25%) patients were satisfied and nine (45%) were very satisfied.</p><p><strong>Conclusion: </strong>Immediate sphincter repair in supra-sphincteric and high trans-sphincteric fistula through a lay-open procedure was determined to be safe, easier than classic operations, and associated with a low incidence of recurrence at the 1‑year follow-up and a high quality of life.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989627","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":"Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial.","authors":"Mohamed Ali Mohamed Nada, Philobater Bahgat Adly Awad, Andrew Morcos Azmy Kirollos, Mostafa Mohamed Abdelaziz, Karim Mohamed Saad Mohamed, Kerolos Bahgat Adly Awad, Basma Hussein Abdelaziz Hassan","doi":"10.1007/s00104-023-02010-9","DOIUrl":"10.1007/s00104-023-02010-9","url":null,"abstract":"<p><strong>Background: </strong>This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year.</p><p><strong>Patients and methods: </strong>This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles.</p><p><strong>Results: </strong>The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).</p><p><strong>Conclusion: </strong>Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"14-22"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139076058","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":"[Hybrid diagnosis-related groups-The challenge].","authors":"Tobias Kisch, Ralf Müller-Rath, Sven Gregor, Ralph Lorenz, Axel Neumann, Stephan Dittrich, Michael Müller, Ralf Lippert, Jan Henniger, Burkhard Lembeck, Eva-Maria Baur, Jörg Karst, Frank Vescia, Ralf Schmitz","doi":"10.1007/s00104-024-02196-6","DOIUrl":"10.1007/s00104-024-02196-6","url":null,"abstract":"<p><p>The introduction of hybrid diagnosis-related groups (DRG) presents new challenges for healthcare providers and health insurances. The same applied in 2023 to the institute designated by the Federal Ministry of Health (BMG) to extract medical procedures and calculate remuneration levels for the first hybrid DRGs. A responsible calculation methodology and a realistic data basis are required as the result of the calculation can lead to controversy, even to a splitting among specialist groups and constructs. There is also the threat of mismanagement with subsequent supply problems. In this context, a loss of quality can occur due to the use of simple surgical procedures that are less complex and not expensive with respect to material costs and are economical but not state of the art and thus directly worsen the medical care of patients in the statutory health insurance (GKV). Furthermore, it is already becoming apparent that procedures that are uneconomical due to the miscalculation are partially no longer being comprehensively rendered by healthcare providers due to adjustment of the service portfolio. An appropriate compensation of procedures is only possible based on a remuneration that adequately covers the costs. In this respect, this article is not intended to be understood as a \"solution to the problem of the internal distribution of the remuneration in hybrid DRGs\" but more to offer suggestions for solutions for the required further development of the hybrid DRG compensation level calculation to prevent a threat to the treatment of GKV patients due to mismanagement. As required in § 115f of the Sozialgesetzbuch V (SGB V), the recalculation of an economic remuneration must be carried out urgently and promptly using an empirical calculation basis and methodology and this must be regularly adapted.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"1007-1011"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592426","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":"[Change to outpatient treatment in surgery].","authors":"Christoph Reißfelder","doi":"10.1007/s00104-024-02163-1","DOIUrl":"https://doi.org/10.1007/s00104-024-02163-1","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":"95 12","pages":"953-955"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711245","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":"[Extended mesenterial resection vs. mesentery-sparing resection in ileocolic resection for Crohn's disease].","authors":"C T Germer, J Reibetanz","doi":"10.1007/s00104-024-02188-6","DOIUrl":"10.1007/s00104-024-02188-6","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"1016-1017"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373676","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":"[Feasibility and structural prerequisites for conversion to outpatient treatment in proctology].","authors":"Stefan Fritz, Christoph Reissfelder, Dieter Bussen","doi":"10.1007/s00104-024-02168-w","DOIUrl":"10.1007/s00104-024-02168-w","url":null,"abstract":"<p><strong>Background: </strong>Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis.</p><p><strong>Objective: </strong>The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary.</p><p><strong>Material and methods: </strong>The present article is intended to provide a narrative overview with reference to the literature on the topic of outpatient care in proctology. A literature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG.</p><p><strong>Results: </strong>In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions.</p><p><strong>Conclusion: </strong>In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":"970-977"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302306","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}