RESUMEN

INTRODUCTION: The aim of this study was to evaluate the effectiveness of initially conservative therapy compared to immediate appendectomy for acute appendicitis with abscess in terms of medical and economic outcomes. METHODS: Of all the patients treated for appendicitis from January 2009 to December 2017 in five German hospitals, 240 were included in the study. Fifty-three patients received conservative (CON) and 195 patients received surgical (SUR) therapy as initial treatment. RESULTS: Length of stay was similar (12.5 days in CON vs. 13.3 days in SUR, p = 0.530). Readmission rate was higher in the conservative group (54.7% vs. 6.2%, p < 0.001). The majority (53.7%) of the 41 operations in CON group were appendectomies (22 procedures), 1 (4.5%) of them was in the first hospital stay because of persisting symptoms, 21 (95.5%) after a recovery interval. Seven (33.3%) of the recovery appendectomies were performed due to persisting or recurrent symptoms and 14 (66.7%) due to the request of patient. Twenty-one patients (39.6%) in the CON group did not need surgery. The rates of complication-related operations per patient (0.04 versus 0.58, p < 0.001), conversions of surgical technique (1.9% vs. 34.9%, p = 0.0287), and extended resections (1.9% vs. 31.3%, p < 0.001) were higher in SUR group. Furthermore, morbidity, hospital costs, and loss in quality of life were significantly higher in the surgical group (17.0% vs. 66.2%, p < 0.001; € 5044 vs. € 8457, p < 0.001, and 4.3 days vs. 7.5 days, p < 0.001, CON vs. SUR). CONCLUSION: Initially, conservative treatment for acute appendicitis with abscess is preferable to immediate surgical treatment in reduction of morbidity, hospital costs, and loss in quality of life.

Asunto(s)

Absceso/complicaciones , Apendicitis/complicaciones , Apendicitis/cirugía , Tratamiento Conservador , Hospitales , Enfermedad Aguda , Apendicitis/economía , Apendicitis/mortalidad , Economía Hospitalaria , Alemania , Humanos , Tiempo de Internación/economía , Morbilidad , Complicaciones Posoperatorias/etiología , Calidad de Vida

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BACKGROUND: Pulmonary sequestration is a rare pulmonary malformation whose complex pathogenesis is not completely understood. Extrapulmonary sequestrations are always hereditary malformations and are usually diagnosed during childhood. Some intralobar sequestrations in adults, by contrast, seem to be acquired. The clinical presentation is non-specific and often misinterpreted, which results in delayed diagnosis. Surgical resection continues to be the gold standard. Despite the low incidence, new technologies developed in the past few decades, e.g. preoperative interventional angiology procedures and video-assisted lung resection, have changed the management of the disease. METHODS: A prospective data collection was performed on adult patients who had undergone surgical resection of a pulmonary sequestration in four different centres during a period of 23 years. These data were retrospectively analysed. RESULTS: A total of 14 patients with intralobar sequestrations (n = 11, 79 % left lower lobe) underwent surgical resection. The male/female ratio was 8/6 (median age 50 years). Non-specific pulmonary symptoms such as recurrent infections had a high prevalence (n = 6, 42 %). Two patients had haemoptysis. Three patients were asymptomatic. All patients had a chest CT, 7 patients had an additional abdominal CT, while 10 underwent angiography. Preoperative embolization was performed in 5 of these patients (branches of the thoracic aorta: in 2 cases, branches of abdominal aorta: in 2 cases, and branches of both: in 1 case). Resection was mostly performed with an open surgical approach (n = 12, 86 %). Most patients had a non-anatomic pulmonary resection (n = 8, 57 %). In 7 patients, a microbiologic examination revealed a superinfection with Streptococcus pneumoniae, while 1 patient had an invasive mycosis with Candida albicans. CONCLUSION: In patients with non-specific pulmonary symptoms and undetermined lesions, especially in the lower lobes, pulmonary sequestrations must be considered in the differential diagnostic evaluation even in adult and elderly patients. If there are no contraindications, surgical removal is basically recommended and may be minimally-invasive in selected cases. The planning of the resection can be facilitated by preoperative evaluation of the arterial supply (branches of the thoracic or abdominal aorta, or both). In cases with haemoptysis or blood supply over the abdominal aorta, preoperative embolization is indicated.

Asunto(s)

Secuestro Broncopulmonar/cirugía , Adulto , Angiografía , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/etiología , Secuestro Broncopulmonar/patología , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/irrigación sanguínea , Pulmón/patología , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Prospectivos , Estudios Retrospectivos , Cirugía Torácica Asistida por Video/métodos , Toracotomía/métodos , Tomografía Computarizada por Rayos X

RESUMEN

PURPOSE: Laparoscopy for colorectal cancer resection bares early post-operative advantages and results in equal oncologic long-term outcome. However, data on laparoscopic right hemi-colectomy is scarce. Aim of the present study was to analyze a well selected collective of patients with right-sided colon cancer treated open and laparoscopically with regard to peri-operative and long-term outcome. METHODS: We analyzed all patients who underwent right-sided hemi-colectomy for colon cancer between January 1996 and March 2013. Data was extracted from our prospective database. Inclusion criteria were tumor localization in the ascending colon, oncologic resection, histology of an adenocarcinoma, tumors UICC I-III, and R0 resection. Exclusion criteria were multiple malignancies including colon, emergency operation, adenoma or pT0 status, and UICC IV. For the matched pairs approach between patients undergoing laparoscopic (LAP) or open (OPEN) surgery, the parameters age, UICC stage, tumor grading, and sex were applied. RESULTS: A total of 188 patients was included in the analysis with n = 94 in both the LAP and the OPEN group. Some peri-operative results demonstrated advantages for laparoscopy including median return to liquid (p < 0.0001) and solid diet (p = 0.008), median length of ICU stay (p < 0.0001), and median length of hospital stay (p = 0.022). No significant differences were revealed for complication rates, rates of anastomotic leakage, or 30-day mortality. Lymph node yield was identical. Also, no differences in oncologic long-term outcome were detected. Rates for local recurrence were 4.3 and 2.0 %. CONCLUSION: This matched pairs analysis verifies peri-operative advantages of laparoscopy explicitly for the sub-group of CRC patients undergoing right-sided hemi-colectomy in comparison to open surgery while demonstrating equivalent oncologic long-term results.

Asunto(s)

Colon/patología , Colon/cirugía , Neoplasias del Colon/cirugía , Laparoscopía , Adulto , Anciano , Anciano de 80 o más Años , Demografía , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Estadificación de Neoplasias , Análisis de Supervivencia

RESUMEN

PURPOSE: The purpose of the present study was to investigate on the acceptance and frequency of laparoscopic surgery for the management of acute and chronic bowel obstruction in a general patient population in German hospitals. METHODS: To receive an authoritative opinion on laparoscopic treatment of bowel obstruction in Germany, a cross-sectional online study was conducted. We designed an online-based survey, supported by the German College of Surgeons (Berufsverband der Deutschen Chirurgen, BDC) to get multi-institutional-based data from various level providers of patient care. RESULTS: Between January and February 2014, we received completed questionnaires from 235 individuals (16.7 %). The participating surgeons were a representative sample of German hospitals with regard to hospital size, level of center size, and localization. A total of 74.9 % (n = 176) of all responders stated to use laparoscopy as the initial step of exploration in expected bowel obstruction. This procedure was highly statistically associated with the frequency of overall laparoscopic interventions and laparoscopic experience. The overall conversion rate was reported to be 29.4 %. CONCLUSIONS: This survey, investigating on the use of laparoscopic exploration or interventions in bowel obstruction, was able to show that by now, a majority of the responding surgeons accept laparoscopy as an initial step for exploration of the abdomen in the case of bowel obstruction. Laparoscopy was considered to be at least comparable to open surgery in an emergency setting. Furthermore, data analysis demonstrated generally accepted advantages and disadvantages of the laparoscopic approach. Indications for or against laparoscopy are made after careful consideration in each individual case.

Asunto(s)

Encuestas de Atención de la Salud , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/cirugía , Laparoscopía , Abdomen/cirugía , Alemania/epidemiología , Tamaño de las Instituciones de Salud , Humanos

RESUMEN

INTRODUCTION: The gastric and duodenal perforations are a life-threatening complication of peptic ulcer disease with the indication for immediate surgical intervention. To which extent laparoscopy is a suitable method in an acute situation was examined in the present investigation. MATERIALS AND METHODS: The data of all patients within a period of 15 years (01/1996-12/2010) who were operated laparoscopically because of a perforated gastric or duodenal ulcer, were collected prospectively in terms of age, gender, localisation of perforation, diagnostics, symptoms, surgical procedures, intraoperative and postoperative complications and postoperative course, and were analysed retrospectively. RESULTS: During the observation period 45 patients were operated laparoscopically due to gastric or duodenal perforation. The median age at operation was 58 (18-91) years. An NSAID medication was present in 11 (24.4 %) patients. The perforation was juxtapyloric in 12 (26.7 %) patients, postpyloric in 10 (22.2 %) patients, one (2.2 %) patient in each small and greater curvature, in 18 (40.0 %) at the front and in three (6.7 %) patients on the rear wall. In two cases, previous surgical treatment in the upper abdomen was performed. After primary diagnostic laparoscopy, an indication for conversion was seen in 20 (44.4 %) patients. During laparoscopically completed operations simple suturing was done in 18/25 (72.0 %) patients and excision and suturing was performed in 7/25 (37.8 %) patients. After conversion simple suturing was observed in 7/20 (35.0 %) patients, whereas in 10/20 (50.0 %) patients excision and suturing was performed. 3/20 (15.0 %) patients underwent a resective operation. The median operative time was 105 (40-306) minutes and mean hospitalisation 11 (4-66) days. The ICU stay was in median 2 (0-37) days. Major complications were seen in 11 (24.4 %) patients, namely re-laparotomy (n = 7; 15.6 %) and haemorrhage (n = 4; 8.9 %). Minor complications were observed in 8 (17.8 %) of cases. The mortality rate was 11.1 % (n = 5). CONCLUSION: The laparoscopic treatment of gastric and duodenal perforations is a minimally invasive therapeutic option for the definitive treatment of this life-threatening disease. The indication for a laparoscopic approach has to be considered individually and depends to a decisive extent on the experience of the laparoscopic surgeon.

Asunto(s)

Úlcera Duodenal/cirugía , Urgencias Médicas , Laparoscopía , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Duodeno/cirugía , Femenino , Alemania , Humanos , Unidades de Cuidados Intensivos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/mortalidad , Complicaciones Intraoperatorias/cirugía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Selección de Paciente , Úlcera Péptica Perforada/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Estómago/cirugía , Úlcera Gástrica/mortalidad , Técnicas de Sutura , Adulto Joven

RESUMEN

BACKGROUND: Neuroendocrine neoplasia (NEN) are a rare and heterogenous tumour entity. The subgroup with unknown primary tumour (N-CUP) seems to have a worse prognosis as resection of the primary is necessary for cure. The diagnostics and therapeutic algorithms for N-CUP in a German single centre are presented. PATIENTS/METHODS: Analysis of the surgical databank showed 35 cases of N-CUP in 261 cases with NEN from gastroenteropancreatic and lung origin over 2 decades (03/1990-03/2011). Three groups were built: K1 - primary detection after operative exploration (n = 10), K2 - unknown primary after operative exploration (n = 10) and K3 - no operative exploration for various reasons (n = 13). RESULTS: Initially 13.4 % (35/261) of patients presented as N-CUP, after intensified diagnostics 12.7 % (33/261) and after operative exploration 8.8 % (23/261) remained with unknown primary tumour. The sex ratio was 1 : 1, the median age is significantly higher in N-CUP [63.8 years (y) vs. 55.9 y, p = 0.004), the 5-year-survival is lower (58 vs. 72 %, n. s.). compared to NEN with known primary. Operative exploration was performed in 60.6 % (20/33), 30 % (6/20) of them were found to have inoperable situations, in 20 % (4/20) single site metastases were removed completely and in 50 % (10/20) a primary tumour was detected (8 × midgut, 2 × pancreas) intraoperatively. In these cases 70 % (7/10) got complete tumour resection (R0) and in 30 % (3/10) primary tumour resection with debulking of liver metastasis was done. In K3 (39.4 %, 13/33) most patients [69.2 % (9/13)] were treated with chemotherapy. The median age in K1 was significantly lower than in K3 (54.9 y vs. 68.3 y, p = 0.028), male dominance was seen in K3 (3,3 : 1, n. s.). The average Ki-67 index was 4.3, 23.8 and 53 % in K1, K2 and K3 (p < 0.0001 for K1 and K3 and p = 0.035 for K2 and K3), respectively. The death rate was 20, 30 and 76.9 % in K1, K2 and K3, respectively. CONCLUSION: Primary tumours of the midgut and pancreas are often found in the subset of well differentiated neuroendocrine CUP syndrome after open surgical exploration. A high rate of complete tumour resection and cure can be achieved in these cases. After common diagnostic tools (CT, MRI and somatostatin receptor scintigraphy), immunhistochemistry can give important hints (CDX-2 for midgut, TTF-1 for lung and thyroid) for a primary lesion. Also in single site metastasis without primary tumour detection a good clinical outcome is seen after complete resection.

Asunto(s)

Neoplasias del Sistema Digestivo/diagnóstico , Neoplasias del Sistema Digestivo/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/cirugía , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/secundario , Tumores Neuroendocrinos/cirugía , Adulto , Anciano , Algoritmos , Neoplasias del Sistema Digestivo/mortalidad , Supervivencia sin Enfermedad , Femenino , Alemania , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/mortalidad , Neoplasias Primarias Desconocidas/patología , Tumores Neuroendocrinos/mortalidad , Pronóstico

RESUMEN

OBJECTIVE: The rotational atherothrombectomy with Straub Rotarex(®) is a safe and efficient treatment of acute/subactute vascular occlusions. The purpose of this study was to evaluate the benefit of paclitaxel-coated angioplasty after rotational atherothrombectomy over an observation period of six months. MATERIALS AND METHODS: Overall, 29 patients were treated with the Rotarex catheter in combination with paclitaxel-coated angioplasty. All patients had acute/subacute and chronic occlusions of the superficial femoral artery (SFA) and/or popliteal arteries. The ankle-brachial index (ABI) was detected before the intervention, after the procedure, and after six months. Also clinical examination and ultrasound scans were done in the observation period. RESULTS: There were no technical failures. The ABI shows a significant increase from 0.52 ± 0.17 to 0.91 ± 0.25 in the follow-up. By ultrasound examination, there were found two (6.9%) restenoses during the follow-up. There was one dissection during the intervention (3.5%). CONCLUSION: The rotational atherothrombectomy in combination with paclitaxel-coated angioplasty might be an effective and safe method with a promising low rate of restenosis at six months.

RESUMEN

OBJECTIVES: Pain sensitivity is a risk factor for postoperative pain and is usually determined by experimental pain stimulation. Ruscheweyh et al. (Pain 146:65-74, 2009) developed the pain sensitivity questionnaire (PSQ) which assesses general pain sensitivity by self-rating without using extensive and painful experimental stimulation. The objective of this study was to examine whether subjective pain sensitivity affects postoperative pain intensity and can be considered as a risk factor for postoperative pain. MATERIALS AND METHODS: After obtaining informed consent 162 patients were enrolled in the study. Subjective pain sensitivity was assessed prior to surgery by using the PSQ. With respect to the results patients were classified into one of three groups (low, medium and high pain sensitivity). Primary outcome was postoperative pain intensity measured by numerical rating scales (NRS) on the first and second days after surgery. Other variables concerned administration of analgesics and patient satisfaction. The psychological control variables stress coping (SVF-48) as well as depression and anxiety (HADS-D) were also examined using the appropriate questionnaire. RESULTS: Patients with high pain sensitivity reported significantly higher postoperative pain than patients with low pain sensitivity. This result remained significant considering negative coping styles as a covariate. Patients with high pain sensitivity reported a stronger increase of pain intensity from resting in bed to moving in bed (effect size= 1.17) as compared to patients with low pain sensitivity (effect size= 0.77). Stronger pain (NRS > 4) was reported significantly more often by patients with high pain sensitivity. Furthermore, the patient group with low pain sensitivity reported the highest satisfaction with their own health recovery. CONCLUSIONS: Subjective pain sensitivity can easily be measured by the PSQ and is a risk factor for postoperative pain intensity.

Asunto(s)

Autoevaluación Diagnóstica , Dimensión del Dolor/métodos , Umbral del Dolor , Dolor Postoperatorio/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Umbral del Dolor/efectos de los fármacos , Dolor Postoperatorio/clasificación , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/psicología , Satisfacción del Paciente , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

BACKGROUND: Iatrogenic colon perforation is a rare but life-threatening complication of colonscopy. As in other diseases, laparoscopic treatment has increasingly been propagated for the treatment of colonic disorders in the last years. The aim of this comparative study was to answer the question of whether laparoscopic surgical treatment may serve as a suitable treatment for the acute colon perforation comparable to open surgery. PATIENTS AND METHODS: The data of all patients who underwent surgery for iatrogenic colon perforation within a 13-year time period (1997-2009) were recorded prospectively and analysed retrospectively with regard to different perioperative parameters. In the following analysis the laparoscopically and open surgically treated patients were compared. RESULTS: In the observation period 24 patients with iatrogenic colon perforation were treated laparoscopically and 12 patients with open surgery. There were no significant differences concerning age in both groups. In both groups resection of the affected region was preferred [open surgically: 58 % (n = 7), laparoscopically: 80 % (n = 19)]. The median operation time was 105 min (range: 35 - 180) for the open surgically treated patients and 165 min (90 - 420) for laparoscopic procedures (p = 0.006). In 4 cases of the laparoscopic group a conversion via laparotomy was -necessary. There was no significant difference concerning the hospital stay between both groups with 14.5 days (7-40) for the open surgical and 11 days (7-25) for the laparoscopic group. Concerning the postoperative morbidity a significantly higher incidence could be seen in the open surgical group (p < 0.0001). CONCLUSION: An iatrogenic colon perforation mostly leeds to the immediate indication for a surgical treatment. The morbidity and mortality is -primarily determined through the appearance of postoperative complications due to delays in diagnostics and treatment. In this study the feasibility of a laparoscopic treatment could be shown. The laparoscopy with its minimal access trauma offers an enlargement of the diagnostics as well as a safe treatment of the perforation in most patients. However, the laparoscopic treatment especially in emergancy situations requires -advanced experience of the surgeon and always needs a critical benefit-risk consideration in the individual situation.

Asunto(s)

Colon/lesiones , Colonoscopía/efectos adversos , Enfermedad Iatrogénica , Perforación Intestinal/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica , Conversión a Cirugía Abierta , Estudios Transversales , Diagnóstico Tardío , Estudios de Factibilidad , Femenino , Alemania , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/mortalidad , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Análisis de Supervivencia

RESUMEN

BACKGROUND: In obstructive defecation syndrome (ODS) combinations of morphologic alterations of the pelvic floor and the colorectum are nearly always evident. Laparoscopic resection rectopexy (LRR) aims at restoring physiological function. We present the results of 19 years of experience with this procedure in patients with ODS. METHODS: Between 1993 and 2012, 264 patients underwent LRR for ODS at our department. Perioperative and follow-up data were analyzed. RESULTS: The female/male ratio was 25.4:1, mean age was 61.3 years (±14.3 years), and mean body mass index (BMI) was 25.2 kg/m(2) (±4.2 kg/m(2)). The pathological conditions most frequently found in combination were a sigmoidocele plus a rectocele (n = 79) and a sigmoidocele plus a rectal prolapse or intussusception (n = 69). The conversion rate was 2.3 % (n = 6). The mortality rate was 0.75 % (n = 2), the rate of complications requiring surgical re-intervention was 4.3 % (n = 11), and the rate of minor complications was 19.8 % (n = 51). Follow-up data were available for 161 patients with a mean follow-up of 58.2 months (±47.1 months). Long-term results showed that 79.5 % of patients (n = 128) reported at least an improvement of symptoms. In cases of a sigmoidocele (n = 63 available for follow-up) or a rectal prolapse II°/III° (n = 72 available for follow-up), the improvement rates were 79.4 % (n = 50) and 81.9 % (n = 59), respectively. CONCLUSIONS: LRR is a safe and effective procedure. Our perioperative results and long-term functional outcome strengthen the evidence regarding benefits of LRR in patients with an outlet obstruction. However, careful patient selection is essential.

Asunto(s)

Estreñimiento/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Recto/cirugía , Anciano , Algoritmos , Enfermedad Crónica , Comorbilidad , Estreñimiento/epidemiología , Estreñimiento/fisiopatología , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Recuperación de la Función , Prolapso Rectal/cirugía , Rectocele/epidemiología , Recto/fisiopatología , Técnicas de Sutura , Síndrome , Resultado del Tratamiento

RESUMEN

Skin and soft tissue infections are among the most common diseases requiring surgical treatment. The presentation of patients varies from folliculitis to severe necrotizing infections with a fatal outcome. The diagnosis of a necrotizing infection is often difficult. The correct diagnosis is often made after deterioration of the patient's condition in the rapid course of the disease. The early and correct diagnosis and immediate surgery are decisive for the prognosis. Treatment at a specialized intensive care unit and the administration of a broad spectrum antibiotic are pivotal for the survival of individual patients.

Asunto(s)

Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/cirugía , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/cirugía , Tejido Conectivo/patología , Diagnóstico Diferencial , Diagnóstico Precoz , Intervención Médica Temprana , Erisipela/diagnóstico , Erisipela/cirugía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/cirugía , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/cirugía , Humanos , Miositis/diagnóstico , Miositis/cirugía , Necrosis , Pronóstico , Piel/patología

RESUMEN

INTRODUCTION: The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis. MATERIAL AND METHODS: Between 1 / 2000 and 1 / 2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data. RESULTS: In a timespan of ten years 36 patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n = 21) and earlier surgical measures (n = 6). Moreover tumour-associated fistulas (n = 5) and fistulas with unknown genesis (n = 4) were seen. As surgical techniques anterior resection (n = 21), transrectal flap plasty (n = 7), subtotal colectomy (n = 3), pelvine exenteration (n = 2) and rectal exstirpation (n = 1) were used. The closure of the vaginal lesion was performed by single suture (n = 25), flap plasty (n = 6), transvaginal omental plasty (n = 2) and posterior vaginal plasty (n = 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12 months (6 - 36). Within this timespan 6 patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n = 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence). CONCLUSION: The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept.

Asunto(s)

Fístula Rectovaginal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colectomía , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/patología , Colitis Ulcerosa/cirugía , Conducta Cooperativa , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/patología , Diverticulitis del Colon/cirugía , Femenino , Humanos , Ileostomía/métodos , Comunicación Interdisciplinaria , Persona de Mediana Edad , Estadificación de Neoplasias , Epiplón/cirugía , Exenteración Pélvica , Perineo/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Proctoscopía , Pronóstico , Neoplasias del Recto/complicaciones , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Fístula Rectovaginal/diagnóstico , Fístula Rectovaginal/etiología , Recto/patología , Recto/cirugía , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Mallas Quirúrgicas , Vagina/cirugía , Neoplasias Vaginales/complicaciones , Neoplasias Vaginales/patología , Neoplasias Vaginales/cirugía

RESUMEN

BACKGROUND: The initial manifestation of Crohn's disease is often located within the terminal ileum. Other portions of the G.I. tract may be affected, however, as the disease involves the entire organ system. The disease often progresses chronically in flares and remissions and involves all layers of the intestinal wall, leading to strictures, stenosis and fistulas. These complications should only be treated surgically when clinically relevant in order to prevent acute exacerbations. METHODS: Laparoscopic surgery offers one the possibility to minimize surgical trauma with its very small incisions and proper dissection through the correct anatomical layers with 10-fold optic magnification. RESULTS: Multifocal procedures can be carried out in the same operation. We present the case of a 26-year-old female with terminal ileum stenosis and gastric outlet obstruction, who underwent simultaneous laparoscopic pyloroplasty and ileocecal resection. DISCUSSION: Providing the surgeon possesses the necessary expertise, complex laparoscopic simultaneous procedures.

Asunto(s)

Ciego/cirugía , Enfermedad de Crohn/cirugía , Obstrucción de la Salida Gástrica/cirugía , Íleon/cirugía , Laparoscopía , Píloro/cirugía , Adulto , Enfermedad de Crohn/complicaciones , Femenino , Obstrucción de la Salida Gástrica/complicaciones , Humanos

RESUMEN

BACKGROUND: New findings on immunological und haematological functions of the spleen, the postoperative risks following splenectomy, as well as improved surgical techniques resulted in an increased interest in organ preservative surgery after traumatic spleen injury in recent years. MATERIAL AND METHODS: The data of all patients who underwent surgery for traumatic spleen injuries between 1995-2009 were recorded prospectively and analysed concerning type of operation, intra-and postoperative complications and the postoperative course. RESULTS: A total of 214 patients with splenic trauma underwent surgery. The spleen could be preserved in 80 patients (37.4%, group 1), using thermocoagulation, suture, glue sealant, splenorhaphy and partial spleen resection or combined techniques. 4 of those patients (5%) required a revision operation, in which two spleens could be salvaged by application of glue sealant. Eight of the patients of group 1 could be treated laparoscopically (10%). CONCLUSION: Under consideration of the surgical segment anatomy of the spleen and the surgical techniques presented, organ preservation is possible with high success rates, even in patients with severe splenic damage. In stable patients with minor splenic injury, laparoscopic or conservative treatment can be considered. Splenectomy should be reserved for patients with complete shattering of the spleen or instable patients.

Asunto(s)

Bazo/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bazo/patología , Bazo/cirugía , Esplenectomía , Adhesivos Tisulares , Heridas no Penetrantes/patología , Heridas no Penetrantes/cirugía , Adulto Joven

RESUMEN

The development of polymers with different surface properties and surface modifications of intraocular lenses (IOL) should reduce foreign body reactions after implantation by reducing the surface hydrophobicity of the lenses. It was examined how far such surface variations influenced the adhesiveness of bacteria. The most common organism isolated from cases of postoperative endophthalmitis is Staphylococcus epidermidis. For this reason, three strains of this species, the type strain ATCC 14990 and two clinical isolates (8687, 6579 I), with different hydrophobic surfaces, were studied. IOL made of PMMA, silicone, and a copolymer as well as PMMA lenses with modified surfaces (unpolished, polished, silanized, and heparinized) were used. Bacteria were radiolabelled with 3H-thymidine and the adherent bacteria were calculated per mm2 of lens surface. The three strains adhered better to the unpolished surface of silicone than to PMMA. Treatment of PMMA surface by polishing diminished the differences between the strains. An influence of hydrophobic interactions on the adherence of S. epidermidis ATCC 14990 was demonstrated. The adherence of this hydrophobic type strain was clearly reduced by heparinization of the PMMA surface. In contrast, the hydrophilic catheter isolate 6579 I adhered better to modified surfaces. This strain differed clearly in its PFGE pattern from both hydrophobic strains. Hydrophobic interactions play a role in the bacterial adherence to intraocular lenses in vitro and in vivo. Modifications of polymer surfaces, however, can result in rather different effects depending on the bacterial surface composition and properties.

Asunto(s)

Adhesión Bacteriana/fisiología , Lentes Intraoculares , Staphylococcus epidermidis/fisiología , Adhesión Bacteriana/genética , Electroforesis en Gel de Campo Pulsado , Polimetil Metacrilato/análisis , Siliconas/análisis , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/aislamiento & purificación , Propiedades de Superficie

RESUMEN

BACKGROUND: A major goal in research on intraocular lenses (IOL) is the development of new polymers and modifications to reduce foreign-body reactions after implantation. This effect may be achieved by a reduction in the surface hydrophobicity of the polymers. To illustrate the influence of surface modifications on bacterial adhesiveness, the most often isolated organism in "low-grade" postoperative endophthalmitis, Staphylococcus epidermidis, was used. MATERIALS AND METHODS: For this reason three strains of this species, the type strain ATCC 14990 and two clinical isolates (8687, 6579 I) with different hydrophobic surface properties were studied. IOL, used in the experiments were either made of PMMA or silicone with modified surfaces (unpolished, polished, heparinized). The adhesiveness of H3-thymidin-labeled bacteria was calculated/mm2 of lens surface. Each experiment was performed in triplicate and repeated three times. RESULTS: The hydrophobic-type strain showed stronger adherence to unpolished PMMA surface (8000 bacteria per mm2) compared to the polished (5200 bacteria/mm2). In contrast, the hydrophilic strain adhered with 2000 bacteria/mm2 to the unpolished and with 4200 bacteria/mm2 to the polished surface. Polishing PMMA lenses diminished the differences between the three strains. However, surface passivation of silicone lenses increased the adhesion rate of the hydrophilic strain up to 9600 bacteria/mm2. Treatment of PMMA lenses with heparin increased the adhesiveness of the hydrophilic strain and reduced the adhesion rate of the hydrophobic type strain to 250 bacteria/mm2. CONCLUSIONS: It was demonstrated that bacterial adherence to IOL also involves hydrophobic interactions. Obviously, however, that adherence reflects a complex of interactions between the two surfaces.

Asunto(s)

Adhesión Bacteriana/fisiología , Lentes Intraoculares/microbiología , Staphylococcus epidermidis/fisiología , Endoftalmitis/microbiología , Humanos , Polimetil Metacrilato , Diseño de Prótesis , Elastómeros de Silicona , Propiedades de Superficie , Infección de la Herida Quirúrgica/microbiología