Abstract Objectives The gold standard for the treatment of pathologies of the aortic arch remains the open surgical reconstruction of the affected segments. However, endovas-cular treatment options have emerged that eliminate the need for invasive open surgery. Several endograft devices – with fenestrations or branches for the supraaortic vessels – are currently available to address different pathologies and anatomical variations. Parallel-graft techniques and in situ fenestrations expand the treatment options for emergent cases. In this selective review of the literature of 2020 and 2021, we summarize the current chances and challenges of endovascular aortic repair. Content Reported mortality rates range from 0 to 13.2 %. Although technical success rates for fenestrated and branched devices are promising (98 %), stroke rates remain a relevant issue (10 and 3 % for BTEVAR and FTEVAR respectively). The reported technical success rate for in situ fenestrations is also encouraging (94 %) and the stroke rates acceptable (5 %). Parallel-graft techniques are associated with high early and late endoleak rates (early 76 %; late 31 %), but still hold a valuable place in the treatment of emergent cases or in bail-out situations. Summary and Outlook The endovascular repair of the aortic arch expands the range of patients with pathologies of the arch eligible for treatment to those unfit for open surgery offering a minimally invasive, yet technically challenging procedure. More data and meta-analyses are needed to define the benefits and drawbacks of this promising treatment option in an aging population with increasing co-morbidities.
{"title":"Endovascular repair of the aortic arch","authors":"Florian Kursch, Panagiotis Doukas","doi":"10.1515/iss-2023-0029","DOIUrl":"https://doi.org/10.1515/iss-2023-0029","url":null,"abstract":"Abstract Objectives The gold standard for the treatment of pathologies of the aortic arch remains the open surgical reconstruction of the affected segments. However, endovas-cular treatment options have emerged that eliminate the need for invasive open surgery. Several endograft devices – with fenestrations or branches for the supraaortic vessels – are currently available to address different pathologies and anatomical variations. Parallel-graft techniques and in situ fenestrations expand the treatment options for emergent cases. In this selective review of the literature of 2020 and 2021, we summarize the current chances and challenges of endovascular aortic repair. Content Reported mortality rates range from 0 to 13.2 %. Although technical success rates for fenestrated and branched devices are promising (98 %), stroke rates remain a relevant issue (10 and 3 % for BTEVAR and FTEVAR respectively). The reported technical success rate for in situ fenestrations is also encouraging (94 %) and the stroke rates acceptable (5 %). Parallel-graft techniques are associated with high early and late endoleak rates (early 76 %; late 31 %), but still hold a valuable place in the treatment of emergent cases or in bail-out situations. Summary and Outlook The endovascular repair of the aortic arch expands the range of patients with pathologies of the arch eligible for treatment to those unfit for open surgery offering a minimally invasive, yet technically challenging procedure. More data and meta-analyses are needed to define the benefits and drawbacks of this promising treatment option in an aging population with increasing co-morbidities.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"25 ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139172810","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}
Pub Date : 2023-12-06eCollection Date: 2023-09-01DOI: 10.1515/iss-2021-0045
Florian Andreas Probst, Paris Liokatis, Gerson Mast, Michael Ehrenfeld
In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.
{"title":"Virtual planning for mandible resection and reconstruction.","authors":"Florian Andreas Probst, Paris Liokatis, Gerson Mast, Michael Ehrenfeld","doi":"10.1515/iss-2021-0045","DOIUrl":"https://doi.org/10.1515/iss-2021-0045","url":null,"abstract":"<p><p>In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 3","pages":"137-148"},"PeriodicalIF":1.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10709695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811176","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}
Yasmin Youssef, Anna K. I. M. Dietrich, Annika Hättich
Abstract Objectives Proximal femur fractures (PFF) are common injuries in elderly patients and can have considerable effects on their quality of life, morbidity, and mortality. Due to pre-existing comorbidities, the prevalence of anticoagulated patients is increasing. The right timing for surgery and perioperative anticoagulation treatment remains controversial. Content This overview aims to summarize current practices in the pre- and postoperative anticoagulation management and the recommended time to surgery in elderly patients with PFF. Summary and Outlook Time to surgery for anticoagulated patients is often prolonged due to worries about serious perioperative bleeding and higher transfusion demands. But the delay of surgical PFF treatment increases the risk for perioperative complications like pulmonary embolism, pneumonia, deep vein thrombosis and urinary tract infections. Early surgery can be achieved with a consistent and interdisciplinary perioperative anticoagulation management. Antiplatelets do not have to be discontinued and surgery should be performed early without delay. For patients taking vitamin K antagonists (VKA) an INR less than 1.5 is recommended prior to surgery, which can be achieved by pausing VKA intake or by administering vitamin K, prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). For the treatment with direct oral anticoagulants (DOAC) a plasma drug level of under 50 pg/mL is considered safe for surgery. If the plasma level can not be determined, a gap of 24 h between the last DOAC dose and surgery is recommended. The systemic administration of tranexamic acid can reduce overall blood loss and transfusion rates in anticoagulated patients with PFF. Surgical treatment of PFF should be performed within 24 h, as delayed surgery increases the risk for perioperative complications. This also applies to anticoagulated patients, when clinically appropriate. International and interdisciplinary guidelines are necessary to ensure early and appropriate treatment of anticoagulated elderly patients with PFF.
{"title":"Anticoagulation management in elderly patients with proximal femur fractures – overview of current concepts","authors":"Yasmin Youssef, Anna K. I. M. Dietrich, Annika Hättich","doi":"10.1515/iss-2023-0030","DOIUrl":"https://doi.org/10.1515/iss-2023-0030","url":null,"abstract":"Abstract Objectives Proximal femur fractures (PFF) are common injuries in elderly patients and can have considerable effects on their quality of life, morbidity, and mortality. Due to pre-existing comorbidities, the prevalence of anticoagulated patients is increasing. The right timing for surgery and perioperative anticoagulation treatment remains controversial. Content This overview aims to summarize current practices in the pre- and postoperative anticoagulation management and the recommended time to surgery in elderly patients with PFF. Summary and Outlook Time to surgery for anticoagulated patients is often prolonged due to worries about serious perioperative bleeding and higher transfusion demands. But the delay of surgical PFF treatment increases the risk for perioperative complications like pulmonary embolism, pneumonia, deep vein thrombosis and urinary tract infections. Early surgery can be achieved with a consistent and interdisciplinary perioperative anticoagulation management. Antiplatelets do not have to be discontinued and surgery should be performed early without delay. For patients taking vitamin K antagonists (VKA) an INR less than 1.5 is recommended prior to surgery, which can be achieved by pausing VKA intake or by administering vitamin K, prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). For the treatment with direct oral anticoagulants (DOAC) a plasma drug level of under 50 pg/mL is considered safe for surgery. If the plasma level can not be determined, a gap of 24 h between the last DOAC dose and surgery is recommended. The systemic administration of tranexamic acid can reduce overall blood loss and transfusion rates in anticoagulated patients with PFF. Surgical treatment of PFF should be performed within 24 h, as delayed surgery increases the risk for perioperative complications. This also applies to anticoagulated patients, when clinically appropriate. International and interdisciplinary guidelines are necessary to ensure early and appropriate treatment of anticoagulated elderly patients with PFF.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"63 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138600723","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}
Pub Date : 2023-11-27eCollection Date: 2023-06-01DOI: 10.1515/iss-2023-0027
Michael Arndt, Hans Lippert, Roland S Croner, Frank Meyer, Ronny Otto, Karsten Ridwelski
<p><strong>Objectives: </strong>In the surgical treatment of colorectal carcinoma (CRC), 1 in 10 patients has a peritumorous adhesion or tumor infiltration in the adjacent tissue or organs. Accordingly, multivisceral resection (MVR) must be performed in these patients. This prospective multicenter observational study aimed to analyze the possible differences between non-multivisceral resection (nMVR) and MVR in terms of early postoperative and long-term oncological treatment outcomes. We also aimed to determine the factors influencing overall survival.</p><p><strong>Methods: </strong>The data of 25,321 patients from 364 hospitals who had undergone surgery for CRC (the Union for International Cancer Control stages I-III) during a defined period were evaluated. MVR was defined as (partial) resection of the tumor-bearing organ along with resection of the adherent and adjacent organs or tissues. In addition to the patients' personal, diagnosis (tumor findings), and therapy data, demographic data were also recorded and the early postoperative outcome was determined. Furthermore, the long-term survival of each patient was investigated, and a "matched-pair" analysis was performed.</p><p><strong>Results: </strong>From 2008 to 2015, the MVR rates were 9.9 % (n=1,551) for colon cancer (colon CA) and 10.6 % (n=1,027) for rectal cancer (rectal CA). CRC was more common in men (colon CA: 53.4 %; rectal CA: 62.0 %) than in women; all MVR groups had high proportions of women (53.6 % vs. 55.2 %; pairs of values in previously mentioned order). Resection of another organ frequently occurred (75.6 % vs. 63.7 %). The MVR group had a high prevalence of intraoperative (5.8 %; 12.1 %) and postoperative surgical complications (30.8 % vs. 36.4 %; each p<0.001). Wound infections (colon CA: 7.1 %) and anastomotic insufficiencies (rectal CA: 8.3 %) frequently occurred after MVR. The morbidity rates of the MVR groups were also determined (43.7 % vs. 47.2 %). The hospital mortality rates were 4.9 % in the colon CA-related MVR group and 3.8 % in the rectal CA-related MVR group and were significantly increased compared with those of the nMVR group (both p<0.001). Results of the matched-pair analysis showed that the morbidity rates in both MVR groups (colon CA: 42.9 % vs. 34.3 %; rectal CA: 46.3 % vs. 37.2 %; each p<0.001) were significantly increased. The hospital lethality rate tended to increase in the colon CA-related MVR group (4.8 % vs. 3.7 %; p=0.084), while it significantly increased in the rectal CA-related MVR group (3.4 % vs. 3.0 %; p=0.005). Moreover, the 5-year (yr) overall survival rates were 53.9 % (nMVR: 69.5 %; p<0.001) in the colon CA group and 56.8 % (nMVR: 69.4 %; p<0.001) in the rectal CA group. Comparison of individual T stages (MVR vs. nMVR) showed no significant differences in the survival outcomes (p<0.05); however, according to the matched-pair analysis, a significant difference was observed in the survival outcomes of those with pT4 colon CA (40.6 % vs.
目的:在结直肠癌(CRC)的手术治疗中，每10例患者中就有1例存在瘤周粘连或肿瘤浸润邻近组织或器官。因此，这些患者必须进行多脏器切除(MVR)。本前瞻性多中心观察性研究旨在分析非多脏器切除(nMVR)和MVR在术后早期和长期肿瘤治疗结果方面可能存在的差异。我们还旨在确定影响总生存率的因素。方法:对来自364家医院的25321例CRC手术患者(国际癌症控制联盟I-III期)的数据进行评估。MVR的定义是(部分)切除荷瘤器官，同时切除附着和邻近的器官或组织。除了患者的个人、诊断(肿瘤发现)和治疗数据外，还记录了人口统计学数据，并确定了术后早期结局。此外，对每位患者的长期生存进行了调查，并进行了“配对”分析。结果:2008 - 2015年，结肠癌(结肠CA)的MVR率为9.9 % (n= 1551)，直肠癌(直肠CA)的MVR率为10.6 % (n= 1027)。结直肠癌在男性中更为常见(结肠CA: 53.4% %;直肠CA: 62.0 %)高于女性;所有MVR组的女性比例都很高(53.6 % vs. 55.2% %;按前面提到的顺序排列的值对)。另一器官的切除经常发生(75.6% % vs. 63.7 %)。MVR组术中发生率高(5.8% %;12.1 %)和术后手术并发症(30.8 % vs 36.4 %;每个p0.05)。两种肿瘤类型的共同危险因素为高龄(>79 yr)、pT分期、性别和发病率(各危险比>1;结论:MVR可以通过R0切除进行治疗，并有足够的长期生存。对于结肠或直肠CA, MVR往往与5年总生存率降低相关(基于MPA结果，仅pT4结肠CA显著)，并且两种肿瘤实体的发病率均显著增加。在总体数据中，配对分析表明，MVR与医院死亡率的显著增加相关(仅对直肠CA有显著性)。
{"title":"Multivisceral resection of advanced colon and rectal cancer: a prospective multicenter observational study with propensity score analysis of the morbidity, mortality, and survival.","authors":"Michael Arndt, Hans Lippert, Roland S Croner, Frank Meyer, Ronny Otto, Karsten Ridwelski","doi":"10.1515/iss-2023-0027","DOIUrl":"10.1515/iss-2023-0027","url":null,"abstract":"<p><strong>Objectives: </strong>In the surgical treatment of colorectal carcinoma (CRC), 1 in 10 patients has a peritumorous adhesion or tumor infiltration in the adjacent tissue or organs. Accordingly, multivisceral resection (MVR) must be performed in these patients. This prospective multicenter observational study aimed to analyze the possible differences between non-multivisceral resection (nMVR) and MVR in terms of early postoperative and long-term oncological treatment outcomes. We also aimed to determine the factors influencing overall survival.</p><p><strong>Methods: </strong>The data of 25,321 patients from 364 hospitals who had undergone surgery for CRC (the Union for International Cancer Control stages I-III) during a defined period were evaluated. MVR was defined as (partial) resection of the tumor-bearing organ along with resection of the adherent and adjacent organs or tissues. In addition to the patients' personal, diagnosis (tumor findings), and therapy data, demographic data were also recorded and the early postoperative outcome was determined. Furthermore, the long-term survival of each patient was investigated, and a \"matched-pair\" analysis was performed.</p><p><strong>Results: </strong>From 2008 to 2015, the MVR rates were 9.9 % (n=1,551) for colon cancer (colon CA) and 10.6 % (n=1,027) for rectal cancer (rectal CA). CRC was more common in men (colon CA: 53.4 %; rectal CA: 62.0 %) than in women; all MVR groups had high proportions of women (53.6 % vs. 55.2 %; pairs of values in previously mentioned order). Resection of another organ frequently occurred (75.6 % vs. 63.7 %). The MVR group had a high prevalence of intraoperative (5.8 %; 12.1 %) and postoperative surgical complications (30.8 % vs. 36.4 %; each p<0.001). Wound infections (colon CA: 7.1 %) and anastomotic insufficiencies (rectal CA: 8.3 %) frequently occurred after MVR. The morbidity rates of the MVR groups were also determined (43.7 % vs. 47.2 %). The hospital mortality rates were 4.9 % in the colon CA-related MVR group and 3.8 % in the rectal CA-related MVR group and were significantly increased compared with those of the nMVR group (both p<0.001). Results of the matched-pair analysis showed that the morbidity rates in both MVR groups (colon CA: 42.9 % vs. 34.3 %; rectal CA: 46.3 % vs. 37.2 %; each p<0.001) were significantly increased. The hospital lethality rate tended to increase in the colon CA-related MVR group (4.8 % vs. 3.7 %; p=0.084), while it significantly increased in the rectal CA-related MVR group (3.4 % vs. 3.0 %; p=0.005). Moreover, the 5-year (yr) overall survival rates were 53.9 % (nMVR: 69.5 %; p<0.001) in the colon CA group and 56.8 % (nMVR: 69.4 %; p<0.001) in the rectal CA group. Comparison of individual T stages (MVR vs. nMVR) showed no significant differences in the survival outcomes (p<0.05); however, according to the matched-pair analysis, a significant difference was observed in the survival outcomes of those with pT4 colon CA (40.6 % vs.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 2","pages":"61-72"},"PeriodicalIF":1.3,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500697","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":"Issue on general and abdominal surgery – an exciting and challenging surgical discipline in the spectrum of operative medicine","authors":"Karsten Ridwelski, Frank Meyer","doi":"10.1515/iss-2023-0053","DOIUrl":"https://doi.org/10.1515/iss-2023-0053","url":null,"abstract":"","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"54 39","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134993078","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}
Mihailo Andric, Jessica Stockheim, Mirhasan Rahimli, Michael Klös, Torben Esser, Ivan Soldatovic, Maximilian Dölling, Sara Al-Madhi, Sara Acciuffi, Roland Croner, Aristotelis Perrakis
Abstract Objectives The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg. Methods Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649 days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649 days). Subgroup analysis related to conservative or surgical treatment has been performed. Results A total of 385 patients was included in the study, 203 (52.73 %) during Non-COVID-19 period and 182 (47.27 %) during COVID-19 period. Mean age of entire collective was 43.28 years, containing 43.9 % female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7 % of entire collective), increasing from 9.9 % to 15.9 % during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3 % (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5 % vs. 13.1 %, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3 % (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57 days vs. 3.16 days, p<0.001) and it was given longer in the conservative treatment group (5.63 days vs. 4.26 days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67 days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08 days vs. 4.47 days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2 % vs. 7.7 %, p=0.005) and for conservative therapy compared to appendicectomy (2 % vs. 14.3 %, p=0.016). There was no mortality documented. Conclusions According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine.
摘要目的2019冠状病毒病大流行期间，全球卫生系统意外超载，导致全球急性阑尾炎管理发生变化。尽管保守治疗被广泛推荐，但阑尾切除术仍是德国的标准治疗方法。我们的目的是调查COVID-19大流行对马格德堡大学医院急性阑尾炎治疗常规的影响。方法对临床和(或)影像学诊断为急性阑尾炎的成年患者进行单中心回顾性研究。收集患者人口统计、治疗方式和结果(包括发病率和住院时间)的数据。将2020年3月22日至2021年12月31日(649天)与2018年6月12日至2020年3月21日(649天)的非COVID-19患者数据进行比较。进行了与保守或手术治疗相关的亚组分析。结果共纳入385例患者，其中非COVID-19期203例(52.73%)，COVID-19期182例(47.27%)。患者平均年龄43.28岁，女性占43.9% (p=0.095)。49例患者(占全部患者的12.7%)完成保守治疗，在COVID-19期间从9.9%增加到15.9% (p=0.074)。在COVID-19期间，99.3% (n=152)的手术患者进行了腹腔镜阑尾切除术(p=0.013)，术后并发症较对照组少(23.5% vs 13.1%， p=0.015)。在COVID-19期间，无论采用何种治疗方式，诊断后开始抗生素治疗的比例从37.9%增加到53.3% (p=0.002)。抗生素治疗在大流行期间持续时间较短(5.57天对3.16天，p= 0.001)，保守治疗组持续时间较长(5.63天对4.26天，p=0.02)。总住院时间在新冠肺炎期间较短(4.67天比4.12天，p=0.052)，保守治疗组较短(3.08天比4.47天，p= 0.001)。然而，在COVID-19期间，总发病率低于术前(17.2%比7.7%，p=0.005)，保守治疗低于阑尾切除术(2%比14.3%，p=0.016)。没有死亡记录。结论2019冠状病毒病大流行对急性阑尾炎的治疗有一定影响，但可以维持传统的诊断和治疗途径。尽管腹腔镜阑尾切除术仍然是一种推荐手术，但在潜在的新一波COVID-19大流行期间和日常生活中，对无并发症的阑尾炎进行保守治疗可作为手术的安全替代方法，且短期疗效良好。
{"title":"Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany","authors":"Mihailo Andric, Jessica Stockheim, Mirhasan Rahimli, Michael Klös, Torben Esser, Ivan Soldatovic, Maximilian Dölling, Sara Al-Madhi, Sara Acciuffi, Roland Croner, Aristotelis Perrakis","doi":"10.1515/iss-2022-0021","DOIUrl":"https://doi.org/10.1515/iss-2022-0021","url":null,"abstract":"Abstract Objectives The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg. Methods Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649 days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649 days). Subgroup analysis related to conservative or surgical treatment has been performed. Results A total of 385 patients was included in the study, 203 (52.73 %) during Non-COVID-19 period and 182 (47.27 %) during COVID-19 period. Mean age of entire collective was 43.28 years, containing 43.9 % female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7 % of entire collective), increasing from 9.9 % to 15.9 % during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3 % (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5 % vs. 13.1 %, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3 % (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57 days vs. 3.16 days, p<0.001) and it was given longer in the conservative treatment group (5.63 days vs. 4.26 days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67 days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08 days vs. 4.47 days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2 % vs. 7.7 %, p=0.005) and for conservative therapy compared to appendicectomy (2 % vs. 14.3 %, p=0.016). There was no mortality documented. Conclusions According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"53 28","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134993645","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}
Ellen Hajduk, Frank Meyer, Ronny Otto, Roland Croner, Karsten Ridwelski
Abstract Objectives To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA). Methods All consecutive patients with the histologically diagnosed primary colon CA (design, prospective multicenter observational study) were registered with regard to patient-, diagnostic-, tumor (Tu) finding-, and treatment-related aspects using a computer-based registry with 60 items to characterize early postoperative and long-term oncological outcome. Results Basic data : From 2010 to 2016, data from a total of 14,466 patients were documented (mean age, 72.8 [range, 22–96] years; sex ratio, m:f=7,696:6,770). – 717/14,466 patients (4.96 %) were included in a matched-pair analysis. The majority of these patients underwent elective surgery ( n =12,620 patients; 87.2 %) regardless of whether a bowel anastomosis or an ostomy was created. In emergency surgery, a bowel anastomosis was possible in a large proportion ( n =1,332 patients [72.1 %]). In contrast, in 514 patients (27.9 %) who underwent emergency surgery, an ostomy was created. Interestingly, ostomy had to be created even less frequently in patients who had undergone planned surgery ( n =366 [2.5 %]). – Early postoperative outcome : Cases of postoperative mortality were mainly due to general complications. Especially among the patients treated in an emergency situation without intestinal anastomosis, a high proportion died of their pre-existing condition (17.0 %). Patients who underwent ostomy creation or emergency surgery had a worse risk profile (incl. arterial hypertension, diabetes mellitus, and secondary cardiac or renal diseases) which led to the decision to operate without anastomosis. Furthermore, data show no matter which technique had been used, patients that had undergone surgical intervention without anastomosis were more likely to develop complications. – Long-term oncosurgical outcome : The most important factors influencing long-term survival were age, resection status, and tumor stage (according to TNM and UICC). The more advanced the tumor growth, the lower the long-term survival. Patients categorized with the same tumor stage, age, and risk factors had a better chance of survival, if they underwent elective surgical intervention and with intestinal anastomosis. Interestingly, the multivariable analysis showed that older patients and such with distant metastasis benefit from a discontinuity resection. Conclusions The association of intraoperative and postoperative complications with increased postoperative mortality, as well as preexisting risk factors and perioperative complications is in line with findings of current studies. Furthermore, current studies also agree that older patients and such with reduced general condition benefit from discontinuity resection.
{"title":"Does intestinal anastomosis in resection of colon cancer have a significant impact onto early postoperative outcome and long-term survival?","authors":"Ellen Hajduk, Frank Meyer, Ronny Otto, Roland Croner, Karsten Ridwelski","doi":"10.1515/iss-2023-0026","DOIUrl":"https://doi.org/10.1515/iss-2023-0026","url":null,"abstract":"Abstract Objectives To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA). Methods All consecutive patients with the histologically diagnosed primary colon CA (design, prospective multicenter observational study) were registered with regard to patient-, diagnostic-, tumor (Tu) finding-, and treatment-related aspects using a computer-based registry with 60 items to characterize early postoperative and long-term oncological outcome. Results Basic data : From 2010 to 2016, data from a total of 14,466 patients were documented (mean age, 72.8 [range, 22–96] years; sex ratio, m:f=7,696:6,770). – 717/14,466 patients (4.96 %) were included in a matched-pair analysis. The majority of these patients underwent elective surgery ( n =12,620 patients; 87.2 %) regardless of whether a bowel anastomosis or an ostomy was created. In emergency surgery, a bowel anastomosis was possible in a large proportion ( n =1,332 patients [72.1 %]). In contrast, in 514 patients (27.9 %) who underwent emergency surgery, an ostomy was created. Interestingly, ostomy had to be created even less frequently in patients who had undergone planned surgery ( n =366 [2.5 %]). – Early postoperative outcome : Cases of postoperative mortality were mainly due to general complications. Especially among the patients treated in an emergency situation without intestinal anastomosis, a high proportion died of their pre-existing condition (17.0 %). Patients who underwent ostomy creation or emergency surgery had a worse risk profile (incl. arterial hypertension, diabetes mellitus, and secondary cardiac or renal diseases) which led to the decision to operate without anastomosis. Furthermore, data show no matter which technique had been used, patients that had undergone surgical intervention without anastomosis were more likely to develop complications. – Long-term oncosurgical outcome : The most important factors influencing long-term survival were age, resection status, and tumor stage (according to TNM and UICC). The more advanced the tumor growth, the lower the long-term survival. Patients categorized with the same tumor stage, age, and risk factors had a better chance of survival, if they underwent elective surgical intervention and with intestinal anastomosis. Interestingly, the multivariable analysis showed that older patients and such with distant metastasis benefit from a discontinuity resection. Conclusions The association of intraoperative and postoperative complications with increased postoperative mortality, as well as preexisting risk factors and perioperative complications is in line with findings of current studies. Furthermore, current studies also agree that older patients and such with reduced general condition benefit from discontinuity resection.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"153 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775926","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}
Aristoteles Perrakis, Frank Meyer, Hubert Scheidbach
Abstract Objectives Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal prolapse with colon cancer in an older female patient, (ii) comment on management-specific aspects and (iii) derive some generalizing recommendations by means of a scientific case report and based on the case-specific experiences related to the clinical management and current references from the medical literature. Case presentation A 69-year old female patient with cancer of the sigmoid colon at a manifest rectal prolapse was diagnosed. Literature search (using the data bank of “PubMed”) resulted in only six patients (the majority of them were females) with the coincidence of rectal prolapse and rectal or colon cancer have been reported so far. Conclusions A patient with a manifest rectal prolapse needs always to undergo colonoscopy and – in case of an ulcer – histological investigation of representative biopsies.
{"title":"Complete rectal prolapse presenting with colorectal cancer","authors":"Aristoteles Perrakis, Frank Meyer, Hubert Scheidbach","doi":"10.1515/iss-2023-0014","DOIUrl":"https://doi.org/10.1515/iss-2023-0014","url":null,"abstract":"Abstract Objectives Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal prolapse with colon cancer in an older female patient, (ii) comment on management-specific aspects and (iii) derive some generalizing recommendations by means of a scientific case report and based on the case-specific experiences related to the clinical management and current references from the medical literature. Case presentation A 69-year old female patient with cancer of the sigmoid colon at a manifest rectal prolapse was diagnosed. Literature search (using the data bank of “PubMed”) resulted in only six patients (the majority of them were females) with the coincidence of rectal prolapse and rectal or colon cancer have been reported so far. Conclusions A patient with a manifest rectal prolapse needs always to undergo colonoscopy and – in case of an ulcer – histological investigation of representative biopsies.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"15 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136316986","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}
Adrian Sugar, Peter Evans, Scott Bartlett, Steven Key
Abstract Objectives This article describes the many anomalies within and outside the head and neck of hemifacial microsomia (HFM). Methods The OMENS+ classification system is described with particular reference to the mandibular features classified by Pruzansky and modified by Kaban. The application of virtual surgical planning (VSP) to HFM, largely in children, is described and taken through to aspects indicated in maturity. Results VSP is demonstrated with clinical cases examples in HFM patients for (1) grafts and flaps replacing missing parts of the zygomatic bone, temporo-mandibular joint and mandible, (2) distraction osteogenesis for lengthening of the mandibular ramus, advancement of the mandibular body, widening of the face and simultaneous mid-face and mandibular rotation, (3) implants and correction of microtia for bone anchored ear prostheses, (4) correction of microtia by autogenous ear construction, and (5) end stage rotational bimaxillary osteotomies. Conclusions 3D virtual and physical planning is a valuable adjunct to the treatment of this complex condition.
{"title":"Virtual planning for corrections of hemifacial microsomia","authors":"Adrian Sugar, Peter Evans, Scott Bartlett, Steven Key","doi":"10.1515/iss-2021-0010","DOIUrl":"https://doi.org/10.1515/iss-2021-0010","url":null,"abstract":"Abstract Objectives This article describes the many anomalies within and outside the head and neck of hemifacial microsomia (HFM). Methods The OMENS+ classification system is described with particular reference to the mandibular features classified by Pruzansky and modified by Kaban. The application of virtual surgical planning (VSP) to HFM, largely in children, is described and taken through to aspects indicated in maturity. Results VSP is demonstrated with clinical cases examples in HFM patients for (1) grafts and flaps replacing missing parts of the zygomatic bone, temporo-mandibular joint and mandible, (2) distraction osteogenesis for lengthening of the mandibular ramus, advancement of the mandibular body, widening of the face and simultaneous mid-face and mandibular rotation, (3) implants and correction of microtia for bone anchored ear prostheses, (4) correction of microtia by autogenous ear construction, and (5) end stage rotational bimaxillary osteotomies. Conclusions 3D virtual and physical planning is a valuable adjunct to the treatment of this complex condition.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993350","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}
Pub Date : 2023-10-06eCollection Date: 2023-03-01DOI: 10.1515/iss-2023-0012
Sophie M Eschlböck, Benjamin Weixler, Carl Weidinger, Ioannis Pozios
Objectives: Postoperative entero-enteric intussusception is a rare complication in adult patients with Crohn's disease (CD). The knowledge of this distinct complication and its timely diagnosis and therapy are of utmost importance to prevent fatal intestinal necrosis. There is no consensus about the optimal management of postoperative entero-enteric intussusception, although surgical exploration is widely advised.
Case presentation: In this report we describe an unusual case of postoperative jejuno-jejunal intussusception following small bowel resection in a patient with stricturing CD. Furthermore, this report offers an overview of the available literature and summarizes the best approach and management strategies for adult intussusception associated with CD.
Conclusions: Delay in diagnosis and therapy can lead to life-threatening complications. Early diagnosis and emergent surgical treatment prevent intestinal necrosis and reduce the risk of short bowel syndrome.
{"title":"Postoperative intussusception: a rare but critical complication in adult patients with Crohn's disease - case report and literature review.","authors":"Sophie M Eschlböck, Benjamin Weixler, Carl Weidinger, Ioannis Pozios","doi":"10.1515/iss-2023-0012","DOIUrl":"10.1515/iss-2023-0012","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative entero-enteric intussusception is a rare complication in adult patients with Crohn's disease (CD). The knowledge of this distinct complication and its timely diagnosis and therapy are of utmost importance to prevent fatal intestinal necrosis. There is no consensus about the optimal management of postoperative entero-enteric intussusception, although surgical exploration is widely advised.</p><p><strong>Case presentation: </strong>In this report we describe an unusual case of postoperative jejuno-jejunal intussusception following small bowel resection in a patient with stricturing CD. Furthermore, this report offers an overview of the available literature and summarizes the best approach and management strategies for adult intussusception associated with CD.</p><p><strong>Conclusions: </strong>Delay in diagnosis and therapy can lead to life-threatening complications. Early diagnosis and emergent surgical treatment prevent intestinal necrosis and reduce the risk of short bowel syndrome.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"3-8"},"PeriodicalIF":1.3,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239680","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}
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