{"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}
Michael Brinkers, Mandy Istel, Moritz Kretzschmar, Giselher Pfau, Frank Meyer
Abstract Objectives The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (−/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course. Methods In 2017, all consecutive new admissions to a normal ward of general surgery at a university hospital (“tertiary center”) were monitored over half a year according to a standardized procedure. Pain severity (measured by the “Numeric rating scale” [NRS] respectively “Visual analogue scale” [VAS]) from admission to discharge was recorded, as well as the length of stay and the administered medication. Patient groups were sub-classified as surgery, intensive care unit, cancer and pain consultation. An algorithm in two parts (part 1, antipyretics and piritramide; part 2, WHO-scheme and psychotropic drugs), which was defined years before between surgeons and pain therapists, was pursued and consequently used as a basis for the evaluation of the therapeutic success. Results 269 patients were included in the study. The mean pain intensity of all patients at admission was VAS 2.2. Most of the groups (non-cancer, intensive care unit [ICU], non-ICU, surgical intervention (=Operation [OP]), non-OP, pain intensity greater than VAS 3) were significantly reduced in pain at discharge. An exception in this context was patients with cancer-associated pain and, thus, initiated pain consultation. Conclusions Since three quarters of the consultation patients also reported cancer pain, it might be possible that the lack of treatment success in both the consultation and cancer groups is associated with cancer in these patients. However, it can be shown that the successfully treated groups (without ICU-based course) had a mean length of stay from 4.2 ± 3.9 up to 8.4 ± 8.1 days (d), while the two unsuccessfully treated groups experienced a longer stay (mean “cancer” , 11.1 ± 9.4 d; mean “consulation” , 14.2 ± 10.3 d). Twenty-one consultation patients, in whom it had been intended to improve pain intensity, could not be successfully treated despite adapted therapy – this can be considered a consequence of the low number of patients. Since the consultation patients were the only patient group treated with part 2 of the algorithm, it can be concluded that part 1 of the algorithm is sufficient for a mean length of stay up to 9 days. For all patients above this time point, a pain consultation with adaption of medical treatment sh
{"title":"Status of inpatient pain therapy using the example of a general and abdominal surgery normal ward – a prospective questionnaire study to review a pain therapy algorithm (“real-world data”)","authors":"Michael Brinkers, Mandy Istel, Moritz Kretzschmar, Giselher Pfau, Frank Meyer","doi":"10.1515/iss-2023-0016","DOIUrl":"https://doi.org/10.1515/iss-2023-0016","url":null,"abstract":"Abstract Objectives The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (−/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course. Methods In 2017, all consecutive new admissions to a normal ward of general surgery at a university hospital (“tertiary center”) were monitored over half a year according to a standardized procedure. Pain severity (measured by the “Numeric rating scale” [NRS] respectively “Visual analogue scale” [VAS]) from admission to discharge was recorded, as well as the length of stay and the administered medication. Patient groups were sub-classified as surgery, intensive care unit, cancer and pain consultation. An algorithm in two parts (part 1, antipyretics and piritramide; part 2, WHO-scheme and psychotropic drugs), which was defined years before between surgeons and pain therapists, was pursued and consequently used as a basis for the evaluation of the therapeutic success. Results 269 patients were included in the study. The mean pain intensity of all patients at admission was VAS 2.2. Most of the groups (non-cancer, intensive care unit [ICU], non-ICU, surgical intervention (=Operation [OP]), non-OP, pain intensity greater than VAS 3) were significantly reduced in pain at discharge. An exception in this context was patients with cancer-associated pain and, thus, initiated pain consultation. Conclusions Since three quarters of the consultation patients also reported cancer pain, it might be possible that the lack of treatment success in both the consultation and cancer groups is associated with cancer in these patients. However, it can be shown that the successfully treated groups (without ICU-based course) had a mean length of stay from 4.2 ± 3.9 up to 8.4 ± 8.1 days (d), while the two unsuccessfully treated groups experienced a longer stay (mean “cancer” , 11.1 ± 9.4 d; mean “consulation” , 14.2 ± 10.3 d). Twenty-one consultation patients, in whom it had been intended to improve pain intensity, could not be successfully treated despite adapted therapy – this can be considered a consequence of the low number of patients. Since the consultation patients were the only patient group treated with part 2 of the algorithm, it can be concluded that part 1 of the algorithm is sufficient for a mean length of stay up to 9 days. For all patients above this time point, a pain consultation with adaption of medical treatment sh","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134948262","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":"Computer assistance in modern craniomaxillofacial surgery","authors":"Nils-Claudius Gellrich, Michael Ehrenfeld","doi":"10.1515/iss-2023-2002","DOIUrl":"https://doi.org/10.1515/iss-2023-2002","url":null,"abstract":"","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385879","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}
Abstract Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surg
{"title":"Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?","authors":"Armin Kraus, Hans-Georg Damert, Frank Meyer","doi":"10.1515/iss-2023-0042","DOIUrl":"https://doi.org/10.1515/iss-2023-0042","url":null,"abstract":"Abstract Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surg","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136129513","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}
Abstract Objectives Heat stroke is a serious condition that might lead from moderate organ impairment to multiple organ dysfunction syndrome. Appropriate diagnosis-finding, fast initiation of cooling and intensive care are key measures of the initial treatment. Scientific case report based on i) clinical experiences obtained in the clinical management of a particularly rare case and ii) selected references from the medical scientific literature. Case presentation We present a case of a young and healthy construction worker who suffered from an exertional heat stroke with a body core temperature exceeding 42 °C by previous several hour work at 35 °C ambient temperature. Heat stroke was associated with foudroyant, not reversible multiple organ dysfunction syndrome, in particular, early disturbed coagulation, microcirculatory, liver and respiratory failure, and subsequent fatal outcome despite immediate diagnosis-finding, rapid external cooling and expanded intensive care management. Conclusions Basic knowledge on an adequate diagnosis(-finding in time) and treatment of heat stroke is important for (almost each) physician in the summertime as well as is essential for the initiation of an appropriate management. Associated high morbidity and mortality rates indicate the need for implementation of standard operation protocols.
{"title":"Fatal heat stroke based on foudroyant irreversible multiple organ dysfunction in German summer","authors":"Eric Lorenz, Joerg Herold, Uwe Lodes, Frank Meyer","doi":"10.1515/iss-2023-0013","DOIUrl":"https://doi.org/10.1515/iss-2023-0013","url":null,"abstract":"Abstract Objectives Heat stroke is a serious condition that might lead from moderate organ impairment to multiple organ dysfunction syndrome. Appropriate diagnosis-finding, fast initiation of cooling and intensive care are key measures of the initial treatment. Scientific case report based on i) clinical experiences obtained in the clinical management of a particularly rare case and ii) selected references from the medical scientific literature. Case presentation We present a case of a young and healthy construction worker who suffered from an exertional heat stroke with a body core temperature exceeding 42 °C by previous several hour work at 35 °C ambient temperature. Heat stroke was associated with foudroyant, not reversible multiple organ dysfunction syndrome, in particular, early disturbed coagulation, microcirculatory, liver and respiratory failure, and subsequent fatal outcome despite immediate diagnosis-finding, rapid external cooling and expanded intensive care management. Conclusions Basic knowledge on an adequate diagnosis(-finding in time) and treatment of heat stroke is important for (almost each) physician in the summertime as well as is essential for the initiation of an appropriate management. Associated high morbidity and mortality rates indicate the need for implementation of standard operation protocols.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135010793","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：