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[Ultrafast intraoperative monitoring of parathyroid hormone-Results of a prospective multicenter validation study].
Pub Date : 2025-03-01 Epub Date: 2025-02-14 DOI: 10.1007/s00104-025-02240-z
Elisabeth Maurer, Detlef K Bartsch
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引用次数: 0
[(No) Treatment for people without health insurance coverage : When access to inpatient surgical care is denied]. [(否)为没有医疗保险的人提供治疗:当住院手术治疗被拒绝时]。
Pub Date : 2025-03-01 Epub Date: 2025-02-03 DOI: 10.1007/s00104-024-02234-3
Sarah Alexandra Lang, Carolin Austermann-Grofer, Maria Siwek, Peter Tinnemann, Rebecca Zöllner

Background: For people without health insurance coverage access to healthcare is severely restricted. In large cities such as Frankfurt am Main, parallel structures have emerged to ensure free basic medical care for those affected; however, when inpatient treatment is required the medical infrastructure for people without health insurance is inadequate. This article outlines the importance of access to surgical treatment for people without health insurance and the serious consequences when this access is denied.

Material and method: The Clearing Center 1.0 at the Public Health Authority of Frankfurt am Main and the Elisabeth Street Outpatient Department of the Caritas Association Frankfurt represent two low-threshold outpatient clinics that exist in the city of Frankfurt. The basic structure and function of each clinic are described along with a characterization of the patient populations, including a description of the sociodemographic characteristics. From the total patient collective, three case scenarios are selected as examples and are outlined with respect to (1) social history, (2) access barriers, (3) findings, (4) surgical indications and (5) treatment course.

Results: Patients face complex barriers due to legal restrictions, financial hardships and precarious living conditions. The lack of a funding provider results in necessary surgery not being performed. The consequences are pain, functional limitations and worsening of life-threatening diseases.

Conclusion: Timely surgical care for people without health insurance is essential to maintain health and avoid high follow-up costs. A treatment fund provides a solution. The combination of case management, secure accommodation and raising awareness among professionals helps close care gaps and develop solutions.

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引用次数: 0
[Prognostic value of body composition in oncological visceral surgery]. [肿瘤内脏手术中身体成分的预后价值]。
Pub Date : 2025-03-01 Epub Date: 2024-10-29 DOI: 10.1007/s00104-024-02189-5
Saleem Elhabash, Nils Langhammer, Ulrich Klaus Fetzner, Jan-Robert Kröger, Ioannis Dimopoulos, Nehara Begum, Jan Borggrefe, Berthold Gerdes, Alexey Surov

Screening of nutritional status of cancer patients plays a crucial role in the perioperative management and is mandatory for the certification of oncological centers by the German Cancer Society (DKG). The available screening tools do not differentiate between muscle and adipose tissue. Recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) as well as the automatic picture archiving communication system (PACS) imaging analysis by high performance reconstruction systems have recently enabled a detailed analysis of adipose tissue and muscle quality. Rapidly growing evidence shows that body composition parameters, especially reduced muscle mass, are associated with adverse outcomes in cancer patients and have been reported to negatively affect overall survival (OS), disease-free survival (DFS), toxicity associated with chemotherapy and surgical complications. In this article, we summarize the recent literature and present the clinical influence of body composition in oncological visceral diseases.

癌症患者的营养状况筛查在围手术期管理中起着至关重要的作用,也是德国癌症协会(DKG)认证肿瘤中心的必备条件。现有的筛查工具无法区分肌肉和脂肪组织。最近,计算机断层扫描(CT)和磁共振成像(MRI)技术的进步,以及通过高性能重建系统进行的自动图像存档通信系统(PACS)成像分析,使得对脂肪组织和肌肉质量的详细分析成为可能。越来越多的证据表明,身体成分参数,尤其是肌肉质量的降低,与癌症患者的不良预后有关,并已报道会对总生存期(OS)、无病生存期(DFS)、化疗相关毒性和手术并发症产生负面影响。在本文中,我们总结了近期的文献,并介绍了身体成分对肿瘤内脏疾病的临床影响。
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引用次数: 0
[Patient safety in palliative surgery]. [姑息性手术中的患者安全]。
Pub Date : 2025-03-01 Epub Date: 2025-01-14 DOI: 10.1007/s00104-024-02202-x
Felix O Hofmann, Simon Sirtl, Christian Heiliger, Jens Werner

Palliative surgery aims to improve the quality of life for patients with incurable diseases. This patient group is vulnerable due to the underlying illness, prior treatment and comorbidities, which increase the risk of complications that can negatively impact the course of the disease and quality of life. Palliative surgical interventions often provide effective long-term symptom control but are more invasive than conservative, interventional endoscopic or interventional radiological alternatives. This article exemplary discusses frequent palliative visceral surgical procedures and less invasive alternatives. In practice, a close interdisciplinary collaboration, open and realistic communication, optimized perioperative care and in particular the minimization of cumulative invasiveness are crucial to maximize the quality of life and safety for oncological patients.

姑息手术的目的是改善不治之症患者的生活质量。由于潜在的疾病、先前的治疗和合并症,这一患者群体是脆弱的,这增加了并发症的风险,可能对疾病的进程和生活质量产生负面影响。姑息性手术干预通常提供有效的长期症状控制,但比保守、介入内窥镜或介入放射治疗更具侵入性。这篇文章示范性地讨论了常见的姑息性内脏外科手术和侵入性较小的替代方法。在实践中,密切的跨学科合作,开放和现实的沟通,优化围手术期护理,特别是最小化累积侵入,对于最大限度地提高肿瘤患者的生活质量和安全至关重要。
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引用次数: 0
[Robotic vs. laparoscopic adrenalectomy in pheochromocytoma]. [嗜铬细胞瘤的机器人与腹腔镜肾上腺切除术]。
Pub Date : 2025-02-27 DOI: 10.1007/s00104-025-02257-4
Ioannis Mintziras, Detlef K Bartsch
{"title":"[Robotic vs. laparoscopic adrenalectomy in pheochromocytoma].","authors":"Ioannis Mintziras, Detlef K Bartsch","doi":"10.1007/s00104-025-02257-4","DOIUrl":"https://doi.org/10.1007/s00104-025-02257-4","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525221","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}
引用次数: 0
[Kasai-hepatoportoenterostomy for the treatment of biliary atresia - What is important?]
Pub Date : 2025-02-27 DOI: 10.1007/s00104-025-02259-2
Omid Madadi-Sanjani, Uta Herden, Marie Uecker

Biliary atresia (BA) is a rare disease in neonates of unknown etiology. BA is defined by the extent of extra- and intrahepatic bile duct destruction, which results in liver deterioration and cirrhosis within the first years of life. Liver transplantation (LT) is the only curative treatment for BA, accompanied by LT-associated risks and complications; however, more than 60 years after it's first report, the Kasai hepatoportoenterostomy (KPE) is still an essential procedure in the sequential management of BA, as the primary surgical treatment option that can achieve long-term survival with a native liver. We highlight the key surgical steps of KPE and discuss relevant aspects.

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引用次数: 0
[Alterations to the metabolic, microbiological and immuno-inflammatory profile after sleeve gastrectomy and gastric bypass].
Pub Date : 2025-02-25 DOI: 10.1007/s00104-025-02261-8
Alida Finze, Mirko Otto, Christoph Reissfelder
{"title":"[Alterations to the metabolic, microbiological and immuno-inflammatory profile after sleeve gastrectomy and gastric bypass].","authors":"Alida Finze, Mirko Otto, Christoph Reissfelder","doi":"10.1007/s00104-025-02261-8","DOIUrl":"https://doi.org/10.1007/s00104-025-02261-8","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506482","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}
引用次数: 0
[3-D reconstruction of the liver].
Pub Date : 2025-02-19 DOI: 10.1007/s00104-025-02260-9
Oliver Rohland, Michael Ardelt, Utz Settmacher
{"title":"[3-D reconstruction of the liver].","authors":"Oliver Rohland, Michael Ardelt, Utz Settmacher","doi":"10.1007/s00104-025-02260-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02260-9","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451115","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}
引用次数: 0
[Is cytoreductive surgery with HIPEC adequately funded?]
Pub Date : 2025-02-19 DOI: 10.1007/s00104-025-02246-7
Can Yurttas, Sarah Kalmbach, Emilia Ansorge, Mohamed Bezmawi, Gunnar Blumenstock, Markus W Löffler, André L Mihaljevic, Christian Ernst, Martin Holderried

Background: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment concept for highly selected patients with peritoneal metastases and primary tumors (PMT). A challenge from the perspective of hospitals is the cost intensity of this promising multimodal treatment option.

Research question: Which factors influence the cost and revenue structure of CRS/HIPEC treatment in the current diagnosis-related group (DRG) system according to § 17b of the German Hospital Financing Act (KHG)?

Material and methods: The database for this analysis was constituted by all patients treated with combined CRS/HIPEC at a certified tumor center between 2017 and 2021. The statistical analysis performed was descriptive, using two-sample and multisample comparisons (ANOVA) as well as linear correlation and regression analyses.

Results: The total length of hospitalization for 173 patients was on average 16.1 days and the average length of stay in the intensive care unit was 2.2 days. Postoperative complications occurred in 110 (63.6%) patients. The average DRG revenue obtained was € 21,658.48. The total costs for the combined CRS/HIPC treatment amounted to an average of € 23,764.77 and were therefore on average € 2106.29 (8.86%) higher than the DRG revenue granted for the treatment. The length of stay in the intensive care unit and the total length of hospitalization correlated positively with the treatment costs and DRG revenue.

Discussion: This study presents key factors influencing the cost and revenue structure of CRS/HIPEC and illustrates that this promising surgical treatment approach is relevantly underfunded by the German DRG system. A reform of the current DRG system with special consideration of highly complex oncological treatment concepts is therefore recommended.

背景:细胞切除手术后腹腔内热化疗(CRS/HIPEC)是一种治疗理念,适用于经过严格筛选的腹膜转移瘤和原发性肿瘤(PMT)患者。从医院的角度来看,这一前景广阔的多模式治疗方案的成本强度是一个挑战:研究问题:根据《德国医院融资法》(KHG)第 17b 条,在当前的诊断相关组(DRG)系统中,哪些因素会影响 CRS/HIPEC 治疗的成本和收入结构?本次分析的数据库由2017年至2021年间在认证肿瘤中心接受CRS/HIPEC联合治疗的所有患者构成。所进行的统计分析为描述性分析,使用了双样本和多样本比较(方差分析)以及线性相关和回归分析:173名患者的总住院时间平均为16.1天,在重症监护室的平均住院时间为2.2天。110名患者(63.6%)出现了术后并发症。DRG 平均收入为 21,658.48 欧元。CRS/HIPC联合治疗的总费用平均为23764.77欧元,因此平均比DRG治疗收入高出2106.29欧元(8.86%)。重症监护室的住院时间和总住院时间与治疗费用和 DRG 收入呈正相关:本研究介绍了影响 CRS/HIPEC 成本和收入结构的关键因素,并说明德国 DRG 系统对这种前景广阔的外科治疗方法的资助严重不足。因此,建议改革现行的 DRG 系统,特别考虑高度复杂的肿瘤治疗概念。
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引用次数: 0
[Long-term results of a pilot study on a two-stage procedure with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease].
Pub Date : 2025-02-18 DOI: 10.1007/s00104-025-02252-9
Michael Ardelt, Falk Rauchfuss, Felix Dondorf, Aladdin Ali Deeb, Astrid Bauschke, Oliver Rohland, Laura Schwenk, Utz Settmacher

Background: The current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines recommend among others a Limberg flap for the treatment of pilonidal sinus disease. This article reports the long-term results of the pilot study: "Results of a two-stage intervention with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease", published in 2015.

Method: From 2010 to 2013 a total of 50 patients with sacrococcygeal pilonidal sinus disease were treated. Following initial excision patients were offered plastic coverage in the presence of clean wound conditions according to the then relevant AWMF guidelines in primary cases and recommended in recurrent cases. Of the patients 22 opted for a Limberg flap. In 2022 recurrences were recorded via telephone interviews with patients. The groups with a Limberg flap were compared with the excision group.

Results: There were no recurrences in the Limberg flap group (0%) while there were six recurrences in the excision group (23%) p = 0.028. In the Limberg group one patient and in the excision group two patients were lost to follow-up.

Conclusion: With a two-stage technique a Limberg flap is obviously more effective under inflammation-free wound conditions. The Limberg flap is a simple plastic surgery procedure; however, one should remember that it is a transposition flap.

{"title":"[Long-term results of a pilot study on a two-stage procedure with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease].","authors":"Michael Ardelt, Falk Rauchfuss, Felix Dondorf, Aladdin Ali Deeb, Astrid Bauschke, Oliver Rohland, Laura Schwenk, Utz Settmacher","doi":"10.1007/s00104-025-02252-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02252-9","url":null,"abstract":"<p><strong>Background: </strong>The current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines recommend among others a Limberg flap for the treatment of pilonidal sinus disease. This article reports the long-term results of the pilot study: \"Results of a two-stage intervention with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease\", published in 2015.</p><p><strong>Method: </strong>From 2010 to 2013 a total of 50 patients with sacrococcygeal pilonidal sinus disease were treated. Following initial excision patients were offered plastic coverage in the presence of clean wound conditions according to the then relevant AWMF guidelines in primary cases and recommended in recurrent cases. Of the patients 22 opted for a Limberg flap. In 2022 recurrences were recorded via telephone interviews with patients. The groups with a Limberg flap were compared with the excision group.</p><p><strong>Results: </strong>There were no recurrences in the Limberg flap group (0%) while there were six recurrences in the excision group (23%) p = 0.028. In the Limberg group one patient and in the excision group two patients were lost to follow-up.</p><p><strong>Conclusion: </strong>With a two-stage technique a Limberg flap is obviously more effective under inflammation-free wound conditions. The Limberg flap is a simple plastic surgery procedure; however, one should remember that it is a transposition flap.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Chirurgie (Heidelberg, Germany)
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