Chirurgie (Heidelberg, Germany)最新文献

Peripheral arterial occlusive disease (PAOD) is a frequent manifestation of atherosclerosis associated with high morbidity and mortality. This article summarizes the current recommendations of the German S3 guidelines "Diagnostics, treatment and follow-up of PAOD" (Association of the Scientific Medical Societies in Germany, AWMF 2024) and discusses the implications of the ongoing hospital reform. Key diagnostic modalities include patient history taking, clinical examination, ankle-brachial index measurement and duplex ultrasonography. In cases of suspected chronic limb-threatening ischemia (CLTI), the WIfI score enables a structured risk assessment for amputation. Treatment management emphasizes strict secondary prevention (low-density lipoprotein, LDL < 3,1 mmol/l, smoking cessation), supervised exercise training and optimized antithrombotic therapy (clopidogrel is preferred; dual pathway inhibition for high-risk patients or after revascularization). Revascularization can be performed endovascularly or surgically and increasingly in specialized centers. The German Hospital Reform supports the centralization of complex procedures and the expansion of outpatient care, thereby underscoring the pivotal role of nonvascular surgical departments in early detection and coordinated referral.

In the highly complex environment of the operating room, the perioperative nursing personnel make an essential contribution to the quality, safety and efficiency of surgical procedures. Increasing specialization, technological development and rising demands for safety and cost-effectiveness position perioperative nursing as a central pillar of interprofessional care. This article highlights the key areas of responsibility and spheres of impact within perioperative nursing as well as the duties of nursing management. The focus is on patient safety, quality of care and sustainable process optimization.

Background: Recurrence and reoperation rates as well as intraoperative and postoperative complications are much higher in the treatment of inguinal hernia recurrences than in the treatment of primary hernias and increase with each additional follow-up procedure. Is endoscopic treatment of endoscopically pre-operated patients an alternative technique?

Aim of the study: Retrospective case study analysis on the feasibility of treating recurrent inguinal hernias after initial endoscopic, i.e., total extraperitoneal patch (TEP) or transabdominal preperitoneal (TAPP) repair technique, pre-operation using the TEP technique (RE-TEP) based on data from our own patient collective.

Material and methods: Since 2016 a total of 79 patients with recurrences after minimally invasive surgery (MIS) hernioplasty were operated on using the RE-TEP technique. In 30 patients, perioperative data and the results of clinical and sonographic follow-up examinations were evaluated and analyzed, particularly with respect to the quality of life.

Results and discussion: Perioperative and postoperative data and results were comparable to those of primary hernia repair. There were no conversions, no intraoperative or postoperative complications, no re-operations or evidence of recurrence with good postoperative quality of life. We were thus able to demonstrate feasibility in a larger group and confirm the results of individual publications of smaller studies.

Conclusion: The RE-TEP technique can be seen as an option for the treatment of recurrent inguinal hernias after primary MIS techniques.

The preoperative logistics for operating room preparation require interdisciplinary cooperation between surgery, anesthesia, nursing and administration as well as a clear standardization of procedures to ensure safety and efficiency. The starting point is the patient presentation with diagnostics and interpretation of the indications, followed by surgical and anesthesiological preparation, which focuses on the clinical examination, information, additional diagnostics and, if necessary, nutritional measures. This is supplemented by nursing assessments and the clarification of organizational issues, such as insurance status and optional services. Patient blood management for the early diagnosis and treatment of preoperative anemia and enhanced recovery after surgery (ERAS) concepts, which reduce postoperative complications and promote faster recovery through multimodal management, are of particular importance. In order to bundle these diverse processes, a centralized patient management provides an efficient interface that coordinates scheduling, diagnostics and resource allocation. As a result the preoperative preparation can increasingly be carried out on an outpatient basis, while inpatient admission is often only necessary on the day of surgery. This leads to shorter hospital stays, better use of resources and higher patient satisfaction.

Background: Liver tumors in childhood are rare and associated with high treatment demands. Over the past decades substantial progress has been achieved through effective chemotherapies and improved surgical techniques as well as international collaborations. Nevertheless, the challenges for the surgical treatment remain high. In Germany additional specific difficulties arise in this context.

Objective: To summarize the current evidence on the surgical management of pediatric liver tumors, to analyze the care structures in Germany and to develop perspectives for optimizing treatment.

Material and methods: Narrative review of the current evidence, systematic analysis of the surgical results of previous hepatoblastoma studies, and evaluation of German care pathways in order to identify problems and perspectives.

Results: The improved prognosis of children with liver tumors (particularly hepatoblastoma) is mainly due to multimodal, risk-adapted treatment concepts and advances in surgical strategies. Because of the rarity of pediatric liver resections, pediatric liver tumor surgery in Germany is positioned at the intersection of pediatric, visceral and transplantation surgery. Surgically, strategies adapted to children are crucial to increase resection rates and avoid postoperative complications. A direct transfer of concepts from adult liver surgery carries substantial risks. In Germany the basic prerequisites are good but care can be further improved through better communication with reference structures, intelligent centralization approaches and investment in surgical training.

Discussion: Pediatric liver tumor surgery is associated with specific challenges due to the rarity and high demands. In Germany, strengthening multidisciplinary structures and communication as well as efficient centralization of treatment planning, can further improve patient safety and outcomes for children with liver tumors.

Background: The Russian invasion of Ukraine has confronted Germany with the realities of military conflict, including the medical care of seriously injured soldiers and civilians brought in through humanitarian efforts. This raises concerns about the preparedness of the German healthcare system for such scenarios, particularly in terms of personnel and structural resources for the treatment of penetrating injuries, which are typical for the military context.

Material and methods: An online survey was distributed via email to members of the German Society for General and Visceral Surgery (DGAV). Respondents were asked about structural prerequisites in emergency care capabilities at their institutions and personal experiences managing penetrating trunk injuries (n = 411; 94.6% from civilian hospitals).

Results: Despite increasing specialization 34% of visceral surgeons reported performing emergency thoracotomy themselves. Access to a thoracic surgeon is available in only 50% of the hospitals and to a cardiac surgeon in 26%. The majority of respondents felt inadequately prepared to manage penetrating injuries, especially those resembling military trauma patterns (e.g., shrapnel, blast injuries) as opposed to civilian gunshot wounds.

Conclusion: Given these findings and the evolving geopolitical and security landscape, basic military surgical knowledge must be more broadly disseminated and systematically integrated into national emergency preparedness and disaster response frameworks in order to strengthen the capability for treatment in exceptional situations.