Chirurgie (Heidelberg, Germany)最新文献

The anorectic peptide-based obesity management medications (OMM) have dominated the treatment of obesity over the last decade. This review analyses the evidence that has laid the ground for the three most frequently used drugs (liraglutide, semaglutide and tirzepatide) with regulatory approval. In this context, the SCALE program investigated liraglutide for weight loss and found its effectiveness to be roughly 6-8%. Similarly, the STEP program extensively researched semaglutide as a weight loss intervention and found it to be effective in reducing body weight by 9.6% in people with type 2 diabetes and by 15% in those without. Likewise, for tirzepatide this evaluation was done under the SURMOUNT program, which reported an efficacy of 14.7% in body weight reduction for type 2 diabetes patients as opposed to 22.1% in people without diabetes. The positive effects usually diminish when treatment is discontinued. The SELECT trial provided the first concrete evidence of risk reduction of major adverse cardiovascular events (MACE) by 20% with the use of semaglutide. Overall, safety and tolerability of these 3 drugs is generally good across all studies. Additionally, the most common adverse events reported are gastrointestinal, which occur early during treatment and subside over time. Data on other hard end points and long-term outcomes do not yet exist.

Metabolic/bariatric surgery is considered to be safe and the most effective treatment for obesity and its associated medical problems. It not only leads to sustained weight loss but also improves a variety of metabolic disorders, such as type 2 diabetes, reduces the risk of several obesity-associated cancers and increases life expectancy. The most commonly performed procedures worldwide are Sleeve gastrectomy, Roux-en‑Y gastric bypass and one anastomosis gastric bypass. Newer techniques, such as single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) show promising results, especially in patients with a high body mass index (BMI). A growing number of studies now provide data on hard clinical endpoints and long-term outcomes. The choice of surgical procedure is made individually and within an interdisciplinary setting. Lifelong follow-up care is crucial to ensure long-term success. Numerous studies also demonstrate significant improvements in the quality of life and a reduction in overall mortality through metabolic/bariatric surgery.

Intraoperative ultrasound (IOUS), also potentially as contrast-enhanced (CE)-IOUS, is a versatile tool for surgical decision-making. It enhances intraoperative orientation, enables precise resection guidance and helps prevent complications and follow-up procedures; however, in Germany, IOUS is currently only selectively used, often in nonsurgical disciplines. While this is reasonable in certain scenarios, it reaches its limits when imaging directly influences surgical actions. The clinical benefits of IOUS are well-documented in several specialties, particularly liver surgery, neurosurgery and surgical senology. Nevertheless, a systematic integration into surgical training, clinical practice, and guidelines is still lacking. In visceral surgery only a few surgeons have their own IOUS experience. In other fields, such as vascular or transplantation surgery, its use is already standard, although this has not been confirmed by randomized studies. The German Society for Ultrasound in Medicine (DEGUM), as the leading professional society for ultrasound in medicine, advocates a broader and structured integration of IOUS into surgical medicine. It provides practical modular training formats, promotes scientific projects and works with guidelines to make existing evidence visible and future evidence usable. The goal is to establish IOUS as a fixed component of quality-assured surgical care both interdisciplinary and cooperative but with independent sonographic expertise on the surgical side. Therefore, DEGUM recommends the use of IOUS for control and guidance during tumor resections, for navigation in anatomically unclear situations, for assessment of vascular anastomoses or organ perfusion and for extended diagnostics, particularly in liver surgery, potentially with the supplementary use of contrast-enhanced ultrasound.

The thoracic outlet syndrome (TOS) refers to a group of clinical conditions caused by compression of nerves and blood vessels in congenital or acquired anatomical narrowing of the upper thoracic aperture. This includes the anatomical structures, such as the scalene muscles, the first rib, a possibly present cervical rib, the costoclavicular joint or the pectoralis minor muscle. Isolated venous compression is also known as thoracic inlet syndrome (TIS). The symptoms are diverse and the path to a correct diagnosis is often prolonged. In the absence of anatomical anomalies, conservative treatment is indicated, such as physical therapy and adequate pain management. Especially in young patients, TOS should be considered when embolic events in the upper extremities occur without other risk factors. Appropriate multimodal diagnostics and targeted therapy are challenging and require treatment in specialized departments. Surgical treatment is complex and over the years various procedures with a favorable outcome for the affected patients have been established.