Chirurgie (Heidelberg, Germany)最新文献

Morbid obesity is a recognized chronic disease. Metabolic bariatric surgery (MBS) currently represents the most effective treatment, with efficacy in achieving significant weight reduction and improving obesity-related comorbidities, quality of life and overall survival; however, unsatisfactory treatment outcomes manifesting as suboptimal weight loss, recurrent weight gain, or poor control of comorbid conditions, represent a clinically relevant challenge requiring further treatment. Conversion surgery can positively influence weight trajectories and associated comorbidities but are associated with higher risk profiles compared to primary procedures. Additive pharmacological treatment, particularly glucagon-like peptide 1 (GLP-1) analogues, also demonstrate efficacy with an acceptable side effect profile. This article examines the definitions of suboptimal treatment success following MBS and provides an overview of available treatment options as well as the decision-making process for individualized treatment. Special attention must be paid to the comorbidities and the preferences of patients within an interdisciplinary framework supported by appropriate clinical expertise.

Bone metastases are the most common malignant bone tumors and are often the first clinical sign of a malignant disease. Although the occurrence of bone metastases in a malignant disease usually means a palliative situation for patients, adequate treatment of the metastases can greatly improve the patient's prognosis and ensure that the quality of life is maintained. In addition to oncological and radiotherapeutic treatment options, there are many surgical treatment options available. For this reason, metastasis surgery is the most common oncological operation in musculoskeletal surgery. The indications for metastasis surgery should always be assessed in an interdisciplinary setting, taking the patient's life expectancy, physical limitations and wishes into account. This review article summarizes the various surgical treatment options for bone metastases depending on the region of the body.

Background: The surgical rotation during the final year of medical school (practical year, PJ) is intended to equip all medical students with essential elements of surgical practice; however, little is known about the practical surgery-related experience students have prior to starting this rotation.

Objective: The aim of this study is to systematically assess the practical prior experience of medical students at the beginning of the surgical rotation in the PJ.

Material and methods: Prior experience was recorded using the concept of Entrustable Professional Activities (EPA). Medical students in the surgical rotation at the Charité and its teaching hospitals documented their experience in a mandatory e‑portfolio. This portfolio is based on 10 EPAs and 20 procedures defined by the National Competence-based Catalogue of Learning Objectives (NKLM 2.0). The analysis focused on the level of independence with which students had already performed these EPAs and procedures before starting their first rotation.

Results: Data from 516 students between May 2023 and May 2025 were included. Overall, there was a high individual variability in students' practical experience across the different EPAs and procedures. A substantial proportion of students reported little or no prior experience with 7 of the 10 EPAs and 9 of the 20 procedures.

Conclusion: Students begin their surgical rotation in the PJ with varying levels of practical experience. A structured assessment of individual experience based on the EPA framework makes it possible to clearly identify competency levels, to tailor task assignments and supervision and develop personalized learning plans. In the long term this can contribute to more practice-oriented surgical teaching during the PJ and prepare students better for future medical practice, thereby also increasing interest in specialist training in surgery.

Brain metastases are the most frequent intracranial tumor entity and in most cases are a sign of advanced systemic cancer. Advances in neurosurgery, pathology, radiotherapy and oncology, especially with the introduction of immune and targeted systemic treatment, have significantly improved the prognosis for patients with brain metastases in recent years. Neurosurgical treatment plays a key role in symptom relief, reduction of the tumor burden and tissue acquisition for molecular analysis to enable patients to undergo postoperative radiotherapy and systemic therapy. The creation of an optimal patient-oriented treatment concept requires close interdisciplinary coordination and structured follow-up to make individualized and evidence-based treatment decisions.

Background: A prospective vascular trauma registry (VascTR-Aux) is being conducted at Augsburg University Hospital. This first evaluation of the registry data aims to present the treatment results after vascular extremity injuries at discharge.

Material and methods: From 1 January 2016 to 31 March 2024, a total of155 injured persons were included in the VascTR-Aux. Extremity vessels were affected in 83 patients.

Results: Of the 83 injured people included, 62 were male. The average age was 37 years. The vascular injuries affected the upper limb in 28 cases and the lower limb in 55 cases. In 14 cases, the injuries were severe. The patients presented clinically with 29 hemorrhages, 32 ischemia and 14 combinations of both entities and 7 cases were asymptomatic. Patients were treated surgically (n = 51), as a hybrid procedure (n = 7) and as endovascular procedures (n = 8). In 76 cases functional preservation of the extremity was possible. Major amputation was necessary in six cases and minor amputation in two cases. The average length of stay was 23 days.

Discussion: The initial treatment was often interdisciplinary, whereas inpatient follow-up care is often provided by specialist departments other than vascular surgery due to the concomitant injuries requiring treatment. The vascular surgery procedure for treatment and follow-up care must be discussed and communicated individually in the case of vascular injuries, and a vascular surgery follow-up protocol must be established for post-inpatient follow-up examinations. Both endovascular and open surgical treatment options should be available for the treatment of vascular limb injuries. The aim of the registry is to contribute to evidence for the treatment of vascular trauma and to collect long-term results for reconstructions after vascular trauma.

The transfer of knowledge, experience and practical skills in the care of patients in palliative settings takes place in a largely unstructured and sporadic manner in surgical resident training in Austria. The present work assesses the status quo using an online survey of residents in general and visceral surgery, presents their subjective experiences with palliative care and expectations on palliative care providers and their training needs. Over 80% of residents have frequent contact with patients in palliative settings and nearly 60% care for patients in end-of-life situations. Support from a palliative care team is experienced as helpful. Residents would like more support and articulate how they envision this form of support. They rate their own palliative skills as medium to good but 85% would still like additional training and 68% advocate for the integration of palliative care into the surgical curriculum.