Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera最新文献

Purpose: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer and to evaluate the oncologic follow-up.

Methods: Between March 1993 and December 2000 103 patients with colorectal cancer were treated by laparoscopy. Surgical, pathologic and follow-up data were recorded in a prospective registry database and analyzed by type of resection.

Results: A total of 42 women and 61 men with a mean age of 66.7 years underwent 9 right hemicolectomies, 6 left hemicolectomies, 35 sigmoidectomies, 41 low anterior resections and 12 abdominoperineal resections. Conversion was necessary in 14.5%. Postoperative complications occurred in 21 patients (20.3%) and decreased with experience. Hospital mortality was 0.9%. All cancers (31% stage UICCI, 28% stage II, 37% stage III et 3% stage IV) were resected with tumor-free margins and the mean number of lymph nodes was 19.6. Patients resumed solid diet on the second postoperative day and mean hospitalization was 12.6 days. Three port site recurrences, 4 local recurrences and 10 distant metastases occurred after a mean follow-up of 34.5 months (8-92).

Conclusion: Laparoscopic colorectal cancer surgery is technically feasible with acceptable morbidity and low mortality. An oncologic adequate resection can be performed. To determine whether the recurrence rates and the survival data are equivalent to open surgery, prospective randomized trials are necessary.

Intracranial subdural empyema is a rare form of suppuration in Europe and North America, and is a potentially dangerous but treatable disease. The clinician must be aware that this complication requires prompt diagnosis and urgent neurosurgical intervention. The etiology, pathology, bacteriology, clinical features, diagnostic procedures and the different surgical approaches to this disease are reviewed. It seems that there is no single best surgical approach for treating subdural empyema, however, multiple burr holes drainage and craniotomy remain the most frequently used approaches.

Between 1994 and 2000 122 open and endoscopic carpal tunnel releases were performed. 82 of them were analysed retrospectively with major interest in security and results of the endoscopic technique. 39 patients were treated with an open, 41 patients with an endoscopic carpal tunnel release (26 using the two portal technique, 17 using the single portal technique). No major irreversible complications were reported, regarding the outcome their were no significant differences. From the 39 patients with open carpal tunnel release nine had persistent complaints and one of them was reoperated because of an injury of the motoric branch of the median nerve. Eight patients out of 26 treated with the two portal technique still had complaints and one needed to be reoperated because of excessive fibrosis around the median nerve. From the 17 patients operated with the single portal technique five had persistent complaints but no reoperation was necessary. Our study showed similar findings regarding security and results using the three different operation methods. But there were no advantages for the endoscopic carpal tunnel release because of the more atraumatic procedure.

This is the report of the events of September 11th seen through the eyes of a Swiss Trauma Fellow. This ill-fated day is described by someone who went down to ground zero with other doctors to help and save lives and came back frustrated because there was so little to be done.

Stromal tumors are rare neoplasms of the small bowel that locate in Meckel's diverticulum with high preference. Perforation of those tumors is very uncommon. There are 96 cases reported in current literature, including only 6 perforations. The diagnosis of that kind of tumor is very difficult because of lack of pathognomonic signs and symptoms. The clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforation. We report the case of a 61-years old patient with a poorly differentiated stromal tumor in a perforated Meckel's diverticulum. The difficulty of identifying a stromal tumor preoperatively and the therapeutic options are emphasised. It is suggested that an aggressive attitude should be taken in the preoperative management of any patient over 50 years of age who presents with melena and abdominal pain.

Documentation of complications is a "must" today. Several societies have been formed and several systems of documentation exist to fulfill these requirements. But there are also very simple tools for quality management in every hospital. Since 1995 all surgical/orthopedic interventions have been prospectively recorded at the hospital of Frutigen. Every other month a list of all operations and their complications is put together by the two surgeons-in-chief. This list is then presented at the so-called interdisciplinary complications-conference. This meeting is open to all employees of the hospital and to all medical doctors of the region. From the 1st January 1995 to the 31st December 2001 7396 surgical interventions were performed on in- or outpatients. 134 complications (1.8%) occurred. These were: 49/7396 infections (0.7%), 14/1395 re-osteosyntheses (1%), 21/7396 hematomas requiring evacuation (0.3%), 8/7396 disturbances in wound healing (0.1%) and 42 other, postoperative complications. Postoperative infection occurred most frequently after appendectomies 10/251 (4%), the rate after internal fixation was 0.6% (9/1395). Hematomas were encountered most frequently after total joint replacement (hip and knee) 4/180 (2.2%), followed by inguinal hernias 4/287 (1.4%). The rate of re-osteosynthesis was highest after internal fixation of proximal humerus fractures 5/58 (8.6%). This systematic documentation of complications allows an analysis of the operative/perioperative management. By introducing specific measures (compression-bandage after operations of inguinal hernias and total hip prosthesis, new implant with rotational stability for proximal humerus fractures) an attempt can be made to reduce the rate of the most frequent complications. The public presentation of the complications at the meeting makes it possible to communicate good and bad results to the whole staff including the general practitioners, and the interdisciplinary mode of discussion permits the inclusion of not only the surgical but also all other possible aspects of the treatment of the patients.

We report a case of a 31-year-old male drug addict with acute ischaemia of the right hand after inadverted intraarterial injection of suspended tablets into brachial artery. He was successfully treated with intraarterial administration of urokinase (250'000 IU as bolus, then continuous infusion of 250'000 IU per 12 hours), papaverin (40 mg i.v. 3 x every 4 hours), systematic heparinisation and with axillary plexus anesthesia (Bupivacain 0.25%, 10 ml/h). Treatment options are discussed reviewing recent publications. Early onset of treatment is mandatory for a good outcome.