Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

Under strict indication criteria (solitary tumor < 5 cm or up to 3 tumors < 3 cm, no vascular invasion) the 5-year-survival rate after liver transplantation for HCC in cirrhosis is up to 70% to 75% in comparison to 80% to 90% in benign disease. With regard to organ shortage an extended indication for liver transplantation in HCC, i.e. for highly differentiated HCC between 5 cm and 7 cm, can only be discussed if there is an increase in the number of donor livers. Currently, living donation offers the only solution for this problem. The decision for living donor liver transplantation for an extended indication has to be drawn most carefully and individually. In addition to the donor's risk, to the prognosis of the recipient and to economical aspects the desire of the donor to offer the chance of transplantation despite a probably poor prognosis has to be considered and respected.

Progress in the surgery of implants and biomaterials can be accomplished by: 1. Painstakingly analysing and registering of defaulting implants after explantation within a "National Registry of Implant Pathology". 2. Development of a DNA-microarray named "Implantat/Chronic Wound" in order to discover the differential transcriptional activities of cells brought into contact with different foreign surfaces. 3. Predictive cell-engineering combined with custom-made implant surfaces with the aim of optimal patient care.

Handsurgeons are normally more interested in clinical tests evaluating sensory and movement disorders of hand. Since these are often unprecise and require a cooperative (and intelligent) patient, neurologists and neurosurgeons prefer precise diagnostic procedures. For this reason they use electrophysiological techniques to evaluate and localize peripheral nerve lesions, i.e. electromyography, sensory and motor nerve conduction velocity and somatosensory-evoked potentials (SEP), by which most nerves of the arm and hand (median, ulnar and radial nerves including their major branches) can be easily assessed. Insufficient technique (submaximal stimulation, no temperature control, stimulation of a neighbouring nerve) and mis- or overinterpretation are sources of error, which can best be avoided when the diagnosis is made in context with the clinical picture--especially when the surgeon is familiar with electrophysiological techniques.

Endoscopic polypectomy being a standard procedure for "normal" colorectal polyps, big and complicated polyps and adenomas, however, are mostly subject to surgical operations. The analysis of 3300 polypectomies performed in the own institution with up to 36% difficult polyps shows, that using new techniques for submucosal injection (SIT) and innovative rf-surgical technologies (FC) even these difficult polyps can be removed with very low complication rates. Technical and oncological aspects however, have to be respected thoroughly.

In a prospective study we compared the subjective scar assessment by the Vancouver Scar Scale with an objective viscoelastic measurement. Donor sites from the thigh primarily dressed with vaseline gauze (F), biobrane or occlusive dressing(O) were evaluated 0.5 years postoperatively by VSS and with the Cutometer (Courage and Khazaka). VSS of donor sites was 2.74 +/- 0.91 (F), 4.25 +/- 0.77 (B) and 2.57 +/- 0.72(O) (mean +/- sem). All ratings were significant compared to normal mirror-sided skin. Viscoelastic measurements by the Cutometer were near normal compared to uninjured skin. No correlation was found between subscale VSS pliabilty rating and Cutometer readings.

The surgical suture should be chosen in dependence of the tissue being operated upon and be oriented on the main properties of its chemical composition. Synthetic absorbable suture materials are the first choice in the majority of the procedures, to prevent the formation of foreign body reaction--excepting sites subjected to continuous mechanical stress, for example hernias, orthopedic and vascular surgery. By causing lesser tissue damage and interfilament bacterial transport, monofilament sutures are preferable than multifilament ones. However, knotting monofilament sutures requires additional skills in comparison to multifilament strains, due to their special handling an knotting properties.

Some 10 to 25 percent of all patients with diverticulosis will come down with diverticulitis in the course of their lives. Apart from physical examinations, sonography and--if results are still unclear--computer tomography are seen as the most important diagnostic devices. 75 percent of patients with acute diverticulitis can initially be treated conservatively, and only one in four ever falls ill again with another inflammation. According to those numbers a conservative method is justified when dealt with a primary uncomplicated diverticulitis. If a second attack occurs, should an elective resection be considered. An increased mortality and morbidity exists among young and immunocompromised patients so that elective surgery is recommended already after the first incident.

The use of surgery for the treatment of advanced gall bladder cancer is controversially discussed. This retrospective study included 204 patients who were subjected to surgery due to advanced gall bladder cancer at the Klinikum Grosshadern. Mean survival time of all patients was 4.5 months. Advancement of the tumor stage resulted in a decreased percentage of possible R0 resections (T3 n = 48, R0 31%, T4 n = 87, R0 13%). Nonetheless, R0 resections of T3 tumors significantly increased the survival rate compared to R1 and R2 resections (mean survival 20.2 vs. 4.5 months). R0 resections of T4 tumors also significantly attenuated the survival rate (18.1 vs. 2.4 months compared to R1 and R2 resections). Thus, diagnostic procedures have to focus on identifying patients with possible R0 resections and perform extensive resections on those patients.

Long lasting alterations of anal function and persistent pain in a few patients after ano-rectal operations are a great therapeutic problem. Sometimes more than 6 months after LAR there are complaints about incontinence, disturbance connected to a spastic evacuation--whereas pain is more often connected with the situation after Stapler hemorrhiodectomy or other anal interventions. The therapeutic management has to consider all etiological factors and consists mainly of conservative therapy, including regulation of stool volume, slow-down of colon transit, strengthening of anal and pelvic floor muscles, regulation of co-ordination and ability of relaxation and straining, therapy of pain and--last not least--psychological support.