Chirurgische Klinik

Karlsruhe, Germany

Chirurgische Klinik

Karlsruhe, Germany

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According to the current European and German S3 guidelines, neoadjuvant chemotherapy is now an integral part of the treatment of locally advanced gastric cancer and adenocarcinoma of the esophagogastric junction. Neoadjuvant therapy seeks to achieve downsizing of the primary tumor, lowering of the T and N categories and eradication of micrometastases. As the indications for neoadjuvant treatment are based on pretherapeutic information alone, a sophisticated clinical staging plays a central role. Despite all progress made in the field of diagnostic work-up, clinical staging often fails. Despite this fact, controlled randomized trials showed that neoadjuvant chemotherapy enhances the rate of curative (R0) resections and reduces the likelihood of systemic relapse. Overall, survival can be improved by neoadjuvant chemotherapy. The current research is focused on the molecular prediction of response and early response monitoring with functional imaging. New targeted drugs are being integrated into the peri-operative treatment. © 2011 Springer-Verlag.


Ambe P.C.,Witten/Herdecke University | Wassenberg D.R.,Chirurgische Klinik
Patient Safety in Surgery | Year: 2015

Background: Hemorrhoidal disease is highly prevalent in the western world. Stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. Proctitis following stapled hemorrhoidopexy has not been reported previously. Herein, we report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy. Materials and methods: A retrospective analysis of the data of patients undergoing stapled hemorrhoidopexy with the PPH03 in the coloproctology unit of the department of surgery of a primary care hospital in Germany within a 5-year period was performed. All cases were managed and followed up by a single attending surgeon with expertise in coloproctology. Results: 129 patients were included for analysis including 21 cases with grade 2, 103 cases of grade 3 and 5 cases of grade 4 hemorrhoids. The median duration of surgery was 20 min. 17 complications including two recurrences were recorded. Post-pph proctitis was recorded in 14 cases (10.9 %). Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, BMI and ASA (p >0.05). All cases recovered within 4 weeks following management with nonsteroidal anti-inflammatory drugs and suppositories. Conclusion: Proctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories. © 2015 Ambe and Wassenberg.


Rosenberg R.,TU Munich | Engel J.,Tumorregister Munich des Tumorzentrum Munich | Engel J.,Ludwig Maximilians University of Munich | Bruns C.,Ludwig Maximilians University of Munich | And 10 more authors.
Annals of Surgery | Year: 2010

Objective: We analyzed 3 previously identified cut-off values of lymph node ratios (0.17, 0.41, and 0.69) in a large population-based collective of patients with colorectal cancer for their prognostic value. Summary background data: The lymph node ratio (LNR) (relation of tumor-infiltrated to total examined lymph nodes) has a high prognostic impact, but the relevant cut-off values are not determined. Methods: Patients (N = 27,803) with a primary colorectal cancer diagnosed and operated in the Munich region between 1991 and 2006 were registered in the Munich Cancer Registry. Lymph node numbers and survival data were available for 17,309 patients with a mean follow-up of 5.9 years. Results: The mean number (±SD) of resected lymph nodes was 16.8 ± 8.4. Twelve or more lymph nodes were resected in 76.8%. Estimated 5-year overall survival decreased significantly with increasing LNR: LNR = 0 in 71.4%, LNR 0.01 to 0.17 in 52.4%, LNR 0.18 to 0.41 in 33.3%, LNR 0.42 to 0.69 in 19.8%, and LNR ≥0.70 in 8.3% (P < 0.001). Multivariable survival analyses identified separately both LNR and pN-category, as well as number of resected lymph nodes, patient's age, tumor location, pT-category, pM-status, R-status, tumor grade, and year of operation as independent prognostic factors. Conclusion: The 3 cut-off values of LNRs had strong independent prognostic value in a population-based collective of patients with colorectal cancer. The LNR should be routinely reported and included in the American Joint Committee on Cancer staging system. Nevertheless, the benefit of lymphadenectomy on survival is still unclear. © 2010 Lippincott Williams & Wilkins.


Dargel J.,University of Cologne | Kupper F.,Chirurgische Klinik | Wegmann K.,University of Cologne | Oppermann J.,University of Cologne | And 2 more authors.
Journal of Orthopaedic Science | Year: 2015

Background: Ulnar collateral ligament insufficiency may result in medial elbow pain, instability, and reduced athletic performance in throwing athletes. Several reconstruction methods have been described, but biomechanical studies suggest that in general, stability of the graft construct is inferior to the native ulnar collateral ligament. This study investigates whether a stronger graft would yield greater resistance to valgus load over the range of motion. Methods: Ten cadaveric elbows were mounted to a testing fixture and incremental valgus moments of 2.5, 5, and 7.5 Nm were applied with the elbow in 120°, 90°, 60°, 30° and 0° of flexion and in varying rotational forearm positions. The intact and the ulnar collateral ligament released elbow joint were compared with the docking ulnar collateral ligament reconstruction technique, using different graft sources with increasing cross-sectional areas: palmaris longus, tricpes brachii, extensor carpi radialis longus, and semitendinosus. The resulting angular displacement was evaluated and compared between graft sources and different elbow positions. Results: Compared with the intact situation, ulnar collateral ligament release resulted in a significant increase in valgus deformation over the entire range of flexion–extension motion. Ligament reconstruction using any graft source significantly restored valgus stability at 60°, 90°, and 120°, while at 0° and 30°, angular valgus deformation did not significantly differ from the ulnar collateral ligament deficient situation. There were no significant differences in angular valgus deformation between the graft sources over the range of flexion motion or forearm rotation. Conclusions: This study did not prove that a thicker graft yielded more resistance to valgus moments when using the docking technique. Thicker grafts require larger bone tunnels, cannot be adequately tensioned, and are non-anatomic. Therefore, the palmaris longus or a triceps tendon strip are considered more appropriate for ulnar collateral ligament reconstruction. © 2015, The Japanese Orthopaedic Association.


Hopf J.C.,Chirurgische Klinik | Berger V.,Chirurgische Klinik | Krieglstein C.F.,Chirurgische Klinik | Muller L.P.,Universitatsklinikum Cologne | Koslowsky T.C.,Chirurgische Klinik
Journal of Shoulder and Elbow Surgery | Year: 2015

Background: The aim of this study was to provide subjective and objective results of surgical treatment of unstable elbow dislocations with the hinged external fixation technique. Methods: Twenty-six patients were available for re-examination after treatment. Parameters used to quantify the subjective functional results were the Mayo Elbow Performance Score, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire, and the stability of the elbow joint. In addition, we measured the medial and lateral joint space by varus and valgus stress ultrasound examinations of the elbow. Results: The mean Mayo Elbow Performance Score was 93.5 (±8.3 standard deviation), and the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire showed an average of 7.3 points (±8.9 standard deviation). We saw 18 patients with stable joints and 8 patients with slight instability. In the ultrasound stress test, we saw a significant difference of the affected joint under varus stress (7.8±1.7mm) compared with the healthy joint (5.8±1.2mm) laterally. Furthermore, medially the gap was significantly larger (4.8±0.9mm; treated elbow) than contralaterally under valgus stress (3.3±0.7mm) (. P<.001). Conclusion: Closed reduction and hinged external fixation of unstable elbow dislocations resulted in good and very good results. We could identify a slight difference in the stability of the affected elbow compared with the contralateral side in all patients without clinical relevance. © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.


Symptomatic patients with primary hyperparathyroidism (pHPT) are all candidates for surgery. Due to an increased morbidity and mortality of patients with asymptomatic disease in long-term surveys the indication for surgery has been expanded in recent years. Experienced surgeons perform up to 50% of operations for pHPT in minimally invasive techniques with intraoperative quick-iPTH monitoring with equal results to open surgery. Preoperative exact localisation of the parathyroid adenoma with ultrasound and MIBI-SPECT scintigrafy is essential in minimal invasive surgery for pHPT. All minimal invasives procedures must compete with the high success rates (up to 98%) and low complication rates (recurrent laryngeal nerve palsy rate <1%) of the gold standard open procedure.


Zingg U.,Chirurgische Klinik | Oertli D.,University of Basel
Therapeutische Umschau | Year: 2012

Functional and metabolic syndromes after surgery of the upper gastrointestinal tract (including the pancreas) are frequent. Resections of organs mandate the reconstruction with a change of anatomy. Predominantly, the reconstruction using a Y-en-Roux jejunal loop is used. The surgical alteration of the anatomy may lead to a different physiology. Patients after esophagectomy or gastrectomy may suffer from dysphagia, dumping syndromes, reflux and anaemia. Pancreatic resections or drainage operations may cause an exocrine or endocrine insufficiency. Patients after surgery for gastroesophageal reflux or achalasia may have gas-related symptoms such as bloating and flatulence. The treatment options of these syndromes include physical measures, drugs, interventional procedures and even revisional surgery. Detailed preoperative information of the procedure and multidisciplinary postoperative treatment (general practitioner surgeon, gastroenterologist etc.) of evolving functional syndromes is mandatory to achieve a high standard of care. © 2012 by Verlag Hans Huber, Hogrefe AG, Bern.


the sleeve gastrectomy becomes the most frequently used bariatric procedure. Also if it seems to be a relative «simple» procedure, the procedure itself includes some risk points. Die nodal points of the surgical procedure was detailed explained. The prevention of complications starts with the respect of the key risk points.


Weiner R.A.,Chirurgische Klinik
Gastroenterologe | Year: 2010

The prevalence of overweight and obesity and the number of surgical interventions for morbid obesity are increasing worldwide. Conservative therapy is largely ineffective in producing maintained weight loss in morbidly obese patients and surgery is therefore increasingly considered as the only available option for these patients. Until approximately 15 years ago many patients and physicians regarded bariatric surgery as a dangerous instrument because it required a large laparotomy and was associated with a relatively high risk of complications. Since laparoscopic techniques have been available, however, the number of patients referred for surgery has been increasing constantly. The principles of standard procedures are independent of access routes, open or laparoscopic. The most important pathophysiological mechanisms are restriction, malabsorption or a combination of both. New findings in the field of endocrine and humoral regulations have shown that surgical procedures can induce complex changes in the regulation of enterohormones. These mechanisms are the basis for metabolic effects, especially on diabetes mellitus type 2. Obesity surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea. Surgery for severe obesity goes way beyond weight loss. Improvement of quality of life and extended life expectancy will also be influenced in a positive manner. Copyright © Springer-Verlag 2010.


Hottenrott C.,Chirurgische Klinik
Gastric and Breast Cancer | Year: 2011

Although there is no evidence for improving overall survival, comparative-effectiveness research indicates better short-term outcome and quality-of-life with minimally invasive surgery than open surgery for specific cancer types. For example, laparoscopic colectomy has been the standard for colon cancer in specialized hospital. Positive results are also reported recently for laparoscopic resections of rectal and gastric cancer that may also replace open surgery in the next years. Latest advances include the use of robots as the Da Vinci Surgical System and single-incision minimally invasive techniques. Robotic surgery with prostatectomy and low anterior rectum resection is increasingly now used in the treatment of prostate and rectal cancer. Here I discuss the advances, limitations and opportunities to overcome challenges for future establishment of robotic and laparoscopic surgery for specific tumor locations personalizing surgical decisions in the treatment of solid cancers.

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