Chirurgische Klinik

Karlsruhe, Germany

Chirurgische Klinik

Karlsruhe, Germany
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Greger A.,Medizinische Klinik | Hamelmann W.,Chirurgische Klinik | Konermann M.,Medizinische Klinik
Internist | Year: 2017

A 67-year-old man suffering from epigastric pain showed a phytobezoar in the endoscopy. Therapy with Coca Cola® and enzymes was initiated. The (partial) lysis led to a migration of the bezoar into the ileum, resulting in a small bowel obstruction. After removal of the remaining bezoar via ileotomy a secondary pneumatosis intestinalis occurred. As a rare finding the (phyto-)bezoar should be considered as a differential diagnosis of abdominal pain – especially considering the rising numbers of bariatric surgery, which is a potential risk factor. Furthermore, intestinal obstruction after migration has to be considered as a relevant complication of treatment. © 2017 Springer Medizin Verlag GmbH


Vallbohmer D.,Chirurgische Klinik | Erhard J.,Chirurgische Klinik
Onkologe | Year: 2017

The histopathologically confirmed detection of tumor metastases without identifying the primary anatomical site is defined as cancer of unknown primary (CUP syndrome). Of all cancer patients 3–5% have CUP syndrome, which represents a frequent malignant disease in the clinical routine and is highly challenging in terms of diagnostic and therapeutic procedures for clinical oncologists. The prognosis of most patients with CUP syndrome is very poor and in most patients a palliative treatment is performed; however, in recent years some prognostically favorable special cases have been differentiated for which specific therapeutic options exist, including surgical resection; therefore, the current review describes in detail the surgical options in these subgroups of patients with CUP syndrome. © 2017 Springer Medizin Verlag GmbH


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.


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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