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Karlsruhe, Germany

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.

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.

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.

The prevalence of arterial and venous vascular diseases will further increase in the future due to demographic changes. Simultaneously the diagnostics and treatment of vascular diseases have made considerable progress particularly in endovascular therapeutic procedures. These improvements have led to a substantial reduction in the duration of stay in hospital and less invasive treatment especially in the treatment of peripheral arterial occlusive disease (PAOD) and aortic aneurysms. Because of the rapid technological progress, endovascular medicine requires the willingness to learn new techniques and to become acquainted with new products. In the majority of cases treatment of vascular main diagnoses is carried out in Germany in vascular surgical or surgical departments. Vascular surgery therefore has the main responsibility for the care of vascular disease patients. According to the guidelines of the Joint Federal Committee (GBA) in the future abdominal aortic aneurysms can only be treated in hospitals which can demonstrate a structural competence in vascular surgery. From the perspective of the German Society for Vascular Surgery and Vascular Medicine (DGG) - Society for operative, endovascular and preventive vascular medicine - the qualified performance of endovascular interventions requires the acquisition of profound endovascular techniques and fundamental knowledge of all fields of conservative, operative and diagnostic vascular medicine. An isolated qualification as interventional specialist with no clinical competence and clinical responsibility is not acceptable to the DGG for qualitative reasons. The DGG has developed a staged further training concept including a course system, which enables the qualification to endovascular surgeonDGG and endovascular specialistDGG. © 2010 Springer-Verlag.

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.

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