Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Meta Analysis Comparative Study
[Conventional and minimally invasive surgical methods for gastroesophageal reflux].
The introduction of minimally invasive techniques has had great influence on the indication and surgical therapy for gastroesophageal reflux disease. This analysis is an overview of the current evidence-based status and a critical reprisal of open and laparoscopic antireflux surgery. ⋯ The analysis of randomized trials showed an advantage for patients after laparoscopy for total and partial fundoplication because of reduced morbidity, shorter postoperative hospitalization due to faster recovery, and significantly fewer scar and wound problems. The functional results of open and laparoscopic techniques were similar. Five-year follow-up results for the latter showed effective reflux control in at least 85% of patients. Randomized trials regarding technical variations did not show an advantage for division of the short gastric vessel. A bougie for the cardia calibration can prevent postoperative dysphagia after fundoplication.
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The aim of this study was to analyse the number of thoracic injuries associated with acute traumatic paraplegia of the upper and middle thoracic spine and review the early management in respect to treatment standards. ⋯ Acute traumatic paraplegia of the upper and middle thoracic spine caused by high energy trauma is highly associated with severe chest trauma. Therefore, respiratory impairment must be kept in mind during the early treatment. If respiratory failure becomes more evident, emergency procedures such as intubation and chest drainage have to be performed. Secondary transfer should be avoided.
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This paper reviews the surgical management of vascular injuries. Precise clinical and ultrasound evaluation is mandatory during the first steps of emergency treatment. ⋯ Especially during the acute phase, the latter is indicated for evaluating the interventional therapy. The key to successful treatment of vascular injuries is immediate surgical control of hemorrhaging vessels.