Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Meta Analysis
[Survival, mortality and quality of life after pylorus-preserving or classical Whipple operation. A systematic review with meta-analysis].
Two surgical procedures are mainly performed for the treatment of pancreatic head cancer and periampullary carcinoma: the classical Whipple operation and the pylorus-preserving Whipple operation. ⋯ Mortality, survival and QoL were not significantly different between the classical Whipple and the pylorus-preserving Whipple operations. Given the poor quality of the underlying trials a pragmatic RCT is recommended to prove the findings of this systematic review.
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Case Reports
[Necrotizing fasciitis after "banal" back pain. An unusual course of a retrocoecal appendicitis and its sequellae].
Necrotizing fasciitis is a life-threatening disease which can only be successfully treated by an interdisciplinary team. An immediate and radical debridement with opening of all compartments and debridement of the affected fascia is the basis for a successful therapy. We report about the treatment of a 21-year-old man who was taken to hospital due to "banal" back pain which was caused by a perforated appendicitis. In only 2 days necrotizing fasciitis developed which spread out over the complete right leg.
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It has been proven that pre-operative and postoperative surgical safety checklists designed to improve team communication and consistency of care are useful tools to improve surgical outcome. The aim of this study was to investigate the effectiveness of intra-operative consultation (IOC) with regard to its feasibility. IOC comprises an assessment of definite pathways in the operative procedure by another surgeon present in the operating theatre in a consultative capacity during specific steps of the operation. ⋯ It was found that IOC is feasible in the majority of operations. In the case of tactical IOC a large number of treatment-relevant decisions are taken. This means that in the area of operative disciplines IOC represents a potential preventive strategy within the framework of quality management and a useful addition to the WHO checklist to improve safety in surgery.