Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Cost savings by disinfection for prevention of surgical wound dehiscence after gastrectomy].
The aim of this study was to examine the effect of decontamination as compared to placebo medication on post-gastrectomy treatment costs. The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. For the cost analysis, only patients who had been decontaminated according to the study protocol (n = 90) were compared to the non-decontaminated patients (n = 103). ⋯ The average costs per patient in the placebo group amounted to DM 20,000 while the costs for decontaminated patients were only DM 16,200, which was due to a significantly lower number of patients requiring treatment in the ICU (P = 0.0082), significantly fewer patients requiring i.v. antibiotics (P = 0.0232) and fewer patients with reoperations (P = 0.0909). The prophylaxis employing decontaminating drugs in the amount of DM 400 lowered post-gastrectomy treatment costs by DM 3800 or 19%. The prophylaxis can be recommended, because it lowers morbidity, mortality and the costs of total gastrectomy.
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We report on a 28-year-old patient, who acquired a left diaphragmatic hernia after suffering a motorcycle accident seven years ago. The diaphragmatic hernia was not diagnosed at that time. After a laparoscopic cholecystectomy performed for acute cholcystitis, there was herniation and secondary incarceration of a bowel segment into the preexistent diaphragmatic hernia. We describe laparoscopic surgical repositioning of the bowel segment and closure of the diaphragmatic defect.
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Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and to improve exercise tolerance in patients with severe lung emphysema. Selection of patients for LVR is based on history, clinical investigation, chest X-ray studies, CT scan, lung perfusion scan, lung function testing, and blood gas analysis. Selection criteria are severe emphysema (FEV1 20-35% pred., TLC > 120% pred., RV > 250% pred.), dyspnea despite optimized medical therapy, abstinence from smoking, acceptable nutritional status and rehabilitation potential. ⋯ Three cases of a delayed pneumothorax were observed. Early hospital mortality (< 30 days) was 1.7% and 90 days mortality 3.4%. Few follow-up data are available beyond 1 year, and the long-term benefit of LVR surgery therefore remains to be defined.
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Pelvic floor hernias are rare. Three different types can be distinguished; these are, in order of decreasing frequency: obturator, perineal and sciatic hernias. We report a rare case of a perineal hernia with an intra- and extraperitoneal part. Furthermore a two-stage surgical approach (first transabdominal, then posterior) is presented.