Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
The structural organization of research facilities within a surgical university center should aim at strengthening the department's research output and likewise provide opportunities for the scientific education of academic surgeons. We suggest a model in which several independent research groups within a surgical department engage in research projects covering various aspects of surgically relevant basic, translational or clinical research. ⋯ Importantly, a focus needs to be placed on obtaining evidence-based data to judge the efficacy of novel diagnostic and treatment concepts. Integration of modern technologies from the fields of physics, computer science and molecular medicine into surgical research necessitates cooperation with external research facilities, which can be strengthened by coordinated support programs offered by research funding institutions.
-
Surgical research in Germany occupies a lower position in international ranking than expected. According to the size of the population, the economic impact, the gross domestic product and the research funding capacity, the impact of German surgical research should be much higher. ⋯ If the situation is to be improved all factors have to be evaluated and, if possible, changed. Overall, German surgeons are underrepresented as readers and authors in the scientific market, which is mostly in the English language.
-
During the last two decades research in surgery has changed from a specific to an interdisciplinary approach. Accordingly, the research approaches in surgery show marked overlap with those of other disciplines, such as oncology, immunology, gastroenterology, cardiology and intensive care medicine. This questions the need of experimental surgery in the future. ⋯ In addition experimental surgery coins the analytical thinking of young surgeons and mediates the enthusiasm and motivation to search for the undiscovered in surgery. Therefore, there is need to further support experimental surgery as an essential component of academic surgery. Thus, it can be concluded that experimental research still represents a prerequisite for innovations in operative medicine and also contributes to the improvement of scientific performance in surgery.
-
After stoma formation, parastomal hernia develops in 30-50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. ⋯ A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies. Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.
-
Incisional hernias are the most common long-term complication after laparotomy with a cumulative incidence up to 20%. Generally all injuries to the integrity of the abdominal wall can result in the development of an incisional hernia. Midline and transverse incisions cause similar hernia rates. ⋯ Results from randomized controlled trials have not yet demonstrated a superiority of laparoscope-assisted procedures compared to laparotomy for the prevention of incisional hernias. Access through natural orifices and removal of specimens through the same approach (NOTES) may prevent incisional hernias completely. The approach to the abdominal cavity has to be chosen according to the underlying disease of the patient, the anatomical conditions and further circumstances (e.g. urgency, extensibility, preservation of function of the abdominal wall and safety).