Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Complications are quite common in thoracic surgery due to the comorbidities of the mostly elderly patients and to the fact that the surgical procedure itself compromises the respiratory apparatus. Consequently, pneumonia and respiratory failure represent the most common causes of death. Postoperatively, early diagnosis and treatment of these complications are paramount while most other events can be anticipated and thus be avoided with corresponding operative experience.
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Postoperative complications occur in 10% of patients following major visceral surgery. Of these more than 80% are surgical complications, more than 70% are septic complications and more than 60% are related to anastomotic leakage which accounts for the majority of postoperative deaths. To achieve successful management, early diagnosis is mandatory in cases of deviations from the normal postoperative course. ⋯ The spectrum of therapeutic options is different and depends on the location of the leakage in the gastrointestinal tract. In the surgical treatment of peritonitis, the fundamental requirements for successful management are early detection of persistent abdominal sepsis and of newly developing abdominal complications during the treatment. Furthermore early initiation of effective antibiotic concepts is mandatory.
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Case Reports
[The role of intensive care medicine in early postoperative complications. Is surgical expertise in danger?].
Intensive care medicine is the backbone of surgery. We describe a profile of parameters which has to be repeatedly evaluated to allow early detection of postoperative complications. Complex surgical diseases are analyzed to underscore that only a surgeon experienced in intensive care medicine is able to interpret abnormalities in correlation with the intra-operative findings resulting in appropriate decisions with respect to diagnostic measures and reintervention. ⋯ Identification of young surgeons with intensive care medicine is further hampered by the establishment of interdisciplinary operative ICUs excluding surgeons from the leadership. Our current survey of 38 university departments of general and gastro-intestinal surgery in Germany shows that a cooperative ICU steering structure of anesthesiologists and surgeons exists in only 19%. The imminent deficit of training in surgical intensive care medicine can only be counteracted by equal leadership structures.
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Case Reports
[Neuralgia of the genitofemoral nerve after hernioplasty. Therapy by peripheral nerve stimulation].
The peripheral nerve stimulation (PNS) is an established therapy in the management of neuropathic pain. Here, we describe a case of successful epifascial stimulation in the proximity of the genitofemoral nerve, which was injured during an endoscopic hernioplasty. ⋯ There were no adverse events until now. In conclusion, PNS is a promising procedure in the treatment of neuralgia after hernioplasty.
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In general and visceral surgery fast-track rehabilitation means a procedure-specific, evidence-based, multimodal, interdisciplinary and patient-focussed clinical pathway in perioperative therapy. The primary goals of fast-track rehabilitation are to maintain patient autonomy and homeostasis, minimization of postoperative organ dysfunction and prevention of postoperative general morbidity (i.e. cardiopulmonary complications, nosocomial infections). At the same time, postoperative recovery is accelerated and early discharge from hospital after surgery becomes possible. ⋯ Therefore, implementation of fast-track programs should be accompanied by intensive education and collaboration of all professional groups concerned with perioperative patient care. So far, visceral surgeons have been leading the field of fast-track rehabilitation and fast-track could be a way for surgeons to recapture lost ground in perioperative medicine. Therefore, intensive experimental and clinical research in fast-track rehabilitation is strongly recommended for visceral surgeons to maintain competence in scientific discussions with other medical specialists.