Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Comparative Study
[Indicators of quality in surgical treatment of rectal carcinoma].
For the assessment of surgical therapy for rectal cancer, perioperative and oncological as well as aspects of quality of life have to be taken into consideration. The objective of the present analysis was to identify indicators allowing assessment of the quality of the surgical intervention. ⋯ For the assessment of surgery for rectal carcinoma, only a few parameters are necessary. As indicators of quality after rectal resection, the rate of anastomotic leakage should be registered; after abdominoperineal resection, the rate of perineal wound infection, the ratio of postoperative bladder dysfunction, and the locoregional rate of recurrence should be registered.
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Comparative Study
[Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate].
There is a high incidence of postoperative complications and late recurrences after operative therapy of a pilonidal sinus. The optimal treatment strategy is still matter of discussion. We studied the long-term results after excision of a pilonidal sinus and primary midline closure compared with the open surgical procedure. ⋯ Despite of numerous previously operated patients (38%), there was a high recurrence rate (42%) after excision of a pilonidal sinus and primary midline closure. Alternative operative techniques creating a lateral wound or the various skin flap procedures may be promising alternatives. We are in the process of changing our treatment strategy for patients suffering from a pilonidal sinus.
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After subtotal resection of multinodular goiter, rates of up to 40% are reported for recurrent goiter in the long-term follow-up. Because of the increased morbidity of surgery for recurrent goiter, this study evaluated the preconditions that would justify total thyroidectomy as part of the primary therapy concept for benign multinodular goiter. ⋯ Total thyroidectomy is associated with an increased rate of RLN palsies and hypoparathyroidism in comparison to less extensive thyroid surgery. In the hands of well-trained surgeons using an appropriate intraoperative technique, primary thyroidectomy is justified if the patient has an increased risk of recurrent goiter. Due to the increased postoperative morbidity after total thyroidectomy, subtotal thyroid resection based on the morphologic changes in the thyroid gland is still recommended as the standard treatment regimen for multinodular goiter.