Langenbeck's archives of surgery
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Langenbecks Arch Surg · Jan 2010
Multicenter Study Comparative StudyGeneral and visceral surgery practice in German hospitals: a real-time work analysis on surgeons' work flow.
Surgeons have criticized the working conditions at German hospitals. They complain in particular about long working hours, an inadequate salary for their work, insufficient training/supervision, and an increasing amount of time spent on administration duties. Since these critics are only subjective perceptions, they should be compared to data that can be quantified more objectively and accurately. In this study, we sought to report precise data on surgeons' workflow in several German hospitals. ⋯ For the first time, surgeons' workflow in German hospitals was studied in real time. The study results substantiate physicians' statements about their own working conditions, especially with concerns to large amount of time spent on administration tasks. The findings of this study form a basis upon which further analysis can be built and recommendations for improvements in physicians' workflows at German hospitals can be made.
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Langenbecks Arch Surg · Jan 2010
Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis.
The aim of this study was to assess quality of life (QOL) in a long-term follow-up of patients with ulcerative colitis (UC) 10 years and more after ileal pouch-anal anastomosis (IPAA) to correlate these results with pouch function and to assess the long-term pouch failure rate. ⋯ QOL and functional results of patients with UC 10 years or more after IPAA were acceptable; however, those were reduced when compared to a healthy population. Pouch failure rate still increases up to 15.5% 15 years after IPAA. This result represents an important issue in providing patients with comprehensive preoperative information.
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Langenbecks Arch Surg · Nov 2009
Randomized Controlled TrialAppendicitis score for children with suspected appendicitis. A randomized clinical trial.
Appendicectomy is often performed without certainty of diagnosis. We have previously constructed and validated a diagnostic score for acute appendicitis in children. The purpose of this prospective study was to determine whether diagnosis by using the appendicitis score may improve clinical outcomes for children with suspected appendicitis. ⋯ The use of the appendicitis score can reduce the unnecessary appendicectomy rate in general surgeons treating children with suspected appendicitis.
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Langenbecks Arch Surg · Nov 2009
Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients.
The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome is a rare vascular disorder caused by an extrinsic compression of the celiac artery from the median arcuate ligament, prominent fibrous bands, and ganglionic periaortic tissue. Clinical symptoms are postprandial abdominal pain, nausea, vomiting, unintentional weight loss, and sometimes, abdominal pain during body exercise caused by an intermittent visceral ischemia. The aim of this study was to evaluate the operative management of patients with MALS in our institution, especially in consideration of various vascular reconstructive techniques. ⋯ The MALS is a rare vascular disorder caused by an extrinsic compression of the celiac artery and induces upper abdominal, mostly, postprandial pain. A definite diagnosis of MALS can be achieved by lateral aortography of the visceral aorta and its branches during inspiration and expiration. Open surgical therapy is a safe and reliable procedure with no mortality and low morbidity. As to the local and specific pathology of the celiac trunk after decompression with fixed stricture or stenosis, further vascular procedures are necessary. The long-time follow-up seemed adequate. The laparoscopic approach reduces the procedure of decompression only, something which seemed inadequate for most cases. Endovascular treatment with percutaneous transluminal angioplasty and insertion of a stent does not solve the underlying problem of extrinsic compression of the celiac trunk and often requires open procedures during the long-term course. Due to the low incidence of MALS, no guidelines will do justice to all the patients sufficiently, and the choice of treatment must depend on the specific clinical situation for each patient.
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Langenbecks Arch Surg · Sep 2009
Randomized Controlled Trial Comparative StudyThe effectiveness of FloSeal matrix hemostatic agent in thyroid surgery: a prospective, randomized, control study.
The objective of this study was to compare the effectiveness of FloSeal matrix hemostatic agent with hemostatic surgical procedures and Tabotamp in thyroid surgery. ⋯ FloSeal matrix is an effective additional agent to conventional haemostatic procedures in thyroid surgery.