Zentralblatt für Chirurgie
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The surgical treatment of pilonidal sinus with the Limberg transposition flap will be demonstrated in 40 patients (22 male; 18 female). First step is draining the infect by incision, followed by radical excision of the pilonidal sinus and covering of the defect by a rhomboid transposition flap. In 39 out of 40 cases primary wound healing occurred. ⋯ In one case a seroma was observed which was drained and showed secondary wound healing. The mean hospital stay was 7.9 days and the mean time until return to work was about 15 days. We consider the Limberg transposition flap to be an effective treatment of pilonidal sinus disease due to its technical simplicity and low complication rate.
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Comparative Study
[The acute mesenteric ischemia - not understood or incurable?].
Despite surgical research and progress, the high mortality of acute intestinal ischemia seems to be improved insignificantly over the past fifty years. In this study we analyzed the specific diagnostic and therapeutic problems of the disease in order to improve further management of acute mesenteric ischemia. ⋯ Early diagnosis before hospitalisation and in-hospital (arteriography) and operation are essential to improve the outcome of patients with acute intestinal ischemia. To avoid short bowel syndrome bowel resection should be combined with mesenteric revascularization. Resection of malperfused bowel should be done cautiously and should be followed automatically by second look operations. Special expertise and good team work of visceral and vascular surgeons are required to achieve better therapeutic results.
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With the planned introduction of Diagnosis related groups (DRG) in the German in-patient reimbursement system an economic brake will be put on the hospitals. The upcoming expected growth of the older German population and the ongoing process of better diagnostic and therapeutic procedures leads to a gap between costs and resources in the established health care system. ⋯ The short time consequences result in great efforts of correct coding of diagnoses and procedures, as a survival strategy for surgical departments. More or less are new structures necessary, the development of "clinical pathways" and the increase or decrease of capacities will become the main tasks in the next years.