Zentralblatt für Chirurgie
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In the light of an incisional hernia incidence of between 10 and 20 % that remains constantly high in spite of modifications of suture materials and suture techniques, intensified scientific efforts aiming at incisional hernia prevention are -required. This article reviews the scientific results dealing with incisional hernia incidence, time of manifestation, risk factors and the influence of suture material and suture technique. A lack of evidence-based data and no current consensus concerning the ideal material and technique to close laparotomies has to be mentioned. ⋯ This technique has almost no influence on abdominal wall per-fusion, leaves the architecture and dynamics of the abdominal wall intact, and results in a favour-able ultra-structural composition of collagen and a mechanically stable laparotomy healing after 15 months. Measures to prevent incisional hernia formation - which is in fact the post-operative complication in surgery most frequently leading to re-operation - require intensified research activities. Success will only be achieved if the development of -unconventional closure techniques is encouraged and the beaten path of suturing the incisional edges is discarded.
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Case Reports
[Stenosis and iatrogenic perforation as complication following long-term stenting of the oesophagus].
Anastomotic leaks after oesophagojejunostomy usually are treated by endoluminal stenting with self-expandable metal or plastic stents. Here we present a patient with more than 4 years of oesophageal stenting for anastomotic leakage after gastrectomy. ⋯ Emergency surgery with complete resection of the stent and transhiatal oesophagojejunostomy was performed. Generally, early removal of oesophageal stents 4-6 weeks after implantation is recommended, as later attempts often fail and may lead to extensive surgery.
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Retroperitoneal soft-tissue sarcomas (RSTS) represent a rare and heterogeneous class of diseases for which the clinical management is still largely non-standardised. Based on a selective review of recent publications, it was the purpose of the present review article to summarize the current concepts of disease classification, diagnostics and surgical as well as multimodal therapy for these tumors. ⋯ The clinical management of RSTS is complex and can only partly be considered as evidence-based. Due to the required level of experience in the treatment of these tumor lesions and the involvement of several subspecialties, pre-therapeutic planning, treatment and follow-up should be limited to high-volume surgical centres. In order to achieve microscopically negative resection margins, multivisceral resections are a valuable option after thorough consideration of the risks and benefits. Adjuvant radiotherapy needs to be decided upon on an individual basis, taking into account patient- and tumor-specific factors as well as resection status.
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About 160 palliative care units with 1228 beds or 15 beds / 1 million inhabitants were available in German hospitals in the year 2008. Demand analyses consider 35 beds / 1 million inhabitants as necessary. Whether the additional demand could be reduced by a greater use of home- and hospice-based end-of-life care is discussed. ⋯ However, data suggest that prior experience in palliative care alters the selection of treatment recommendations by surgeons with respect to more supportive or aggressive interventions in patients with advanced cancer. Ethical decision-making regarding therapy and counselling of patients at the end of life and discussing the prognosis with patients and their families require education in palliative medicine. A core curriculum to teach palliative care for surgical residents therefore has been presented.