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Background: The digitalization process is currently on everyone's lips and sweeping changes in the field of public health and especially in surgery are to be expected within the next few years. Besides general issues, such as electronic health records and medical information systems, artificial intelligence, robotics and model-based surgery will decisively impact on the daily routine. In order to provide the necessary knowledge base, to point out related risks and chances and also to define fields of action for surgery, the German Society of Surgery commissioned a position paper on digitalization. A first appraisal in form of an online survey is the subject of this article. Methods: This article is based on an online survey of the members of the German Society of Surgery and selected members of other related societies. The survey asked for the members' personal assessment concerning different aspects of the digitalization process and the respective state of knowledge as well as the impact on the field of surgery. Results: A total of 296 members contributed to this survey. According to their assessment, digitalization in surgery is currently associated with terms such as electronic health records and medical information systems but they also assume a relevant influence on their own activities and on the fields of interventional medicine and surgery. A relevant need for improvement of the current state of knowledge was highlighted, not only for general aspects of digitalization but also for surgically relevant issues in particular. The vast majority of interviewed members saw digitalization more as a chance for improvement than as a risk factor. Conclusion: According to the views of interviewed members of the German Society of Surgery the process of digital transformation will significantly impact the field of surgery. All those involved should feel responsible to contribute to and guide this process in order to maintain the surgically inherent requirements and to protect patient safety. The position paper on digitalization can serve as a basis and should define concrete recommendations for action. In the sense of an academic approach the new possibilities should be critically evaluated with respect to suitability and should be exclusively confined to applications that are beneficial to ourselves and to our patients. [ABSTRACT FROM AUTHOR]

Background: Every third surgical patient already suffers from anemia before surgery. The main cause is iron deficiency. Objective: This article describes the perioperative risk of iron deficiency with/without anemia and summarizes potential preventive measures. Material and methods: Presentation of various current original papers, guidelines and own experiences from the German patient blood management network. Results and conclusion: Preoperative iron deficiency with/without anemia is an underestimated risk factor for perioperative complications. The implementation of preoperative diagnostics and treatment as part of a comprehensive patient blood management reduces complications and increases patient safety. [ABSTRACT FROM AUTHOR]

Background: Benign biliary diseases comprise entities, which present with very similar pathognomonic symptoms despite fundamental etiological differences. Obstructions of intrahepatic and extrahepatic bile ducts due to stones, tumors or parasites as well as stenoses and cystic alterations belong to the group of benign biliary diseases. Objective: This article provides a systematic overview of the indications and differential treatment of benign biliary diseases with special emphasis on the surgical treatment. Material and methods: The presented recommendations are in accordance with national and international guidelines, current scientific papers and expert opinions. Results: Essentially the surgical options for benign biliary diseases consist of revision, reconstruction through bilioenteric anastomosis, resection and complete organ replacement in the sense of liver transplantation. The location of the affected segment of the biliary tree, the symptoms, the progress of the disease and suspected malignancy essentially determine the level of escalation in the described treatment level scheme. Conclusion: The treatment of benign biliary diseases is complex and requires achievement of unimpaired, unobstructed bile drainage. It serves the purpose of resolving cholestasis and thereby avoiding recurrent cholangitis and long-term complications, such as biliary cirrhosis and malignant transformation; however, in some cases of premalignant lesions of the bile ducts the strategy resembles cancer surgery, including resection of the affected tissue. [ABSTRACT FROM AUTHOR]

Social interactions are hardly possible without trust. Medical and in particular surgical actions can change the lives of people directly and indirectly existentially. Thus, the relationship between doctor and patient is a special form of social interaction, and will be hard to find anywhere else. The nature of the doctor-patient relationship also determines the success of a treatment. The core and the importance of trust, as a central part of this relationship, will be reconstructed in the present paper. The increasing possibilities of information acquisition in modern societies, and the ever-present need for transparency, impact more and more on the doctor-patient relationship. At first glance, concepts of trust seem to be of secondary importance. The current developments regarding the remuneration of services in the medical system likewise bear the risk to increasingly determine the importance of trust in the doctor-patient relationship. However, it is necessary to delineate reliability from trust. Due to the conditions which are constitutive for the operational disciplines, a climate of trust, even in a modern information society, is more necessary than ever. [ABSTRACT FROM AUTHOR]

The treatment of the severely injured is, just as the injury severity and combinations, often highly complex and leaves little leeway for delay, dissent or even error. In order to reduce this to a minimum, trained emergency room teams in addition to optimal technical and structural prerequisites are necessary. This must function in an interdisciplinary fashion according to fixed consensus algorithms which are known to all team members and have been agreed by all participants. The White Paper on treatment of the severely injured of the German Society of Trauma Surgery (DGU) and the recently published S3 guidelines offer evidence-based recommendations on the structural, technical, organizational and personnel prerequisites. [ABSTRACT FROM AUTHOR]

Background: Systemic mast cell activation disease (MCAD) is characterized by an increased and unregulated release of mast cell mediators which can evoke a multifaceted clinical picture often resembling irritable bowel syndrome or fibromyalgia. Because of the considerable prevalence (~ 17 %) of MCAD surgeons are frequently unwittingly confronted with MCAD patients in whom unexpected intraoperative and postoperative complications may occur. Therefore, knowledge of the particular requirements is of relevance for surgical treatment of MCAD patients. Objective: The present paper outlines a concept of surgical treatment of MCAD patients based on the literature which is illustrated by a case report on emergency laparoscopic cholecystectomy. Conclusions: Due to the high prevalence of MCAD in the general population it can be assumed that the frequency in the surgical patient population is similar. If a patient has MCAD, specific characteristics should be taken into account in the surgical procedure to avoid increased operative and complication risks resulting from MCAD. [ABSTRACT FROM AUTHOR]

The treatment of rectal cancer has evolved significantly in recent decades. Both modern radiotherapy treatment concepts and surgical techniques have been able to improve oncological as well as functional outcomes for rectal cancer patients. Large-scale, multicenter, randomized trials have been able to demonstrate the benefits of neoadjuvant treatment over adjuvant radiotherapy. In addition, local tumor control is improved by neoadjuvant irradiation. Conversely, patients receiving a total mesorectal excision showed no survival advantage following irradiation vs. only surgically resected patients. In addition, radiation therapy is associated with a certain morbidity and mortality. This paper summarizes the available evidence regarding postoperative morbidity, mortality, and long-term chronic effects of neoadjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Background: The German National Surgical Trial Network (CHIR-Net) which has been funded since 2006 by the Federal Ministry of Education and Research (BMBF, funding code 01GH1001A-01GH1001F, 01GH0702) is made up of eight regional surgical centers. The aim of the CHIR-Net is the design, implementation and publication of prospective, randomized, multicenter trials to support evidence-based medicine in surgery. Two main pillars of the CHIR-Net are the surgeon on rotation program and the flying study nurse program. With these two programs the surgical hospitals are supported in their trial working by educating competent investigators and the infrastructural support of flexible and mobile study nurses. Methods: The surgeon on rotation program and the concept of the flying study nurse are presented descriptively. Furthermore, this paper provides reports of experiences of a surgeon on rotation and a flying study nurse of the CHIR-Net. Additionally, the results of an on-line evaluation of the regional surgical hospitals (belonging to the regional surgical center of the universities Witten/Herdecke and Cologne) regarding the needs and requirements of the regional surgical hospitals are presented. Results: The surgeon on rotation program of the CHIR-Net offers investigators the possibility to acquire the basics of designing, developing and implementation of high quality clinical trials. In addition, their own study projects could be intensively driven forward. The flying study nurse program enables in particular non-university surgical hospitals to be supported competitively in performing their own study projects and participating in muliticenter clinical trials. The success of these two programs has been confirmed by the conducted evaluations and the presented field reports. Conclusion: The CHIR-Net is able to develop a high quality study culture in Germany with its surgeon on rotation and flying study nurse program. In addition to the funding period by the BMBF, the continuance of the CHIR-Net should be a primary aim of further measures. [ABSTRACT FROM AUTHOR]

Surgical therapy of anal sphincter insufficiency is only indicated if it leads to symptoms and conservative treatment fails to achieve adequate symptom relief. Various new surgical options have evolved over the last decade but evidence of the efficacy varies substantially. Some have gained broader clinical acceptance based on the efficacy, ease of applicability and low risk profile. The paper aims to outline the currently commonly accepted and frequently applied surgical techniques for the treatment of anal sphincter insufficiency and the results, put these into the context of a treatment algorithm and to present novel techniques which carry potential for the future. [ABSTRACT FROM AUTHOR]

The choice of potential options for an arteriovenous (AV) access is limited for each individual patient. Complications shorten the maximum life span of any AV access. This paper stresses the importance of recognizing complications in time so as to initiate early and adequate therapy which are explained in further detail. Existing vascular accesses should be used as long as possible while maintaining further alternatives for future AV access surgery. [ABSTRACT FROM AUTHOR]

The committee draft for the new patient rights act was approved by the Federal Cabinet on 23 May 2012. Both the demands of the patient representative of the Federal government and some of the demands from the cornerstone paper of the State commission were taken into consideration. The draft of the new act contains comprehensive amendments to the Civil Code with the subtitle'Treatment contract in accordance with §630' and encompasses §§630a-h. The valid legal situation is therefore to all intents and purposes now codified. [ABSTRACT FROM AUTHOR]

Placing drains is one the most common procedures following operations in surgical disciplines. The indication for placing a drain is, however, usually based on a traditional belief rather than being evidence-based. This paper presents an overview of the literature regarding the indications and the evidence level for placing drains following operations in visceral, vascular, thoracic and orthopeedic surgery as well as traumatology. In visceral surgery the indications for placing drains could be clarified over the past decades but in other surgical fields the level of evidence needs further investigation and clarification through future studies. The available data suggest that in most cases a prophylactic drainage can be avoided. In addition, drains may lead to increased morbidity and higher treatment costs. [ABSTRACT FROM AUTHOR]

Spigelian hernias are rare forms of abdominal hernia but can lead to severe complications. Besides conventional techniques there are only a few reports on the successful use of minimally invasive surgery (MIS) techniques. In this paper the combination of laparoscopy and TEP (total extraperitoneal patch plasty) technique without mesh fixation is presented. In our opinion laparoscopy - TEP - laparoscopy is a logical, safe and beneficial method for treatment of Spigelian hernias. [ABSTRACT FROM AUTHOR]

Background and Purpose: Acute gastrointestinal bleeding (AGIB) requiring transfusion and surgical treatment still constitutes a life-threatening situation. The purpose of this paper was to examine the treatment outcome for this group of patients as a function of various risk factors and to present our diagnostic and therapeutic regime. Methods: A retrospective analysis of data from 154 patients with AGIB who underwent surgical procedures and received massive transfusions in a university hospital between 1999 and 2008 was carried out. Results: The patients were divided into two groups. Group I include 91 patients with acute upper gastrointestinal bleeding and group II included 63 patients with lower gastrointestinal bleeding. The average age was 67 years (range 29-93 years) in group I and 70 years (39-97 years) in group II. The initial hemoglobin level was 8.4 g/dl in group I and 10.5 g/dl in group II. Univariate analysis of mortality revealed the following significant risk factors for group I: postoperative need for ventilation (p=0.007), prolonged ICU stay (p=0.004) and anticoagulants in the medical history. The risk factors in group II were blood transfusions >10 units (p=0.031), postoperative need for ventilation (p=0.004), necessary reoperations (p=0.016) and an initial hemoglobin level <8.0 g/dl (p=0.043). The complication rate was 76.9% (mortality rate 34.1%) in group I and 60.3% (mortality rate 15.9%) in group II. Conclusions: Examination and stabilization of the patient is directly followed by diagnostic localization. The indication for surgery is mainly limited to peracute, uncontrollable and recurrent forms of gastrointestinal bleeding. The mortality rate for these critically ill, negatively selected patients remains high and could not be lowered in the last decade. Postoperative need of ventilation is a predictor for poor prognosis. [ABSTRACT FROM AUTHOR]

Medical professionals with additional economic qualifications are in high demand. For doctors who aim for leading positions at medical institutions the most popular additional qualification is a Master of Business Administration (MBA). The demands on executive managers in hospitals have without any doubt changed in recent years requiring them to be trained in basic economic understanding, human resource management etc. in addition to having excellent medical training. However, MBA programs differ from one academic institution to the next. Due to the lack of standardized schedules in MBA programs it cannot be ascertained whether a candidate received adequate training and can offer the skills necessary for a higher level medical profession. In this paper the author suggests that specific training in individually required skills would be more reasonable and effective rather than encouraging medical staff to pursue academic studies leading to an MBA. [ABSTRACT FROM AUTHOR]