9 results on '"D. Tittelbach-Helmrich"'
Search Results
2. [Pancreaticogastrostomy: when and how?]
- Author
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D, Tittelbach-Helmrich, T, Keck, and U F, Wellner
- Subjects
Gastrostomy ,Anastomosis, Surgical ,Pancreaticoduodenectomy ,Pancreatic Neoplasms ,Survival Rate ,Pancreatic Function Tests ,Pancreatectomy ,Postoperative Complications ,Pancreaticojejunostomy ,Humans ,Minimally Invasive Surgical Procedures ,Follow-Up Studies ,Randomized Controlled Trials as Topic ,Retrospective Studies - Abstract
Pancreaticojejunostomy and pancreaticogastrostomy are the two techniques for pancreatic anastomosis that are widely established for the reconstruction after pancreaticoduodenectomy. Pancreaticogastrostomy is the most recent and to date less frequently performed method, the history, techniques and indications of which are presented.Review of the literature and current evidence.Current evidence from randomized controlled trials and meta-analyses does not demonstrate significant differences in complication rates or pancreatic function after pancreaticogastrostomy versus pancreaticojejunostomy.Pancreaticogastrostomy is the technically less demanding procedure, offering at least the same level of safety as pancreaticojejunostomy. Minimally invasive and parenchyma-sparing procedures provide new areas of application for this anastomotic technique.
- Published
- 2016
3. [Comment to: Schneider R et al. 'Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve (CIONM) - Where we are today?']
- Author
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O, Thomusch and D, Tittelbach-Helmrich
- Subjects
Monitoring, Intraoperative ,Recurrent Laryngeal Nerve Injuries ,Thyroidectomy ,Humans ,Intraoperative Complications - Published
- 2011
4. [Insurance costs in pancreatic surgery : does the pecuniary aspect indicate formation of centers?]
- Author
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D, Tittelbach-Helmrich, L, Abegg, U, Wellner, F, Makowiec, U T, Hopt, and T, Keck
- Subjects
Gastrostomy ,Male ,Reoperation ,National Health Programs ,Health Care Costs ,Length of Stay ,Middle Aged ,Hospitals, University ,Pancreatic Neoplasms ,Intensive Care Units ,Pancreatectomy ,Postoperative Complications ,Pancreatitis, Chronic ,Costs and Cost Analysis ,Humans ,Female ,Clinical Competence ,Diagnosis-Related Groups ,Aged ,Quality Indicators, Health Care - Abstract
Pancreatic resections in specialized centers are associated with low mortality, however, still with high morbidity. The complication rate can be reduced by long-term experience in high volume centers. In this study the influence of complications on costs in the German DRG system were analyzed.Data regarding operation time, hospital stay, complications and costs of 36 patients undergoing pancreatic head resection in the years 2005 and 2006 were collected and analyzed retrospectively. Statistical analysis was performed using the Mann-Whitney U-test. A p-value of p0.05 was considered statistically significant.Postoperative complications caused an increase in the duration of hospital stay from a median of 16 (range 11-38) to 33 (10-69) days. Costs, especially for ICU treatment and radiographic diagnostics, rose significantly. The average overall costs were 10,015 EUR (range 8,099-14,785 EUR) in patients without complications (n = 21) and 15,340 EUR (9,368-31,418 EUR) in patients with complications (n = 15). In contrast, according to the German DRG system 13,835 EUR (10,441-15,062 EUR) and 15,062 EUR (10,441-33,217 EUR) were refunded on average, respectively.This case-cost calculation proves that pancreatic surgery in the context of the German DRG system can only be performed economically neutral in centers with low complications rates. The concentration of pancreatic surgery to centers with low complications rates, namely high volume centers, must be recommended from an economic point of view.
- Published
- 2010
5. [Erratum to: Pancreaticogastrostomy: when and how?]
- Author
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Tittelbach-Helmrich D, Keck T, and Wellner UF
- Published
- 2017
- Full Text
- View/download PDF
6. [Pancreaticogastrostomy: when and how?]
- Author
-
Tittelbach-Helmrich D, Keck T, and Wellner UF
- Subjects
- Follow-Up Studies, Humans, Minimally Invasive Surgical Procedures methods, Pancreatectomy methods, Pancreatic Function Tests, Pancreatic Neoplasms mortality, Pancreaticojejunostomy, Postoperative Complications etiology, Postoperative Complications mortality, Randomized Controlled Trials as Topic, Retrospective Studies, Survival Rate, Anastomosis, Surgical methods, Gastrostomy methods, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods
- Abstract
Background: Pancreaticojejunostomy and pancreaticogastrostomy are the two techniques for pancreatic anastomosis that are widely established for the reconstruction after pancreaticoduodenectomy. Pancreaticogastrostomy is the most recent and to date less frequently performed method, the history, techniques and indications of which are presented., Method: Review of the literature and current evidence., Results: Current evidence from randomized controlled trials and meta-analyses does not demonstrate significant differences in complication rates or pancreatic function after pancreaticogastrostomy versus pancreaticojejunostomy., Conclusion: Pancreaticogastrostomy is the technically less demanding procedure, offering at least the same level of safety as pancreaticojejunostomy. Minimally invasive and parenchyma-sparing procedures provide new areas of application for this anastomotic technique.
- Published
- 2017
- Full Text
- View/download PDF
7. [Comment to: Schneider R et al. "Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve (CIONM) - Where we are today?"].
- Author
-
Thomusch O and Tittelbach-Helmrich D
- Subjects
- Humans, Intraoperative Complications prevention & control, Monitoring, Intraoperative methods, Recurrent Laryngeal Nerve Injuries prevention & control, Thyroidectomy
- Published
- 2012
- Full Text
- View/download PDF
8. [Indication and extent of cervical lymph node dissection in differentiated thyroid carcinoma].
- Author
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Kayser C, Tittelbach-Helmrich D, Meyer S, and Thomusch O
- Subjects
- Adenocarcinoma, Follicular mortality, Adenocarcinoma, Follicular pathology, Adenocarcinoma, Papillary mortality, Adenocarcinoma, Papillary pathology, Disease-Free Survival, Evidence-Based Medicine, Humans, Neoplasm Invasiveness, Neoplasm Staging, Thyroid Neoplasms mortality, Thyroid Neoplasms pathology, Thyroidectomy, Adenocarcinoma, Follicular surgery, Adenocarcinoma, Papillary surgery, Lymph Node Excision, Neck Dissection, Thyroid Neoplasms surgery
- Abstract
Introduction: Indication and extent of lymph node dissection in differentiated thyroid carcinoma are still subject to controversy. The overall favourable prognosis, low study numbers and the different biological features of papillary and follicular carcinoma lead to few evidence-based recommendations and a low level of evidence. The different therapeutic and operative strategies are illustrated on the principles of evidence-based medicine., Material and Methods: A literature search was carried out in Medline and EMBase using the keywords differentiated/papillary/follicular thyroid carcinoma, lymphadenectomy, lymph node dissection., Results: PTC: Eleven retrospective studies outline the effect of prophylactic vs. no lymph node dissection on tumour relapse rate and long-term survival. Six of these studies combine PTC and FTC. A minor evidence-based recommendation for prophylactic cervico-central lymph node dissection in PTC can be given (evidence level 3). Lymph node dissections involving the cervico-lateral compartment can be recommended in the case of clinically pathological findings at the lymph nodes (evidence level 3). A prophylactic mediastinal lymph node dissection is not indicated (evidence level 4), a therapeutic mediastinal LAD cannot be recommended because of higher morbidity and mortality (evidence level 3). FTC: 3 retrospective studies outline the effect of prophylactic lymph node dissection on tumour relapse rate and long-term survival. Based on these, a recommendation for prophylactic cervico-central systematic lymph node dissection can be given for invasive follicular carcinoma (evidence level 3). There is no indication for prophylactic cervico-lateral or mediastinal lymph node dissection (evidence level 3)., Conclusion: The following recommendations can be given in differentiated thyroid carcinoma: In the case of clinically pathological findings in cervical lymph nodes, a systematic lymph node dissection of the lateral and central compartment is indicated (evidence level 3). Prophylactic cervico-central lymph node dissection is recommended for PTC larger than 10 mm in diameter and invasive FTC, a cervico-lateral or mediastinal prophylactic lymph node dissection is not indicated (evidence level 3). In papillary microcarcinoma and minimally invasive follicular carcinoma, a prophylactic lymph node dissection is not indicated (evidence level 3)., (© Georg Thieme Verlag Stuttgart ˙ New York.)
- Published
- 2011
- Full Text
- View/download PDF
9. [Insurance costs in pancreatic surgery : does the pecuniary aspect indicate formation of centers?].
- Author
-
Tittelbach-Helmrich D, Abegg L, Wellner U, Makowiec F, Hopt UT, and Keck T
- Subjects
- Aged, Costs and Cost Analysis, Diagnosis-Related Groups economics, Female, Gastrostomy economics, Gastrostomy standards, Hospitals, University economics, Humans, Intensive Care Units economics, Length of Stay economics, Male, Middle Aged, Pancreatectomy standards, Postoperative Complications epidemiology, Postoperative Complications surgery, Quality Indicators, Health Care standards, Reoperation economics, Reoperation standards, Clinical Competence economics, Clinical Competence standards, Health Care Costs statistics & numerical data, National Health Programs economics, Pancreatectomy economics, Pancreatic Neoplasms economics, Pancreatic Neoplasms surgery, Pancreatitis, Chronic economics, Pancreatitis, Chronic surgery, Postoperative Complications economics
- Abstract
Background: Pancreatic resections in specialized centers are associated with low mortality, however, still with high morbidity. The complication rate can be reduced by long-term experience in high volume centers. In this study the influence of complications on costs in the German DRG system were analyzed., Patients and Methods: Data regarding operation time, hospital stay, complications and costs of 36 patients undergoing pancreatic head resection in the years 2005 and 2006 were collected and analyzed retrospectively. Statistical analysis was performed using the Mann-Whitney U-test. A p-value of p<0.05 was considered statistically significant., Results: Postoperative complications caused an increase in the duration of hospital stay from a median of 16 (range 11-38) to 33 (10-69) days. Costs, especially for ICU treatment and radiographic diagnostics, rose significantly. The average overall costs were 10,015 EUR (range 8,099-14,785 EUR) in patients without complications (n = 21) and 15,340 EUR (9,368-31,418 EUR) in patients with complications (n = 15). In contrast, according to the German DRG system 13,835 EUR (10,441-15,062 EUR) and 15,062 EUR (10,441-33,217 EUR) were refunded on average, respectively., Conclusions: This case-cost calculation proves that pancreatic surgery in the context of the German DRG system can only be performed economically neutral in centers with low complications rates. The concentration of pancreatic surgery to centers with low complications rates, namely high volume centers, must be recommended from an economic point of view.
- Published
- 2011
- Full Text
- View/download PDF
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