5 results on '"Malkomes, Patrizia"'
Search Results
2. Excisional biopsy of perforated gastric ulcer: mandatory or potentially harmful?
- Author
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Koca F, Koch C, Schulze F, Pession U, Bechstein WO, and Malkomes P
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Biopsy, Adult, Postoperative Complications etiology, Aged, 80 and over, Stomach Ulcer pathology, Stomach Ulcer surgery, Peptic Ulcer Perforation surgery, Peptic Ulcer Perforation pathology, Peptic Ulcer Perforation mortality
- Abstract
Purpose: This study aimed to evaluate the morbidity associated with excisional biopsy in patients with spontaneous gastric perforation., Methods: A retrospective, single-center, observational study was performed. All consecutive patients with spontaneous gastric perforation who underwent surgical therapy were included. Outcomes were assessed concerning the performance of excisional biopsy., Results: A total of 135 adult patients were enrolled. Of these, 110 (81.5%) patients underwent excisional biopsy, while 17 (12.6%) did not. The remaining eight (5.9%) patients who underwent gastric resection were excluded from the analysis. Patients undergoing excisional biopsy developed significantly higher rates of postoperative complications (p = 0.007) and experienced more severe complications according to the Clavien-Dindo classification, particularly type III and above (p = 0.017). However, no significant differences were observed regarding in-hospital mortality, reoperation, suture dehiscence, or length of hospital stay., Conclusion: Excisional biopsy for gastric perforation has been shown to be associated with increased morbidity. Surgical closure followed by early endoscopic biopsy may be a superior approach for gastric perforation management to rule out malignancy., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
3. Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany.
- Author
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Willms AG, Oldhafer KJ, Conze S, Thasler WE, von Schassen C, Hauer T, Huber T, Germer CT, Günster S, Bulian DR, Hirche Z, Filser J, Stavrou GA, Reichert M, Malkomes P, Seyfried S, Ludwig T, Hillebrecht HC, Pantelis D, Brunner S, Rost W, and Lock JF
- Subjects
- Adolescent, Adult, Aged, Appendectomy adverse effects, Appendicitis diagnosis, Appendicitis etiology, COVID-19 diagnosis, COVID-19 epidemiology, Female, Germany, Humans, Length of Stay, Male, Middle Aged, Procedures and Techniques Utilization, Retrospective Studies, Treatment Outcome, Young Adult, Appendectomy statistics & numerical data, Appendicitis surgery, COVID-19 prevention & control, Communicable Disease Control, Postoperative Complications epidemiology
- Abstract
Purpose: The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany., Methods: Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed., Results: A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change., Conclusion: The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.
- Published
- 2021
- Full Text
- View/download PDF
4. DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis.
- Author
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Malkomes P, Edmaier F, Liese J, Reinisch-Liese A, El Youzouri H, Schreckenbach T, Bucher AM, Bechstein WO, and Schnitzbauer AA
- Subjects
- Acute Disease, Algorithms, Appendectomy, Female, Humans, Infant, Newborn, Prospective Studies, Sensitivity and Specificity, Ultrasonography, Appendicitis diagnostic imaging, Appendicitis surgery
- Abstract
Purpose: The management of patients with suspected appendicitis remains a challenge in daily clinical practice, and the optimal management algorithm is still being debated. Negative appendectomy rates (NAR) continue to range between 10 and 15%. This prospective study evaluated the accuracy of a diagnostic pathway in acute appendicitis using clinical risk stratification (Alvarado score), routine ultrasonography, gynecology consult for females, and selected CT after clinical reassessment., Methods: Patients presenting with suspected appendicitis between November 2015 and September 2017 from age 18 years and above were included. Decision-making followed a clear management pathway. Patients were followed up for 6 months after discharge. The hypothesis was that the algorithm can reduce the NAR to a value of under 10%., Results: A total of 183 patients were included. In 65 of 69 appendectomies, acute appendicitis was confirmed by histopathology, corresponding to a NAR of 5.8%. Notably, all 4 NAR appendectomies had other pathologies of the appendix. The perforation rate was 24.6%. Only 36 patients (19.7%) received a CT scan. The follow-up rate after 30 days achieved 69%, including no patients with missed appendicitis. The sensitivity and specificity of the diagnostic pathway was 100% and 96.6%, respectively. The potential saving in costs can be as much as 19.8 million €/100,000 cases presenting with the suspicion of appendicitis., Conclusion: The risk-stratified diagnostic algorithm yields a high diagnostic accuracy for patients with suspicion of appendicitis. Its implementation can safely reduce the NAR, simultaneously minimizing the use of CT scans and optimizing healthcare-related costs in the treatment of acute appendicitis., Trial Registration: ClinicalTrials.gov Identifier: NCT02627781 (December 2015).
- Published
- 2021
- Full Text
- View/download PDF
5. Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons.
- Author
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Reinisch A, Malkomes P, Liese J, Schreckenbach T, Holzer K, Bechstein WO, and Habbe N
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Clinical Competence, Female, Humans, Length of Stay, Male, Matched-Pair Analysis, Middle Aged, Operative Time, Retrospective Studies, Thyroid Diseases pathology, Thyroidectomy adverse effects, Young Adult, Internship and Residency, Postoperative Complications epidemiology, Specialties, Surgical, Thyroid Diseases surgery, Thyroidectomy education
- Abstract
Purpose: Resident participation in operative procedures is mandatory in educational residency programs but remains controversial, especially in the context of patient safety. This study compared the surgical quality and outcomes of thyroidectomies performed by surgical residents (RESs) and board-certified surgeons (BCSs)., Methods: This retrospective matched-pair study included patients undergoing thyroidectomies for multinodular goiter, Grave's disease and early-stage thyroid cancer that were performed by a RES with BCS supervision between 2006 and 2014. The intraoperative and postoperative course, complication rates and handling of the recurrent laryngeal nerve (RLN) and parathyroid glands were analyzed., Results: In total, 112 thyroidectomies that were performed by a RES fulfilled the inclusion criteria and were matched 1:1 with BCS patients. We included 88 hemithyroidectomies, 80 subtotal thyroidectomies and 56 total thyroidectomies. No significant differences in the handling of the RLN or parathyroid glands, the rates of postoperative RLN palsies or the rates of hypocalcaemia were found. No intraoperative complications led to the replacement of the RES as the surgeon-in-charge. Three RES and two BCS patients experienced postoperative haemorrhages (p = 0.205), and three surgical site infections (p = 1.000) occurred in each group. The mean operative time and the length of stay did not differ significantly between the two groups., Conclusions: Major aspects of patient safety in thyroid surgery are not affected by resident participation. Thyroidectomies performed by RES are not significantly longer and reveal no differences in length of stay or complication rates. The economic burden of resident involvement is modest.
- Published
- 2016
- Full Text
- View/download PDF
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