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Introduction: It was our aim to evaluate the results of laparoscopic transabdominal preperitoneal hernia repair (TAPP) with regard to recurrent hernias treated in our department., Methods: Included were 276 operations for first or subsequent recurrence of inguinal hernia previously treated with suture repair. All final repairs were carried out using the TAPP technique. The data were collected prospectively. The patients were examined 2 weeks and 1 year postoperatively. The rate of follow-up amounted to 78.1 % at 1 year after operation., Results: Perioperative complications were monitored prospectively and divided into intraoperative, minor and major. The overall complication rate amounted to 9 %, major complications 5.3 %. The re-recurrence rate was 0.4 %., Conclusions: Because of the general advantages of laparoscopic surgery and the low recurrence rate we prefer laparoscopic hernioplasty using the TAPP technique.

It was the aim of this report to evaluate the laparoscopic transabdominal preperitoneal hernia repair (TAPP) which has been standardized at our department. Along with the demographic characterisation of 795 patients with 1000 inguinal hernia repairs we report about complications and early recurrences. The patient data were collected prospectively. The rate of follow-up amounted to 79.9% with an average follow-up of 1 year. The complications were divided into intraoperative, minor, major, as well as severe ones. In 30 repairs minor complications (3%) were detected. Major (n = 28) and severe (n = 9) complications were detected in 3.7% of the cases. There were two deaths, 3 patients with an intestinal obstruction due to adhesions (2 segmental small bowel resections), two patients with testicular atrophy, two mesh infections, two trocar hernias, 6 surgical revisions for removal of hematomas, one exploration of a testicle, 4 diagnostic laparoscopies for suspected recurrences with a negative result, and 15 patients with a nerve irritation syndrome. The early rate of recurrence was 0.7%. In 6 cases primary hernias had been repaired and in one case a recurrent hernia. The recurrent hernias became apparent in an average of 2 years (minimum 2.5 months, maximum 36 months) after surgery. The results of the clinical study demonstrate an acceptable rate of complications and a low rate of early recurrences. Based on these data we recommend the laparoscopic transabdominal preperitoneal technique and see an ideal indication in the case of bilateral, recurrent and femoral hernias.

This retrospective study (1986-1996) investigated 60 patients after total thyroidectomy indicated by a differentiated thyroid carcinoma. Analyzing the rate of paralysis of the recurrent nerve after secondary thyroidectomy due to the timing of the second operation, we found that only patients with secondary thyroidectomy having their second operation at an interval > 7 days suffered from permanent paralysis of the recurrent nerve. In conclusion, a second radical surgical procedure must be performed as early as possible to minimize complications.

Clinical, laboratory, functional, and volumetric data of 340 consecutive patients undergoing hepatic resection for malignant disease between November 1990 and June 1995 were analyzed. The operative mortality was 3.3% (8/244 patients). Among 178 patients with liver metastases and 66 with primary hepatobiliary tumors the hospital mortality was 4.1% (10/244 patients) and morbidity 22.0% (54/244 patients). Survival after hepatectomy was strongly influenced by the extent of resection quantified by the parenchymal hepatic resection rate. The prediction of fatal postoperative complications can be improved for patients with hepatic metastases by calculating the liver resection index (sensitivity 75%, specificity 83%).

Objective: A prospective, randomized, double-blind, placebo controlled multicenter trial was undertaken in 205 patients treated with total gastrectomy for gastric malignancies to evaluate whether local antimicrobial measures reduce the incidence of esophagojejunal anastomotic leakage., Summary Background Data: Anastomotic leakage of the esophagojejunostomy is always a septic complication of total gastrectomy for gastric malignancies, but it never has been attempted to prevent this complication with the administration of topical antimicrobial agents during the critical phase of anastomotic wound healing., Methods: To evaluate the efficacy and safety of topical decontamination, the study was carried out as a prospective, randomized, double-blind and placebo-controlled clinical multicenter trial in patients with total gastrectomy for gastric cancer. Patients received either placebo or decontamination with polymyxin B (100 mg), tobramycin (80 mg), vancomycin (125 mg), and amphotericin B (500 mg) four times per day orally from the day before the operation until the seventh postoperative day. All patients received a perioperative intravenous prophylaxis with cefotaxime 2 x 2 g. Other interventions including the administration of antibiotics and fluids, were not affected by the study protocol., Results: Of 260 patients who were randomized, total gastrectomy was not carried out in 55 patients. They dropped out of the study. Patients receiving an esophagojejunostomy were observed until day 42, when they were discharged from the clinic or died. An intention-to-treat analysis of the data was carried out. Among the 103 recipients of placebo, there were 11 (10.6%) with an anastomotic leakage of the esophagojejunostomy, and among the 102 recipients of decontamination, there were 3 (2.9%) with an anastomotic leakage of the esophagojejunostomy (p = 0.0492). Pulmonary infections were observed in 23 patients (22.3%) receiving placebo and in 9 patients (8.8%) who were decontaminated (p = 0.02). There were 11 deaths (10.6%) among the recipients of placebo and 5 deaths (4.9%) among the recipients of decontamination (p = 0.1)., Conclusions: Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy.

Purpose: Technical innovations of angioplasty have introduced new therapeutic options in the treatment of symptomatic arteriosclerotic disease. Atherectomy devices, aspiration catheters and vascular endoprostheses can be used not only for angioplasty purpose but also for correction of iatrogenic dissections and thromboembolic complications., Material and Methods: 54 patients with vascular complications after surgical (n = 7) and percutaneous (n = 47) interventions were observed in a 5 years period. The complications included acute dissections in 34 cases, acute thrombosis in 4 cases, distal embolism after angioplasty in 14 cases, and two cases with arterial rupture after balloon dilatation., Results: 34 patients with dissections and 18 patients with acute thrombosis were treated. Stent implantation for repair of vessel dissection was successful in 33 of 34 cases. Percutaneous catheter aspiration in combination with local thrombolysis was successful in 4 cases with local thrombosis. Distal emboli after angioplasty were successfully removed using aspiration catheters in 13 of 14 patients. Vessel rupture after angioplasty was closed with prolonged balloon dilatation in two patients avoiding emergency surgery., Conclusion: Using newly developed intravascular technologies such as atherectomy, stents, and catheter aspiration, many iatrogenic complications after vascular surgery or vascular interventions can be treated. These technologies should be available in every radiology department performing angioplasty.