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Preoperative evaluation before cholecystectomy includes detailed history of the disease and blood chemistry. Hepatobiliary ultrasonography is the main noninvasive preoperative investigation. The decision to evaluate the common bile duct for stones prior to planned laparoscopic cholecystectomy by ERC may be prompted by clinical suspicion or evidence of jaundice, recent pancreatitis, or a dilated common duct on sonography. Preoperative ERC has the advantage of allowing the simultaneous treatment of duct stones. Intraoperative cholangiography should be available.

Surgery of colorectal cancer is suited for assurance of surgical quality. The R0-resection rate in 1927 operations for colorectal cancer was 74.4%. The postoperative mortality was 7.1%. Wound suppuration occurred after surgery of the colon in 6.5%, after surgery of rectal cancer in 9.9% of the cases. In 68.6% of pT4-tumors we found lymphoid metastasis, in 19.3% around the trunk of the inferior mesenteric artery. For compilation of comparative data the quality assurance in colorectal surgery should be realised every 3 to 5 years.

For selected indications on the colorectum safe laparoscopic operative techniques are already available. The use of these procedures for colorectal carcinoma with curative intention can only be recommended under study conditions.

In the period of time between September 1, 1991 and August 31, 1993 a total of 1927 patients at 22 East German hospitals were operated for colorectal carcinoma. In anticipation of quality assuring aspects these surgeries were registered and interpreted. An application of a constant classification (pTNM, R-classification) at this was essential. The resection rates of 87.3% on the colon (R0-resections 74.4%) and of 83.1% on the rectum (R0-resection 70.8%) were established in total patient group. Preoperative measures and technique of surgery were also registered. The rate of the colonic anastomosis insufficiencies was about 3.2%, resp. of the rectum 8.2%. Wound suppurations occurred after surgery of the colon in 6.5% of the cases, resp. the rectum in 9.9%. The postoperative mortality was 7.1% in the overall patient group. The practical realization and the efficiency of studies for quality assurance is pointed out.

There is no disagreement over the advantages of minimal-invasive surgical procedures even in the older patient. However the criteria for indication and patient selection concerning cardiopulmonary contraindications for CO2-pneumoperitoneum must be strictly considered. Using cholecystectomy and colorectal surgery as an example the problems and limits of the laparoscopic method are described.

Extended lymph node dissection, creation of a safe anastomosis and specimen retrieval pose the greatest problems in laparoscopic colorectal surgery. A safe technique for the performance of extended lymph node dissection with high vessel ligation has been developed on the basis of experimental studies. Abdominoperineal excision of the rectum is ideal for laparoscopic colorectal surgery because this procedure requires no anastomosing, and the specimen is retrieved perianally. From January to August 1992, we performed a laparoscopic excision of the rectum with high ligation of the inferior mesenteric artery in ten patients with low carcinomas. This paper presents clinical and technical data.

As our experimental studies demonstrate save laparoscopic tubular resection of colon and rectum is possible using linear staplers for resection and circular staplers for the anastomosis. As soon as linear endostaplers are available this technique can be applied in clinical work. Open colon resection and subsequent purse-string suture or endoloops to fixate the bowel ends on PCEEA-staplers turned out to be insufficient.

The diagnosis of appendicitis in 1989 admitted patients with an age of 1 to 14 years was prospectively investigated. In 82.6% acute inflammatory changes were found. Rate of perforation was 9.9%. Between 2 and 5 years old patients 28.5% had a perforated appendix. In two cases a colon disease and in one case a malignant carcinoid was found. No death was registered after appendectomy.

Between 1.7. 1988-31. 12. 1989 in 18 surgical departments of the former GDR 6, 266 patients suffering from "appendicitis" were registered and qualitatively evaluated. The perforation rate was 8.3%. 30% of these patients had no typical diagnosis. Postoperative lethality was 0.32%.

Hundred cases of multiple injuries of the third degree of severity, according to Schweiberer, were analysed for type and severity of cranial, thoracic, and abdominal traumas. Reference is made to differentiated diagnostic and therapeutic measures. The lethality of these severe polytraumas amounted to 43 percent.

An account is given in this paper of computer-assisted statistical records of surgery, with reference being made to the example of annual evaluation in 1988 as compared to 1985/86 data. Surgical statistics are shown to be important to administrative and medical management of a surgical hospital or department as well as to defined appraisal of surgical activities.

Thoracic trauma was treated in 159 hospitalised patients within a five-year period, with polytrauma being recorded from 40 per cent of the patients. Application of thorax suction drainage proved to be the most effective first treatment for 50 per cent of all cases. Emergency thoracotomy was necessary in 7.6 per cent. The lethality rate recorded from these cases of thorax injury amounted to twelve per cent.

General perioperative antibiotic prophylaxis is rejected in the context of cardiac pacemaker implantation. Selective, short-time perioperative application of a potent antibiotic or a sufficiently high-dosed combination may be justified in problem situations in the context of first implantation or re-implantation.

This is a progress report on work carried out to draft a coherent system for documentation and quality assurance in surgery. Methods and value of the system are described, with particular reference being made to results obtained from pilot studies in the Region of Suhl.

Reference is made in this paper to a possibility of quality checking in surgery. Methods and usefulness of quality assurance are expounded on the basis of results obtained from a one-year study into three surgical centres.

Typical morphological changes resulting from Crohn's disease, including hyperplasia of resident lymphatic tissue, abscesses, fistulae, adhesions, and diverticula, are described in this paper, with reference being made to a case history. The following demands are derived from the findings for gynaecological practice: 1. intestinal diagnosis for all unelucidated adnexal tumours; 2. cooperation with surgeons for surgery; 3. anal lesions should in any case be regarded as a reason to think of Crohn's disease; 4. Crohn's disease should be included into differential diagnosis, whenever pathological alterations are recordable from the intestines with no conspicuous findings from internal genitals on exploratory laparotomy.