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This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy.MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively.This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low.Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.

Summary Background Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure. Materials and methods A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders. Results Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P = 0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P = 0.001). The overall duration of surgery was 74.0 min in the female cohort and 93.0 min in the male group, P = 0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0 min in the female group and 89.0 min in the male group, P = 0.67. Conclusion Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population.

Resume Introduction La reparation des hernies de l’aine est une part importante de l’activite chirurgicale quotidienne. La laparoscopie est actuellement la voie de reparation de reference des hernies de l’aine. Le but de ce travail etait de verifier l’hypothese selon laquelle les patients de sexe feminin beneficieraient moins de la voie laparoscopique. Materiel et methodes Il s’agit d’une analyse retrospective des patients operes a froid pour une hernie de l’aine de 2013 a 2016. Le taux de reparation laparoscopique etait calcule en fonction du sexe. Resultats L’effectif comprenait 94 femmes et 752 hommes. Les femmes etaient significativement plus âgees que les hommes (68,0 vs. 61,0 ans, p = 0,02). Le taux de reparation laparoscopique etait significativement plus faible chez les femmes que chez les hommes (30 % vs. 60 %, p = 0,001). La duree d’intervention etait de 74,0 minutes chez les femmes et 93,0 minutes chez les hommes, p = 0,001. Mais, il n’y avait pas de difference concernant la duree de la technique laparoscopique : 78,0 minutes chez les femmes vs. 89,0 minutes chez les hommes, p = 0,67. Conclusion Cette etude retrospective suggere une discrimination relative dans le traitement laparoscopique des hernies de l’aine en defaveur des femmes.

Background Surgery for colorectal cancer (CRC) is increasingly being performed via the minimally invasive route. However, reports of postoperative wound and port site seeding as well as peritoneal spillage have been worrisome. We investigated the risk of peritoneal spillage in patients undergoing laparoscopic surgery for CRC. Methods Cytology specimens were gained from the retrieval bag following intracorporeal resection and specimen retrieval using an endoscopic retrieval bag. Histopathologic examination of the cytology specimens was performed for the presence of malignant cells. Results Cytology specimens of 73 (34 female and 39 male) consecutive patients with a median age of 71 years were included for analysis. Advanced CRC in stages III and IV was present in 41% of the study population. Malignant cells were not found in any specimen. Conclusion Laparoscopic oncologic resection of colorectal cancer is not a risk factor for peritoneal spillage. Minimally invasive oncologic colorectal resection is safe without the increased risk of peritoneal carcinomatosis.

Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Transverse loop colostomy is most commonly involved. Although ostomy function is rarely impaired, large prolapses may cause patients distress and impair stoma dressing. Strangulation and ischemia of the prolapsed segment have been reported as complications. Herein, we report a stapler-associated repair of a prolapsed transverse loop colostomy with real-time perfusion studies using indocyanine green.

It is well known that hypercholesterolemia in the body has pro-inflammatory effects through the formation of inflammasomes and augmentation of TLR (Toll-like receptor) signaling, which gives rise to cardiovascular disease and neurodegenerative diseases. However, the interaction between cholesterol-related lipids and acute pancreatitis (AP) has not yet been summarized before. This hinders the consensus on the existence and clinical importance of cholesterol-associated AP. This review focuses on the possible interaction between AP and cholesterol-related lipids, which include total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein (Apo) A1, from the bench to the bedside. With a higher serum level of total cholesterol, LDL-C is associated with the severity of AP, while the persistent inflammation of AP is allied with a decrease in serum levels of cholesterol-related lipids. Therefore, an interaction between cholesterol-related lipids and AP is postulated. Cholesterol-related lipids should be recommended as risk factors and early predictors for measuring the severity of AP. Cholesterol-lowering drugs may play a role in the treatment and prevention of AP with hypercholesterolemia.

Background Anastomotic leakage (AL) following colorectal resection is a serious issue. AL in oncologic patients might negatively affect the overall survival. Recently, mechanical bowel preparation with additive oral antibiotics (MBP + AB) prior to surgery has been suggested as a means of reducing AL. However, it is unclear whether this positive effect is secondary to MBP alone or secondary to the additive oral antibiotic (MBP + AB). The aim of this study was to investigate the effect of mechanical bowel preparation with additive oral antibiotics (MBP + AB) and without additive oral antibiotics (MBP − AB) on the rate of AL following colorectal resection for cancer. Materials and methods Patients undergoing surgical management for colorectal cancer with anastomosis from January 2014 till September 2017 were included for analysis. Cases undergoing MBP + AB were included in the study group. Patients undergoing MBP − AB were included in the control group. Both groups were compared with regard to the rate of AL. Results Four hundred and ninety-six patients: 125 undergoing MBP + AB and 371 undergoing MBP – AB were included for analysis. Significantly, more male patients were included in the MBP – AB group compared to the MBP + AB group: 60.1% vs. 45.6% respectively (p = 0.03). Both groups were similar with regard to age distribution and clinicopathological findings (p > 0.05). The rate of AL was significantly higher in the control group (MBP − AB) compared to study group (MBP + AB) (9.1% vs. 4.0%, p = 0.03). Conclusion Mechanical bowel preparation with additive oral antibiotics prior to elective colorectal resection with anastomosis significantly reduces the risk of AL. Therefore, mechanical bowel preparation with additive non-absorbable oral antibiotics should be recommended in all cases prior to elective colorectal surgery.

Background An intestinal ostomy is an artificial bowel opening created on the skin. Procedure-related mortality is extremely rare. However, the presence of an ostomy may be associated with significant morbidity. Complications negatively affect the quality of life of ostomates. Preoperative stoma site marking can reduce stoma-related complications and is recommended by several guidelines. However, there is no consensus on the procedure and recommendations are based on low-quality evidence. The objective of the systematic review will be to investigate if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces or prevents the rate of stoma-related complications. Methods We will include (cluster-) randomised controlled trials and cohort studies that involve patients with intestinal ostomies comparing preoperative stoma site marking to no preoperative marking and report at least one patient-relevant outcome. For study identification, we will systematically search MEDLINE/PubMed, EMBASE, CENTRAL and CINHAL as well as Google Scholar, trial registries, conference proceedings and reference lists. Additionally, we will contact experts in the field. Two reviewers will independently perform study selection and data extraction. Outcomes will be prioritised based on findings from telephone interviews with five ostomates and five ostomy and wound nurses prior to conducting the review. Outcomes may include but are not limited to stoma-related complications (infection, parastomal abscess, hernia, mucocutaneous separation, dermatological complications, stoma necrosis, stenosis, retraction and prolapse) or other patient-relevant postoperative endpoints (quality of life, revision rate, dependence on professional care, mortality, length of stay and readmission). We will use the ROBINS-I or the Cochrane risk of bias tool to assess the risk of bias of the included studies. We will perform a meta-analysis and assess the certainty of evidence using the GRADE approach. Discussion With the results of the systematic review, we aim to provide information for future clinical guidelines and influence clinical routine with regard to preoperative stoma site marking in patients undergoing ostomy surgery. When the evidence of our systematic review is low, it would still be a useful basis for future clinical trials by identifying data gaps. Systematic review registration PROSPERO registration number: CRD42021226647

Background Surgical site infection (SSI) describes an infectious complication of surgical wounds. Although SSI is thought to be preventable, it still represents a major cause of morbidity and substantial economic burden on the health system. Wound irrigation (WI) might reduce the level of bacterial contamination, but current data on its role in reducing or preventing SSI is conflicting. Our aim was to investigate the effectiveness of WI with normal saline prior to wound closure for the reduction of SSI in patients undergoing abdominal surgery. Methods We conducted a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to present, and cross-checked the reference lists of all included primary studies and relevant systematic reviews. (Quasi-) randomized controlled trials (RCTs) investigating the rate of SSI when using normal saline vs. no irrigation prior to wound closure following abdominal surgery were included. Primary outcome was the rate of SSI, secondary outcome the mean length of hospital stay (LOS). Results Four RCTs including a total of 1194 patients were included for analysis. All studies compared wound irrigation with normal saline with no wound irrigation prior to wound closure. Their risk of bias was moderate. The relative risk of developing a SSI was lower when wound irrigation with normal saline was performed prior to wound closure although the effect was not statistically significant (risk ratio 0.73, 95%-confidence level: 0.37 to 1.43). Similarly, there was no difference in the LOS amongst both intervention arms. Conclusion This systematic review could not identify an advantage for routine irrigation of abdominal wounds with normal saline over no irrigation prior to wound closure in preventing or reducing the rate of SSI. Systematic review registration PROSPERO registry number CRD42018082287.

Patienten mit Stoma im distalen Ileum oder Kolon entwickeln wenige klinisch relevante physiologische Veranderungen. Erhohte Verluste von Flussigkeit, Kalium, Natrium, Vitamin B12 und Eisen konnen jedoch bei Ileostoma- und speziell Jejunostomatragern vorkommen. Eine Diversionskolitis im ausgeschalteten Darmsegment zwigt sich haufiger, sie ist in bis zu 30 % der Falle klinisch relevant und nach der Stomaruckverlagerung stets reversibel – selbst bei Patienten mit M. Crohn.

Hamartomatous polyps may arise as solitary lesions, usually in childhood or early adolescence and, are denoted histologically by an overgrowth of mesenchymal or ectodermal cell native to the area of origin. These polyps may occur “sporadically” or in the context of inherited syndromes. Since proper characterization is relevant for patient management, nowadays appropriate genetic testing should always be taken into account and the results should direct clinical practice. Identifying a hereditary hamartomatous syndrome (HPS) at an early age in families not known to harbor the mutation enables tremendous preventative potential and should drive cancer preventative strategies, extended to at-risk relatives. Hamartomatous syndromes are overall rare, exhibit an autosomal dominant mode of inheritance, and are associated with specific gene alterations and an increased lifetime risk of malignancy. Both intestinal and extraintestinal malignancies have been described in specific hamartomatous polyposis syndromes. Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) represent the most common hamartomatous polyposis syndromes. The PTEN hamartoma tumor syndrome including Cowden syndrome (CD), Bannayan-Riley-Ruvalcaba syndrome (BRRS), and the Proteus syndrome represent less common HPS. Other syndromes with hamartomatous gastrointestinal polyposis include multiple endocrine neoplasia syndrome 2B (MEN 2B), hereditary mixed polyposis syndrome Cronkhite–Canada syndrome, and basal cell nevus syndrome.

Summary: Background: Incisional hernia is a common problem following open abdominal surgery. Hernia repair in patients with relevant medical conditions is a topic of controversy due to the high risk of morbidity and recurrence. We investigated the risk of recurrence in patients with relevant medical conditions managed with a prosthesis in the retromuscular position. Methods: A retrospective review of the data of patients undergoing midline incisional hernia repair was performed. The outcomes of patients with relevant concomitant medical conditions defined as ASA scores >2 were compared with those of healthier patients with ASA scores ≤2. Results: 115 patients including 41 with ASA >2 and 74 with ASA ≤2 were included for analysis. There were no statistically significant differences amongst both groups with regard to the size of the hernia defect, the duration of surgery (123.0 ± 71 vs. 149.0 ± 92 min, p = 0.73), the incidence of postoperative seroma (14.6% vs. 29.7%, p = 0.07), postoperative hematoma (12.2% vs. 4.1%, p = 0.10) and surgical site infection (14.6% vs. 8.1%, p = 0.27). No statistically significant difference was seen amongst both groups with respect to the rate of long-term recurrence after a median follow-up of 63.0 ± 36 months (12.2% vs. 6.8%, p = 0.32). Conclusion: Relevant medical condition alone cannot be seen as a contraindication for midline incisional hernia repair using the retromuscular technique. Rates of morbidity and long-term recurrence following mesh-associated closure are not difference from those of healthier patients. Keywords: incisional hernia, retromuscular position, mesh closure, prosthetic mesh, rate of recurrence

Colorectal cancer (CRC) is the second leading cause for cancer-related death in industrialized nations. Nodal involvement has been identified as a relevant prognostic feature in CRC. Extra nodal metastasis (ENM) describes the spread of malignant cells beyond the nodal capsule. ENM is thought to be an independent risk factor for poor survival. This study examined ENM as an independent risk factor for poor overall survival in patients with node-positive CRC. Data from a prospectively maintained CRC database was retrospectively analyzed. Blinded slides of patients with stage III and IV CRC following radical surgical resection were re-examined for the presence of ENM. The effect of ENM on overall survival was examined using Kaplan–Meier curves. One hundred forty-seven cases with node-positive CRC (UICC stages III and IV) including 78 cases with ENM were included for analysis. ENM was seen in 60 patients with colon cancer (58.8%) and in 18 patients with rectal cancer (40%), p = 0.033. ENM-positive patients had a significantly higher odd for cancer-related death compared to ENM-negative patients ratio of [OR 0.44: 0.22–0.88, CI 95%, p = 0.021], p = 0.02. The median overall survival was significantly longer in patients without ENM, 51.0 ± 33 vs. 30.5 ± 42 months, p = 0.02. Extra nodal metastasis is an independent prognostic factor in patients with node-positive colorectal cancer. Extra nodal metastasis is associated with high odds of tumor-related mortality and poor overall survival.

Tumorerkrankungen stellen die zweithaufigste Todesursache in der industrialisierten Welt dar. Das zunehmende Verstandnis der molekularen Atiopathogenese von Tumoren und des Einflusses auf die klinische Heterogenitat und das Therapieansprechen hat zu einer Prazisierung onkologischer Strategien gefuhrt. Hereditare Dispositionssyndrome werden aufgrund fehlender Awareness hierzulande nur zu einem kleinen Anteil durch klinische und konsekutive molekulargenetische Testung identifiziert. In Anbetracht des weitreichenden Benefits fur Betroffene und deren Familien waren systematische molekulargenetische Untersuchungen bei allen gastrointestinalen Tumoren sinnvoll. Eine Recherche und Auswertung aktueller Literatur wurden durchgefuhrt. Durch Identifikation von Mutationstragern eroffnen sich zahlreiche Optionen fur Praventionsstrategien. Diese reichen von einer Anderung der Lifestyle-Faktoren uber eine medikamentose Pravention bis hin zu risikoreduzierenden prophylaktischen Operationen. Allerdings muss hierbei das syndrombezogene Risiko des Auftretens der Tumorerkrankung (Penetranz) unter Berucksichtigung des Gens oder evtl. des genauen Genlokus und des Geschlechts (Gender) sowie des Alters mit der Morbiditat jeder Masnahme genau abgewogen werden. Es ist die Rolle der Behandler unterschiedlicher Disziplinen, uber die Moglichkeiten und Grenzen praventiver Masnahmen so zu beraten, dass Betroffene eine informierte Entscheidung treffen konnen. In dieser Ubersichtsarbeit werden der aktuelle Stand praventiver Optionen in der Behandlung hereditarer Tumorerkrankungen des Gastrointestinaltrakts dargestellt und Konsequenzen fur das klinische Management diskutiert.

Multiple new procedures for treatment of complex anal fistula have been described in the past decades, but an ideal single technique has yet not been identified. Factors that predict the outcome are required to identify the best procedure for each individual patient. The aim of this study was to find those predictors for advancement flap at midterm follow-up. From 2012 to 2015 in a tertiary university clinic, all patients who underwent advancement flap for treatment of complex cryptoglandular fistula were prospectively enrolled. Pre- and postoperatively standardized anamnestic and clinical examinations were performed. Predictive factors for therapy failure were identified using univariate and multivariate analysis. Out of 65 patients, 61 (93%) completed all examinations and were included in the study. Therapy failure after a mean follow-up period of 25 months occurred in total n = 11 patients (18%). There was no significant disturbance of continence among the entire study cohort as shown by the incontinence score (preop 0.34 ± 0.91 pts., postop 0.37 ± 0.97 pts.; p = 0.59). Univariate analysis for risk factors for therapy failure revealed age (p = 0.004), history of surgical abscess drainage (p = 0.04), BMI (p = 0.002), suprasphincteric fistula (p = 0.019) and horseshoe abscess (p = 0.036) as independent parameters for therapy failure. During multivariate analysis, only history of surgical abscess drainage (OR = 8.09, p = 0.048, 95% CI 0.98–64.96), suprasphincteric fistula (OR = 6.83, p = 0.032, 95% CI 1.17–6.83) and BMI (OR = 1.23, p = 0.017, 95% CI 1.03–1.46) were independent parameters for therapy failure. Advancement flap for treatment of complex fistula is effective and has low risk of disturbed continence. BMI, suprasphincteric fistula and history of surgical abscess drainage are predictors for therapy failure.

Acute perforated cholecystitis (APC) is probably the most severe complication of acute cholecystitis. However, data on the outcome of cholecystectomy for APC are limited to small series. This study investigated the outcomes of cholecystectomy for APC. Data from a prospectively maintained quality control database in Germany were analyzed. Cases with APC were compared to cases without gallbladder perforation with regard to demographic characteristics, clinical findings and surgical outcomes. A total of 5704 patients with APC were compared to 39,661 patients without perforation. Risk factors for APC included: the male gender, advanced age (>65 years), ASA score >2, elevated white blood count (WBC), positive findings on abdominal ultrasound sonography and fever. The APC group differed significantly from the control group with regard to fever (29.8 vs. 12.2 %), elevated WBC (83.8 vs. 65.4 %) and positive findings from ultrasound sonography (84.9 vs. 78.9 %), p

Background Acute cholecystitis is a common diagnosis for which surgery is usually indicated. However, the heterogeneity of clinical presentation makes it difficult to standardize management. The variation in clinical presentation is influenced by both patient-dependent and disease-specific factors. A preoperative clinical scoring system designed to included patient-dependent and clinical factors might be a useful tool in clinical decision making. Methods The data of patients undergoing laparoscopic cholecystectomy for acute cholecystitis in a university hospital were retrospectively reviewed. Patient-dependent factors (age, sex, body mass index, and American Society of Anesthesiologists score) and disease-specific factors (history of biliary colics, white blood count, C-reactive protein, and gallbladder wall thickness) were used to compute a clinical score between zero and nine for each patient. Cholecystitis was classified as mild (score ≤ 3), moderate (4 ≤ score ≤ 6), or severe (score ≥ 7). Results Cholecystitis was mild in 45 cases, moderate in 105 cases, and severe in 27 cases. Among patient-dependent factors, the male gender, age >65 y, and American Society of Anesthesiologists score >2 correlated significantly with high scores, P = 0.001. Equally, high white blood count, elevated C-reactive protein, and gallbladder wall thickness >4 mm correlated significantly with high scores, P = 0.001. These findings were confirmed on multivariate analyses. High scores correlated significantly with the duration of surgery (P = 0.007), the need of intensive care unit management (P = 0.001) and the length of stay (P = 0.001). However, there was no significant association between the preoperative score and the rate of conversion (P = 0.103) or the rate of complication (P = 0.209). Conclusions This preoperative clinical scoring system has a potential to select patients with severe cholecystitis and therefore might be a useful tool in clinical decision making.

Background Cholecystolithiasis is a highly prevalent condition in the Western world. Gallbladder stone-related conditions represent the second most common gastrointestinal pathology. Cholesterol stones represent over 80% of gallstones. Cholesterol stones develop secondary to crystallization of bile cholesterol. Water resorption from gallbladder bile via aquaporin in the gallbladder mucosa might play a role in the development of cholesterol stones. This study investigated the expression of Aquaporin-1 (AQP1) and Aquaporin-8 (AQP8) in the human gallbladder mucosa and their possible association with the formation of gallbladder stones. Methods The expression of AQP1 and AQP8 in the gallbladder mucosa was examined via immunohistochemical staining. The expression of both AQP1 and AQP8 in the gallbladder mucosa of stone carriers (study group) was compared to that of nonstone carriers (control group). Results Eighty-four gallbladder specimens from 44 male (52·2%) and 40 female (47·6%) patients were analysed. The study group included 47 specimens from stone carriers, while 37 specimens from stone-free gallbladders were included in the control group. Immunostaining for both AQP1 and AQP8 was positive in 80 cases. AQP1 was expressed both over the apical and intercellular membrane, while AQP8 was expressed only over the apical membrane. A similar distribution was recorded in specimens from the cystic duct. Immunostaining with AQP1 was generally stronger in comparison with AQP8. No significant (P > 0·05) relationship was found between aquaporin expression and the presence or absence of gallbladder stones. Conclusion AQP1 and AQP8 are both expressed in the gallbladder and cystic duct mucosa. However, their role in the development of gallbladder stones is still to be proven.

Background Bile duct injury is the most feared complication during laparoscopic cholecystectomy. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. We compared the outcomes of laparoscopic cholecystectomy in patients with and without real-time ICG. Methods A retrospective analysis of the data of patients undergoing laparoscopic cholecystectomy with and without ICG in a referral centre for minimally invasive surgery was performed. We hypothesized that laparoscopic cholecystectomy with real-time ICG enables a better identification of the biliary tree and thus increases surgical safety. The outcomes of laparoscopic cholecystectomy with and without ICG were compared using the duration of surgery, the rate of bile duct injury, the rate of conversion, complications and the length of stay. Results Seventy patients including 29 with and 41 without ICG underwent laparoscopic cholecystectomy within the period of investigation. The median duration of surgery was 53.0 vs. 54.0 min while the median length of stay was 2.0 d in the group with and without ICG respectively. The rate of conversion was 2.4% in the group without ICG, while no conversion was performed in the group with ICG. NO bile duct injury occurred in both groups. These differences were not statistically significant. Conclusion Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy.

Background Bowel incarceration represents a dreaded complication amongst patients with hernias. The intraoperative evaluation of the bowel perfusion following hernia reduction with regard to the need for resection of ischaemic bowel can be challenging. In this case report we discuss intraoperative fluorescence angiography with indocyanine green (ICG) as an objective means of accessing bowel perfusion following hernia reduction. Case presentation The case of a 92-year-old, caucasian, female patient presenting with symptoms of small bowel obstruction secondary to an incarcerated left sided obturator hernia is presented. An incarcerated segment of the small bowel was reduced during emergency laparoscopy. Intraoperative ICG fluorescence angiography revealed ischaemic changes in the normal appearing bowel, so that the involved segment was resected. The postoperative course was uneventful and the patient was discharged home safely on postoperative day seven. Conclusion Intraoperative ICG fluorescence angiography provides an objective method of judging bowel perfusion and therefore represents a useful tool for assessing intestinal perfusion in patients with incarcerated hernia.

About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life.This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience.Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications.Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.

Small- and medium-sized ventral hernias including umbilical hernias can be repaired using prosthetic patches placed in the peritoneum. However, bowel-associated complications secondary to intraperitoneally placed hernia patches have been reported. Herein, we report the outcome of small and medium umbilical hernia closure with prosthetic hernia patches in the preperitoneal space. Prospectively collected data of patients undergoing repair of small- and medium-sized umbilical hernias with the proceed ventral patch in a primary care hospital in Germany was retrospectively analyzed. A total of 39 cases, including 11 female and 28 male patients, were managed with prosthetic patches in the preperitoneal position. Small-sized patches were implantated in 16 cases, whereas medium-sized patches were used in 23 cases. The median duration of surgery was 40 minutes. The median length of hospital stay was four days. Four minor complications were recorded (10.3%) and the rate of recurrence was 2.6 per cent within a follow-up period of up to 30 months. Small and medium size umbilical hernias can be effectively closed with prosthetic patches placed in the preperitoneal space without risk of serious bowel associated complications.

Esophageal dilation (ED) has been described as a long-term complication following laparoscopic adjustable gastric banding (LAGB) with an incidence of 0.5–50 %. The purpose of this study was to evaluate the effect of major ED on weight loss and find methods to diagnose ED and possible treatment strategies based on a classification. We performed a retrospective analysis of all patients undergoing LAGB between 2004 and 2008 in three community-based hospitals. ED was classified in four stages of dilation using gastrografin swallow. We report body mass index (BMI), failure rates and reoperations among these patients, with a mean follow-up period of 6.7 years. Nineteen (18.4 %) of 103 patients who underwent LAGB presented with esophageal dilation. Band deflation failed for all nine patients (8.7 %) with major ED. The mean BMI at LAGB (BMI 1), revision (BMI 2), and 1 year after conversion (BMI 3) were 45.9 ± 3.2, 42.8 ± 4.9 and 30.3 ± 5.5 kg/m2, respectively. No significant difference was found comparing BMI 1 and BMI 2 (p = 0,065, EWL1: 14.2 ± 21.7 kg/m2). In contrast, the weight loss after the revision surgery was significant (p = 0.001, EWL2: 67.1 ± 30 kg/m2). No significant difference was found concerning age, gender, ASA, preoperative (LAGB) weight, and mean interval between LAGB and revision comparing patients with major ED (IV) to patients with milder forms (ED I-III). ED is a serious long-term complication after LAGB and seems to prevent effective weight loss in stage IV. Furthermore, untreated dilation could cause long-term damage to the esophagus. Therefore, we suggest routine radiographic follow-up after LAGB even in asymptomatic patients and a treatment based on a classification with an early surgical revision for major ED.

Background Wrong site surgery defines a category of rare but totally preventable complications in surgery and other invasive disciplines. Such complications could be associated with severe morbidity or even death. As such complications are entirely preventable, wrong site surgery has been declared by the World Health Organization to be a "never event". Material and methods A selective search of the PubMed database using the MeSH terms "wrong site surgery", "wrong site procedure", "wrong side surgery" and "wrong side procedure" was performed. Results The incidence of wrong site surgery has been estimated at 1 out of 112,994 procedures; however, the number of unreported cases is estimated to be higher. Although wrong site surgery occurs in all surgical specialities, the majority of cases have been recorded in orthopedic surgery. Breakdown in communication has been identified as the primary cause of wrong site surgery. Risk factors for wrong site surgery include time pressure, emergency procedures, multiple procedures on the same patient by different surgeons and obesity. Check lists have the potential to reduce or prevent the occurrence of wrong site surgery. Conclusion The awareness that to err is human and the individual willingness to recognize and prevent errors are the prerequisites for reducing and preventing wrong site surgery.

Background Accidental foreign body ingestion is a common phenomenon in children between 6 months to 6 years of age. In adults, foreign body ingestion is commonly observed in the geriatric population and in patients with psychiatric disorders. Over 80% of ingested foreign bodies pass uneventfully through the intestinal tract. Endoscopic retrieval is needed in about 20% while surgical intervention is indicated in less than 1%. Herein we report an extremely rare case of esophagocutaneous fistula following operative retrival of an impacted denture in the esophagus with spontaneous healing within 3 weeks. A similar case to the best of our knowledge has so far not been reported previously. Case presentation A case of accidental ingestion of a dental prosthesis in a 35-year old schizophrenic patient is presented. The patient was referred to our department after accidentally swallowing one of his dental prosthesis. Surgical retrieval was indicated after two unsuccessful endoscopic retrieval attempts. The denture was retrieved following a longitudinal incision of the esophagus via a left cervical approach. The postoperative course was complicated by a clinically suspected esophagocutaneous fistula which was managed conservatively via nothing per os with enteral feeding via a nasogastric tube. Secretion ceased 3 weeks later and a fistula could not be found on contrast enhanced radiographic examination with gastrographin®. Conclusion Esophagocutaneous fistula represents a rare but serious complication following foreign body ingestion. An interdisciplinary management including an early surgical consultation should be considered in patients with foreign body impaction in the esophagus following failure of endoscopic retrieval.

Anastomotic leakage (AL) is the most feared complication in colorectal surgery. A diverting ileostomy is routinely used to prevent or reduce morbidity and mortality following AL. However, a diverting ileostomy cannot prevent AL. Besides, diverting ileostomy might be associated with relevant complications. Herein, we introduce the virtual ileostomy as an alternative to diverting ileostomy in patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for familial adenomatous polyposis (FAP). The results of eight patients, five females and three males with a median age of 19.5 ± 6.0 years (range 16.0–31.0 years), undergoing restorative proctocolectomy with IPAA and virtual ileostomy for FAP are presented. All cases were laparoscopically managed. The virtual ileostomy was released between postoperative day 7 and 9. No AL was registered. Postoperative recovery was uneventful in all cases. A diverting ileostomy was prevented via the use of virtual ileostomy in all cases. Thus, virtual ileostomy is a good alternative to diverting ileostomy in patients undergoing restorative proctocolectomy with IPAA for FAP.

Background The role of colonoscopy in the screening of colorectal cancer (CRC) has been unequivocally established. In Germany, screening colonoscopy with full insurance reimbursement is available for individuals aged 55 and above, and/or for persons with well-known risk factors for CRC. However, advanced CRC is not uncommon in individuals below 55 years. This study was designed to investigate the incidence of advanced CRC in patients

Transanal total mesorectal excision (taTME) is a minimally invasive technique which was developed to overcome the difficulties associated with the “top-down” pelvic dissection by enabling a “bottom-up” dissection in patients with mid- and low rectal cancer. While this technique was primarily designed to manage tumors in the mid- and lower rectum, its spectrum of indications has been broadened to include benign colorectal pathologies. The aim of the present study was to assess our initial experience with taTME in patients undergoing restorative proctocolectomy for familial adenomatous polyposis (FAP). All consecutive patients (undergoing prophylactic restorative proctocolectomy with IPAA for FAP using taTME between April and October 2016 at our institution) were included in the study. There were 8 patients (6 females and 2 males). The median age was 19.5 years (range 16–31 years). In all cases, surgery was successfully completed using with taTME. No perioperative complications were recorded. A median of 5 bowel movements (range 4–6 bowel movements) with intermittent anti-diarrheal medication was recorded in all cases. Our initial experience with 8 consecutive cases suggests taTME is safe and effective in patients undergoing prophylactic restorative proctocolectomy with IPAA for FAP.