102 results on '"R, Croner"'
Search Results
2. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors
- Author
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S. Acciuffi, F. Meyer, A. Bauschke, R. Croner, U. Settmacher, and A. Altendorf-Hofmann
- Subjects
Cancer Research ,Radiofrequency Ablation ,Oncology ,Liver Neoplasms ,Hepatectomy ,Humans ,General Medicine ,Colorectal Neoplasms ,Prognosis ,Embolization, Therapeutic - Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
- Published
- 2021
3. [Acutely occurring upper abdominal pain : Rare cause in adulthood with instructive imaging computed tomography(CT)-based phenomenon]
- Author
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C, Paasch, M, Franz, C, March, R, Croner, and F, Meyer
- Subjects
Adult ,Humans ,Tomography, X-Ray Computed ,Abdominal Pain ,Retrospective Studies - Published
- 2021
4. [Recommendations on treatment of acute appendicitis : Recommendations of an expert group based on the current literature]
- Author
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M, Andric, J C, Kalff, W, Schwenk, S, Farkas, W, Hartwig, A, Türler, and R, Croner
- Subjects
Treatment Outcome ,Germany ,Acute Disease ,Appendectomy ,Humans ,Laparoscopy ,Appendicitis - Abstract
The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis.
- Published
- 2020
5. Treatment of the focal nodular hyperplasia of the liver. Is there any place for surgical indication?
- Author
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Aristotelis Perrakis, R. Croner, Nikolaos Vassos, M. Andric, and Robert Grützmann
- Subjects
Pathology ,medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Focal nodular hyperplasia ,medicine ,medicine.disease ,business - Published
- 2019
6. Vergleich der offenen vs. laparoskopischen Technik der kompletten mesokolischen Exzision (CME) bei der Hemikolektomie rechts
- Author
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R. Croner, C. W. Strey, and W. Hohenberger
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Neoplasm staging ,business - Abstract
Zielsetzung: Die offene komplette mesokolische Exzision (CME) hat die Prognose von Patienten mit Kolonkarzinomen verbessert. Daher hat sich dieses Verfahren international durchgesetzt. Unklar ist, ob die laparoskopische Technik Resektionen in vergleichbarer Qualitat ermoglicht. Ein Videovergleich der Methoden soll Einblick in die unterschiedlichen Praparationstechniken geben. Indikation: Die offene CME wird bei einer asymptomatischen 79-jahrigen Patientin mit histologisch gesichertem Kolonkarzinom des Colon ascendens ohne Fernmetastasen durchgefuhrt, welches im Rahmen einer Vorsorgekoloskopie auffiel. Der laparoskopische Eingriff erfolgt bei einer 72-jahrigen Patientin, ebenso mit einem in einer Vorsorgekoloskopie histologisch gesicherten Karzinom des Colon ascendens ohne Fernmetastasierung. Methode: Bei der offenen CME wird mittels scharfer Praparation zwischen parietalem und viszeralem Blatt des Mesenteriums das Colon ascendens und das Duodenum mobilisiert. Anschliesend wird das Mesocolon ascendens und Mesocolon transversum vom Duodenum und Pankreas abprapariert. Dies geschieht unter strenger Wahrung des parietalen und viszeralen Mesenteriums. Nach Darstellung der V. und A. mesenterica superior werden die Gefase stammnah abgesetzt. Anschliesend wird das Colon in einer Distanz von 10 cm zum Tumor abgesetzt. Die Anastomose wird als Ileotransversostomie in fortlaufender Nahttechnik angelegt. Der Mesenterialschlitz wird verschlossen. Die laparoskopische CME wird in 4-Trokar-Technik mit umbilikaler Optik durchgefuhrt. Die Praparation erfolgt, ausgehend von der V. mesenterica superior, von medial nach lateral. Unter radikularem Absetzen der Gefase wird der Raum dorsal des Mesokolons unter Wahrung der Grenzlamelle etabliert und bis zur kompletten Mobilisation des Colon ascendens erweitert. Das mobilisierte Colon wird uber die erweiterte umbilikale Minilaparotomie eventeriert, reseziert und durch eine 2-reihige Seit-zu-Seit-Ileotransversostomie rekonstruiert. Schlussfolgerung: Offene und laparoskopische CME ermoglichen eine zentrale Gefasdissektion unter Berucksichtigung mesenterialer Schichten. Allerdings stellt die laparoskopische CME an den Operateur spezielle Anforderungen und kann daher nur von erfahrenen laparoskopischen Chirurgen sicher durchgefuhrt werden.
- Published
- 2015
7. [Robot-assisted liver resection]
- Author
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H, Aselmann, T, Möller, J-N, Kersebaum, J H, Egberts, R, Croner, M, Brunner, R, Grützmann, and T, Becker
- Subjects
Male ,Carcinoma, Hepatocellular ,Cost-Benefit Analysis ,Liver Neoplasms ,Middle Aged ,Survival Analysis ,Cholangiocarcinoma ,Bile Duct Neoplasms ,Robotic Surgical Procedures ,Germany ,Hepatectomy ,Humans ,Female ,Laparoscopy ,Colorectal Neoplasms ,Learning Curve ,Aged ,Follow-Up Studies - Abstract
Robotic liver resection can overcome some of the limitations of laparoscopic liver surgery; therefore, it is a promising tool to increase the proportion of minimally invasive liver resections. The present article gives an overview of the current literature. Furthermore, the results of a nationwide survey on robotic liver surgery among hospitals in Germany with a DaVinci system used in general visceral surgery and the perioperative results of two German robotic centers are presented.
- Published
- 2017
8. [Robotic-Assisted Liver Surgery]
- Author
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R, Croner, A, Perrakis, R, Grützmann, W, Hohenberger, and M, Brunner
- Subjects
Adult ,Male ,Carcinoma, Hepatocellular ,Liver Diseases ,Liver Neoplasms ,Length of Stay ,Middle Aged ,Surgical Instruments ,Surgical Equipment ,Postoperative Complications ,Liver ,Robotic Surgical Procedures ,Germany ,Hepatectomy ,Humans ,Female ,Laparoscopy ,Aged - Abstract
The advantages of minimally invasive liver resections for selected patients are evident. Robots provide new innovations that will influence minimally invasive liver surgery in the future. This article presents our initial experience with this technology in our patient population. Material und Methods: In 14 patients with benign or malignant liver tumours, robotic-assisted liver surgery was performed. Selection criteria were compensated liver function and resection of ≤ 3 liver segments. Chronic liver disease or previous abdominal surgery were no exclusion criteria.Malignant liver tumours were removed in 10 patients (71%) and benign symptomatic liver tumors in 3 patients (21%), respectively, with histopathologically negative margins (R0). One patient suffering from HCC underwent intraoperative ablation. In one case (7%) conversion was necessary. Mean operation time was 296 min (120-458 min); mean estimated blood loss was 319 ± 298 ml. The mean hospital stay of the patients was 8 days (3-17 days). Three patients (21%) suffered from postoperative complications, which were manageable by conservative treatment (Clavien-Dindo I) in 2 cases (14%). One patient (7%) needed endoscopic treatment for postoperative bile leak (Clavien-Dindo III a). No patient died intra- or perioperatively.Robotic-assisted liver surgery is a safe procedure, which provides patients with all benefits of minimally invasive surgery. This highly advanced technology requires surgeons to strive for an increasing level of specialisation, in addition to being well-trained in liver surgery. Hence, a clear definition of the procedures and standardised teaching programs are necessary.
- Published
- 2016
9. [Comparison of Open vs. Laparoscopic Techniques in Complete Mesocolic Excision (CME) During Right Hemicolectomy]
- Author
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R, Croner, W, Hohenberger, and C W, Strey
- Subjects
Colon, Ascending ,Dissection ,Colonic Neoplasms ,Humans ,Female ,Laparoscopy ,Adenocarcinoma ,Adenocarcinoma, Mucinous ,Colectomy ,Aged ,Mesocolon ,Neoplasm Staging - Abstract
The technique of open complete mesocolic excision (CME) has improved the outcomes of patients with colon carcinoma. Meanwhile it has become an established international standard procedure. It remains unclear if laparoscopic procedures are able to match the high quality of open resections. A video comparison of the two methods gives insight into the different dissection techniques.Open CME is demonstrated in a 79-year-old female patient with an asymptomatic carcinoma of the ascending colon verified by histopathology. The tumour was diagnosed during routine colonoscopy. No distant metastases were identified during the staging procedure. Laparoscopic CME is performed in a 72-year-old female patient with a biopsy-proven carcinoma of the ascending colon. Similarly this patient was diagnosed during a screening colonoscopy and had no distant metastasis.During open CME the ascending colon and the duodenum are mobilised by sharp dissection between the parietal and visceral layer of the mesentery. Afterwards the ascending and transverse mesocolon are dissected from the duodenum and pancreas. The parietal and the visceral mesentery are strictly preserved during these procedures. After the exposure of the superior mesenteric artery and vein, a central dissection of the vessels follows. The colon is cut 10 cm distal to the carcinoma. An ileotransversostomy is performed with a running suture. The hole in the mesentery is closed. The laparoscopic CME is performed using the 4-trocar technique with an umbilical camera position following a medial to lateral approach with primary dissection of the superior mesenteric vein. Radicular vessel ligation opens the space dorsal to the mesocolon with the border lamella remaining intact. The space is widened until the ascending colon is entirely mobilised. The mobilised colon is eventrated through an enlarged umbilical midline incision. Colon resection and the subsequent two-layered side-to-side ileotransversostomy are performed in a standard open surgical fashion.Open and laparoscopic CME enable central vessel dissection while preserving the mesenteric layers. However, the laparoscopic procedure is technically demanding and should therefore only be performed by surgeons experienced in laparoscopy.
- Published
- 2015
10. Aneurysmen an viszeralen Arterien
- Author
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M. Uder, A. Meyer, Werner Lang, and R. Croner
- Subjects
medicine.medical_specialty ,Common hepatic artery ,business.industry ,medicine.medical_treatment ,Stent ,Anastomosis ,medicine.disease ,Surgery ,Aneurysm ,Abdominal trauma ,medicine.artery ,medicine ,Radiology ,Embolization ,business ,Ligature ,Rare disease - Abstract
Visceral artery aneurysms (VAA) are relatively rare disease patterns. Withregard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60 %) and common hepatic artery (20-50 %). The common hepatic artery (80 %) and the pancreatico-duodenal artery (75 %) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n = 19; 1996-2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.
- Published
- 2010
11. Onkologische Chirurgie auf der Basis molekularer Diagnostik
- Author
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R. Croner
- Subjects
Surgery - Published
- 2006
12. Adjvant HIPEC in gastric cancer patients with high risk of peritoneal carcinomatosis
- Author
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R. Croner, I. Pantsulaia, and A. Aladashvili
- Subjects
Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,Internal medicine ,medicine ,Cancer ,medicine.disease ,business ,Gastroenterology ,Peritoneal carcinomatosis - Published
- 2017
13. Ist die prophylaktische intraoperative Anus praeter Anlage bei der tiefinfiltrierenden Darmendometriose noch zeitgemäß?
- Author
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R Croner, Hermann Kessler, M. W. Beckmann, Johannes Lermann, Thomas B. Hildebrandt, Stefan P. Renner, Judith Schwitulla, Falk Thiel, and K Proske
- Subjects
Maternity and Midwifery ,Obstetrics and Gynecology - Published
- 2014
14. [Surgical Indications for Diverticulitis in Germany: Are All Operations Justified?]
- Author
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C W, Schildberg, V, Schellerer, R, Croner, H, Oberländer, and W, Hohenberger
- Subjects
Cross-Sectional Studies ,Patient Admission ,Sigmoid Diseases ,National Health Programs ,Intestinal Perforation ,Germany ,Prospective Studies ,Unnecessary Procedures ,Diagnosis-Related Groups ,Diverticulitis, Colonic - Abstract
Pathological changes of preexisting sigma diverticulosis into a state of sigma diverticulitis are possible. Treatment of sigma diverticulitis accounts for a significant proportion of emergency treatments in clinics. The number of patients treated for sigma diverticulitis has risen steadily in recent years. Although it can be observed that operated cases making 7 % compared with 14 % to all stationary admissions, there is a less marked increase. Nevertheless, the question should be clarified as to how high the proportion of complicated surgical cases is in relation to non-complicated cases. It is important to clarify, in this context, if each operation is justified or whether in some cases there is over-treatment.All data relating to Germany, were prospectively collected by the treating hospitals using the DRG and evaluated by the Federal Statistical Office. The treatment numbers from Erlangen were prospectively collected from the encrypted DRG and analysed retrospectively by the coding officer. The investigated period lasted from 2005 to 2010. To demonstrate some treatment options, the following possible forms of therapy were examined with reference to the Hansen/Stock classification.In Germany, about 40 % of stationary patients with sigma diverticulitis are treated surgically. It is striking that in about two thirds of all operated patients uncomplicated forms of diverticulitis were present. The remainder consisted of covered or free perforations. For these complicated forms, various treatment approaches have been established. Ultimately, in dependence of timing these are always surgically treated. In the milder forms the general indication for surgery has come into discussion as the recommendation for a surgical approach after the second relapse in the symptom-free interval is being questioned by several groups based on the age of the studies on which the recommendations are based.A significant increase in hospital admissions and surgically treated patients is demonstrated. Striking was that a closer analysis of data revealed that mainly non-complicated cases were surgically treated. This should be seen as a clear indication for an over-treatment. Therefore, possibly not all surgeries performed are justified. In the case of complicated forms, in consideration of various treatment paths, surgery is inevitable in most cases.
- Published
- 2013
15. [Colorectal Carcinoma in Young Patients - Is Age a Prognostic Factor?]
- Author
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V, Schellerer, R, Croner, M, Langheinrich, W, Hohenberger, and S, Merkel
- Subjects
Adult ,Aged, 80 and over ,Male ,Adolescent ,Age Factors ,Kaplan-Meier Estimate ,Adenocarcinoma ,Middle Aged ,Prognosis ,Disease-Free Survival ,Neoplasms, Multiple Primary ,Young Adult ,Humans ,Female ,Neoplasm Recurrence, Local ,Child ,Colorectal Neoplasms ,Aged - Abstract
Concerning younger patients with colorectal carcinoma (CRC) controversies still exist regarding outcome. The aim of this study was to evaluate possible differences between patients suffering from CRC at a younger age ( 40 years) and at an age over 40 years.Data of 51 younger patients ( 40 years) and 2122 older patients (≥ 40 years) were prospectively collected and retrospectively evaluated according to clinical parameters, treatment and prognosis. Patients with a CRC arising from familial adenomatous polyposis, ulcerative colitis or Crohn's disease have been excluded.The younger patients presented significantly more often with mucinous adenocarcinomas (p = 0.033). There were no differences between the groups concerning gender, localisation, elective and emergency surgery, UICC (Union internationale contre le cancer) stages and residual tumour classification. Postoperative therapy - in adjuvant, therapeutic or palliative intent - was applied significantly more often in younger patients, especially in those with colon carcinoma (p = 0.001). After curative resection of colon carcinoma a significantly better observed (5 year rate 94 vs. 76 %; p = 0.024) and disease-free (88 vs. 69 %; p = 0.013) survival were found. This trend was similar in patients with rectal carcinoma (84 vs. 75 % and 72 vs. 65 %) without reaching the level of significance (p = 0.155 and 0.269). Taking into account differences in life expectancy, just minor differences were detected in relative survival (colon carcinoma, 5 year rate 94 vs. 89 %; rectal carcinoma, 84 % both).The general assumption of a poorer prognosis in younger patients with CRC could not be confirmed. Younger patients have a poorer histological subtype of carcinoma. But this is compensated by the better overall condition, less comorbidities, faster postoperative recovery and an optimally organised post-operative (adjuvant, therapeutic or palliative) therapy. In summary, younger patients have a better observed survival but - considering differences in life expectancy - a similar relative survival.
- Published
- 2013
16. COX-2, TFF1, and Src define better prognosis in young patients with gastric cancer
- Author
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Claus, Schildberg, M, Abbas, S, Merkel, A, Agaimy, A, Dimmler, A, Schlabrakowski, R, Croner, J, Leupolt, W, Hohenberger, and H, Allgayer
- Subjects
Adult ,Male ,Tumor Suppressor Proteins ,Carcinoma ,Proto-Oncogene Proteins pp60(c-src) ,Age Factors ,Kaplan-Meier Estimate ,Middle Aged ,Prognosis ,Immunohistochemistry ,Cyclooxygenase 2 ,Predictive Value of Tests ,Stomach Neoplasms ,Tissue Array Analysis ,Germany ,Biomarkers, Tumor ,Humans ,Female ,Trefoil Factor-1 ,Esophagogastric Junction ,Prospective Studies ,Neoplasm Grading ,Neoplasm Staging ,Retrospective Studies - Abstract
Despite its dwindling occurrence, gastric cancer remains a leading cause of cancer related mortality worldwide. Molecular determinants of prognosis that impact survival are being sought out as a means to facilitate rational clinical decision-making and enhance patient management. In this study, we evaluated three molecules implicated in gastric carcinogenesis and demonstrated that the differential expression of cyclooxygenase-2 (COX-2) and the viral oncogene homolog Src proteins could explain the differences in survival observed in patients older and younger than 50 years of age.We evaluated 5-year survival in a cohort of 423 gastric cancer patients using chronological age as a variable. Additionally, we assessed the protein expression of three molecules (COX-2, TFF1, Src) implicated in the pathogenesis of gastric cancer using immunohistochemistry.We found that patients younger than 50 years of age had a better 5-year survival rate in all tumor stages. We found that the expression of COX-2 and Src correlated significantly with survival in this group without any significant impact attributable to TFF1.Our study demonstrates that young gastric cancer patients have a better prognostic outlook that could in part be explained by the differential expression of COX-2 and Src.
- Published
- 2013
17. [Results of surgical treatment of hiatal hernia]
- Author
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C W, Schildberg, A, Perrakis, R, Croner, V, Schellerer, W, Haupt, T, Weidinger, W, Hohenberger, and T, Horbach
- Subjects
Male ,Reoperation ,Fundoplication ,Middle Aged ,Surgical Mesh ,Conversion to Open Surgery ,Hernia, Hiatal ,Postoperative Complications ,Recurrence ,Gastroscopy ,Quality of Life ,Humans ,Minimally Invasive Surgical Procedures ,Female ,Laparoscopy ,Aged ,Retrospective Studies - Abstract
Hiatus hernias are considered as the most prominent form of diaphragmatic hernias. The passage is defined through the oesophageal hiatus, resulting in a superdiaphragmatic displacement of parts of the stomach or the complete stomach, respectively. In our work we investigated the treatment of partial thoracic stomach with both open and minimally invasive surgical procedures emphasising the view on operating data, the success of the surgery and recurrence rates. Patients with mesh insertion for hernia defect closures were considered separately.94 Patients were treated in the period from 01.01.2003 to 01.06.2010. The ratio male/female was 2 : 1. The median age was 66 years. All data were prospectively collected by means of surgical protocols and data from the central patient records and analysed retrospectively. The statistical analyses were performed with SPSS 18.0 (SPSS Inc., Chicago, IL, USA). Any existing significances were determined using the T-test.Of the 94 patients, 65 were operated laparoscopically. In the case of nine patients an initial laparoscopic surgery had to be changed to an open procedure. The reasons for switching surgical procedures were splenic bleeding in the case of 2 patients, intestinal injury due to perforation by the trocar in one case and unclear surgical situs in 6 cases. The postoperative complication rate was 24 %. The main reasons were a delayed achievement of passage. The mortality rate was 0 %. The comparison between laparoscopic and open groups showed, by comparable complication and recurrence rates, a shorter recovery time in favour of patients operated on laparoscopically. Additionally it can be stated that a bridge closure with mesh (ePTFE) had no significant influence on the postoperative outcome. Therefore we cannot confirm the postulated poor postoperative results of other groups.In summary, the clear trend in the surgical treatment of hiatus hernias is to minimally invasive surgery. Only for patients with multiple previous operations, who are expected to have strong adhesions, the operation with comparable morbidity and mortality rates can also be planned primarily as open. In this case, however, longer postoperative recovery times must be expected. Large defects can be treated with comparable complication and recurrence rates by mesh insertion (ePTFE).
- Published
- 2012
18. [Pathogenesis, classification and diagnosis of necrotizing soft tissue infections]
- Author
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S, Schnürer, J P, Beier, R, Croner, R J, Rieker, and R E, Horch
- Subjects
Soft Tissue Infections ,Skin Diseases, Bacterial ,Combined Modality Therapy ,Systemic Inflammatory Response Syndrome ,Anti-Bacterial Agents ,Diagnosis, Differential ,Necrosis ,Debridement ,Connective Tissue ,Humans ,Fasciitis, Necrotizing ,Gas Gangrene ,Fournier Gangrene ,Skin - Abstract
Necrotizing soft tissue infections are caused by a variety of pathogens and may affect different types of soft tissue. Even today mortality and lethality are very high. The primary symptoms of necrotizing soft tissue infections are local pain out of proportion, swelling, erythema and crepitation in cases of subcutaneous gas. A systemic inflammatory response syndrome (SIRS) is often associated. During the last decades early recognition and initiation of an adequate therapy were able to reduce lethality to an average of 20%. The physical examination remains the diagnostic gold standard and may be supported by typical findings of imaging technologies, e.g. subcutaneous gas on x-rays and laboratory tests. After diagnosis an adequate antibiotic and surgical therapy should be performed immediately.
- Published
- 2012
19. [Visceral artery aneurysms]
- Author
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A, Meyer, M, Uder, W, Lang, and R, Croner
- Subjects
Adult ,Male ,Arteriosclerosis ,Duodenum ,Pregnancy Complications, Cardiovascular ,Abdominal Injuries ,Aneurysm, Ruptured ,Blood Vessel Prosthesis Implantation ,Hepatic Artery ,Imaging, Three-Dimensional ,Pregnancy ,Image Processing, Computer-Assisted ,Humans ,Ligation ,Pancreas ,Aged ,Angiography ,Infant, Newborn ,Aneurysm ,Embolization, Therapeutic ,Mesenteric Arteries ,Viscera ,Female ,Stents ,Tomography, X-Ray Computed ,Splenic Artery ,Aneurysm, False - Abstract
Visceral artery aneurysms (VAA) are relatively rare disease patterns. With regard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60%) and common hepatic artery (20-50%). The common hepatic artery (80%) and the pancreatico-duodenal artery (75%) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n=19; 1996-2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.
- Published
- 2010
20. [Rational diagnostics of acute abdomen]
- Author
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C W, Schildberg, J, Skibbe, R, Croner, V, Schellerer, W, Hohenberger, and T, Horbach
- Subjects
Abdomen, Acute ,Adult ,Aged, 80 and over ,Male ,Adolescent ,Digestive System Diseases ,Fecal Impaction ,Middle Aged ,Appendicitis ,Magnetic Resonance Imaging ,Diverticulitis, Colonic ,Diagnosis, Differential ,Hospitals, University ,Young Adult ,Ileus ,Ischemia ,Germany ,Cholecystitis ,Humans ,Female ,Mesentery ,Tomography, X-Ray Computed ,Aged - Abstract
In view of the threat that comes with an acute abdomen, it is of major importance that diagnostics are executed quickly and efficiently. In the course of this two tendencies can be differentiated: 1) general use of complex examination (e.g. CT, MRT) of all potential patients and 2) step-by-step-diagnostics with advanced diagnostics as and when required.A total of 444 patients with an acute abdomen as admission diagnosis were investigated. All data were evaluated prospectively and analyzed retrospectively. All patients had the same basic diagnostics consisting of aclinical history, clinical examination, laboratory examination, abdominal sonography and x-ray overview images. These examinations were supplemented when required by advanced measures, such as CT, colon enema with contrast fluid, endoscopic examination and diagnostic laparotomy.Three different disease groups of unequal diagnostic need could be identified. The first group, presented in the form of an appendicitis showed that in 80% of all patients a basic diagnosis was sufficient. Advanced examination such as CT affected 14%. The negative appendectomy rate amounted to 8%. Other diseases belonging to the first group were ileus, acute biliary diseases, perforation etc. In the second group presented in the form of a diverticulitis, an advanced radiological examination was required in 84% of all cases. Similar results are also expected in cases of pancreatitis. In the third group presented in the form of coprostasis, inflammatory etiology was found in 39% of all secondary diseases. However the symptoms became clinically apparent after treatment of the coprostasis. In this group a basic diagnosis was satisfactory in 84% of cases, however, a diagnostic laparotomy was inevitable for 3% of these patients.Generally step-by-step diagnostic approach has proven itself to be efficient. For 80% of all patients it makes advanced diagnostic measures unnecessary. The exceptions are diseases in which it is necessary to know not only the diagnosis but also the disease stage. In these cases (e.g. pancreatitis, diverticulitis etc.) advanced diagnostics should be pursued from the onset. The necessity of a diagnostic laparotomy has lost importance for 1% of all patients.
- Published
- 2010
21. Erhöhter postoperativer Opiatverbrauch bei Morbus Crohn ist nicht assoziiert mit veränderten Schmerzschwellen oder mit Varianten der OPRM1 und COMT Gene
- Author
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Bernd Rautenstrauss, A Wehrfritz, K. Hühne, S. Winter, S. Leis, T Förtsch, A Winterpacht, Christian Maihöfner, A Reis, T Münster, and R. Croner
- Subjects
Neurology (clinical) - Abstract
Fragestellung: Der M. Crohn ist eine schmerzhafte entzundliche Darmerkrankung. Es handelt sich um eine komplexe multifaktorielle Erkrankung, fur die eine genetische Pradisposition gesichert ist. Verglichen mit Patienten, die sich einem ahnlich schweren abdominellen Eingriff unterzogen, konnte bei Crohn Patienten ein erhohter intraoperativer Analgetikaverbrauch gezeigt werden. Die Erkrankung konnte also ein geeignetes Modell darstellen, um neue Schmerzsuszeptibilitatsgene zu identifizieren. In der vorliegenden Studie wurde untersucht, ob bei Crohn Patienten ein erhohter postoperativer Opiatverbrauch vorliegt und ob diesem eine veranderte Schmerzwahrnehmung oder bekannte Varianten der Gene des µ-Opioidrezeptors (OPRM1) oder der Katechol-O-Methyltransferase (COMT) zugrunde liegen. Methoden: Um den postoperativen Opiatverbrauch zu untersuchen, wurden die PCA Daten (patient controlled analgesia) der ersten 48h nach Ileocoecalresektion von 61 Crohn Patienten (41,0±12,0 Jahre) mit denen von 34 Patienten (66,1±11,2 Jahre) nach Hemikolektomie verglichen und die Patienten als „Hoch-“, „Durchschnitts-“ oder „Niedrigverbraucher“ klassifiziert. Zur somatosensorischen Funktionsprufung wurde bei 52 Patienten (38,5±12,0 Jahre) eine quantitative sensorische Testung (QST) mit Bestimmung thermischer und mechanischer Empfindungs- und Schmerzschwellen durchgefuhrt und mit 31 gesunden Freiwilligen (31,0±11,3 Jahre) verglichen. Schlieslich wurden bei 145 Crohn-Patienten bekannte Varianten des OPRM1 und des COMT Gens untersucht und mit 163 Kontrollen verglichen. Ergebnisse: Der postoperative Opiatverbrauch war bei Crohn-Patienten signifikant erhoht (ANOVA, F=6,41, p
- Published
- 2009
22. Differences in mRNA expression profile in patients with Crohnʼs disease with high and low postoperative morphine consumption?
- Author
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R. Croner, R. Atreya, T. Rau, Andreas Winterpacht, and Tino Münster
- Subjects
Consumption (economics) ,Anesthesiology and Pain Medicine ,business.industry ,Anesthesia ,Mrna expression ,Morphine ,Medicine ,In patient ,Disease ,business ,medicine.drug - Published
- 2014
23. Effects of partial and total colectomy on mineral and acid-base homoeostasis in the rat: magnesium deficiency, hyperphosphaturia and osteopathy, in the presence of high serum 1,25-dihydroxyvitamin D but normal parathyroid hormone
- Author
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R, Croner, P O, Schwille, R G, Erben, H, Gepp, K, Stahr, G, Rümenapf, R, Parth, and H, Scheuerlein
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Acid-Base Equilibrium ,Male ,Minerals ,Phosphorus Metabolism Disorders ,Bone and Bones ,Rats ,Rats, Sprague-Dawley ,Calcitriol ,Intestinal Absorption ,Parathyroid Hormone ,Animals ,Calcium ,Bone Diseases ,Magnesium Deficiency ,Biomarkers ,Colectomy - Abstract
The effects of colectomy on acid-base status, extra-osseous and bone minerals, calciotropic hormones and bone morphology have not yet been studied. To rectify this, groups of normally fed male rats were subjected to distal (n=11), proximal (n=12) or total (n=12) colectomy. Sham-operated rats (n=12) served as controls. At 112 (+/-2) days after colectomy the following changes were noted: (1) weight gain was delayed; (2) faecal excretion of calcium and phosphorus was normal, whereas that of magnesium was increased; (3) intestinal calcium secretion and absorption of calcium and phosphorus were normal, but magnesium absorption was decreased; (4) urinary excretion of magnesium was also decreased, that of phosphorus was increased, and that of pyridinium and deoxypyridinium tended to be high; (5) the serum levels of ionized magnesium, total calcium, 25-hydroxyvitamin D and parathyroid hormone were normal, while that of 1,25-dihydroxyvitamin D was markedly elevated; and (6) bone magnesium and phosphorus content were decreased, but bone calcium was normal, and thus the bone calcium/phosphorus ratio was high. These abnormalities were associated with moderate metabolic acidosis, as reflected by high urinary ammonium, low citrate and low total CO(2), but normal blood gases. Significant structural abnormalities of bone were not detectable, but trabecular bone tended to show rarefication. Distal colectomy had the least effect, whereas proximal and total colectomies had a distinct effect, on these parameters. It is concluded that colectomy in the rat causes: (1) a syndrome of magnesium deficiency of intestinal origin, compensated metabolic acidosis, urinary phosphorus loss, and high circulating 1,25-dihydroxyvitamin D levels, with the degree depending on the extent of surgical resection; and (2) brittle bones, a feature characteristic of low bone magnesium and more generalized magnesium deficiency. The mechanisms leading to this syndrome are unknown, but altered tissue levels of magnesium and phosphorus may play a key role.
- Published
- 2000
24. Expression of Human Collectins in Colorectal Carcinoma
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M. Siassi, R. Croner, and W. Hohenberger
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Pathology ,medicine.medical_specialty ,Proteases ,Innate immune system ,Colorectal cancer ,Immunology ,Collectin ,General Medicine ,Biology ,medicine.disease ,Molecular biology ,In vitro ,Malignant transformation ,Gene expression ,medicine ,Gene - Abstract
Introduction: The human collectins, mannan-binding lectin (MBL), surfactant protein-A (SP-A) and surfactant-protein-D (SP-D) play a central role in the innate immune system. Immunological responses to malignant transformation of epithelial cells gained increasing interest recently. A former study could demonstrate binding of MBL to certain colorectal carcinoma (CRC) cell lines in vitro. We therefore examined the expression of human collectins in normal colon mucosa and in colorectal carcinomas. Materials and methods: Colon samples from 20 CRC patients and 10 normal mucosa samples were collected immediately after surgery. The tissue was microdissected and RNA isolated (Qiagen, Rneasy-Kit). Gene expression profiles were analysed using Gene-chips (Affymetrix, HG-U133). We analysed the data for the expression of MBL, its associated serine proteases mannan-binding lectin-associated serine protease 1/2 (MASP 1/2), SP-A and SP-D. The signal intensity of the genes of interest was compared using the Mann–Whitney U-test. Results: The expression of human collectins in normal human colon mucosa was generally low. Only the expression of SP-A and MASP-2 reached the noise threshold of 250 signals. These genes were significantly downregulated in CRC specimens. The expression of the other proteins showed no difference in normal mucosa and CRC. Conclusion: As demonstrated before, the expression of human collectins in normal colon was low in this study. Only SP-A showed a significant expression in normal mucosa which was downregulated in CRC. As the absolute signal level was below the noise threshold, these results have to be interpreted with caution and require confirmation by direct measurenment of the proteins. Our results suggest that there is no major role for the human collectins in colorectal cancer.
- Published
- 2008
25. Effects of partial and total colectomy on mineral and acid‒base homoeostasis in the rat: magnesium deficiency, hyperphosphaturia and osteopathy, in the presence of high serum 1,25-dihydroxyvitamin D but normal parathyroid hormone
- Author
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H. Gepp, H. Scheuerlein, R. Croner, Paul Otto Schwille, Reinhold G. Erben, Kerstin Stahr, R. Parth, and G. Rümenapf
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Calcium metabolism ,medicine.medical_specialty ,Colectomies ,Bone disease ,Magnesium ,chemistry.chemical_element ,Parathyroid hormone ,General Medicine ,Calcium ,medicine.disease ,Hypomagnesemia ,Endocrinology ,chemistry ,Internal medicine ,Magnesium deficiency (medicine) ,medicine - Abstract
The effects of colectomy on acid–base status, extra-osseous and bone minerals, calciotropic hormones and bone morphology have not yet been studied. To rectify this, groups of normally fed male rats were subjected to distal (n = 11), proximal (n = 12) or total (n = 12) colectomy. Sham-operated rats (n = 12) served as controls. At 112 (±2) days after colectomy the following changes were noted: (1) weight gain was delayed; (2) faecal excretion of calcium and phosphorus was normal, whereas that of magnesium was increased; (3) intestinal calcium secretion and absorption of calcium and phosphorus were normal, but magnesium absorption was decreased; (4) urinary excretion of magnesium was also decreased, that of phosphorus was increased, and that of pyridinium and deoxypyridinium tended to be high; (5) the serum levels of ionized magnesium, total calcium, 25-hydroxyvitamin D and parathyroid hormone were normal, while that of 1,25-dihydroxyvitamin D was markedly elevated; and (6) bone magnesium and phosphorus content were decreased, but bone calcium was normal, and thus the bone calcium/phosphorus ratio was high. These abnormalities were associated with moderate metabolic acidosis, as reflected by high urinary ammonium, low citrate and low total CO2, but normal blood gases. Significant structural abnormalities of bone were not detectable, but trabecular bone tended to show rarefication. Distal colectomy had the least effect, whereas proximal and total colectomies had a distinct effect, on these parameters. It is concluded that colectomy in the rat causes: (1) a syndrome of magnesium deficiency of intestinal origin, compensated metabolic acidosis, urinary phosphorus loss, and high circulating 1,25-dihydroxyvitamin D levels, with the degree depending on the extent of surgical resection; and (2) brittle bones, a feature characteristic of low bone magnesium and more generalized magnesium deficiency. The mechanisms leading to this syndrome are unknown, but altered tissue levels of magnesium and phosphorus may play a key role.
- Published
- 2000
26. Enhancing Veress Needle Entry with Proximal Vibroacoustic Sensing for Automatic Identification of Peritoneum Puncture.
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Spiller M, Esmaeili N, Sühn T, Boese A, Turial S, Gumbs AA, Croner R, Friebe M, and Illanes A
- Abstract
Laparoscopic access, a critical yet challenging step in surgical procedures, often leads to complications. Existing systems, such as improved Veress needles and optical trocars, offer limited safety benefits but come with elevated costs. In this study, a prototype of a novel technology for guiding needle interventions based on vibroacoustic signals is evaluated in porcine cadavers. The prototype consistently detected successful abdominal cavity entry in 100% of cases during 193 insertions across eight porcine cadavers. The high signal quality allowed for the precise identification of all Veress needle insertion phases, including peritoneum puncture. The findings suggest that this vibroacoustic-based guidance technology could enhance surgeons' situational awareness and provide valuable support during laparoscopic access. Unlike existing solutions, this technology does not require sensing elements in the instrument's tip and remains compatible with medical instruments from various manufacturers.
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- 2024
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27. Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients.
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Sijberden JP, Hoogteijling TJ, Aghayan D, Ratti F, Tan EK, Morrison-Jones V, Lanari J, Haentjens L, Wei K, Tzedakis S, Martinie J, Osei Bordom D, Zimmitti G, Crespo K, Magistri P, Russolillo N, Conci S, Görgec B, Benedetti Cacciaguerra A, D'Souza D, Zozaya G, Caula C, Geller D, Robles Campos R, Croner R, Rehman S, Jovine E, Efanov M, Alseidi A, Memeo R, Dagher I, Giuliante F, Sparrelid E, Ahmad J, Gallagher T, Schmelzle M, Swijnenburg RJ, Fretland ÅA, Cipriani F, Koh YX, White S, Lopez Ben S, Rotellar F, Serrano PE, Vivarelli M, Ruzzenente A, Ferrero A, Di Benedetto F, Besselink MG, Sucandy I, Sutcliffe RP, Vrochides D, Fuks D, Liu R, D'Hondt M, Cillo U, Primrose JN, Goh BKP, Aldrighetti LA, Edwin B, and Abu Hilal M
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- Humans, Female, Male, Retrospective Studies, Middle Aged, Aged, Postoperative Complications epidemiology, Treatment Outcome, Liver Diseases surgery, Robotic Surgical Procedures, Propensity Score, Hepatectomy methods, Laparoscopy methods
- Abstract
Objective: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings., Background: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined., Methods: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+., Results: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance., Conclusions: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS., Competing Interests: M.A.H. and M.G.B. received grants from Medtronic GmbH, Intuitive Surgical Inc., and Johnson & Johnson Medical GmbH for investigator-initiated studies. S.L.B. reported received fees from Baxter, Olympus, and Johnson & Johnson. M.S. reported received fees from Merck Serono GmbH, Bayer AG, ERBE Elektromedizin GmbH, Amgen Inc., AstraZeneca, Avateramedical GmbH, Johnson & Johnson Medical GmbH, TakedaPharmaceutical Limited, Olympus K.K., Medtronic GmbH, Intuitive Surgical Inc., Corzamedical, Baxter Int Inc. A.A.F. reported speaker’s honoraria from Bayer and Olympus. F.R. reported speakers' honoraria from Olympus. The remaining authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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28. Surgical Outcome and Microbial Colonization of Standardized Smear Locations after Pancreatic Head Resection (Pylorus-Preserving Pancreatoduodenectomy, PPPD) for Chronic Pancreatitis and Pancreatic Head Carcinoma.
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Grabowski M, Otto R, Tammer I, Jechorek D, Ptok H, Al-Madhi S, Croner R, and Meyer F
- Abstract
Introduction: Patients with chronic pancreatitis (CP) as well as with pancreatic head carcinoma (CA) undergo the surgical intervention named "pylorus-preserving pancreatoduodenectomy according to Traverso-Longmire (PPPD)", which allowed a comparative analysis of the postoperative courses. The hypothesis was that patients with CA would have worse general as well as immune status than patients with CP due to the severity of the tumor disease and that this would be reflected in the more disadvantageous early postoperative outcome after PPPD. Methods : With the aim of eliciting the influence of the different diagnoses, the surgical outcome of all consecutive patients who underwent surgery at the Dept. of General, Abdominal, Vascular and Transplant Surgery at the University Hospital at Magdeburg between 2002 and 2015 (inclusion criterion) was recorded and comparatively evaluated. Early postoperative outcome was characterized by general and specific complication rate indicating morbidity, mortality, and microbial colonization rate, in particular surgical site infection (SSI, according to CDC criteria). In addition, microbiological findings of swabs and cultures from all compartments as well as preoperative and perioperative parameters from patient records were retrospectively documented and used for statistical comparison in this systematic retrospective unicenter observational study (design). Results : In total, 192 cases with CA (68.1%) and 90 cases with CP (31.9%) met the inclusion criteria of this study. Surprisingly, there were similar specific complication rates of 45.3% (CA) vs. 45.6% (CP; p = 0.97) and in-hospital mortality, which differed only slightly at 3.65% (CA) vs. 3.3% (CP; p = 0.591); the overall complication rate tended to be higher for CA at 23.4% vs. 14.4% (CP; p = 0.082). Overall, potentially pathogenic germs were detected in 28.9% of all patients in CP compared to 32.8% in CA ( p = 0.509), and the rate of SSI was 29.7% (CA) and 24.4% (CP; p = 0.361). In multivariate analysis, CA was found to be a significant risk factor for the development of SSI (OR: 2.025; p = 0.048); the underlying disease had otherwise no significant effect on early postoperative outcome. Significant risk factors in the multivariate analysis were also male sex for SSI and microbial colonization, and intraoperatively transfused red cell packs for mortality, general and specific complications, and surgical revisions. Conclusions : Based on these results, a partly significant, partly trending negative influence of the underlying disease CA, compared to CP, on the early postoperative outcome was found, especially with regard to SSI after PPPD. This influence is corroborated by the international literature.
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- 2024
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29. Robotic Complete ALPPS (rALPPS)-First German Experiences.
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Arend J, Franz M, Rose A, March C, Rahimli M, Perrakis A, Lorenz E, and Croner R
- Abstract
Background: ALPPS leads to fast and effective liver hypertrophy. This enables the resection of extended tumors. Conventional ALPPS is associated with high morbidity and mortality. MILS reduces morbidity and the robot adds technical features that make complex procedures safe., Material and Methods: The MD-MILS was screened for patients who underwent rALPPS. Demographic and perioperative data were evaluated retrospectively. Ninety days postoperative morbidity was scored according to the CD classification. The findings were compared with the literature., Results: Since November 2021, five patients have been identified. The mean age and BMI of the patients were 50.0 years and 22.7 kg/m
2 . In four cases, patients suffered from colorectal liver metastases and, in one case, intrahepatic cholangiocarcinoma. Prior to the first operation, the mean liver volume of the residual left liver was 380.9 mL with a FLR-BWR of 0.677%. Prior to the second operation, the mean volume of the residual liver was 529.8 mL with a FLR-BWR of 0.947%. This was an increase of 41.9% of the residual liver volume. The first and second operations were carried out within 17.8 days. The mean time of the first and second operations was 341.2 min and 440.6 min. The mean hospital stay was 27.2 days. Histopathology showed the largest tumor size of 39 mm in diameter with a mean amount of 4.7 tumors. The mean tumor-free margin was 12.3 mm. One complication CD > 3a occurred. No patient died during the 90-day follow up., Conclusion: In the first German series, we demonstrated that rALPPS can be carried out safely with reduced morbidity and mortality in selected patients.- Published
- 2024
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30. International consensus guidelines on robotic pancreatic surgery in 2023.
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Liu R, Abu Hilal M, Besselink MG, Hackert T, Palanivelu C, Zhao Y, He J, Boggi U, Jang JY, Panaro F, Goh BKP, Efanov M, Nagakawa Y, Kim HJ, Yin X, Zhao Z, Shyr YM, Iyer S, Kakiashvili E, Han HS, Lee JH, Croner R, Wang SE, Marino MV, Prasad A, Wang W, He S, Yang K, Liu Q, Wang Z, Li M, Xu S, Wei K, Deng Z, Jia Y, and van Ramshorst TME
- Abstract
Background: With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS., Methods: World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline., Results: After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence., Conclusions: The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-132/coif). M.A.H., F.P. and H.S.H. serve as unpaid editorial board members of Hepatobiliary Surgery and Nutrition. M.G.B. acknowledges grants support to his hospital for the investigator-initiated DIPLOMA-2 randomized trial. B.K.P.G. reports grant from Intuitive Foundation and consulting fees from Transmedic, Local distributor of the Da Vinci robot. U.B. is proctor for Intuitive Surgical (pancreas surgery). The other authors have no conflicts of interest to declare., (2024 Hepatobiliary Surgery and Nutrition. All rights reserved.)
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- 2024
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31. Transient receptor potential channels as predictive marker and potential indicator of chemoresistance in colon cancer.
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Hu W, Wartmann T, Strecker M, Perrakis A, Croner R, Szallasi A, Shi W, and Kahlert UD
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- Humans, Drug Resistance, Neoplasm genetics, Computational Biology, Transient Receptor Potential Channels, Colonic Neoplasms drug therapy, Colonic Neoplasms genetics, Adenocarcinoma
- Abstract
Transient receptor potential (TRP) channels are strongly associated with colon cancer development and progression. This study leveraged a multivariate Cox regression model on publicly available datasets to construct a TRP channels-associated gene signature, with further validation of signature in real world samples from our hospital treated patient samples. Kaplan-Meier (K-M) survival analysis and receiver operating characteristic (ROC) curves were employed to evaluate this gene signature's predictive accuracy and robustness in both training and testing cohorts, respectively. Additionally, the study utilized the CIBERSORT algorithm and single-sample gene set enrichment analysis to explore the signature's immune infiltration landscape and underlying functional implications. The support vector machine algorithm was applied to evaluate the signature's potential in predicting chemotherapy outcomes. The findings unveiled a novel three TRP channels-related gene signature (MCOLN1, TRPM5, and TRPV4) in colon adenocarcinoma (COAD). The ROC and K-M survival curves in the training dataset (AUC = 0.761; p = 1.58e-05) and testing dataset (AUC = 0.699; p = 0.004) showed the signature's robust predictive capability for the overall survival of COAD patients. Analysis of the immune infiltration landscape associated with the signature revealed higher immune infiltration, especially an increased presence of M2 macrophages, in high-risk group patients compared to their low-risk counterparts. High-risk score patients also exhibited potential responsiveness to immune checkpoint inhibitor therapy, evident through increased CD86 and PD-1 expression profiles. Moreover, the TRPM5 gene within the signature was highly expressed in the chemoresistance group ( p = 0.00095) and associated with poor prognosis ( p = 0.036) in COAD patients, highlighting its role as a hub gene of chemoresistance. Ultimately, this signature emerged as an independent prognosis factor for COAD patients ( p = 6.48e-06) and expression of model gene are validated by public data and real-world patients. Overall, this bioinformatics study provides valuable insights into the prognostic implications and potential chemotherapy resistance mechanisms associated with TRPs-related genes in colon cancer., Competing Interests: The authors declare that they have no conflicts of interest to report regarding the present study., (© 2024 Hu et al.)
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- 2023
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32. Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany.
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Andric M, Stockheim J, Rahimli M, Klös M, Esser T, Soldatovic I, Dölling M, Al-Madhi S, Acciuffi S, Croner R, and Perrakis A
- Abstract
Objectives: The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg., Methods: Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649 days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649 days). Subgroup analysis related to conservative or surgical treatment has been performed., Results: A total of 385 patients was included in the study, 203 (52.73 %) during Non-COVID-19 period and 182 (47.27 %) during COVID-19 period. Mean age of entire collective was 43.28 years, containing 43.9 % female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7 % of entire collective), increasing from 9.9 % to 15.9 % during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3 % (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5 % vs. 13.1 %, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3 % (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57 days vs. 3.16 days, p<0.001) and it was given longer in the conservative treatment group (5.63 days vs. 4.26 days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67 days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08 days vs. 4.47 days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2 % vs. 7.7 %, p=0.005) and for conservative therapy compared to appendicectomy (2 % vs. 14.3 %, p=0.016). There was no mortality documented., Conclusions: According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine., Competing Interests: Competing interests: Authors state no conflict of interest., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)
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- 2023
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33. Does intestinal anastomosis in resection of colon cancer have a significant impact onto early postoperative outcome and long-term survival?
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Hajduk E, Meyer F, Otto R, Croner R, and Ridwelski K
- Abstract
Objectives: To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA)., Methods: All consecutive patients with the histologically diagnosed primary colon CA (design, prospective multicenter observational study) were registered with regard to patient-, diagnostic-, tumor (Tu) finding-, and treatment-related aspects using a computer-based registry with 60 items to characterize early postoperative and long-term oncological outcome., Results: Basic data : From 2010 to 2016, data from a total of 14,466 patients were documented (mean age, 72.8 [range, 22-96] years; sex ratio, m:f=7,696:6,770). - 717/14,466 patients (4.96 %) were included in a matched-pair analysis. The majority of these patients underwent elective surgery ( n =12,620 patients; 87.2 %) regardless of whether a bowel anastomosis or an ostomy was created. In emergency surgery, a bowel anastomosis was possible in a large proportion ( n =1,332 patients [72.1 %]). In contrast, in 514 patients (27.9 %) who underwent emergency surgery, an ostomy was created. Interestingly, ostomy had to be created even less frequently in patients who had undergone planned surgery ( n =366 [2.5 %]). - Early postoperative outcome : Cases of postoperative mortality were mainly due to general complications. Especially among the patients treated in an emergency situation without intestinal anastomosis, a high proportion died of their pre-existing condition (17.0 %). Patients who underwent ostomy creation or emergency surgery had a worse risk profile (incl. arterial hypertension, diabetes mellitus, and secondary cardiac or renal diseases) which led to the decision to operate without anastomosis. Furthermore, data show no matter which technique had been used, patients that had undergone surgical intervention without anastomosis were more likely to develop complications. - Long-term oncosurgical outcome : The most important factors influencing long-term survival were age, resection status, and tumor stage (according to TNM and UICC). The more advanced the tumor growth, the lower the long-term survival. Patients categorized with the same tumor stage, age, and risk factors had a better chance of survival, if they underwent elective surgical intervention and with intestinal anastomosis. Interestingly, the multivariable analysis showed that older patients and such with distant metastasis benefit from a discontinuity resection., Conclusions: The association of intraoperative and postoperative complications with increased postoperative mortality, as well as preexisting risk factors and perioperative complications is in line with findings of current studies. Furthermore, current studies also agree that older patients and such with reduced general condition benefit from discontinuity resection., Competing Interests: Competing interests: Authors state no conflict of interest., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)
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- 2023
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34. [Indocyanine Green (ICG) in Robotic Liver Surgery].
- Author
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Franz M and Croner R
- Abstract
Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.
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- 2023
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35. The effect of an abdominal binder on postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial (ABIHR-II).
- Author
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Ortiz PR, Lorenz E, Meyer F, Croner R, Lünse S, Hunger R, Mantke R, Benz-Weisser A, Zarras K, Huenerbein M, and Paasch C
- Subjects
- Male, Humans, Female, Middle Aged, Pilot Projects, Prospective Studies, Seroma etiology, Surgical Mesh, Herniorrhaphy adverse effects, Herniorrhaphy methods, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, Surgical Wound Infection surgery, Pain surgery, Postoperative Complications etiology, Postoperative Complications surgery, Incisional Hernia surgery, Hernia, Ventral surgery
- Abstract
Introduction: Although the evidence is minimal, an abdominal binder is commonly prescribed after open incisional hernia repair (IHR) to reduce pain. This study aimed to investigate this common postoperative treatment., Methods: The ABIHR-II trial was a national prospective, randomized, multicenter non-AMG/MPG pilot study with two groups of patients (wearing an abdominal binder (AB) for 2 weeks during daytime vs. not wearing an AB following open IHR with the sublay technique). Patient enrollment took place from July 2020 to February 2022. The primary endpoint was pain at rest on the 14th postoperative day (POD) using the visual analog scale (VAS). The use of analgesics was not systematically recorded. Mixed-effects linear regression models were used., Results: A total of 51 individuals were recruited (25 women, 26 men; mean age 61.4 years; mean body mass index 30.65 kg/m
2 ). The per-protocol analysis included 40 cases (AB group, n = 21; No-AB group, n = 19). Neither group showed a significant difference in terms of pain at rest, limited mobility, general well-being, and seroma formation and rate. Patients among the AB group had a significantly lower rate of surgical site infection (SSI) on the 14th POD (AB group 4.8% (n = 1) vs. No-AB group 27.8% (n = 5), p = 0.004)., Conclusion: Wearing an AB did not have an impact on pain and seroma formation rate but it may reduce the rate of postoperative SSI within the first 14 days after surgery. Further trials are mandatory to confirm these findings., (© 2023. The Author(s).)- Published
- 2023
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36. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis.
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Thormann M, Hinnerichs M, Barajas Ordonez F, Saalfeld S, Perrakis A, Croner R, Omari J, Pech M, Zamsheva M, Meyer HJ, Wienke A, and Surov A
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- Humans, Prognosis, Muscle, Skeletal, Postoperative Complications pathology, Pancreatic Neoplasms, Pancreatic Neoplasms complications, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms epidemiology, Sarcopenia diagnostic imaging, Sarcopenia epidemiology, Sarcopenia complications, Carcinoma, Pancreatic Ductal complications, Carcinoma, Pancreatic Ductal diagnostic imaging, Carcinoma, Pancreatic Ductal epidemiology
- Abstract
Rationale and Objectives: Sarcopenia is defined as skeletal muscle loss and can be assessed by cross-sectional imaging. Our aim was to establish the effect of sarcopenia on relevant outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) in curative and palliative settings based on a large patient sample., Materials and Methods: MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between sarcopenia and mortality in patients with PDAC up to March 2022. The primary endpoint of the systematic review was the hazard ratio of Sarcopenia on survival. 22 studies were included into the present analysis., Results: The included 22 studies comprised 3958 patients. The prevalence of sarcopenia was 38.7%. Sarcopenia was associated with a higher prevalence in the palliative setting (OR 53.23, CI 39.00-67.45, p<0.001) compared to the curative setting (OR 36.73, CI 27.81-45.65, p<0.001). Sarcopenia was associated with worse OS in the univariable (HR 1.79, CI 1.41-2.28, p<0.001) and multivariable analysis (HR 1.62, CI 1.27-2.07, p<0.001) in the curative setting. For the palliative setting the pooled hazards ratio showed that sarcopenia was associated with overall survival (HR 1.56, CI 1.21-2.02, p<0.001) as well as in multivariable analysis (HR 1.77, CI 1.39-2.26, p<0.001). Sarcopenia was not associated with a higher rate of post-operative complications in univariable analysis (OR 1.10, CI 0.70-1.72, p = 0.69)., Conclusion: Sarcopenia occurs in 38.7% of patients with pancreatic cancer, significantly more in the palliative setting. Sarcopenia is associated with overall survival in both settings. The assessment of sarcopenia is therefore relevant for personalized oncology. Sarcopenia is not associated with postoperative complications., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
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- 2023
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37. Standardization of the Definition and Surgical Management of Splenic Flexure Carcinoma by an International Expert Consensus Using the Delphi Technique: Room for Improvement?
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Benlice C, Parvaiz A, Baca B, Hohenberger W, Miskovic D, Stocchi L, Steele S, Kim SH, Holm T, Spinelli A, Gogenur I, Panis Y, Hasegawa H, Karachun A, Uriburu JCP, Ito M, Croner R, Kessler H, and Kuzu MA
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- Humans, Colon, Colectomy, Reference Standards, Delphi Technique, Colon, Transverse, Carcinoma, Colonic Neoplasms
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Background: Surgical management of splenic flexure carcinoma remains controversial., Objective: This study aimed to establish an expert international consensus on splenic flexure carcinoma management., Design: A 3-round online-based Delphi study was conducted between September 2020 and April 2021., Setting: The first round included 18 experts from 12 different countries. For the second and third rounds, each expert in the first round was asked to invite 2 more colorectal surgeons (n = 47). Out of 47 invited experts, 89% (n = 42) participated in the second and third rounds of the consensus., Interventions: A total of 35 questions were created and sent via the online questionnaire tool., Main Outcome Measures: Levels of recommendation based on voting concordance were graded as follows: more than 75% agreement was defined as strong, between 50% and 75% as moderate, and below 50% as weak., Results: There was moderate consensus on the definition of splenic flexure (55%) as 10 cm from either side where the distal transverse colon turns into the proximal descending colon. Also, experts recommended an abdominopelvic CT scan plus intraoperative exploration (moderate consensus, 72%) for tumor localization and cancer registry. Segmental colectomy was the preferred technique for the management of splenic flexure carcinoma in the elective setting (72%). Moderate consensus was achieved on the technique of complete mesocolic excision and central vascular ligation principles for splenic flexure carcinoma (74%). Only strong consensus was achieved on the surgical approach for minimally invasive surgery (88%)., Limitations: Subjective decisions are based on individual expert clinical experience and not evidence based., Conclusions: This is the first internationally conducted Delphi consensus study regarding splenic flexure carcinoma. The definition of splenic flexure remains ambiguous. To more effectively compare oncologic outcomes among different cancer registries, guidelines need to be developed to standardize each domain and avoid arbitrary definitions. See Video Abstract at http://links.lww.com/DCR/C143 ., Estandarizacin De La Definicin Y Manejo Quirrgico Del Carcinoma De Ngulo Esplnico Establecido Por Un Consenso Internacional De Expertos Utilizando La Tcnica Delphi Espacio Para Mejorar: ANTECEDENTES:El tratamiento quirúrgico del cáncer de ángulo esplénico sigue siendo controvertido.OBJETIVO:Establecer un consenso internacional de expertos sobre el manejo del cáncer del ángulo esplénico.DISEÑO:Se condujo un estudio Delphi en línea de 3 rondas entre septiembre de 2020 y febrero de 2021.ESCENARIO:La primera ronda incluyó a 18 expertos de 12 países distintos. Para la segunda y tercera rondas, a cada experto de la primera ronda se le pidió que invitara a 2 cirujanos colorrectales más de su región (n = 47). De los 47 expertos invitados, el 89% (n = 42) participó en la segunda y tercera ronda del consenso.INTERVENCIONES:Se crearon y enviaron un total de 35 preguntas a través de la herramienta de cuestionario en línea.PRINCIPALES MEDIDAS DE RESULTADO:Los niveles de recomendación basados en la concordancia de votos fueron jerarquizados de la siguiente manera: más del 75% de acuerdo se definió como fuerte, entre 50 y 75% como moderado y por debajo del 50% como débil.RESULTADOS:Hubo un consenso moderado sobre la definición de ángulo esplénico (55%) como 10 cm desde cualquier lado donde el colon transverso distal se convierte en el colon descendente proximal. Así también, los expertos recomendaron la tomografía computarizada abdominopélvica más la exploración intraoperatoria (consenso moderado, 72%) para la localización del tumor y el registro del ángulo esplénico. La colectomía segmentaria fue la técnica preferida para el tratamiento del cáncer de ángulo esplénico en el caso de ser electivo (72%). Se logró un consenso moderado sobre la técnica de escisión completa del mesocolon y los principios de ligadura vascular a nivel central para el cáncer de ángulo esplénico (74%). Solo se logró un fuerte consenso sobre el abordaje quirúrgico para la cirugía mínimamente invasiva (88%).LIMITACIONES:Decisiones subjetivas basadas en la experiencia clínica de expertos individuales y no basadas en evidencia.CONCLUSIONES:Este es el primer estudio internacional de consenso Delphi realizado sobre el cáncer de ángulo esplénico. Si bien encontramos un consenso moderado sobre las modalidades de diagnóstico preoperatorio y el manejo quirúrgico, la definición de ángulo esplénico sigue siendo ambigua. Para comparar de manera más efectiva los resultados oncológicos entre diferentes registros de cáncer, se deben desarrollar pautas para estandarizar cada dominio y evitar definiciones arbitrarias. Consulte Video Resumen en http://links.lww.com/DCR/C143 . (Traducción-Dr. Osvaldo Gauto )., (Copyright © The ASCRS 2023.)
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- 2023
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38. Comment on: Complete mesocolic excision for right colonic cancer: prospective multicentre study.
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Bertelsen CA, Bianchi PP, Croner R, Kleif J, Matzel KE, Merkel S, Miskovic D, Ruiz MG, Stearns AT, and Storli KE
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- Humans, Prospective Studies, Colectomy, Lymph Node Excision, Colonic Neoplasms surgery, Mesocolon surgery, Laparoscopy
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- 2023
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39. Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study.
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MacKenzie P, Färber J, Post M, Esser T, Bechmann L, Kropf S, Croner R, and Geginat G
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- Humans, Case-Control Studies, Retrospective Studies, Inpatients, Multilocus Sequence Typing, Anti-Bacterial Agents therapeutic use, Risk Factors, Vancomycin-Resistant Enterococci genetics, Cross Infection drug therapy, Cross Infection epidemiology, Gram-Positive Bacterial Infections drug therapy, Gram-Positive Bacterial Infections epidemiology
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Background: Investigation of risk factors for the presence of vancomycin-resistant enterococci (VRE) in inpatients on surgical wards and associated intensive care units of a German tertiary care hospital., Methods: A single-centre retrospective matched case-control study was performed with surgical inpatients admitted between July 2013 and December 2016. Patients with in-hospital detection of VRE later than 48 h after admission were included and comprised 116 VRE-positive cases and 116 VRE-negative matched controls. VRE isolates of cases were typed by multi-locus sequence typing., Results: ST117 was identified as the dominant VRE sequence type. Next to length of stay in hospital or on an intensive care unit and previous dialysis the case-control study revealed previous antibiotic therapy as a risk factor for the in-hospital detection of VRE. The antibiotics piperacillin/tazobactam, meropenem, and vancomycin were associated with the highest risks. After taking into account length of stay in hospital as possible confounder other potential contact-related risk factors such as previous sonography, radiology, central venous catheter, and endoscopy were not significant., Conclusions: Previous dialysis and previous antibiotic therapy were identified as independent risk factors for the presence of VRE in surgical inpatients., (© 2023. The Author(s).)
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- 2023
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40. N-glycosylation Regulates Intrinsic IFN-γ Resistance in Colorectal Cancer: Implications for Immunotherapy.
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Krug J, Rodrian G, Petter K, Yang H, Khoziainova S, Guo W, Bénard A, Merkel S, Gellert S, Maschauer S, Spermann M, Waldner M, Bailey P, Pilarsky C, Liebl A, Tripal P, Christoph J, Naschberger E, Croner R, Schellerer VS, Becker C, Hartmann A, Tüting T, Prante O, Grützmann R, Grivennikov SI, Stürzl M, and Britzen-Laurent N
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- Humans, Mice, Animals, Glycosylation, Interferon-gamma, Immunotherapy, Tretinoin, Colorectal Neoplasms pathology, Colitis pathology
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Background & Aims: Advanced colorectal carcinoma (CRC) is characterized by a high frequency of primary immune evasion and refractoriness to immunotherapy. Given the importance of interferon (IFN)-γ in CRC immunosurveillance, we investigated whether and how acquired IFN-γ resistance in tumor cells would promote tumor growth, and whether IFN-γ sensitivity could be restored., Methods: Spontaneous and colitis-associated CRC development was induced in mice with a specific IFN-γ pathway inhibition in intestinal epithelial cells. The influence of IFN-γ pathway gene status and expression on survival was assessed in patients with CRC. The mechanisms underlying IFN-γ resistance were investigated in CRC cell lines., Results: The conditional knockout of the IFN-γ receptor in intestinal epithelial cells enhanced spontaneous and colitis-associated colon tumorigenesis in mice, and the loss of IFN-γ receptor α (IFNγRα) expression by tumor cells predicted poor prognosis in patients with CRC. IFNγRα expression was repressed in human CRC cells through changes in N-glycosylation, which decreased protein stability via proteasome-dependent degradation, inhibiting IFNγR-signaling. Downregulation of the bisecting N-acetylglucosaminyltransferase III (MGAT3) expression was associated with IFN-γ resistance in all IFN-γ-resistant cells, and highly correlated with low IFNγRα expression in CRC tissues. Both ectopic and pharmacological reconstitution of MGAT3 expression with all-trans retinoic acid increased bisecting N-glycosylation, as well as IFNγRα protein stability and signaling., Conclusions: Together, our results demonstrated that tumor-associated changes in N-glycosylation destabilize IFNγRα, causing IFN-γ resistance in CRC. IFN-γ sensitivity could be reestablished through the increase in MGAT3 expression, notably via all-trans retinoic acid treatment, providing new prospects for the treatment of immune-resistant CRC., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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41. Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2).
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Gumbs AA, Croner R, Lorenz E, Cacciaguerra AB, Tsai TJ, Starker L, Flanagan J, Yu NJ, Chouillard E, and Abu Hilal M
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Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan−Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach.
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- 2022
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42. Surgeons' requirements for a surgical support system to improve laparoscopic access.
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Spiller M, Bruennel M, Grosse V, Sühn T, Esmaeili N, Stockheim J, Turial S, Croner R, Boese A, Friebe M, and Illanes A
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- Abdomen surgery, Humans, Needles, Surgical Instruments, Laparoscopy methods, Surgeons
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Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient's abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons' requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures., (© 2022. The Author(s).)
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- 2022
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43. The Advances in Computer Vision That Are Enabling More Autonomous Actions in Surgery: A Systematic Review of the Literature.
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Gumbs AA, Grasso V, Bourdel N, Croner R, Spolverato G, Frigerio I, Illanes A, Abu Hilal M, Park A, and Elyan E
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- Humans, Artificial Intelligence trends, Surgery, Computer-Assisted methods
- Abstract
This is a review focused on advances and current limitations of computer vision (CV) and how CV can help us obtain to more autonomous actions in surgery. It is a follow-up article to one that we previously published in Sensors entitled, "Artificial Intelligence Surgery: How Do We Get to Autonomous Actions in Surgery?" As opposed to that article that also discussed issues of machine learning, deep learning and natural language processing, this review will delve deeper into the field of CV. Additionally, non-visual forms of data that can aid computerized robots in the performance of more autonomous actions, such as instrument priors and audio haptics, will also be highlighted. Furthermore, the current existential crisis for surgeons, endoscopists and interventional radiologists regarding more autonomy during procedures will be discussed. In summary, this paper will discuss how to harness the power of CV to keep doctors who do interventions in the loop.
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- 2022
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44. Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis.
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Thormann M, Omari J, Pech M, Damm R, Croner R, Perrakis A, Strobel A, Wienke A, and Surov A
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- Humans, Muscle, Skeletal pathology, Postoperative Complications etiology, Retrospective Studies, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Liver Neoplasms pathology, Liver Neoplasms surgery, Sarcopenia complications, Sarcopenia diagnostic imaging
- Abstract
Purpose: To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection., Methods: MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument., Results: The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25-1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11-2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis., Conclusion: LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC., (© 2022. The Author(s).)
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- 2022
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45. Endoscopic Imaging Technology Today.
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Boese A, Wex C, Croner R, Liehr UB, Wendler JJ, Weigt J, Walles T, Vorwerk U, Lohmann CH, Friebe M, and Illanes A
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One of the most applied imaging methods in medicine is endoscopy. A highly specialized image modality has been developed since the first modern endoscope, the "Lichtleiter" of Bozzini was introduced in the early 19th century. Multiple medical disciplines use endoscopy for diagnostics or to visualize and support therapeutic procedures. Therefore, the shapes, functionalities, handling concepts, and the integrated and surrounding technology of endoscopic systems were adapted to meet these dedicated medical application requirements. This survey gives an overview of modern endoscopic technology's state of the art. Therefore, the portfolio of several manufacturers with commercially available products on the market was screened and summarized. Additionally, some trends for upcoming developments were collected.
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- 2022
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46. Laparoscopic cholecystectomy during the COVID-19 pandemic in a tertiary care hospital in Germany: higher rates of acute and gangrenous cholecystitis in elderly patients.
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Rahimli M, Wex C, Wiesmueller F, Weber F, Dölling M, Rose A, Al-Madhi S, Andric M, Croner R, and Perrakis A
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- Acute Disease, Aged, Communicable Disease Control, Germany epidemiology, Humans, Pandemics, Retrospective Studies, Tertiary Care Centers, Treatment Outcome, COVID-19 epidemiology, Cholecystectomy, Laparoscopic methods, Cholecystitis epidemiology, Cholecystitis surgery, Cholecystitis, Acute epidemiology, Cholecystitis, Acute surgery
- Abstract
Background: The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany., Patients and Methods: We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year., Results: A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the "pandemic subgroup". Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality., Conclusion: Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly., (© 2022. The Author(s).)
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- 2022
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47. Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM).
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Gumbs AA, Lorenz E, Tsai TJ, Starker L, Flanagan J, Benedetti Cacciaguerra A, Yu NJ, Bajul M, Chouillard E, Croner R, and Abu Hilal M
- Abstract
(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver resection (LLR) and robotic liver resection (RLR). Patients with macrovascular invasion, more than three metastases measuring more than 3 cm or a solitary metastasis more than 5 cm were excluded, and any remaining heterogeneity found was further analyzed after propensity score matching (PSM) to decrease any potential bias. (3) Results: Prior to matching, 566 patients underwent OLR, 462 LLR and 36 RLR for CRLM. After PSM, 142 patients were in each group of the OLR vs. LLR group and 22 in the OLR vs. RLR and 21 in the LLR vs. RLR groups. Blood loss, hospital stay, and morbidity rates were all highly statistically significantly increased in the OLR compared to the LLR group, 636 mL vs. 353 mL, 9 vs. 5 days and 25% vs. 6%, respectively (p < 0.001). Only blood loss was significantly decreased when RLR was compared to OLR and LLR, 250 mL vs. 597 mL, and 224 mL vs. 778 mL, p < 0.008 and p < 0.04, respectively. (4) Conclusions: SIMMILR indicates that minimally invasive approaches for CRLM that follow the Milan criteria may have short term advantages. Notably, larger studies with long-term follow-up comparing robotic resections to both OLR and LLR are still needed.
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- 2022
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48. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors.
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, and Altendorf-Hofmann A
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- Colorectal Neoplasms pathology, Humans, Liver Neoplasms secondary, Prognosis, Colorectal Neoplasms surgery, Embolization, Therapeutic methods, Hepatectomy methods, Liver Neoplasms surgery, Radiofrequency Ablation methods
- Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis., (© 2021. The Author(s).)
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- 2022
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49. [Acutely occurring upper abdominal pain : Rare cause in adulthood with instructive imaging computed tomography(CT)-based phenomenon].
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Paasch C, Franz M, March C, Croner R, and Meyer F
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- Adult, Humans, Retrospective Studies, Abdominal Pain diagnostic imaging, Abdominal Pain etiology, Tomography, X-Ray Computed
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- 2021
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50. The Effect of an Abdominal Binder on Postoperative Pain After Laparoscopic Incisional Hernia Repair–A Multicenter, Randomized Pilot Trial (ABIHR-I) of the Intraperitoneal Onlay-Mesh Technique.
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Paasch C, Santo G, Aljedani N, Ortiz P, Bruckert L, Hünerbein M, Lorenz E, and Croner R
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- Herniorrhaphy adverse effects, Humans, Pain, Postoperative diagnosis, Pain, Postoperative prevention & control, Pilot Projects, Postoperative Complications prevention & control, Recurrence, Surgical Mesh, Incisional Hernia prevention & control, Incisional Hernia surgery, Laparoscopy
- Abstract
Background: Incisional hernias with apertures measuring less than 7 cm can generally be treated adequately with the laparoscopic intraperitoneal onlay-mesh (IPOM) technique. The wearing of an abdominal binder after surgery is often recommended in order to promote wound healing and prevent recurrent herniation. We carried out a multicenter, randomized pilot trial to evaluate the utility of abdominal binders., Methods: The trial was conducted from May 2019 to December 2020. Persons with a laparoscopic IPOM procedure for treatment of an incisional hernia were included in the trial and randomized preoperatively (1:1). The patients in the abdominal binder group wore an abdominal binder during the day for 14 days after surgery, while those in the control group wore no binder. The primary endpoint was pain at rest on postoperative days 1, 2, and 14, as measured on a visual analog scale. The secondary endpoints were overall subjective well-being, the rates of wound infection, recurrence, and complications, mobility, and the rate and size of postoperative seromas (on postoperative days 1, 2, and 14)., Results: Forty patients were included. Three were excluded because of conversion to an open surgical technique. The biometric and perioperative data of the abdominal binder group (n = 18) and the control group (n = 19) did not differ to any statistically significant extent. The patients in the binder group had significantly less postoperative pain (F [dfn, dfd]) 4.44, 95% confidence interval [1; 35]; p = 0.042).The patients in the binder group also had better overall subjective well-being and a higher rate of postoperative seroma formation, but these differences did not reach statistical significance. There was less limitation of mobility than in the control group; however, this difference also did not attain statistical significance., Conclusion: An abdominal binder may reduce pain after incisional hernia repair with the IPOM technique. The postoperative use of analgesic medication was not measured.
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- 2021
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