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Reibetanz J, Germer CT. [Laparoscopic lavage for perforated sigmoid diverticulitis : One-year results of the SCANDIV trial]. Chirurg 2019; 90:45. [PMID: 30758572 DOI: 10.1007/s00104-019-0856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reibetanz J, Germer CT. [Sigmoid resection versus observation after initial conservative treatment of a complicated sigmoid diverticulitis]. Chirurg 2019; 90:36. [PMID: 30758608 DOI: 10.1007/s00104-019-0902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reibetanz J, Germer CT. [Inflammatory markers in the identification of septic complications in colorectal surgery : Results of the IMACORS study]. Chirurg 2019; 90:56. [PMID: 30758623 DOI: 10.1007/s00104-019-0821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reibetanz J, Germer CT. [Laparoscopic lavage for perforated diverticulitis-two-year results of the DILALA Study]. Chirurg 2019; 90:35. [PMID: 30758628 DOI: 10.1007/s00104-019-0906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reibetanz J, Germer CT. [Increased rate of intraoperative complications after complete mesocolic excision]. Chirurg 2019; 90:55. [PMID: 30758625 DOI: 10.1007/s00104-019-0825-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reibetanz J, Germer CT. [Functional long-term results after complete mesocolic excision]. Chirurg 2019; 90:155. [PMID: 30607462 DOI: 10.1007/s00104-018-0784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Germer CT, Reibetanz J. [Risk of ileus, incisional and parastomal hernia after open and laparoscopic surgery for rectal cancer]. Chirurg 2019; 90:65. [PMID: 30607460 DOI: 10.1007/s00104-018-0785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Reibetanz J, Germer CT. [Laparoscopic lavage for perforated diverticulitis-two-year results of the DILALA Study]. Chirurg 2018; 89:831. [PMID: 30135965 DOI: 10.1007/s00104-018-0716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germer CT, Reibetanz J. [Early colectomy in patients with acute exacerbation of ulcerative colitis]. Chirurg 2018; 89:561. [PMID: 29796893 DOI: 10.1007/s00104-018-0657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Reibetanz J, Germer CT. [Rectal cancer surgery: robotic or laparoscopic?]. Chirurg 2018; 89:243-244. [PMID: 29464305 DOI: 10.1007/s00104-018-0613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Reibetanz J, Germer CT. [Laparoscopic ileocecal resection compared with infliximab for terminal ileitis]. Chirurg 2018; 89:157. [PMID: 29374310 DOI: 10.1007/s00104-018-0596-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kelm M, Seyfried F, Reimer S, Krajinovic K, Miras AD, Jurowich C, Germer CT, Brand M. Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC ® treatment: A case report. Int J Surg Case Rep 2017; 41:401-403. [PMID: 29546001 PMCID: PMC5699878 DOI: 10.1016/j.ijscr.2017.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits. PRESENTATION OF THE CASE A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently. DISCUSSION During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage. CONCLUSION In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases.
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Reibetanz J, Germer CT. [Organ-preserving surgery for rectal cancer]. Chirurg 2017; 88:805-806. [PMID: 28752436 DOI: 10.1007/s00104-017-0483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reibetanz J, Germer CT. [Pathologic results after laparoscopic and open surgery for rectal cancer]. Chirurg 2017; 88:709. [PMID: 28695224 DOI: 10.1007/s00104-017-0474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reibetanz J, Germer CT. [Laparoscopic lavage in perforated diverticulitis]. Chirurg 2017; 88:620. [PMID: 28600592 DOI: 10.1007/s00104-017-0455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germer CT, Reibetanz J. [High risk of recurrence after conservative management of complicated diverticulitis]. Chirurg 2017; 88:258. [PMID: 28220222 DOI: 10.1007/s00104-017-0394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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67
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Reibetanz J, Germer CT. [Inflammatory markers in the identification of septic complications in colorectal surgery : Results of the IMACORS study]. Chirurg 2016; 88:73. [PMID: 27981371 DOI: 10.1007/s00104-016-0348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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68
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Krajinovic K, Reimer S, Kudlich T, Germer CT, Wiegering A. "Rendezvous technique" for intraluminal vacuum therapy of anastomotic leakage of the jejunum. Surg Case Rep 2016; 2:114. [PMID: 27757949 PMCID: PMC5069238 DOI: 10.1186/s40792-016-0243-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope. Case presentation We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic “rendezvous technique” in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string. This technique led to a completely closed AL after 27 days and 7 changes of the endosponge. Conclusion The combined surgical and endoscopic rendezvous technique can be useful in cases of otherwise difficult endosponge placement.
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Reibetanz J, Germer CT. [Antibiotic treatment versus appendectomy for non-perforated appendicitis : Results of a meta-analysis]. Chirurg 2016; 87:795. [PMID: 27503617 DOI: 10.1007/s00104-016-0269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reibetanz J, Germer CT. [Laparoscopic lavage for perforated sigmoid diverticulitis]. Chirurg 2016; 87:700. [PMID: 27435246 DOI: 10.1007/s00104-016-0250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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71
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Steger U, Kellersmann A, Germer CT. [Hemihepatectomy]. Zentralbl Chir 2016; 141:253-5. [PMID: 27331287 DOI: 10.1055/s-0042-102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hemihepatectomy continues to be a standard procedure for the resection of primary or secondary liver tumours in hepatobiliary surgery. In this tutorial, a case study illustrates the indication for liver resection as well as surgical steps and different techniques. Indications for right or left hemihepatectomy include liver tumours that cause a diffuse or extended infiltration of one half of the liver or tumours extending to the central confluence of liver veins or the liver hilum. Usually, a resection limit is only required in the case of extended hemihepatectomies, where a two-stage resection is needed. In addition to exploration and intraoperative ultrasound, this tutorial presents different entry sites, liver mobilisation, hilum preparation and common techniques of parenchymal dissection. Finally, a number of haemostasis, closure and biliary monitoring techniques are shown. The video tutorial demonstrates all fundamental steps of hemihepatectomy from indication to closure, with a special focus on different approaches.
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Reibetanz J, Germer CT. [Reconstruction techniques after low anterior rectal resection]. Chirurg 2016; 87:443. [PMID: 27129692 DOI: 10.1007/s00104-016-0191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reibetanz J, Germer CT. [Antibiotic Treatment of acute, uncomplicated appendicitis]. Chirurg 2016; 87:254. [PMID: 26909697 DOI: 10.1007/s00104-016-0166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reibetanz J, Germer CT. Pathologisches Outcome nach laparoskopischer und offener Rektumkarzinomchirurgie. Chirurg 2015; 87:72. [DOI: 10.1007/s00104-015-0130-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Deeken C, Ray S, Zihni A, Thompson D, Gluckstein J, Lake S, Roll S, Ndungu B, Njihia B, Saidi H, Lorenz R, Stechemesser B, Reinpold W, Dietz U, Germer CT, Winstanley J, Miserez M, Fitzgibbons R, Schumpelick V, de Beaux AC, Zollinger R, Matthews BD, Baalman S, Frisella P, Bandyopadhyay S, Raza S, Manu M, Okinyi W, Macharia M, Neema O. Education. Hernia 2015; 19 Suppl 1:S63-7. [PMID: 26518863 DOI: 10.1007/bf03355328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Hernia surgery is generally a rewarding task, patient satisfaction is high and the long-term results are generally good. Incisional hernias are more heterogeneous and there is a higher variability of morphologies to be matched with the available therapeutic approaches but the majority of patients are also satisfied with the results. This positive scenario for hernia surgery can be largely attributable to careful preoperative planning, effective surgical techniques and a high degree of standardization. The picture is somewhat clouded by the complications associated with hernia surgery. If complications do arise, the outcome largely depends on how well the surgeon responds. For inguinal and femoral hernias, the risk profile of the patient is crucial to the surgical planning and the wrong operation on the wrong patient can be disastrous. Open procedures have complication risks in common but the question of how best to deal with the nerves has yet to be answered. Endoscopic procedures are an indispensable part of the hernia surgery repertoire and the hernia specialist should be proficient in TEP and TAPP techniques. Ventral and incisional hernias have higher complication rates and the treatment is similar despite differences in etiology and pathophysiology. Although open procedures are better for morphological reconstruction they are accompanied by a higher complication rate. Laparoscopic procedures had a severe complication profile early on but the situation has greatly improved today due to continued refinement of the learning curve. A critical approach to the application of methods and meshes, a deep knowledge of anatomical peculiarities and the careful planning of tactics for dealing with intraoperative problems are the hallmarks of today's good hernia surgeon.
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Wiegering A, Sinha B, Spor L, Klinge U, Steger U, Germer CT, Dietz UA. Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo). Hernia 2014; 18:691-700. [PMID: 25112382 DOI: 10.1007/s10029-014-1293-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 07/28/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Mesh infection is a severe complication after incisional hernia repair and occurs in 1-3 % of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis. MATERIALS AND METHODS Two different meshes (Parietex™, Covidien; Ultrapro™, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24 h after implantation of gentamicin-impregnated multifilament meshes in 19 patients. RESULTS None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6 h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4-2.9 mg/l, mean 1.2 ± 0.7 mg/l). After 24 h the gentamicin serum levels in all patients had declined 90-65 % of the 6 h values. CONCLUSION Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.
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Germer CT. [Laparoscopic oncological surgery of the lower gastrointestinal tract: state of evidence]. Chirurg 2014; 85:568-9. [PMID: 24957191 DOI: 10.1007/s00104-014-2740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wiegering A, Schlegel N, Isbert C, Jurowich C, Doht S, Germer CT, Dietz UA. Lessons and challenges during a 5-year follow-up of 21 Composix Kugel implantations. Hernia 2013; 17:435-43. [DOI: 10.1007/s10029-013-1096-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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Kerscher AG, Chua TC, Gasser M, Maeder U, Kunzmann V, Isbert C, Germer CT, Pelz JOW. Impact of peritoneal carcinomatosis in the disease history of colorectal cancer management: a longitudinal experience of 2406 patients over two decades. Br J Cancer 2013; 108:1432-9. [PMID: 23511564 PMCID: PMC3629432 DOI: 10.1038/bjc.2013.82] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Recent therapeutic developments demand for an update of information on natural history, risk factors and prognosis of peritoneal carcinomatosis (PC) of colorectal origin. Therefore, prospective registry data should provide information about incidence, predictors and outcome. Methods: From a prospectively expanded single-institutional database with 2406 consecutive patients with colorectal cancer (CRC), clinical, histological and survival data were analysed for independent risk factors and prognosis. Findings were then stratified to the era of treatment without chemotherapy, 5-Fluorouracil-only and contemporary systemic chemotherapy, respectively. Results: Overall, 256 (10.6%) patients were diagnosed with PC thereof 141 (5.85%) with metachronous PC. Independent risk factors for the development of metachronous PC were age <62 years, N2-status, T4-status, location of the primary in the left colon or appendix. In the era of contemporary systemic chemotherapy, prognosis for PC improved only not-significantly (median survival of 17.9 months vs 7.03 months, P=0.054). Conclusion: Despite improvement in the overall outcome with prolonged median survival for the complete patient cohort with CRC, those patients with PC have not experienced the same benefit. In the era of contemporary systemic chemotherapy, progress in treatment resulted in only limited survival benefit. Thus, continuous efforts for further therapeutic advancements should be undertaken in these patients diagnosed with PC.
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Isbert C, Kim M, Reibetanz J, Germer CT. [Stapled transanal resection for the treatment of obstructed defaecation syndrome]. Zentralbl Chir 2012; 137:364-70. [PMID: 22933010 DOI: 10.1055/s-0032-1315124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Stapled transanal rectal resection (STARR) has become a well-evaluated surgical procedure for the treatment of outlet obstruction in the context of conservative refractory obstructed defaecation syndrome (ODS). The diagnosis of ODS needs to be objectified which can be best ensured by clinical scoring systems. Besides a general coloproctological examination, dynamic defecography represents the most important diagnostic procedure. Pelvic floor dyssynergia and slow transit constipation should always be taken into account for the differential diagnosis and for which the STARR procedure is generally contraindicated. Surgery is performed via a transanal approach using a full thickness rectal resection of either the ventral or dorsal proportion of the rectal wall in the PPH01 conventional procedure or circumferentially by monoblock resection in the contour transtar® procedure. Morbidity is best characterised by data of the European STARR registry which contains a total number of n = 2,838 consecutive patients. The overall morbidity rate was 36 % whereby urgency (20 %) and bleeding (5 %) were the most frequent complications. More favourable data have been published in single centre studies. Functional results are available with a follow-up of 1 year up to 68 months postoperatively. Response rates of up to 90 % were reported whereas recurrence rates were given with a maximum of 18 % at 68 months follow-up. In summary, the STARR procedure provides good functional results in conservative refractory outlet obstruction with minor morbidity and the outcome seems to remain stable in the long-term follow-up.
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Thalheimer A, Germer CT. [Molecular detection of tumor cells in lymph nodes of node negative colorectal cancer as negative prognosis predictor. Results of a meta-analysis]. Chirurg 2012; 83:575. [PMID: 22695814 DOI: 10.1007/s00104-012-2318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dietz UA, Wichelmann C, Wunder C, Kauczok J, Spor L, Strauß A, Wildenauer R, Jurowich C, Germer CT. Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia. Hernia 2012; 16:451-60. [PMID: 22618090 PMCID: PMC3412951 DOI: 10.1007/s10029-012-0919-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/22/2012] [Indexed: 12/13/2022]
Abstract
Purpose Once open abdomen therapy has succeeded, the problem of closing the abdominal wall must be addressed. We present a new four-stage procedure involving the application of a two-component mesh and vacuum conditioning for abdominal wall closure of even large defects. The aim is to prevent the development of a giant ventral hernia and the eventual need for the repair of the abdominal wall. Methods Nineteen of 62 patients treated by open abdomen over a two-year period could not receive primary abdominal wall closure. To achieve closure in these patients, we applied the following four-stage procedure: stage 1: abdominal damage control and conditioning of the abdominal wall; stage 2: attachment of a tailored two-component mesh of polyglycolic acid (PGA) and large pore polypropylene (PP) in intraperitoneal position (IPOM) plus placement of a vacuum bandage; stage 3: vacuum therapy for 3–4 weeks to allow granulation of the mesh and optimization of dermatotraction; stage 4: final skin suture. During stage 3, eligible patients were weaned from respirator and mobilized. Results The abdominal wall gap in the 19 patients ranged in size from 240 cm2 to more than 900 cm2. An average of 3.44 vacuum dressing changes over 19 days were required to achieve 60–100 % granulation of the surface area, so final skin suture could be made. Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days. No mesh-related hematomas, seromas, or intestinal fistulas were observed. Conclusion The four-stage procedure presented here is a viable option for achieving abdominal wall closure in patients treated with open abdomen, enabling us to avoid the development of planned giant ventral hernias. It has few complications and has the special advantage of allowing mobilization of the patients before final skin closure. Long-term course in a large number of patients must still confirm this result.
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Jurowich C, Thalheimer A, Hartmann D, Bender G, Seyfried F, Germer CT, Wichelmann C. Improvement of Type 2 Diabetes Mellitus (T2DM) After Bariatric Surgery—Who Fails in the Early Postoperative Course? Obes Surg 2012; 22:1521-6. [DOI: 10.1007/s11695-012-0676-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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85
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Germer CT. Moderne chirurgische Therapie des Rektumkarzinoms: Gibt es Grenzen für die minimal-invasive Technik? ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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86
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Germer CT. [Staging of rectal cancer]. Chirurg 2012; 83:421-2. [PMID: 22526932 DOI: 10.1007/s00104-011-2201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thalheimer A, Germer CT. [Antibiotic therapy of acute uncomplicated diverticulitis : Results of a prospective randomized multicenter study]. Chirurg 2012; 83:387. [PMID: 22407463 DOI: 10.1007/s00104-012-2288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rahden BHAV, Höfelmayr A, Filser J, Germer CT. Pulmonale/laryngeale Symptome der GERD korrelieren mit proximalem Reflux in der Impedanz-pH-Metrie und sind mit Fundoplikatio zu beherrschen. Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1288989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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89
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Rahden BHAV, Grimm M, Lazariotou M, Kircher S, Landmann D, Jung M, Germer CT. GITR und MMP-9: Potentielle molekulare Bindeglieder zwischen Steroid-Einnahme und komplizierten Verlaufsformen der Sigmadivertikulitis. Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1289029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Reibetanz J, Boenicke L, Kim M, Germer CT, Isbert C. Enterocele is not a contraindication to stapled transanal surgery for outlet obstruction: an analysis of 170 patients. Colorectal Dis 2011; 13:e131-6. [PMID: 21564465 DOI: 10.1111/j.1463-1318.2011.02554.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Enterocele is common among patients suffering from obstructive defecation syndrome (ODS), but it is often considered a contraindication for stapled transanal surgery. The functional results and complication rates were compared in patients with or without enterocele who were treated with stapled transanal rectal resection (STARR) for ODS. METHOD Patients presenting with ODS were evaluated using standardized clinical and radiological investigations. A total of 170 patients were treated with either PPH01-STARR or Contour Transtar® and were followed up for a median of 18 months. RESULTS On preoperative defecography, 55 (32%) of 170 patients were found to have an enterocele. The preoperative Cleveland Clinic Constipation Scores (CCCS) in patients with and without enterocele were (mean ± standard deviation) 15.9 ± 5.4 and 15.4 ± 5.2, respectively. At 18 months postoperatively the CCCS were 8.5 ± 2.7 and 8.1 ± 2.6 (P < 0.001), respectively, in patients with and without enterocele. Morbidity was 7.3% (n = 4) in patients with enterocele (anal pain, n = 1; minor bleeding, n = 2; and acute urinary retention, n = 1) and 7.0% (n = 8) in patients without enterocele (anal pain, n = 3; minor bleeding, n = 3; acute urinary retention, n = 1; and staple line dehiscence, n = 1). There were no cases of pelvic sepsis, small bowel injury or postoperative ileus. No patient needed surgical re-operation. CONCLUSION There was no difference in functional outcome and postoperative complications in patients with and without enterocele undergoing STARR for ODS.
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Gasser M, Vetterlein M, Lazariotou M, Grimmig T, Germer CT, Pelz J, Waaga-Gasser AM. Hsp and MDR gene upregulation during hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinosis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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92
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Grimm M, Lazariotou M, Kircher S, Höfelmayr A, Germer CT, von Rahden BHA, Waaga-Gasser AM, Gasser M. Tumor necrosis factor-α is associated with positive lymph node status in patients with recurrence of colorectal cancer--indications for anti-TNF-α agents in cancer treatment. ANALYTICAL CELLULAR PATHOLOGY (AMSTERDAM) 2011; 33:151-63. [PMID: 20978325 PMCID: PMC4605536 DOI: 10.3233/acp-clo-2010-0539] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The progressive growth of malignancies is accompanied by a decline in the immune response through mechanisms which are poorly understood. Apoptosis and induction of inflammation by tumor released cytokines as tumor escape mechanisms have been proposed to play an important role in colorectal carcinogenesis. METHODS Expression of Tumor necrosis factor-alpha (TNF-α) was analyzed in colorectal cancer specimen and the cancer cell line HT-29 by immunohistochemistry and RT-PCR. TNF-α expression on protein and mRNA level were correlated with clinical characteristics and impact on survival. TNFR-1 was co-labelled with TNF-α and CD8+ cytotoxic T cells in immunofluorescence double staining experiments. RESULTS 94% (n=98/104) of the patients with CRC expressed TNF-α. High TNF-α expression was significantly associated with positive lymph node stage and recurrence of the tumor. Multivariate analysis revealed high TNF-α expression as an independent prognostic factor. Immunohistochemistry was correlated with RT-PCR results (τ=0.794). Immunofluorescence double staining experiments revealed increased TNFR-1 expression by CD8+ cells. CONCLUSIONS TNF-α expression by tumor cells may be an efficient immunological escape mechanism by inflammation-enhanced metastases and probably by induction of apoptosis in tumor-infiltrating CD8+ immune cells resulting in a down regulation of the tumoral immune response. Our data support the role of tumor-derived TNF-α expression as an important promoter of tumoral immune escape mechanisms and malignant progression, and suggest that analysis on either protein (immunohistochemistry) or RNA level (RT-PCR) can be used effectively in this respect. Targeting TNF-α may be a promising option, especially in cases with high TNF-α expression and positive lymph node metastases.
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93
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von Rahden BHA, Germer CT. [No cancer prevention with fundoplication : Results of a population-based study in Sweden]. Chirurg 2010; 82:78-9. [PMID: 21085917 DOI: 10.1007/s00104-010-2019-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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94
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Wildenauer R, Germer CT. [Therapy concepts for septic diseases]. Chirurg 2010; 81:477-8; author reply 478-9. [PMID: 20461351 DOI: 10.1007/s00104-010-1939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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95
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Krajinovic K, Germer CT, Agaimy A, Wünsch PH, Isbert C. Outcome after resection of one hundred gastrointestinal stromal tumors. Dig Surg 2010; 27:313-9. [PMID: 20689293 DOI: 10.1159/000280022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 01/17/2010] [Indexed: 12/10/2022]
Abstract
AIMS To evaluate the outcome after surgical resection in patients with gastrointestinal stromal tumors and to determine the factors influencing local tumor recurrence or distant metastatic disease after locally complete tumor resection (R0). METHODS Outcomes of 100 patients with primary gastrointestinal stromal tumors (GIST) surgically managed between 1997 and 2006 at a single institution were reviewed. Univariate and bivariate analyses were used to determine factors affecting recurrence-free and tumor-free survival. RESULTS All patients (n = 100) had c-kit-positive GIST. There were 17% (n = 17) very low risk, 41% (n = 41) low risk, 19% (n = 19) intermediate risk and 23% (n = 23) high risk GIST originating from the stomach, small bowel, colon and rectum. The median patient age was 68 years (range 39-92). Seventy-three percent of the patients had symptomatic local disease. Most (94%; n = 94) of them underwent R0 resections of their primary tumor. R0 resection was significantly associated with a lower tumor-related mortality rate (p = 0.0001). The patients with recurrence/metastases had significantly larger tumors (p = 0.0017) and a mitotic index higher than 5/50 HPF (p = 0.0001). Seven of 20 patients from the high-risk group and 2 of 7 patients with metastatic disease developed local recurrence or further metastatatic tumor spread following R0 resection. CONCLUSION Surgical removal continues to be the mainstay of GIST treatment. R0 resection, tumor size and mitotic index are significant prognostic factors. Overall, more than 30% of the patients with high-risk GIST develop local recurrences and distant metastases despite R0 resection. Additional molecular pathological markers are needed to yield a more accurate tumor profile and to thus achieve a better predictability of the biological behavior of GIST.
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Waaga-Gasser A, Grimm M, Kim M, Rosenwald A, Germer CT, Gasser M. Use of tumor-mediated TRAIL-receptor expression to evaluate apoptotic depletion of infiltrating CD8+ immune cells in clinical colorectal cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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97
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Gasser M, Grimm M, Kim M, Rosenwald A, Germer CT, Waaga-Gasser A. Toll-like receptor (TLR) 7 and TLR8 expression in CD133+ cells in colorectal cancer and role for inflammation-induced TLRs in tumorigenesis and tumor progression. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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98
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Bueter M, Thalheimer A, Jurowich C, Fein M, Germer CT. [Comment on the article "Operative Techniques and Outcomes in Metabolic Surgery: Sleeve Gastrectomy"]. Zentralbl Chir 2010; 135:92-4; author reply 95-7. [PMID: 20196207 DOI: 10.1055/s-0029-1224605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The review article "Operative Techniques and Outcomes in Metabolic Surgery: Sleeve Gastrectomy" by Hüttl et al. is concerned with laparoscopic sleeve stomach operations ("sleeve gastrectomy") for the surgical treatment of morbid obesity (Zentralblatt für Chirurgie 2009; 134: 24-31). After an analysis of the available literature and own results, the authors concluded that the laparoscopic sleeve operation is established today as an effective standard procedure in the therapy for obesity.We would like to comment on the content of this article.
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Rumstadt B, Guenther N, Wendling P, Engemann R, Germer CT, Schmid M, Kipfmueller K, Walz MK, Schwenk W. Multimodal perioperative rehabilitation for colonic surgery in the elderly. World J Surg 2009; 33:1757-63. [PMID: 19452210 DOI: 10.1007/s00268-009-0018-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Traditional perioperative care for colonic surgery in elderly patients is associated with increased morbidity and mortality compared to that of younger patients. Although multimodal perioperative rehabilitation has evolved as a valid concept to improve postoperative outcome, its use has not yet been established for colonic surgery in the elderly. METHODS Data from 24 German hospitals performing multimodal perioperative rehabilitation as the standard perioperative care for elderly patients who have undergone elective colonic resection was assessed in a prospective multicenter study between April 2005 and April 2007. RESULTS A total of 742 patients aged > or = 70 were examined. Overall compliance with the multimodal care protocol decreased with increasing age. Although laparoscopic colonic surgery was performed in 39.1% of the septuagenarians, the number decreased to 25.1% in the very old patients. The overall complication rate was 22.9% in the septuagenarians (18.1% surgical and 11.6% general complications) and increased in the very old patients to 38.4% (28.0% and 23.6%, respectively) The overall mortality rate was 1.0% and showed no age-specific variations. CONCLUSIONS Although the overall morbidity did increase with age, it was still less when compared to that of historical groups with traditional care. Therefore, multimodal perioperative rehabilitation should be recommended for the elderly.
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Graunke F, Völker HU, Larena-Avellaneda A, Germer CT. [Multiple carcinoids in the midgut causing intestinal gangrene--a case report]. Zentralbl Chir 2009; 134:486-8. [PMID: 19757351 DOI: 10.1055/s-0028-1098937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CASE REPORT We report the case of multiple midgut carcinoids causing segmental intestinal ischaemia in a 77-year-old man. He was admitted to our hospital because of a 2-month history of postprandial abdominal pain with nausea / vomiting and anaemia. The extensive diagnostic examinations (blood tests, ultrasound, computed tomography, hydro magnetic resonance) did not reveal any pathological findings. The small-bowel capsule endoscopy demonstrated multiple areas of bleeding. A laparotomy showed a local ischaemia of the small bowel, a segmental resection of the jejunum / ileum was performed. There were no signs of occlusion of the mesenteric artery. The pathological examination revealed 8 carcinoids of the midgut (jejunum / ileum). Immune histology demonstrated serotonin-synaptophysin-chromogranin-producing carcinoids. The patient was re-operated because of suspected ongoing mesenteric ischaemia, but no further pathologies were found. The postoperative course was uneventful. A subsequent octreotide scan was negative for metastases. DISCUSSION Carcinoids may become symptomatic mimicking intestinal ischaemia. Although this coincidence is considered to be typical, it is still a rare event. The diagnosis is often delayed. EVS ("elastic vascular sclerosis") of the mesenteric artery is pathognomonic for these carcinoids but, as our case demonstrates, not mandatory. According to the literature, the stage of the disease corresponds to the extent of the intestinal ischaemia.
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