[Acute pancreatitis--discontinuation of conservative therapy, indications for operation and operation technic]

The surgical treatment of acute pancreatitis aims at the removal of stones in the distal biliary duct, toxic implications and necroses and to treat complications. The correct diagnosis, according to the 3 stages of Kümmerle is the basis for surgery. This staging is possible to a high degree of security by angio-CT and sonography. The effect of the following modalities has been proven: Early peritoneal dialysis which, however, decreases lethality only in combination with a delayed operation; removal of the biliary duct obstruction, and necrosectomy in stage II from the second week onwards. Early duodeno-pancreatectomy did not prove to be a successful procedure.

[Esophageal cancer]

Surgery of oesophageal cancer has a high risk demonstrated by the hospital lethality. 72 resections of the oesophagus done by one surgeon are analysed. The following parameters were used: 1) a nutritional index developed in carcinoma patients in a prospective analysis, 2) the EKG result, 3) the lung-function. Adding these 3 indices we get a certain correlation between the judgement of the preoperative risk and hospital lethality. The preoperative criteria of risk are essential for patients with cancer of the oesophagus since we have to choose among 3 groups of surgical treatment, the risks of which are significantly different.

[Carotid stenosis surgery: results after 10 years' experience]

From 1973 to July 1983 220 patients at the University clinic of Cologne, Germany, had carotid endarterectomies for carotid stenosis. A shunt has always been used. The procedure mortality and morbidity were 3,4% and 6,3% respectively. We do not see any indication to operate in acute stroke.

[Use and limits of preventive antilymphocyte globulin therapy following kidney transplantation. A prospective randomized study]

The influence of prophylactic ALG treatment immediately after transplantation on the results of renal transplantation was examined in a prospectively randomized trial (n = 94). An improved graft survival rate was found after 9 months (ALG group 72.3%, control group 59.6%) which, however, was associated with an increased risk of infections. The increased infection rate was due to the duration of the ALG treatment which was too long in this study (21 days). Prophylaxis should rather be finished after 14 days. The immediate renal function after transplantation was significantly improved in the ALG group. Therefore, it is suggested to give ALG directly after transplantation until normalization of renal function and to change over to cyclosporin afterward.

[Treatment of colorectal cancer in the last 35 years--perioperative requirements and postoperative results]

The development of colorectal surgery during the last 35 years was analyzed on the basis of case reports of a University Surgical Department. It was found, that lethality of the procedure was reduced during this period and that the number of tumor resections per year increased. In cases of carcinoma of the rectum extirpation of the rectum was reduced in favour of deep resection of the tumor in the recent time. In addition the analysis showed, that time of hospitalization was definitely reduced. Postoperative results have improved considerably due to improved methods of preparing the intestinal tract for surgery, due to preoperative prophylactic treatment with antibiotics--this reduces the postoperative need of antibiotics rather definitely--but only due in a limited extent to change of suturing techniques. The extent of pre- and postoperative diagnostic and therapeutic procedures increased, which however was justified because results improved quite definitely.

[Blood vessel wall regeneration in the use of a new monofilament, resorbable suture material for arterial anastomoses]

A new synthetic, absorbable suture has been tested on 15 mongrel dogs. A total of 132 simple end-to-end anastomoses has been performed in common carotid, iliac and femoral arteries and the aorta abdominalis with monofilament, absorbable polydioxanon. Aneurysms or infections did not occur. The patency rate up to 250 days was 98.5%. All vessels were studied by angiography and light- or electron-microscopy. The new monofilament suture material is characterized by extended absorption time and low foreign body reaction. It leads more rapidly to the restitution of the vascular wall than nonabsorbable sutures.

Energy metabolism and histomorphological findings in replanted rat hind limbs using various conservation methods

Using various storage and conservation methods, we examined amputated and subsequently replanted limbs for their ischaemia tolerance level by investigating the changes in the adenylphosphocreatine system and glycolysis cycle. After replantation, amputated limbs that had been stored at room temperature (21.0 +/- 1.5 degrees C) for 2 hours were examined 14 days after operation. The adenosine triphosphate level of the skeletal muscle was reduced to 51% and the creatine phosphate to 77% of that of the control group. The glycogen was 13% of the normal value. The biochemical findings correlate with the histomorphological findings. After 2 hours ischaemia, the cross striations of the skeletal muscle and nuclear staining remained intact. There is a breakdown of the biochemical systems after 4 hours of ischaemia. They are no longer intact and the ischaemic limb does not recover. Histologically, muscle necrosis can be observed.

[Venous thrombectomy]

The aim of surgical treatment of acute deep venous thrombosis is to prevent lethal pulmonary emboli, the venous desobstruction and the maintenance of the valvular mechanism. From 1972 to 1982, 161 patients have been operated at the surgical clinic of Cologne. In 41.4% of the cases the long term result was excellent. The clinical examination, the complaints of the patients, the phlebography were judgement criteria.

[Primary retroperitoneal tumors. Symptoms, diagnosis and therapy]

We reviewed 28 cases of primary retroperitoneal tumors (1972 to 1982). We found 22 malignant and six benign tumors. The tumors revealed no special features. Cardinal symptom was a palpable abdominal mass in 21 of 28 patients (75%). Since 1978 we have at our disposal a modern radiological technique, the computerized tomography, which allows a statement of tumor localization, tumor size and infiltration of neighbouring organs. In our patients no definite statement could be made about resectability and type of the tumors. In spite of computerized tomography there is no change the road-minded operation indication. Surgical therapy is the treatment of choice because of lacking alternatives. Complete extirpation to cure, respectively exploratory laparotomy and biopsy to determine the specific nature of the tumor by histological examination should be aspired. In individual cases palliative gastrointestinal anastomoses are necessary to treat intestinal obstruction. All six benign, but only six of 22 (27%) malignant tumors were completely removable. Although in some cases neighbouring organs were respected, no patient died after operation. For a curative therapy the early diagnosis of the tumors is necessary.

[Hepatic resection for tumors, trauma and Echinococcus]

52 patients with hepatic resection due to liver tumor, metastases, Echinococcus or liver trauma are reported. Hepatic resection represents a relatively harmless procedure in case of benign liver tumor; however, in case of a malignant disease, the prognosis after hepatic resection is impaired by the difficulty to predict the regeneration capability of the liver. The indication for the different operative procedures is being discussed. It is suggested to perform hepatic resection in the border lines of the liver lobes without extensive preparation of the liver hilus and to clamp the liver hilus during resection. If the liver hilus was occluded after steroid pretreatment, 40 min of hepatic ischemia were well tolerated without any consequences and intraoperative bloodloss could be reduced significantly.

[APUDoma of the abdominal area and bronchial system. Surgical therapy and prognosis]

28 patients with APUDomas of the abdomen or bronchial system were reexamined up to 30 years after operation to take a view on therapy and prognosis of these tumors. All patients with benign hyperinsulinism remained free of symptoms after partial pancreatectomy or tumor enucleation, in the mean 12.9 years after operation. In contrast the two patients with islet cell carcinoma died 5 months after operation at the latest. The prognosis of the carcinoid tumors depended decisively on tumor location: The prognosis was favorable in patients with carcinoid tumors of the appendix or bronchial carcinoid (survival time up to 10 years after operation). In contrast all patients with carcinoid tumors of the small intestine died within two years after operation. Tumor size had the most important influence on the prognosis of the disease.

[Colloid osmotic pressure--a parameter of postoperative protein therapy. A pilot study]

120 intensive-care patients were examined postoperatively in a pilot study. The patients were divided into two groups. In group 1 human albumin was given when the serum protein concentration decreased below 5 g%, in group 2 when the colloid osmotic pressure (COP) decreased below 27 cmH2O. Patients of group 2 received less human albumin, but despite the lower human albumin supply these patients did not worse postoperatively as compared to group 1. On the contrary, the trend could be observed that the periods of ventilation were shorter (possibly due to the lower volume load of the patients) and the serum creatinine concentrations were lower (possibly due to the increased supply of crystalloid solutions) if smaller amounts of albumin were given. It may be concluded that the postoperative human albumin supply is unnecessary if the COP ranges 27 cmH2O or more.

["Peel away introducer"--a new technic for implantation of central venous catheters for long-term parenteral feeding]

For longterm intravenous parenteral nutrition silicone catheters are used, which usually are operatively implanted by dissecting out the subclavian or internal jugular vein. By means of the "peel-away-introducer" percutaneous placement of this catheter is now possible using a modified Seldinger technique. The new method of catheter placement is described in detail.

[A recent procedure for intraoperative autotransfusion]

At the surgical unit of the University of Cologne a new system for autotransfusion (Solcotrans) was used in 18 patients. This system consists of a plastic case connected with a vacuum pump by an airtube. After filling the plastic case with 50 ml sodium citrate, 450 ml of blood can be aspirated by the surgeon and be reinfused by the anaesthesiologist. The system was used in shunt-surgery at portal hypertension, at venous thrombectomy and at aneurysms of the aorta abdominalis. Through this, stored blood was not necessary in 13 operations.

[Circular stapling anastomosis (EEA) following gastrectomy]

After total gastrectomy because of gastric malignancies 31 oesophagojejunostomies performed in end-to-side fashion using a standard manual technique were compared with oesophagojejunostomies performed in end-to-end fashion by mechanical stapling (EEA). After manual suturing there was a leak in 29% and 25.8% out of all patients died. After automatic mechanical suturing anastomotic failure was seen in 12.9% with a postmortality rate of 3.2%. These results show, that by mechanical stapling a secure oesophagojejunostomy is possible and the risk of gastrectomy can be reduced.