[Current recommendations for aftercare in patients following hernia repair]. / Nachsorge des Hernienpatienten.

Abdominal wall hernias, in particular inguinal hernias are the most frequently encountered entity in general surgery. Consequently, the socio-economic burden results from the in-hospital phase itself and to a considerable extent from the convalescence period. In addition to the surgical procedure and the occupation of the patient there are two factors of particular significance influencing the aftercare: the post-operative pain and the given recommendations for postoperative strain. Next to patient-factor adapted operative procedures it is therefore essential, to offer a standardized pain management and recommendations for postoperative strain. Currently there is no conclusion, whether the minimally invasive techniques will be established as the "Gold-standard", particularly from an economic point of view and the introduction of the DRG in Switzerland.

Predictive risk factors for intra- and postoperative complications in 526 laparoscopic sigmoid resections due to recurrent diverticulitis: a multivariate analysis.

BACKGROUND: Laparoscopic sigmoid resection is a feasible and frequent operation for patients who suffer from recurrent diverticulitis. There is still an ongoing debate about the optimal timing for surgery in patients who suffer from recurrent diverticulitis episodes. In elective situations the complication rate for this procedure is moderate, but there are patients at high risk for perioperative complications. The few identified risk factors so far refer to open surgery. Data for the elective laparoscopic approach is rare. The objective of this study was to identify potential predictive risk factors for intra- and postoperative complications in patients who underwent laparoscopic sigmoid resection due to diverticular disease. METHODS: Uni- and multivariate analyses of a prospectively gathered database (1993-2006) were performed on a consecutive series of 526 patients who underwent laparoscopic sigmoid resection due to recurrent diverticulitis in a single institution. Patients were assessed for demographic data, operative indications, and intra- and postoperative complications. Altogether, we analyzed 17 potential risk factors to identify significant influence on the intra- and postoperative outcome, including timing of surgery. RESULTS: Statistical analysis of specific medical and surgical complications revealed anemia, previous myocardial infarction, heart failure, experience of the surgeon, and male gender, as independent predictive risk factors for postoperative complications. Patients older than age 75 years was the only independent risk factor for intraoperative complications in a multiple logistic regression model. Early elective surgery led to increased conversion rate but did not influence the postoperative complication rate. CONCLUSIONS: This large, single-center study provides first evidence of the significance of specific predictive risk factors for intra- and postoperative complications in laparoscopic sigmoid resection for diverticular disease.

Do antibacterial skin sutures reduce surgical site infections after elective open abdominal surgery? - Study protocol of a prospective, randomized controlled single center trial.

BACKGROUND: Surgical site infections (SSI) remain one of the most common complications in conventional abdominal surgery with an incidence between 4% and 19% (Sandini et al., Medicine (Baltimore) 95:e4057, 2016) in the literature. It is unclear whether the use of coated suture material for skin closure reduces the risk of SSI. In line with in-vitro results, we hypothesize that the use of antibacterial skin sutures (triclosan-coated poliglecaprone 25) reduces the rate of SSI after open abdominal surgery. METHODS/DESIGN: To prevent SSI, triclosan-coated poliglecaprone 25 sutures will be tested against un-coated suture material for skin closure after elective open abdominal surgery of 364 patients. The study is planned as a single-center, prospective randomized controlled trial. Patients will be followed for 30 days after surgery to detect and document wound complications. The rate of SSI after 30 days will be analyzed in both groups. DISCUSSION: If we can confirm the proposed hypothesis in our study, this could be a promising and feasible approach to lower SSI after open abdominal surgery. By lowering the rate of SSI this might offer a cost-saving and morbidity-reducing procedure. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00010047 . Registered on 05.01.2017.

Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection.

AIM: To characterize the impact of the Pringle maneuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies. METHODS: Sixty one consecutive patients who underwent hepatic resection under inflow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers. RESULTS: Occlusion times of 33 +/- 12 min (mean +/- SD) and 34 +/- 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 +/- 210 U/I vs 550 +/- 650 U/I, P < 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery inflow. CONCLUSION: IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.