Prehabilitation in elective surgical interventions - what must the general and abdominal surgeon know.

Objectives: For years, many efforts have been invested to prepare patients, in particular, those with reduced physical and psychic status, much better to provide and finally achieve better outocme if there is time available to provide several beneficial measures. Methods: Therefore, the objective was to illustrate the concept and various single elements of a complex prehabilitation concept based on (i) selective references from the medical literature and (ii) own clinical experiences from clinical practice in general and abdominal surgery. Results: Prehabiliation can be considered the solution of the efforts to improve preoperative status for patients in a disadvantageous status for almost all types of surgery and all other operative and/or interventional procedures. It is the targeted process to improve individual functionality and organ function before a planned (elective) surgical intervention; P. comprises basically nutritional, physical and psychological measures; P. focusses especially onto the elderly, frail and malnourished patients before a planned surgical intervention; the overall aim is to significantly improve final outcome characterized by shorter length of stay, lower complication rate and mortality as well as cost efficiency; P. is especially important in cancer surgery, in which the beneficial effects can be particularly implemented; P. programs and/or "Standard Operating Protocols" (SOP) may help to establish and materialize its single aspects and enhanced recovery after surgery (ERAS). There is still further potential to reliably establish and to utilize the options of prehabilitation measures as listed above. Conclusions: Prehabiliation is an indispensable aspect in today's preparation for elective surgery, which needs to become obligatory part of the preparation measures to planned surgical interventions, which can further contribute to a better final outcome and ERAS as well as, in addtion, needs to be further developed and accomplished.

International study on the prevalence of malnutrition in centralized care for colorectal cancer patients.

Objectives: Patients with different diseases may show signs of malnutrition both before and during the hospital stay. The presence of malnutrition may impact the recovery and length of stay and consequently the costs. Early identification of malnutrition is thus a critical factor. The objective of this multicenter study is to determine the prevalence of malnutrition in colorectal cancer centers. Another objective is to investigate possible consequences, such as complications or length of stay. In addition, the study aims to demonstrate the relevance of nutrition management in colorectal cancer centers. At the same time, relevant requirements clearly demanded by the Certification Commission for Certified Colorectal Cancer Centers are met through implementation of the study. Methods: Between 2019 and 2021, patients in colorectal cancer centers were examined in the preoperative phase. In addition to questions about patients' state of health and nutrition, the validated screening forms-Subjective Global Assessment (SGA) and Nutritional Risk Screening Tool 2002 (NRS 2002)-were used to assess malnutrition. The data were processed by univariate analysis. Results: In total, data records of 3,102 patients were evaluated. The mean age of the participants was 68.5 ± 11.9 years, and their average body mass index (BMI) was 26.8 ± 5.3 kg/m2. The SGA questionnaire indicated that 23 % of the participants suffered from malnutrition and 38 % were at risk of malnutrition (NRS≥3). Malnutrition was found more frequently in patients with colorectal carcinomas than in patients with rectal carcinomas (53.1 vs. 32.1 %). The length of stay in hospital and the rate of complications were significantly higher when malnutrition was identified. Conclusions: Approximately one in three to four patients with a colorectal carcinoma has an increased risk of malnutrition. The two screening methods calculated a different prevalence (23 and 38 %). Any malnutrition that is present demonstrably has a significant impact both on the rate of complications and the length of stay and may therefore have a decisive influence on the costs. The results of this multicenter study underscore the need for systematic screening for malnutrition and at the same time should increase clinics awareness of the importance of establishing a nutrition management policy.

[The role of postdoctoral qualification candidates in surgical teaching]. / Die Rolle der HabilitandInnen in der chirurgischen Lehre.

OBJECTIVE: This compact overview outlines the responsibilities and broad field of tasks of a post-doctoral fellow in surgical teaching within the framework of studies in human medicine. METHOD: Narrative short review based on own individual and institutional teaching experiences. RESULTS: Role of the post-doctoral fellow (selection): (i) due to the planned (sub)specialization by the respective habilitation project and because of the accumulated (administrative and scientific as well as teaching) experience within the framework of this scientific graduation, the post-doctoral fellow appears to be a more suitable, motivated and competent doctoral manager and supervisor compared to colleagues who do not intend to get the habilitation. (ii) Dependence of medical disciplines: the role that can be taken in teaching is highly dependent on the subject matter and discipline. Thus, there is the possibility and the duty to always mediate competent practical skills in surgical subjects in addition to theoretical knowledge and to pay strict attention to their ready to use acquisition in preparation for clinical/surgical practice. (iii) In nonuniversity (teaching) hospitals, the surgical post-doctoral fellow can fulfill the tasks of surgical teaching through a complete internship and clerkship care. In university clinics the focus is more on holding lectures in addition to internship and clerkship tutorials. CONCLUSION: The post-doctoral fellow plays a central role in surgical teaching. A wide range of tasks with holding and construction of lectures, seminars and block internships up to direct student support within the framework of the clerkship, the practical year and the support of a dissertation can be sufficiently fulfilled by the post-doctoral fellow in addition to the development of facultative teaching concepts full of ideas.

[77-year-old man with rare Littré's hernia]. / 77-jähriger Mann mit seltener Littré-Hernie.

HISTORY AND CLINICAL FINDINGS: A 77-year-old man presented with acute pain and femoral swelling in his right groin. EXAMINATIONS: The clinical finding resulted in the suspicion of an irreducible, possibly incarcerated inguinal hernia. Transcutaneous ultrasound did not reveal any hints confirming the clinical suspicion. Because of the impressive clinically finding, the patient was subjected to open exploration of the groin. TREATMENT AND COURSE: Intraoperatively, the initial clinical finding could be confirmed. Herniotomia showed incarcerated ileal segment with Meckel's diverticle, a so-called Littré's hernia. Subsequently, median laparotomy and ileum segment resection with side-to-side ileoileostomy were performed. The postoperative course was uneventful. The patient was discharged in good health status on the seventh postoperative day. CONCLUSION: Littré's hernia is a rare pathological finding, which can also be considered as an infrequent manifestation of a variant of a commonly encountered clinical/surgical finding such as hernia. The presented case elucidates the difficulty in the timely establishment of the correct preoperative diagnosis. The clinician needs to be aware of this albeit exceptionally rare variation because the symptoms can vary greatly and severe complications can occur. This threat must be encountered via rapid diagnosis-finding and initiation of appropriate therapy.