[Reasons for resignations of senior consultant surgeons]. / Ursachen für das Scheitern chirurgischer Chefärzte.

Up to approximately 15-20 years ago it could be safely assumed that the promotion to senior consultant surgeon was a lifetime position. Nowadays it is different. Contracts for senior consultants are normally for an unlimited period but as with other employees there is the possibility to legally terminate the employment conditions and approximately 50% make use of this. The reasons very rarely concern an inability of the physician and are mostly concerned with the surrounding working conditions. Poor contractual structures, incompatibility in the spectrum of responsibilities, financial restrictions by the finance department and poor communication with the finance department and colleagues are the main problem areas. In this article the potential points of conflict are demonstrated.

[Patient clarification/pre-operative clarification]. / Patientenaufklärung/präoperative Aufklärung.

Every medical intervention constitutes a physical injury and therefore requires the consent of the patient to avoid liability. In order that the patient can effectively consent to the intervention by ensuring autonomy of decision, the patient must be fully informed of the risks involved in medical interventions. The patient must be informed of the essential benchmark data however, it must be borne in mind that each individual case is always decisive for deciding whether clarification has been correctly carried out. In these instances individual factors, such as the personal background of the patient, play a role. Documentation of the clarification serves as proof that it has been carried out and to what extent.

[Operative techniques and outcomes in metabolic surgery: sleeve gastrectomy]. / Operative Techniken und deren Outcome in der metabolischen Chirurgie: Sleeve-Gastrektomie.

Laparoscopic sleeve gastrectomy (LSG) was initially introduced for super-obese patients in a two-step concept in order to reduce the perioperative risk. Many years before a very similar technique - the Magenstrasse and Mill (M & M) operation - was developed by Johnston in Leeds / UK as a "more physiological" bariatric procedure with acceptable weight loss, while preserving gastric emptying mechanisms and thus minimising possible side-effects such as vomiting, dumping and diarrhoea, which are common complications of gastric bypass procedures. The following manuscript analyses the current literature and our own preliminary results and parallels publications of the M & M procedure. Until now numerous modifications (e. g., bougie size and residual volume, stapler technique, use of buttress mate-rial) have been reported. However, reported -morbidity and mortality rates were equal to those of gastric banding and gastric bypass (RYGB). In conclusion, laparoscopic sleeve gastrectomy (LSG) has now proven to be as effective as the RYGB for weight loss over a three-year period. Control of hunger and feeling of fullness are -reported to be superior compared to gastric band-ing. Laparoscopic sleeve gastrectomy is no longer an experimental procedure. It should be accepted as one of the effective standard procedures for surgical treatment of morbid obesity.