[Impact of the COVID-19 pandemic on hepato-pancreato-biliary surgery and organ transplantation]. / Auswirkung der COVID-19-Pandemie auf die hepatopankreatobiliäre Chirurgie und die Organtransplantation.

BACKGROUND AND OBJECTIVE: Due to the coronavirus disease 2019 (COVID-19) pandemic extensive reorganization and limitation of resources within the healthcare system became inevitable. This review highlights the direct and indirect impact of the COVID-19 pandemic on the fields of hepato-pancreato-biliary (HPB) surgery and organ transplantation incorporating the current literature and expert opinions published by national and international societies. Trends in surgical numbers were analyzed via the Eurotransplant Statistics Report Library and an in-center evaluation of HPB surgical procedures. RESULTS: For the fields of HPB surgery and organ transplantation a drastic decrease of procedures performed during the first wave of the pandemic was broadly reported. Interestingly, a compensatory increase of procedures was mostly not observed during the following months resulting in a slight overall decrease for 2020 compared to 2019. Whether this trend was due to increased mortality because of postponed surgeries and altered treatment regimens cannot be ruled out at this time. A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is definitely associated with a complicated course, especially in the perioperative course and after transplantation. DISCUSSION: Due to the increased risk profile of the named patient groups, there is an increased risk for a severe COVID-19 course. This must be considered when weighing up the treatment alternatives, protection recommendations and prioritization for vaccinations.

Clinical course and pancreas parenchyma sparing surgical treatment of severe pancreatic trauma.

INTRODUCTION: Pancreatic trauma (PT) involving the main pancreatic duct is rare, but represents a challenging clinical problem with relevant morbidity and mortality. It is generally classified according to the American Association for the Surgery of Trauma (AAST) and often presents as concomitant injury in blunt or penetrating abdominal trauma. Diagnosis may be delayed because of a lack of clinical or radiological manifestation. Treatment options for main pancreatic duct injuries comprise highly complex surgical procedures. PATIENTS AND METHODS: We retrospectively analyzed clinical data from 12 patients who underwent surgery in two tertiary centers in Germany during 2003-2016 for grade III-V PT with affection of the main pancreatic duct, according to the AAST classification. RESULTS: The median age was 23 (range: 7-44) years. In nine patients blunt abdominal trauma was the reason for PT, whereas penetrating trauma only occurred in three patients. MRI outperformed classical trauma CT imaging with regard to detection of duct involvement. Complex procedures as i.e. an emergency pancreatic head resection, distal pancreatectomy or parenchyma sparing pancreatogastrostomy were performed. Compared to elective pancreatic surgery the complication rate in the emergency setting was higher. Yet, parenchyma-sparing procedures demonstrated safety. CONCLUSIONS: Often extension of diagnostics including MRI and/or ERP at an early stage is necessary to guide clinical decision-making. If, due to main duct injuries, surgical therapy for PT is required, we suggest consideration of an organ preservative pancreatogastrostomy in grade III/IV trauma of the pancreatic body or tail.

[Drainages in abdominal surgery: (in)dispensable?] / Drainagen in der Viszeralchirurgie: (un)verzichtbar?

BACKGROUND: Prophylactic placement of intraperitoneal drains in elective abdominal surgery is still subject to scrutiny. OBJECTIVE: Do currently available data enable the practice of routine placement of abdominal drainages to be abandoned? METHODS: The databases of MEDLINE, PubMed and the Cochrane Library were systematically searched for clinical trials concerning the practice of routine drainage placement in elective abdominal surgery. The available evidence was summarized for cholecystectomy, colorectal surgery, gastrectomy and pancreatic surgery, as well as for liver resection. A total of 6 Cochrane reviews including 65 randomized controlled trials (RCTs) and 9 retrospective analyses, as well as 1 more recent RCT and 3 retrospective analyses that were not included in a meta-analysis were reviewed. CONCLUSION: There is evidence that drains should not be routinely used in elective abdominal surgery, such as cholecystectomy, colorectal resection and gastrectomy. Even for some cases of pancreatic and liver resection, there is growing evidence that routine placement of drains is not mandatory. In conclusion, there is a need for more prospective randomized controlled trials.

Long-term results after surgical treatment of nonparasitic hepatic cysts.

BACKGROUND: Studies evaluating surgical success in patients with benign liver cysts focus on cyst recurrence. The aim of this study was to evaluate the efficacy of surgical treatment with regard to clinical complaints. MATERIALS AND METHODS: Between 1995 and 2007, 99 patients (M:F 1:7.25) with symptomatic, benign, nonparasitic liver cysts (77 simple liver cysts [SLCs], 22 polycystic liver disease [PCLD]) underwent surgical treatment (77% laparoscopic surgery, 23% open surgery). Perioperative parameters (including morbidity) were evaluated. Moreover, a questionnaire was completed by 65 patients monitoring subjective complaints focusing on abdominal pain, vegetative symptoms, and dyspnea pre- and postoperatively (mean follow-up 76 months). RESULTS: Severe complications occurred in 7 patients. Abdominal pain, vegetative symptoms, and dyspnea were significantly improved in SLC patients. In PCLD patients abdominal pain and dyspnea were significantly decreased, whereas vegetative symptoms were unaffected by surgery. The symptom recurrence rate for SLC patients was significantly lower compared with PCLD patients (41% vs 66.6%). CONCLUSION: Indications for surgical treatment of PCLD should be well considered and limited to a selected group of patients.