Endoscopic anterior component separation (ECS) techniques facilitate tension-free midline closure of wide ventral hernia defects. We describe a novel approach with a precostal incision and a new ...cylindrical ballon trocar.
A single-center analysis of 19 patients undergoing ECS between January 1, 2014 and August 2, 2017 was performed with regard to improvement of technique. We currently start with a lateral precostal incision. This access in a low-fat and stable area allows for easy identification of the external oblique muscle with the ribs functioning as dorsal abutment for entering the correct plane between external and internal oblique muscles. Then a trocar is inserted with a cylindrical ballon, thus providing sufficient pneumatic widening of the dissection plane. A second 5-mm port is inserted under direct vision below the 12th rib. From there a unidirectional incision of the external oblique aponeurosis is performed from subcostal to the inguinal ligament. If necessary, the cephalad muscular parts of the external oblique can be transected over several centimeters in both directions starting from the precostal incision.
We documented no procedure-related complications apart from two hematomas that required no interventions. Four procedures were carried out on one side and the remaining ones bilaterally. In one case, a conversion to conventional open component separation was required due to extensive scarring after open cholecystectomy. There were no notable abdominal bulgings or lateral hernias during a structured postoperative follow-up period of 1 year postoperatively.
The technique described offers advantages in terms of determination of the correct entry point for ECS, regardless of abdominal wall conditions and the precostal access allows for unidirectional dissection toward the inguinal ligament with only two trocars in total. The cylindrical shape of the ballon trocar provides adequate widening of the working space and ensures good overview for safe dissection.
Pancreatic neuroendocrine neoplasia (pNEN) show increasing incidence and management is complex due to biological heterogeneity. Most publications report isolated high-volume single-centre data. This ...Austrian multi-centre study on surgical management of pNENs provides a comprehensive real-life picture of quality indicators, recurrence-patterns, survival factors and systemic treatments.
Retrospective, national cohort-study from 7 medium-/high-volume centres in Austria, coordinated under the auspices of the Austrian Society of Surgical Oncology (ASSO).
Two-hundred patients underwent resection for pNEN, 177 had non-functioning tumours and 31 showed stage 4 disease. Participating centres were responsible for 2/3 of pNEN resections in Austria within the last years. The mean rate of completeness of variables was 98.6%. Ninety-days mortality was 3.5%, overall rate of complications was 42.5%. Morbidity did not influence long-term survival. The 5-year overall-survival (OS) was 81.3%, 10-year-OS 52.5% and 5-year recurrence-free-survival (RFS) 69.8%. Recurrence was most common in the liver (68.1%). Four out of five patients with recurrence underwent further treatment, most commonly with medical therapy or chemotherapy. Multivariable analysis revealed grading (HR:2.7) and metastasis (HR:2.5) as significant factors for relapse. Tumours-size ≥2 cm (HR:5.9), age ≥60 years (HR:3.1), metastasis (HR:2.3) and grading (HR:2.0) were associated with OS. Tumours <2 cm showed 93.9% 10-year-OS, but 33% had G2/G3 grading, 12.5% positive lymph-nodes and 4.7% metastasis at diagnosis, each associated with significant worse survival.
Resection of pNENs in Austria is performed with internationally comparable safety. Analysed factors allow for risk-stratification in clinical treatment and future prospective trials. A watch-and-wait strategy purely based on tumour-size cannot be recommended.
Current literature on chronic groin pain suggests that laparoscopic mesh repair on athletes enables a faster recovery and subsequent return to unrestricted athletic activities. The aim of this study ...was to evaluate the role of transabdominal preperitoneal (TAPP) mesh repair in athletes resistant to conservative therapy.
A multidisciplinary approach with tailored physiotherapy. Thirty-nine professional athletes with chronic groin pain were referred to surgery at a single clinic. A full assessment was carried out on each, including medical history, physical examination, dynamic ultrasound, and pelvic magnetic resonance imaging. TAPP repair was performed using a polypropylene mesh and fibrin glue fixation on 30 athletes who had exhibited typical symptoms, shown resistance to conservative therapy, not benefited from accompanying physiotherapy, and had ceased training in the 3 to 6 months prior. The outcome measures were early postoperative recovery of 6 weeks and full resumption of athletic activities.
Mean duration of symptoms from onset to surgical repair was 7 months. Conservative treatment had improved symptoms temporarily or to some extent in 7 athletes, while 2 ceased competing altogether. Twenty-three athletes exhibited unilateral and 16 bilateral groin pain. Laparoscopy confirmed posterior wall deficiency in 24 and true inguinal hernia in 6 athletes. Mild scrotal hematoma occurred in 2 athletes postoperatively; all were discharged within 24 hours of surgery. Twenty-one (70%) returned to sports activities after 6 weeks of convalescence. Persistent mild pain was experienced by 5 athletes postoperatively for up to 1 year, yet did not interfere with normal daily activity. Twenty-five participants (85%) reported full satisfaction with the procedure 1 year after treatment; all returned to the same or even higher level of athletic performance.
The study confirms that the endoscopic placement of retropubic mesh is an efficient, safe, and minimally invasive treatment that enables fast early recovery.
Summary
Background
Despite the significant improvement concerning perioperative mortality, pancreatoduodenectomy is still a challenging procedure. Pancreatic fistula is the most common complication ...underlying 30-day mortality. More than 61 surgical techniques of pancreatic anastomosis with a vast number of variations have been published. Moreover, various risk factors favoring the development of postoperative pancreatic fistulas have been identified.
Methods
This review article presents an outline of ways to achieve the optimal pancreatic anastomosis, concentrating on technical aspects. The following parameters were assessed in this question: pancreatojejunostomy, pancreaticogastrostomy, stents, tissue patches and sealants, surgical experience, and center-specific technique.
Results
With regard to current literature, there is no scientific evidence of an optimal pancreatic anastomotic technique. A distinct inhomogeneity among the trials concerning definitions, patient selection, anastomotic technique, and patient management is important to mention.
Conclusion
The best strategy for reducing pancreatic fistula rate includes a standardized institutional concept of pancreatic anastomosis, documentation of surgical quality, and continuous enhancement by benchmarking.
Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is ...sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.
Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.
Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).
This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.
In the context of Eysenck's assumptions on the relationship between psychoticism, creativity and word association behaviour, a previous experiment was repeated with a sample of 40 writers and actors. ...The word association procedure consisted of a free single-word association test with 25 common German nouns, a common response condition, an individual response condition, ratings as to the commonness or uncommonness of the subjects' own associates and a multiple-choice association test. In addition the Eysenck Personality Questionnaire (EPQ) was filled out. Previously studied samples of 40 schizophrenics and 40 unselected healthy persons served as control groups.
As predicted by Eysenck's theory and by previously obtained results, the presumed creative sample scored significantly higher on the dimension of psychoticism but differed in no other personality scale. In the free word association the creatives gave even fewer primary responses than the schizophrenics and yet their associative behaviour did not resemble that of mental patients and should not be described in connection with `associative disturbances'. They performed best in the individual response condition and used their high creative potential to respond in accordance with the instruction. They presented fewer logical errors in their response behaviour and were well capable of assessing the degree of commonness of their own associations. These results can be understood as a strong corroboration of Eysenck's theory.
The purpose of this Master thesis is to compare the perception and significance of reference work in two countries, Sweden and Germany. This will be achieved by means of a literature review of ...previous research literature and public documents and a content analysis of articles from two library journals.A first step was to examine the historical development of reference work in the selected countries. In connection with this there proved to be distinct phases in the discussion regarding reference work. These phases with their specific discourses, themes and emphases reflected and thus later were confirmed in the second part of the study.The results show that despite some similarities there are also quite a few differences in how reference work is perceived in both countries. For Sweden, the idea of reference work was introduced relatively early. But only little has been done over time to develop this service. Germany has only recently been orientating itself away from a collection-oriented to a service-oriented library. Reference work was therefore established relatively late in German libraries, despite some earlier theoretical discussions. Swedish literature deliberates primarily reference service quality and how it could be improved. The German literature considers in contrast, mainly reference work’s more general role, its functions and forms of organization.In recent years the meaning both countries ascribe to reference work has become more similar, this is due to fact that libraries, regardless of whether they are located in Sweden, Germany or the United States, are faced with the same challenges.
Program: Masterprogram: Biblioteks- och informationsvetenskap, Digitala bibliotek och informationstjänster
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Provider: - Institution: - Data provided by Europeana Collections- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain ...Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
Das Tübinger FrauenFluchtNetz Fischer, Ines; Bundesverband TERRE DES FEMMES e.V. - Menschenrechte für die Frau e.V. - [Hrsg.] Image
Provider: - Institution: - Data provided by Europeana Collections- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain ...Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
