Single-Center Retrospective Analysis of the Outcomes of Patients Undergoing Staged Peritoneal Lavage for Secondary Peritonitis.

BACKGROUND: Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re-laparotomy or re-laparoscopy as a surgical option in the management of abdominal sepsis due to secondary peritonitis are limited and conflicting. Herein, we report the outcomes of patients undergoing staged peritoneal lavage (SPL) for secondary peritonitis in our department. METHODS: This is a single-center retrospective analysis of the data of patients undergoing SPL for secondary peritonitis. SPL was performed via either re-laparotomy or re-laparoscopy. The simplified acute physiology score (SAPS II) was calculated at the time of the initial operation and for each SPL. The end points of interest included: the evolution of sepsis characterized by the SAPS II score, the mortality rate and the rate of definitive abdominal wall closure. RESULTS: The data of 74 patients with a median age of 73 years requiring at least one SPL between 2012 and 2019 were analyzed. The median number of SPL performed was three (range 1-12). A sequential drop of SAPS II score from 41 at the initial procedure to 32 at the third SPL was documented. The overall mortality rate was 16.2%, definitive abdominal closure was achieved in all surviving patients and the median length of stay was 17.5d CONCLUSION: Staged re-laparotomy or re-laparoscopy with peritoneal lavage may reduce the severity of peritonitis and reduce the risk of mortality in patients with abdominal sepsis. Maintaining the abdominal wall under constant retraction using a rigid mesh while creating an open abdomen is a crucial step in achieving definite abdominal wall closure. Thus, staged peritoneal lavage may be a good surgical option for selected patients with peritonitis.

Gender discrimination in endoscopic groin hernia repair. Minimal invasive groin hernia repair is offered less often to female patients compared to male patients.

BACKGROUND: Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure. MATERIALS AND METHODS: A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders. RESULTS: Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P=0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P=0.001). The overall duration of surgery was 74.0min in the female cohort and 93.0min in the male group, P=0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0min in the female group and 89.0min in the male group, P=0.67. CONCLUSION: Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population.

Initial experience with taTME in patients undergoing laparoscopic restorative proctocolectomy for familial adenomatous polyposis.

BACKGROUND: Transanal total mesorectal excision (taTME) is a minimally invasive technique which was developed to overcome the difficulties associated with the "top-down" pelvic dissection by enabling a "bottom-up" dissection in patients with mid- and low rectal cancer. While this technique was primarily designed to manage tumors in the mid- and lower rectum, its spectrum of indications has been broadened to include benign colorectal pathologies. The aim of the present study was to assess our initial experience with taTME in patients undergoing restorative proctocolectomy for familial adenomatous polyposis (FAP). METHODS: All consecutive patients (undergoing prophylactic restorative proctocolectomy with IPAA for FAP using taTME between April and October 2016 at our institution) were included in the study. RESULTS: There were 8 patients (6 females and 2 males). The median age was 19.5 years (range 16-31 years). In all cases, surgery was successfully completed using with taTME. No perioperative complications were recorded. A median of 5 bowel movements (range 4-6 bowel movements) with intermittent anti-diarrheal medication was recorded in all cases. CONCLUSIONS: Our initial experience with 8 consecutive cases suggests taTME is safe and effective in patients undergoing prophylactic restorative proctocolectomy with IPAA for FAP.

[Wrong site surgery : Incidence, risk factors and prevention]. / Verwechselungseingriffe in der Chirurgie : Inzidenz, Risikofaktoren und Prävention.

BACKGROUND: Wrong site surgery defines a category of rare but totally preventable complications in surgery and other invasive disciplines. Such complications could be associated with severe morbidity or even death. As such complications are entirely preventable, wrong site surgery has been declared by the World Health Organization to be a "never event". MATERIAL AND METHODS: A selective search of the PubMed database using the MeSH terms "wrong site surgery", "wrong site procedure", "wrong side surgery" and "wrong side procedure" was performed. RESULTS: The incidence of wrong site surgery has been estimated at 1 out of 112,994 procedures; however, the number of unreported cases is estimated to be higher. Although wrong site surgery occurs in all surgical specialities, the majority of cases have been recorded in orthopedic surgery. Breakdown in communication has been identified as the primary cause of wrong site surgery. Risk factors for wrong site surgery include time pressure, emergency procedures, multiple procedures on the same patient by different surgeons and obesity. Check lists have the potential to reduce or prevent the occurrence of wrong site surgery. CONCLUSION: The awareness that to err is human and the individual willingness to recognize and prevent errors are the prerequisites for reducing and preventing wrong site surgery.

[Hepatic cholestasis resulting from a long-standing enterothorax: a case report]. / Langjähriger Enterothorax als ungewöhnliche Ursache einer Cholestase: ein Fallbericht.

BACKGROUND: Due to the lack of symptoms an enterothorax frequently remains undetected in adults. Most symptomatic patients complain about bowel obstruction and a surgical repair of the diaphragmatic defect, particularly with a mesh, is mandatory. METHODS: This report presents the case of a 72-year-old female patient with a history of an upside-down stomach presenting with a painless jaundice and signs of liver cirrhosis. CLINICAL COURSE: The preoperative work-up revealed an enterothorax with compression of the main bile duct. Explorative laparotomy showed a liver cirrhosis with distinct intrahepatic cholestasis, a hydropic gallbladder and confirmed a right-sided diaphragmatic defect with an enterothorax. After reposition of the intestine, a cholecystectomy, bile duct revision and the closure of the diaphragmatic defect using a mesh were performed. CONCLUSION: Diaphragmatic defects are the basis for the formation of an enterothorax which may be associated with a complicated clinical course. Therefore, in cases of coincidental diagnosis, even in asymptomatic patients, surgical repair should be performed in order to prevent serious complications as presented in this case.

[Gallbladder agenesis, a rare congenital disorder]. / Gallenblasenagenesie - eine seltene kongenitale Fehlbildung.

HISTORY AND ADMISSION FINDINGS: A 51-year-old woman presented with right upper abdominal discomfort for three weeks. Her medical history revealed a lower abdominal gynecological laparoscopy and an ileocaecal resection 7 years ago. INVESTIGATIONS: Blood samples including liver enzymes were within normal limits. An upper abdominal ultrasound failed to reveal a gallbladder. An MRI with MR-cholangiography confirmed the abscence of a gallbladder, thus the diagnosis of a gallbladder agenesis. TREATMENT AND COURSE: The patient was informed about the benign nature of her diagnosis and was discharged. The right upper abdominal discomfort was mild and untypical, and most probably not caused by the gallbladder agenesis. CONCLUSION: Gallbladder agenesis is rare. The congenital disorder has to be taken into account if no gallbladder can be found during imaging or surgery. Sonography is not the adequate method for diagnosing gallbladder agenesis.

[Surgical options in the treatment of the obstructed defaecation syndrome]. / Das obstruktive Defäkationssyndrom - chirurgische Behandlungskonzepte.

Chronic constipation is a symptom complex caused by a wide variety of diseases. Primary causes of constipation, including enterocele, rectocele, rectum prolapse and intussusception, involve changes of the bowel which either delay or prevent the passage of bowel content. This condition has been termed "obstructed defaecation syndrome" (ODS).This article is based on clinical experience and a review of selected literature. The complexity of chronic constipation warrants interdisciplinary work-up and treatment. The diagnostic work-up includes taking a focus on the history of patient's complaints. This can be objectified using a standardized scoring system, e. g. Longo score. Gynaecological examinations must be performed on all female patients. Intraluminal abnormalities are best excluded by colonoscopy and rectoscopy. An abnormal score in combination with negative findings on endoscopy and gynaecologic examinations warrant a radiological assessment with a defaecogramm in symptomatic patients. Treatment is usually medical, involving changes in life style, bowel habits and the use of laxatives. Biofeedback has been shown to be effective in some patients. Surgery is indicated for selected patient who do not improve after medical treatment. A range of surgical procedures have been shown to be effective in the treatment of chronic constipation. The minimal invasive double stapled trans anal rectum resection (STARR procedure) has been proven effective in treating rectocele and rectum prolapse in selected patients. The advantages of the STARR procedure include: short hospital stay, reduced postoperative pain and an early return to work. We consider this procedure as safe and effective when performed by a well trained surgeon in selected patients.

[Squamous cell carcinoma of the colon. A rare histological entity]. / Reines Plattenepithelkarzinom des Rektums. Eine seltene histologische Entität.

Squamous cell carcinoma of the colon is an extremely rare histopathological entity accounting for less than 0.025% of all colonic malignancies. Mucosal metaplasia is believed to be the leading cause of this form of carcinoma and the presentation and diagnosis is the same as for adenocarcinoma. Surgery is the treatment method of choice and adjuvant radiation and chemotherapy are recommended in advanced stages of the disease. Advanced squamous cell carcinoma seems to have a poorer prognosis compared to advanced adenocarcinoma.

Pierre Robin syndrome: an update.

OBJECTIVES: 'Pierre Robin' is one of the most readily recognised eponyms in medicine, yet it is a poorly understood nonspecific grouping of malformations that has no prognostic significance. Previously known as 'Pierre Robin syndrome', the way this diagnostic entity is viewed is now undergoing change. It is the purpose of this paper to review previous thinking about Robin and provide an update on recent clinical observations. SOURCES OF DATA: A computerised literature search using MEDLINE, EMBASE, AJOL and OMIM was conducted for published articles up to March 2006. Mesh phrases used in the search were: Pierre Robin syndrome, Robin anomalad and Robin sequence (RS). RESULTS: This relatively uncommon association of micrognathia with cleft palate and upper airway obstruction which was initially thought to be a specific disease and entire treatment regimens established to deal with presumed problems is now understood to be a grouping of clinical findings that does not represent a distinct multiple anomaly syndrome. The condition is therefore now described as 'Pierre Robin sequence'. Evidence of distinct cytogenetic anomalies has also highlighted the aetiological heterogeneity associated with RS in recent times. CONCLUSION: Infants with Robin sequence can present with varied problems, some of them emergencies. Clinicians must be aware of the high prevalence of associated syndromes and the possible contribution of other syndromic features to the problems for proper patient care. Candidate loci and potential candidate genes are currently being proposed in the literature for RS.