[Comparison of Open vs. Laparoscopic Techniques in Complete Mesocolic Excision (CME) During Right Hemicolectomy]. / Vergleich der offenen vs. laparoskopischen Technik der kompletten mesokolischen Exzision (CME) bei der Hemikolektomie rechts.

AIMS: The technique of open complete mesocolic excision (CME) has improved the outcomes of patients with colon carcinoma. Meanwhile it has become an established international standard procedure. It remains unclear if laparoscopic procedures are able to match the high quality of open resections. A video comparison of the two methods gives insight into the different dissection techniques. INDICATION: Open CME is demonstrated in a 79-year-old female patient with an asymptomatic carcinoma of the ascending colon verified by histopathology. The tumour was diagnosed during routine colonoscopy. No distant metastases were identified during the staging procedure. Laparoscopic CME is performed in a 72-year-old female patient with a biopsy-proven carcinoma of the ascending colon. Similarly this patient was diagnosed during a screening colonoscopy and had no distant metastasis. METHODS: During open CME the ascending colon and the duodenum are mobilised by sharp dissection between the parietal and visceral layer of the mesentery. Afterwards the ascending and transverse mesocolon are dissected from the duodenum and pancreas. The parietal and the visceral mesentery are strictly preserved during these procedures. After the exposure of the superior mesenteric artery and vein, a central dissection of the vessels follows. The colon is cut 10 cm distal to the carcinoma. An ileotransversostomy is performed with a running suture. The hole in the mesentery is closed. The laparoscopic CME is performed using the 4-trocar technique with an umbilical camera position following a medial to lateral approach with primary dissection of the superior mesenteric vein. Radicular vessel ligation opens the space dorsal to the mesocolon with the border lamella remaining intact. The space is widened until the ascending colon is entirely mobilised. The mobilised colon is eventrated through an enlarged umbilical midline incision. Colon resection and the subsequent two-layered side-to-side ileotransversostomy are performed in a standard open surgical fashion. CONCLUSION: Open and laparoscopic CME enable central vessel dissection while preserving the mesenteric layers. However, the laparoscopic procedure is technically demanding and should therefore only be performed by surgeons experienced in laparoscopy.

[Use of biological meshes in abdominal wall reconstruction. Results of a survey in Germany]. / Einsatz biologischer Netze bei der Bauchdeckenrekonstruktion. Ergebnisse einer Umfrage in Deutschland.

BACKGROUND: Surgical treatment of incisional hernia includes implantation of a mesh. The use of synthetic grafts in contaminated fields results in an increased risk of infection. In these cases a potential advantage is described for biological repair material. Evidence for this problem is lacking; therefore, we initiated a survey among surgeons in Germany concerning this question. MATERIAL AND METHOD: A survey concerning indications, experience and techniques of using synthetic and biological meshes was sent to 60 surgical departments. The emphasis of the survey was on the differentiation of clean and contaminated fields. RESULTS: The survey was answered by 42 %. The use of biological repair material was preferred in clean-contaminated, contaminated and soiled fields. Synthetic meshes were preferred in clean, rarely in clean-contaminated and not in contaminated or soiled situations. Primary suture repair was chosen in clean fields and barely in contaminated fields. For closure of giant hernias a component separation technique (CST) was favored by the majority of respondents. A single stage repair was preferred by most of the surgeons even in cases with simultaneous stoma takedown. A total of 72 % of the respondents were satisfied with the use of biological repair material, but the reimbursement was considered to be inappropriate. DISCUSSION: Although the response rate was low, this survey gives an idea of the attitude towards the use of synthetic and biological meshes. Biological repair material is favored for hernia repair in contaminated or soiled fields. The advantage of this choice is a one stage repair despite the contamination. As the results of this survey are not able to provide arguments for the use of different meshes this question should be further investigated with a randomized controlled trial.

[Hepatic angiomyolipoma--a rare liver tumor]. / Das Angiomyolipom der Leber--eine seltene Differenzialdiagnose der Leberraumforderung.

A 22-year-old woman was treated for a hepatic lesion with a high suspicion of a liver adenoma at another hospital. The patient presented with unspecific abdominal pain. Further physical examination was unremarkable. A biopsy of the liver lesion revealed hepatic adenoma. Because of the increasing tumour size over a one-year period the patient was referred to our department for surgical therapy. On MRI scan, the liver mass measured 10 x 9 x 9 cm in the right liver lobe with contact to the right hilum. Because of the histological signs of adenoma a right hepatic lobectomy was performed. Postoperative follow-up was uneventful. The pathological diagnosis of hepatic angiomyolipoma was obtained. Angiomyolipoma of the liver is a rare benign mesenchymal tumour often mimicking other hepatic lesions. Histological features are thick-walled blood vessels, mature fat and smooth muscle in various proportions. The biological behaviour of the tumour is benign, although distant metastases are occasionally possible. Due to the potential for malignant transformation, tumour resection should be performed.