[Cooperation model between an university clinic and a peripheral paediatric surgical department]. / Kinderchirurgische Kooperation zwischen einer Schwerpunktklinik und einem Versorgungskrankenhaus.

INTRODUCTION: The lack of young physicians in Germany, who are willing to train in surgery, is caused by several factors. Due to the demographic development and the specialisation in paediatric surgery in university institutions, attracting trained paediatric surgeons became difficult for non-specialised rural paediatric surgical departments, which is often also complicated by economic pressures. Strategies, such as cooperation between hospitals or departments, are required. We present a mid-term analysis of the first paediatric surgical cooperation between a university clinic and a rural paediatric surgical department in Lower Saxony. METHODS: The Department of Pediatric Surgery, Hannover Medical School (MHH), is a university centre with a case load of about 1,700 surgical procedures per year with a case mix index (CMI) of 1.3. The Department of Paediatric Surgery, St. Bernward Hospital Hildesheim (BK), is a peripheral institution with about 1,200 surgical procedures per year and a CMI of 0.5. A cooperation project was inaugurated in October, 2004, between the two departments. The aim of the cooperation was to support the head of the paediatric surgical department at the BK by rotating trained paediatric surgeons from the MHH. Simultaneously, it was planned to offer attractive conditions for research at MHH for participating surgeons. The cooperation further included sufficient economic cover of 1.5 posts for rotating medical staff by the BK. RESULTS: Three trained paediatric surgeons have so far been included in the rotation programme between the two cooperating paediatric surgical departments. The rotating medical staff costs were covered by the BK. Over a period of 2.5 years, MHH surgeons performed about 50 % of all surgical procedures at BK, while undertaking two-thirds of on-call duties there. Analysis of academic research revealed 3 accomplished experimental and 4 clinical studies, as well as 10 published articles. CONCLUSIONS: The paediatric surgical cooperation was rated as a success by the rotating trained paediatric surgeons, the heads of both departments and the hospital administrations. The academic link to a university clinic also increased the attractiveness to work in a paediatric surgical department at a rural hospital.

Laparoscopic partial external biliary diversion procedure in progressive familial intrahepatic cholestasis: a new approach.

BACKGROUND: Progressive familial intrahepatic cholestasis results in fibrosis, cirrhosis, and liver insufficiency if untreated. Medical therapy often fails and partial external biliary diversion has been recommended to prevent early liver transplantation. We present a new technique of performing a laparoscopic partial external biliary diversion and report our experience in a first series of infants. METHODS: From October to November 2004, four consecutive patients with progressive familial intrahepatic cholestasis underwent the laparoscopic partial biliary diversion procedure. A three-trocar technique was used. A proximal jejunal conduit was constructed after exteriorization of the small bowel via the infraumbilical trocar incision. After repositioning of the bowel, an isoperistaltic cholecystojejunostomy was carried out laparoscopically. The distal jejunal conduit was placed as a stoma at the right abdominal trocar site. RESULTS: There were no intraoperative events. The mean duration of the operation was 156.5 min. The postoperative course was uneventful in all patients with full enteral feedings on day 2. The laboratory and clinical signs of cholestasis were reduced up to a mean follow-up of 2 months (range, 1.5-2.5). CONCLUSION: The laparoscopic partial biliary diversion procedure is feasible with all the benefits of minimally invasive surgery. Long-term results remain to be evaluated.