[Our surgical heritage. The surgical schools in Magdeburg]. / Unser chirurgisches Erbe. Die chirurgischen Schulen in Magdeburg.

During the previous two centuries several leading personalities have worked in the two major surgical hospitals of the city of Magdeburg. This retrospective view remembers a few of these surgeons and their merits for patients, education and scientific life. In the hospital "Krankenhaus Altstadt Magdeburg" the work of surgeons dates back to 1827 with the foundation of a surgical hospital including a teaching facility for surgeons as "Wundärzte II. Klasse". Geheimrat Dr. W. Hagedorn has been the outstanding personality of the 19th century whereas Prof. Dr. Max Biebl is regarded the same for the 20th century. The hospital "Sudenburger Krankenhaus" was founded in 1891. Since 1954 it developed by Prof. Dr. W. Lembcke into an academic teaching hospital. As "Center of Surgery" it is today part of the medical faculty of the university of Magdeburg.

[The indications for the Valtrac-ring--Report on 1015 Anastomoses]. / Indikationsgerechte Anwendung des Valtrac(R)-Ringes bei der Anastomosentechnik - Erfahrungsbericht über 1 015 Anastomosen -

1,015 Valtrac-anastomoses in 876 patients were performed in the Surgical Department of "Städtisches Klinikum - Krankenhaus Altstadt Magdeburg" from June 1991 until June 2000. The registration of data was done prospectively, the mean age of all patients was 62.1 years, the youngest patient was 22 and the oldest 94 years old. In 88 % of all cases patients suffered from malignant and in 12 % from benign diseases. The anastomosis insufficiency rate per patient was 1.3 % and per anastomosis 1.1 %. We found a significant difference in the anastomosis insufficiency rate of the upper (0.4 %) and the lower gastrointestinal tract (4.2 %). As a result of our experiences we propose the use of the Valtrac-ring for anastomoses in intrathoracic oesophagogastrostomy, gastrostomy in inoperable malignant pyloric stenosis, small bowel anastomosis as part of Y-Roux-reconstruction and end-to-end-anastomosis in the lower gastrointestinal tract after colon-resection. We do not see a routine indication for Valtrac-anastomosis in oesophagojejunostomy after gastrectomy and in colorectal anastomosis after rectum-resection.

[Quality assurance in appendicitis--what has changed? Analysis of 2 prospective multicenter quality assurance studies]. / Qualitätssicherung Appendizitis--was hat sich geändert? Analyse zweier prospektiver multizentrischer Qualitätssicherungsstudien.

AIMS OF THE STUDY: The present study aims to determine the influence of introduction of laparoscopic techniques and of DRG (diagnosis related gains) on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1.7.1988 to 31.12.1989, 6,266 patients from 18 hospitals were included, and from 1.6.1996 to 31.5.1997, 7,398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1,869 patients were treated conservatively (29.8%), 4,397 (70.2%) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8%, the perforation rate was 8.3% and the wound infection rate 9.6%. In the second period (1996/97), 2,430 patients were treated conservatively (32.8%), in 24.9% of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9% and the rate of wound infections 2.5%. During this second period, 33.2% of all appendectomies were performed using the laparoscope, the conversion rate was 7.2%. CONCLUSIONS: The introduction of laparoscopic techniques and of DRG did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Overview on compression anastomoses: biofragmentable anastomosis ring multicenter prospective trial of 1666 anastomoses.

This study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow-up evaluation reported no BAR-related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.

[Surgical technique and results in benign bile duct stenoses]. / Operationstechnik und Ergebnisse bei benignen Gallengangsstenosen.

Surgical treatment of benign bile-duct stenosis in the state of extrahepatic cholestasis is not only associated with increased operation risk, but demands a great deal of experience from the surgeon. The results obtained during the last 3 years in 17 patients with an average age of 51 are evaluated. Different techniques corresponding to the individual findings of the bile-duct stenosis were applied for reconstruction. In two thirds of the patients long-term drainages were necessary.

[Surgery of intrathoracic metastases]. / Die Chirurgie intrathorakaler Metastasen.

From 1969 to 1988 on the Department of Thoracic Surgery "Vogelsang" of the District Hospital Magdeburg were performed 128 thoracotomies on 114 patients because of metastases from extrapulmonary tumours. In most of the cases the primary tumours were carcinomas of kidney, of testes, colorectal carcinomas and breast cancer. By resection we employed all important methods of lung surgery, 5 times as median sternotomy. The survival time of 3 years run to 40% and that of 5 years to 24%. By patients with different lung metastases we found an aggravation of prognosis.

[Penetrating thoracic injuries. Report of experience in 20 patients]. / Penetrierende Thoraxverletzungen. Erfahrungsbericht bei 20 Patienten.

It is told about twenty penetrating wounds of thorax in the last ten years. They deal with twelve stab wounds, five gunshot wounds and three impalement wounds. The organic lesions are dominated by wounds of lung. Drainage of thorax is chosen as therapy in uncomplicated cases. Thoracotomy was necessary in 6 cases, 5 of them were urgent.

[Surgical treatment of chronic bronchial foreign bodies and its complications]. / Die chirurgische Behandlung chronisch-bronchialer Fremdkörper und ihrer Komplikationen.

In the last 30 years five patients with foreign bodies from tracheobronchial tree were treated. In four cases the foreign body was not discovered. In all patients was necessary to carry out a lobectomy.

[Tuberculosis in a thoracic surgery patient sample today]. / Die Tuberkulose im thoraxchirurgischen Krankengut heute.

Between 1977-1988 89 patients had an operation on tuberculosis in our thoracic surgical department. It were 11 preoperatively diagnosed and 76 undiagnosed cases of tuberculosis and 2 infections with nontuberculosis mycobacteria. In cases, where tuberculosis was diagnosed, surgical therapy was only used because of uneffective antituberculotic therapy. Surgical operations are always applied as secondary late measures. We have manly employed limited resections saving parenchyma. The frequency of postoperative complications was 11.2%. An adequate postoperative chemotherapy is obligatory.

[Indications and results of surgical treatment of spontaneous pneumothorax]. / Indikation und Ergebnisse der chirurgischen Behandlung des Spontanpneumothorax.

Between 1973 and 1985, 107 thoracotomies were performed in cases of spontaneous pneumothorax in 100 patients. Only in 3 patients we found a primary pneumothorax. In relation to the basic illness, the gravity of accompanying diseases and the frequency of relapses, we employed an graduated concept of treatment: Pleurocentesis, thoracodrainage, thoracotomy. The indication for primary operation was established in 10 patients and for sternotomy in 3 cases of simultaneous bilateral pneumothorax. There was a low frequency of relapses (1 patient) in comparison with conservative treatment. The frequency of complications in total was judged to be low.

[Critical position on indications for selective proximal vagotomy without drainage]. / Kritische Stellungnahme zur Indikation der selektiven proximalen Vagotomie ohne Drainage.

In 128 patients with chronic duodenal ulcer the selective proximal vagotomy without drainage was carried out in a prospective study. Intraoperatively the test for completeness of the vagotomy was performed by means of the dye test in 50%. Postoperatively no lethal complications were to be seen, only three bronchopneumonias and one wound rupture. The late results after one year showed 77.5% Visick II, 10% Visick III and 12.5% Visick IV. After a successless conservative treatment of the 16 patients with recidivation in 10 patients the second operation had to be performed. In 6 of 10 patients pylorus stenoses were found in the operation preparation. The selective proximal drainage is an unsuitable method for pre- and intrapyloric ulcers. The intraoperative application of dye tests had no influence on the rate of recidivations.

[Diagnostic and therapeutic problems of primary non-Hodgkin lymphoma of the stomach]. / Diagnostische und therapeutische Probleme des primären Non-Hodgkin-Lymphoms des Magens.

The primary extranodal manifestation of the non-Hodgkin-lymphomas above all concerns the stomach. An essential problem is the low, exactly positive rate of biopsy. As a rule the non-Hodgkin-lymphoma is diagnosed on the surgical specimen. During 5 years we treated 11 patients with non-Hodgkin-lymphoma, this corresponds to 3.85% of our malignant tumours of the stomach. The anamnesis is uncharacteristic, the endoscopic picture is multiform, penetration and haemorrhage are relatively frequent to be observed. Only in 1 patient of 11 by means of multifarious biopsies the diagnosis could be ascertained preoperatively. At stage I the surgical therapy is sufficient, for all other stages the combination of operation and poly-chemotherapy is the therapy of choice.

[Preoperative examinations by internists before reoperation]. / Internistische Voruntersuchungen bei operativen Zweiteingriffen.

Special attention should be focused upon the cardiopulmonary system and the liver function as well. The concomitant medical therapy in the pre-, intra- and postoperative phase has to be adapted to the patients actual requirements in order to avoid undesirable side-effects due to toxic plasma levels of the admitted drugs.

[Staging of morbus Hodgkin by explorative laparotomy (author's transl)]. / Zur Diagnostik der Lymphogranulomatose aus chirurgischer Sicht.

75 patients suffering from Hodgkin's disease underwent explorative laparotomy. This meant to correct the initial staging in a percentage of 34. There was an increase of postoperative complications in secondary laparotomies. In 4 our of 25 patients an unexpected involvement of the spleen could be demonstrated.

[A special glass electrode for pH-measurements on biological tissues]. / Einstabglaselektrode für pH-Messung auf biologischem Gewebe.

The institute Meinsberg of the Technische Universität Dresden developed on our demand a special glass electrode for pH-estimation on biological surfaces. We used this electrode to check pH on the gastric mucosa intraoperatively. The results show a relation between the preoperative gastric acid stimulation-test and the intraoperative assessment. In case of ulcer perforation the intraoperative estimation of pH allows some conclusions of gastric secretion and will influence the choice of surgical procedure in treatment this complication.