Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Due to the recent terrorist attacks in Paris, Brussels, Ansbach, Munich, Berlin and more recently Manchester and London, terrorism is realized as a present threat to our society and social life, as well as a challenge for the health care system. Without fueling anxiety, there is a need for sensitization to this subject and to familiarize all concerned with the special kind of terrorist attack-related injuries, the operational priorities and tactics and the individual basic principles of preclinical and hospital care. ⋯ It is the aim of this article, from a surgical point of view, to depict the tactics and challenges of preclinical care of the special kind of terrorist attack-related injuries from the site of the incident, via the advanced medical post or casualty collecting point, to the triage point at the hospital. The special needs of medical care and organizational aspects of the primary treatment in the hospital are highlighted and possible decisional options and different approaches are discussed.
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In most cases blunt chest trauma leads to fractures of the bony thorax, i. e. ribs. In the case of accompanying hemothorax or pneumothorax initial management consists of chest tube drainage by mini-thoracotomy. ⋯ Penetrating trauma is always surgically treated and the foreign body is removed in the operating room (OR). Life-threatening conditions, such as tension pneumothorax have to be treated by thorax drainage prior to hospital admission.
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Robotic liver resection can overcome some of the limitations of laparoscopic liver surgery; therefore, it is a promising tool to increase the proportion of minimally invasive liver resections. The present article gives an overview of the current literature. Furthermore, the results of a nationwide survey on robotic liver surgery among hospitals in Germany with a DaVinci system used in general visceral surgery and the perioperative results of two German robotic centers are presented.
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Periprosthetic acetabular fractures in geriatric patients are rare injuries; however, the incidence is increasing because of the current demographic developments. For diagnosis of periprosthetic acetabular fractures, conventional X‑ray images are regularly complemented by computed tomography (CT). For exclusion of loosening of the prosthesis more advanced techniques, such as single photon emission CT (SPECT/CT) are applied. ⋯ In the literature there are several algorithms, which are aimed at supporting the attending physician in making the correct decision for the treatment of periprosthetic acetabular fractures. In cases of periprosthetic acetabular fractures even experienced surgeons are faced with great challenges. Thus, treatment should be carried out in specialized centers.
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There is a high incidence of incisional hernias in specific high-risk patient populations. For these patients, the prophylactic placement of mesh during closure of the abdominal wall incision has been investigated in several prospective studies. ⋯ Prophylactic mesh implantation should be standard of care during construction of an elective end colostomy and will become standard of care for midline laparotomies in patients at a high risk of incisional hernias.