Zentralblatt für Chirurgie
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Fast-track surgery is a comprehensive perioperative treatment concept that has been successfully performed and widely accepted in adult surgery since the 1990s. The crucial aim is to speed up convalescence and to avoid perioperative complications as pneumonia and thrombosis. Compared to conventional treatment strategies, hospital stays are substantially reduced. ⋯ Shorter hospital stays lead to reduced expenses for the health insurances and parents. Fast-track concepts are not implemented in the German reimbursement system G-DRG. Thus, problems with intensified nursing and reimbursement remain to be solved.
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Congenital diaphragmatic hernia (CDH) occurs sporadically with an incidence of 1:2,500 live births. Despite the progress in neonatal intensive care, CDH remains associated with a mortality of at least 30 % in isolated cases. The in essence surgically correctable defect of the diaphragm enables the prenatal herniation of abdominal organs into the thoracic cavity. ⋯ A trial in severely affected -fetuses with survival as main outcome is currently under review by ethics committee. A standardised neonatal management enables optimal treatment and multicentre compatibility. It remains to be proven if fetoscopic surgery can maintain a solid position in the prenatal treatment of CDH to improve both mortality and morbidity of the affected children.