Zentralblatt für Chirurgie
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Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany. ⋯ The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline-based clinical nutrition in surgical care in Germany.
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Observational Study
[An algorithm for postoperative pain management in visceral and thoracic surgery: an observational study].
We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. ⋯ Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.
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The implantation of endoprostheses is an established procedure in orthopaedic and trauma surgery. However, the techniques are often associated with a high risk of post-interventional infections and wound healing disorders that can result in loss of the prosthesis or the limb--most likely based on an insufficient debridement and poor soft-tissue coverage. The purpose of this study was to evaluate the efficacy of the coverage methods in our patient population. ⋯ A radical debridement and an early appropriate defect coverage of the exposed prosthesis is crucial in the reconstruction process. Through a close interdisciplinary collaboration a stable soft-tissue covering can be achieved. Consequently it is possible to avoid a loss of the endoprosthesis, marked functional deficits or even amputations.
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In selected patients laparoscopic distal pancreatectomy with splenectomy has increasingly gained in importance as an alternative to the open approach. Modern imaging procedures detect more frequently neuroendocrine pancreatic tumours. A typical feature of the neuroendocrine pancreatic tumour is that this kind of tumour is mostly small with a size of 1 to 2 cm. Due to their mostly small size they are suited to a laparoscopic approach. We report here the feasibility and surgical technique of a laparoscopic distal pancreatectomy with splenectomy and partial gastric resection due to a neuroendocrine pancreatic tumour. ⋯ Laparoscopic distal pancreatectomy with or without splenectomy is feasible with a low morbidity rate by experienced laparoscopic surgeons. The advantages of laparoscopic compared to open approach are well known, but the laparoscopic approach in pancreatic surgery should be used in selected patients. Due to their mostly small size, especially neuroendocrine tumours in the tail of the pancreas are suited to a laparoscopic approach.