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Surgical Determinants, Perioperative Course and Outcome of a Representative Patient Cohort with Acute Appendicitis Undergoing Appendectomy over 3 Decades

100%
Boenigk H., Meyer F., Koch A., Gastinger I.
Polish Journal of Surgery
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2012
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vol. 84
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issue 10
509-520
EN
Acute appendicitis, one of the most frequent emergencies in general surgery, has been repeatingly investigated with regard to specific aspects such as medical history, clinical symptoms, the perioperative management and follow up. was to investigate relevant and combined determinants for the perioperative management of acute appendicitis a systematic clinical prospective unicenter observational study was conducted. A representative patient cohort was studied (n=9,991; middle Europe) to reflect daily surgical practice through a time period of 27 years divided into 3 separate periods and the frequency of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings as well as complications), their correlation and relative risk factors for the disease as well as prognosis. Results. 1. The wound abscess rate was 10.9%. Perforation, surgical intervention in time, acute, gangrenous and chronic appendicitis, age, accompanying diseases such as obesity, arterial hypertension, diabetes mellitus, sex, and missing pathological finding intraoperatively had a significant impact on the postoperative development of a wound abscess. 2. The longer the specific appendicitis-associated medical history was, the more frequent a perforated appendicitis occurred, greater the appendectomy (AE) rate in a non-inflamed appendix and higher the rate of required second interventions. 3. The average hospital stay was 11 days. 4. There was a significantly decreased percentage of patients with no pathological finding intraoperatively at the appendix vermiformis (p<0.001), who underwent AE, in particular, through the last investigation period from 1997 to 2000 onto only 6.8% (1974-1985, 15.5%; 1986-1996, 10.3%). 5. The mortality was 0.6%, with no significant difference comparing male and female patients (p=1), the three investigation periods (p=0.077), or the patients with AE in non-inflamed appendix (0.4%) and AE in acute appendicitis (0.6%; p=0.515). The study showed a positive, partially significant quality improvement within the presenting clinic with regard to a decreased rate of AE in non-inflamed appendix, wound abscess rate and, in particular, to mortality. Despite this, there is a trendy increase of the perforation rate in the investigated cohort. Conclusion. Quality control remains indispensable for the assessment of the disease´s surgical treatment. A further significant improval of this control might be achieved by multicenter studies and multifactorial evaluations.
2
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Prospective Multicentric Evaluation Studies for Analysis of Surgical Risk Factors in Thyroid Surgery

76%
Dralle H., Machens A., Sekulla C., Lorenz K., Gastinger I., Mroczkowski P., Lippert H.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
325-328
3
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Impact of Fast-Track Concept Elements in the Classical Pancreatic Head Resection (Kausch-Whipple Procedure)

76%
Gastinger I., Meyer F., Lembcke T., Schmidt U., Ptok H., Lippert H.
Polish Journal of Surgery
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2012
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vol. 84
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issue 8
390-398
EN
The aim of the study was to determine statistically significant factors with an impact on the early postoperative surgical outcome.Material and methods. The influence of applied fast-track components on surgical results and early postoperative outcome in 143 consecutive Kausch-Whipple procedure patients was evaluated in a single-center retrospective analysis of a prospective collection of patient-associated pre-, peri- and postoperative data from 1997-2006.Results. The in-hospital mortality rate was 2.8% (n=4). Fast-track measures were shown to have no effect on the morbidity rate in the multi-variate analysis. Over the study period, a decrease of intraoperative infusion volume from 14.2 mL/kg body weight/h in the first year to 10.7 mL/kg body weight/h in the last year was accompanied by an increase in patients requiring intraoperative catecholamines, up from 17% to 95%. The administration of ropivacain/sufentanil via thoracic peri-dural catheter injection initiated in 2000 and now considered the leading analgesic method, was used in 95% of the cases in 2006. Early extubation rate rose from 16.6% to 57.9%.Conclusions. Fast-track aspects in the perioperative management have become more important in several surgical procedure even in those with a greater invasiveness such as Kausch-Whipple. However, such techniques used in peri-operative management of Kausch-Whipple pancreatic-head resections had no impact on the morbidity rate. In addition, the low in-hospital mortality rate was particularly attributed to surgical competence.
4
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Endoscopic Ultrasonography (EUS) in Preoperative Staging of Gastric Cancer - Demand and Reality

76%
Meyer L., Meyer F., Schmidt U., Gastinger I., Lippert H., Oraz Wschodnioniemiecka Grupa Na Rzecz Kontroli Jakości i Rozwoju Regionalnego w Chirurgii
Polish Journal of Surgery
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2012
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vol. 84
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issue 3
152-157
EN
Exact pretherapeutic staging is considered to be essential for decision-making in the therapeutic algorithm of gastric cancer.The aim of the study was to characterize the role and value of EUS in the diagnostic and therapeutic management of gastric cancer in daily surgical practice.Material and methods. Thousand one hundred thirty nine patients with primary gastric cancer from 80 hospitals of each profile of care were enrolled in this systematic clinical prospective multicenter observational study over a time period of 12 months. The characteristics of the diagnostic management, in particular, of EUS were documented. The preoperative EUS findings were compared with the T stage (T1 to T4) and the N category (N+ or N-) revealed by the histopathologic investigation of the surgical specimen. By the mean of X2 test, the impact of EUS on the therapeutic decision-making was determined.Results. Pretherapeutic EUS was only performed in 27.4% (n=312) of all patients. Overall, the diagnostic accuracy for the T stage was 42.6% in average. The subgroup analysis showed the following results: T1, 31.5%; T2, 42.6%; T3, 65.2%; T4, 17.6%. The correct predictive value of the N category was 71.3% reaching a sensitivity of 69.7% and a specificity of 73.3%. Overstaging was observed in 45.8%, understaging in only 10.8%. Additional diagnostic information by EUS was only provided in 4.7% of subjects.Conclusions. The present study indicates the variability, limited reliability and only moderate acceptance of EUS in diagnosing gastric cancer in daily practice. In particular, the prediction of the T stage does not reach the data reported in the literature, which were mostly achieved in specific EUS studies.
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