With an incidence of up to 20%, incisional hernias represent a frequent late complication following abdominal surgery. The diagnosis is primarily made clinically and supported by ultrasound, particularly with smaller defects; however, large or complex hernias should be further evaluated using cross-sectional imaging, preferably with computed tomography (CT). Magnetic resonance imaging (MRI) can be considered a suitable alternative when ionizing radiation is contraindicated. The European Hernia Society (EHS) has developed a classification system to standardize the assessment of hernia location and size, thereby improving comparability between studies and enhancing communication in clinical practice. Considering the low overall risk of incarceration, surgical treatment is typically indicated based on clinical symptoms. Current evidence indicates significantly lower recurrence and complication rates associated with retromuscular mesh hernia repair. It is therefore considered to be the gold standard and is increasingly being performed using minimally invasive and robot-assisted approaches.
For type I gastric neuroendocrine neoplasms (gNEN) larger than 1 cm endoscopic resection should be performed, whereas for tumors larger than 2 cm surgical resection should be carried out. Tumors between 1 and 2 cm in size are generally resected endoscopically following endosonography; however, surgery should be considered in the presence of risk factors such as G2/3 tumors, infiltration of the muscularis propria and vascular invasion. Type II gNENs are treated endoscopically or surgically in the same manner as type I tumors. It is essential to consider treatment of the underlying hypergastrinemia caused by duodenal wall gastrinomas as well as treatment of any potentially concurrent primary hyperparathyroidism (pHPT). For type III gNENs surgical resection is generally recommended. In selected patients with very rare, small (< 1 cm) G1 tumors, endoscopic resection can be appropriate.
Duodenal neuroendocrine neoplasms (d-NEN) are rare neoplasms accounting for approximately 3% of all neuroendocrine neoplasms. They are classified into well-differentiated neoplasms (G1-G3), poorly differentiated neuroendocrine carcinomas (NEC) and mixed tumors; the majority of these tumors are nonfunctional. Some neoplasms are associated with genetic syndromes, such as multiple endocrine neoplasia type 1 or neurofibromatosis type 1. The diagnosis is made using endoscopic, laboratory, cross-sectional and molecular imaging techniques, such as gallium-68-DOTATATE PET/CT. Therapeutically, the tumor size in addition to histopathological findings, is the most important factor: tumors < 5 mm should be removed endoscopically and tumors 5-10 mm in size can also be resected endoscopically after risk assessment. Tumors > 10 mm should generally be treated surgically. An exception is the duodenal nonmetastatic gastrinoma, which should always be resected. The most important surgical interventions are local resections with lymphadenectomy or oncological pancreaticoduodenectomy, particularly for ampullary tumors, which have a higher risk of metastasis. In recent years, increasingly advanced combined surgical endoscopic techniques (rendezvous procedures) have been added to the therapeutic options but due to the oncological value have not yet been incorporated into the guidelines.
The resilience of healthcare systems is their ability to respond to disruptive crises by coping, maintaining key services and perseverance. After the crisis, it is a sign of resilience to evaluate the lessons identified and initiate improvement processes based on these lessons in order to emerge from the crisis with improved structures. An essential prerequisite for resilience is the robustness of hospitals and healthcare systems. This is decisively supported by the pillars of personnel, supplies and spatial/infrastructure. These are embedded in an overarching set of rules consisting of legal foundations, strategic principles and operational tools. It is crucial for the realization of resilience that the rules enable and do not hinder the action and the medical care. Reducing bureaucracy is of crucial importance here and can be put into practice in very concrete terms. A more resilient system that is capable of adequately responding to impending and already existing crises can only be achieved by noticeably reducing the complexity of the healthcare system.
Rectal neuroendocrine tumors (rNET) are rare but increasingly more common entities, which are usually an incidental finding during routine colonoscopy. The rNETs are usually well-differentiated with low metastatic potential. Thus, staging is only required in high-risk situations (size ≥ 10 mm, invasion of the muscularis propria, grading > G1, L1, V1). Endoscopic resection is the most frequently used treatment. Based on the depth of invasion, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) or endoscopic full-thickness resection (EFTR) are applied. In cases of R1 resection, re-endoscopic resection can be conducted to achieve R0 status. Radical surgical resection with higher or lower anterior rectum (HAR/LAR) resection with total mesorectal excision (TME) is indicated for rNETs > 20 mm, rNETs between 10-20 mm with risk factors (R1 resection after second endoscopic resection, Ki67 > 10%, L1, V1), lymph node metastasis and also in cases of distant metastasis if those are also resectable. In cases of unresectable distant metastasis, systemic treatment is applied. The prognosis after treatment of well-differentiated rNETs is generally favorable.
INTRODUCTION:Within the framework of this analysis the duration of the hospital stay of elective minimally invasive oncological colon resections and sigma resections in cases of sigmoid diverticulitis between 2013 and 2024 from the corresponding StuDoQ registers were investigated. The aim of the analysis was to identify risk factors for an extended duration of the hospital stay. METHOD:The data from the StuDoQ registers "Colon cancer" and "LapSigma" were examined. Emergency interventions, open/endoscopic interventions and converted operations were excluded. The shared variables of both registers were age, sex, body mass index (BMI), the American Society of Anesthesiologists (ASA) class, the duration of surgery and the access at the start of surgery. For colon cancer the localization of the tumor, the pT stage, the pN stage and the M status were evaluated in addition to the surgical intervention. For the "LapSigma" register the indications for the intervention and the classification were investigated. Univariate and multivariate analyses were carried out. RESULTS:In the "Colon cancer" register between 2013-2024 from 52,203 patients 17,930 could be included in the analysis. The median duration of hospital stay was 8 days (IQR 6-11). The multivariate analysis showed that the ASA class (odds ratio 1.44, 95% CI 1.37-1.52, p<0.001) and the M status (odds ratio 1.24, 95% CI 1.24-1.34, p<0.001) were risk factors for a hospital stay lasting longer than 8 days. In the "LapSigma" register between 2013 and 2024 there were a total of 33,669 patients of whom 26,324 patients could be included in the analysis. The median duration of hospital stay was 7 days (IQR 6-8). The multivariate analysis showed that the ASA class (odds ratio 1.35, 95% CI 1.29-1.42, p<0.001) and the indications for surgery (odds ratio 1.62, 95% CI 1.53-1.73, p<0.001) had a significant influence on the duration of hospital stay. DISCUSSION:Within the framework of the analysis many of the variables investigated showed a significant effect with a very high number of cases. Under closer examination, particularly for laparoscopic sigma resections for a sigmoid diverticulitis, a higher ASA class and indications for surgery (early elective and elective with bleeding) are decisive for an extended duration of hospital stay. For oncological resections a higher ASA class and a positive M status in particular were shown to be significant risk factors for an extended hospital stay.
Patient safety is a key prerequisite for high-quality, sustainable care, a fact supported by national and international economic data. For physicians, caregivers and healthcare institutions, this implies a mandate to systematically identify risks, improve interfaces, promote a safety culture and consistently implement evidence-based measures. Only through structured action can avoidable harm be reduced, resources used more efficiently and the quality of care secured in the long term.
BACKGROUND:Surgical training in laparoscopic colorectal surgery is characterized by structural deficits and extensive inhomogeneity. Ileocolic resections in Crohn's disease provide an ideal setting for structured training procedures. The aim of this retrospective study was to evaluate the outcomes of intestinal resections in patients with Crohn's disease performed by surgical residents under supervision in a specialized center. METHODS:Between October 2021 and August 2025 a total of 361 intestinal resections in patients with Crohn's disease were performed. Of the procedures 90 (25%) were carried out entirely by residents under supervision. Patient characteristics, operative details and postoperative outcomes were analyzed. The primary endpoint was the rate of intra-abdominal septic complications (IASC). RESULTS:The residents performed primary ileocolic resections in patients with non-penetrating inflammation who had not previously undergone surgery significantly more frequently. The overall postoperative complication rate was 26%, with IASC occurring in 8% of cases, including 5% near to the anastomosis. The postoperative morbidity was not increased in operations performed by residents, on the contrary the rates of IASC (1% vs. 10%, p = 0.003) and anastomotic complications (1% vs. 7%, p = 0.046) were significantly lower. Multivariate analysis identified preoperative weight loss (> 5%) and non-ileocolic resections as independent risk factors for IASC. CONCLUSION:Primary ileocolic resections for Crohn's disease are ideal training procedures in laparoscopic colorectal surgery. With appropriate patient selection and close medical supervision, residents can safely perform these operations and with a low morbidity. The results support the integration of such resections as a core component of a structured operative curriculum.
For more than 30 years outpatient surgery has been established in Germany in a patient-safe manner at approved outpatient surgery locations in the specified diagnostic scope and with risk-adjusted indications. As part of the Federal Government's outpatient strategy, the range of operations and the number of interventions will increase. This development requires special attention to compliance with patient safety-relevant treatment standards and the overdue implementation of sector-independent quality assurance indicators. Patient satisfaction and, above all, patient safety are particularly important test criteria for the quality of results in outpatient, usually elective procedures.
Amputation medicine has evolved into a specialized, technology-driven discipline. With increasing global amputation rates, advanced surgical techniques, innovative prosthetic solutions and digital rehabilitation are gaining importance. Transcutaneous osseointegrated prosthetic systems (TOPS) can improve mobility, proprioception and quality of life but carry risks such as stomal infections or periprosthetic fractures. Neuroreconstructive procedures including targeted muscle reinnervation (TMR), targeted sensory reinnervation (TSR), regenerative peripheral nerve interface (RPNI), agonist-antagonist myoneural interface (AMI) and nerve caps enable intuitive prosthesis control and reduce neuroma and phantom pain. Preoperative diagnostics and careful patient selection are essential. Guidelines emphasize structured rehabilitation and interdisciplinary follow-up. Virtual reality (VR) and extended reality (XR) procedures extend the treatment spectrum and support motor function and phantom pain reduction. Overall, this results in an integrated treatment concept with clear functional and psychosocial advantages.
BACKGROUND AND OBJECTIVE:Despite a growing proportion of women in surgery, there is a significant underrepresentation in clinical and academic leadership positions. The mechanisms are still poorly understood. The German Congress of Visceral Medicine, as the largest interdisciplinary medical congress in German-speaking countries, provides a suitable platform for investigating gender-specific representation patterns. The aim of this study was to analyze the gender distribution in various congress functions between 2013 and 2024 in order to identify potential structural inequalities. MATERIAL AND METHODS:The gender distribution of speakers and chairs at the German Congress of Visceral Medicine from 2013 to 2024 was analyzed based on the official congress programs. After excluding gastroenterological, endoscopic and interdisciplinary sessions, the visceral surgery sessions were analyzed in the categories of abstract sessions, plenary sessions and industry symposia. RESULTS:The analysis revealed a significant increase in the number of female speakers (r2 = 0.585; p = 0.006) and chairs (r2 = 0.777; p < 0.001). The proportion of female speakers significantly increased in both plenary sessions (r2 = 0.600, p = 0.005) and abstract sessions (r2 = 0.445, p = 0.025). An increase in the number of female chairs was also observed for plenary sessions (r2 = 0.796; p < 0.001) and abstract sessions (r2 = 0.678; p = 0.002). Parity could not be achieved except for chairs of abstract sessions. At industry symposia, speakers were male in 88-100%, and chairs were male in 100% of all cases. The congress presidency was held by men in 10 out of 11 years (92%). The Walter Kausch Medal and the Rudolf Pichlmayr Medal went exclusively to men (100%). CONCLUSION:The analysis reveals a persistent underrepresentation of female surgeons in prestigious conference roles. Women were predominantly represented in less visible formats, indicating structural barriers. Following the introduction of transparent selection procedures and gender parity requirements, a significant increase in female participation was observed. These results suggest that targeted institutional measures are suitable for promoting the representation of women in academic surgery and reducing existing imbalances.
The pathological diagnostics of rectal cancer play a central role in stage-adapted and individualized treatment planning. With the update of the German S3 guidelines in 2025, the requirements for histopathological and molecular reporting have been further specified and expanded. In particular, the standardized assessment of mismatch repair status at initial diagnosis, standardized evaluation of resection specimen quality including the circumferential resection margin as well as refined risk stratification of early stage carcinomas, have direct implications for making surgical decisions. In parallel, molecular biomarkers and predictive factors are gaining increasing relevance within multimodal treatment concepts. This review article summarizes the current guideline recommendations from a pathological perspective and classifies their clinical relevance for the surgical practice. The aim is to deepen the understanding of the diagnostic principles and to emphasize the importance of standardized and quality-assured reporting in the interdisciplinary treatment concept of rectal cancer.
Achilles tendon rupture (ATR) is a common injury among middle-aged people who are physically active. A differentiated clinical and sonographic assessment is primarily required to select the optimal treatment. Treatment options include both conservative and surgical methods. In the case of active young patients, there may be a preference for surgical treatment of acute/subacute ATR due to its potential for less loss of strength and enhanced rehabilitation. Minimally invasive surgery (MIS) techniques have reduced the rate of general complications (wound healing disorders, wound infections) compared to open procedures, with a comparable re-rupture rate. Open surgical techniques or reconstructions are the preferred treatment in cases of chronic ATR with defects or muscle atrophy. Conservative treatment and postoperative therapy require stage-specific functional dynamic rehabilitation, which has been shown to lead to better clinical results and a reduction in the re-rupture rate.
Operating rooms represent one of the most material and resource-intensive areas of a hospitals and substantially contribute to the environmental footprint of healthcare systems. Beyond energy consumption, surgical supplies, medical devices and the associated inventory management and procurement processes have gained increasing attention as key levers for sustainability. This narrative review summarizes the current international evidence on sustainable inventory management and procurement strategies in the operating room. Particular emphasis is placed on different stocking models, standardization of surgical sets and modern procurement and supply chain approaches. Systematic reviews and implementation studies consistently demonstrate that structured inventory and procurement strategies can significantly reduce material waste, costs and environmental impact without compromising patient safety or quality of care. Sustainable effects require a systemic approach integrating organizational, logistical and clinical perspectives.
