BACKGROUND: The aim of this retrospective study was to investigate the feasibility and safety of laparoscopic total gastrectomy in gastric cancer. METHODS: From 01/2008 to 09/2011 laparoscopic total gastrectomy was performed in 11 patients with gastric carcinoma. RESULTS: All patients had histopathologically diagnosed gastric cancer according to UICC-TNM classification: pT1 (n = 2), pT2 (n = 3), pT3 (n = 3), pT4 (n = 2), one case without histopathological malignancy in the postoperative specimen. Mean age was 69 years, mean BMI 25 and the average tumour size was 4.6 (1–10) cm. In every case R0-resection could be obtained, the amount of resected lymph nodes (25 mean) was oncologically reasonable. Conversion to open surgery was performed in two patients. Operation time was long compared to experiences in open surgery, 374 (290–465) min. There was no mortality and complication rate was acceptable. Postoperative stay was 18 days mean. CONCLUSIONS: Based on our experience laparoscopic total gastrectomy is a feasible option for treating gastric carcinomas. R0-resection in all cases and the amount of resected lymph nodes demonstrate adherence to oncologic principles.

BACKGROUND: As meshes markedly reduce recurrence rates following surgery for inguinal hernia, surgical methods employing meshes have become increasingly popular among surgeons. Innovations in laparoscopic surgery have enabled the surgeon to minimize the size of trocar incisions. This type of laparoscopy is therefore referred to as minimal incisional laparoscopic surgery (MILS). METHODS: All inguinal hernia patients who reported at our department during the last two years were included in a prospective observational study. In order to assess the feasibility of the MILS technique as well as its benefits for the patient, we investigated and compared the following intra- and postoperative parameters of two laparoscopic TAPP (transabdominal pre-peritoneal) techniques (MILS-TAPP versus conventional-TAPP): operating times, perioperative complications, postoperative and chronic pain, abdominal wall mobility, and recurrence rates. RESULTS: Of 462 patients aged 18 to 94 years (mean, 46 years), 559 inguinal hernias in 481 patients (86.1%) were treated by laparoscopic approach. The Lichtenstein technique was used to treat 65 hernias (11.6%). The mean operating time was 60 minutes for the conventional TAPP technique (n = 217) and 56 minutes for the MILS technique (n = 264). Postoperative abdominal wall mobility scored by Janda's method was significantly superior in the MILS group (4.6) than in the conventional laparoscopic group (3.7). Postoperative pain on the VAS scale was rated 1.3 in the MILS group versus 2.6 in the conventional TAPP group. Three (1.4%) recurrences occurred after the conventional TAPP technique, whereas no hernia recurrence occurred when a self-adhesive mesh was used. CONCLUSIONS: Minimization of trauma secondary to the trocar incision was able to reduce postoperative pain and improve abdominal wall mobility. The self-adhesive mesh may be inserted by the practiced laparoscopic surgeon with no delay, and optimizes incorporation in the groin by laminar mesh adhesion in the preperitoneal cavity.

In der heutigen Chirurgie gibt es zwar laufend technische Weiterentwicklungen, andererseits aber wenige neue Ideen. So hat uns ein besonderer Fall zu einem innovativen Konzept in der Magenchirurgie veranlasst.

BACKGROUND: Mesh implantation by median laparotomy is believed to reduce the rate of incisional hernia. The present study was performed to determine the types of meshes and fixation that would provide the required reinforcement of the midline. METHODS: Median laparotomies were performed on 17 recently deceased cadavers. By the onlay technique, 6 different meshes were fixed by the following methods: Tissucol Duo Quick, ProGrip, A.M.I. EasyTack, AbsorbaTack, ProTack, continuous absorbable monofilament suture fixation using 4-0, 3-0, 2-0, 0, 1 (PDS). Tensile forces were applied to the meshes, using a tensiometer, until mesh ablation or mesh disruption. RESULTS: With regard to the suture fixations, retention strength increased in direct proportion to thread thickness. All other fixation techniques failed to achieve the stipulated fixation strength of 40 Newton. CONCLUSIONS: By continuous suture fixation and by using the onlay technique, a mean mesh stability of 58 N in tissue can be achieved with at least 3-0 sutures. In addition to its simple applicability, this fixation method is economical and may be recommended for clinical use in order to achieve prophylactic reinforcement of the midline.

R adiographic visualization of the biliary and pancreatic ducts requires application of a radi-opaque contrast agent and thus depends on unimpaired bile excretion or invasive procedures. MR imaging may provide sufficient intrinsic contrast for evaluation of biliary and pancreatic ducts I I 1. Pulse sequences based on turbo spin-echo pulse sequences are well suited for ductal display by enhancing T2-relaxation contrast of static fluids 121. Acquisition of three-dimensional volumes during quiet breathing or overlapping two-dimensional slices in breath-holds may serve as source data for a projective ductal display with images resembling those obtained from direct cholangiopancreatography 3-6]. However, ductal display may suffer from mis-registration artifacts. information loss by reconstruction algorithms. lengthy examination and calculation times. and degraded image quality in planes other than the plane of acquisition [3-61. These problems are overcome by ultralong echo trains in turbo spin-echo sequences that provide selective ductal visualization with complete background suppression in a single shot of a few seconds [7, 8]. The purpose of this essay is to illustrate findings of pancreaticobiliary ductal disease using single-shot MR cholangiopancreatography (MRCP) based on more than 200 correlated patient examinations. This essay also shows common artifacts seen on single-shot MRCP images and the limitations of this technique.

PURPOSE: To compare depiction of the biliary tract with magnetic resonance (MR) and intravenous cholangiography before biliary surgery. MATERIALS AND METHODS: Intravenous cholangiograms and heavily T2-weighted single-shot MR images in 60 patients with biliary calculi were compared prospectively. Images obtained with each technique were independently assessed for depiction of anatomy and calculi. RESULTS: The gallbladder was adequately visualized with intravenous cholangiography in 77% of patients and with MR cholangiography in 88%. Rates for visualization of the common bile duct were 97% and 100%, respectively; for the cystic duct, 27% and 75%; and intrahepatic ducts, 28% and 77%. With either technique, calculi in the gallbladder were correctly predicted as solitary or multiple in approximately 80% of patients. Five cases of common bile duct calculi were correctly predicted with this technique, two cases with cystic duct calculi were depicted with only MR cholangiography. CONCLUSION: Single-shot MR cholangiography may replace intravenous cholangiography for visualization of the biliary tract. However, the delineation of tiny gallbladder calculi and shrunken gallbladders with thickened bile is limited.

Purpose: Evaluation of utility and value of a selective projection technique for bile and pancreatic ducts in MRI. Material and methods: 200 patient examinations of the pancreaticobiliary duct system using a turbo-SE pulse sequence in ''single-shot'' technique were evaluated in retrospect concerning anatomic display and diagnostic accuracy compared to surgery, ERCP, i.v. cholangiography, ultrasound and clinical course. Results: Non-dilated ducts allowed visualisation of gallbladders in 78%, common bile ducts in 97%, cystic ducts in 80%, intrahepatic main ducts in 71% and pancreatic main ducts in 69%. When dilatation was present, all common bile, intrahepatic main and pancreatic ducts were visible. Display of cystic ducts and gallbladders with a detection rate of 69 and 85%, respectively, did not improve. Sensitivities for diagnosing papillary stenoses (n = 6), pancreatic ductal stenoses and dilatation (n = 13), compressions and dilatations of the biliary tree (n = 33) as well as for one choledochal cyst were 100%. Choledudolithiasis could correctly be predicted in 11/15 cases (73%), cholecystolithiasis in 71/120 cases (59%). Conclusion: ''Single-shot'' MR-cholangiopancreaticography is a fast and non-invasive modality which can replace i.v. cholangiography and restrict the indication for ERCP to therapeutic indications and problem cases.

"Single-shot" MR-cholangiopancreatography is a fast and non-invasive modality which can replace i.v. cholangiography and restrict the indication for ERCP to therapeutic indications and problem cases.

Ziel: Evaluierung von Eignung und Aussagefähigkeit einer selektiven Darstellung von Gallenwegen und Pankreasgang in der MRT. Methode: 200 Patientenuntersuchungen des pankreatikobiliären Gangsystems mit einer Turbo-SE-Pulssequenz in Einzelschußtechnik wurden retrospektiv hinsichtlich anatomischer Abbildung der verschiedenen Gangabschnitte und diagnostischer Richtigkeit im Vergleich zu Operationsergebnissen, ERCP, i.v. Cholangiographie, Sonographie und klinischem Verlauf ausgewertet. Ergebnisse: Bei nichterweiterten duktalen Strukturen gelang eine durchgängige Abbildung der Gallenblase in 78 %, des D. choledochus in 97 %, des D. cysticus in 80 %, der intrahepatischen Hauptstämme in 71 % und des D. pancreaticus in 69 % der Fälle. Eine pathologische Erweiterung führte zu einer 100 %igen Abgrenzbarkeit von D. choledochus, den intrahepatischen Hauptstämmen und des D. pancreaticus; Gallenblase und D. cysticus kamen mit 85 % bzw. 69 % nicht häufiger zur Abbildung. Papillenstenosen (n = 6), Pankreasgangstenosen und -erweiterungen (n = 13), Kompressionen und Erweiterungen der Gallenwege (n = 33) sowie eine Choledochuszyste konnten in allen Fällen nachgewiesen bzw. wahrscheinlich gemacht werden. Der Nachweis einer Choleduktolithiasis gelang in 11/15 Fällen (73 %), der einer Cholezystolithiasis in 71/120 Fällen (59 %). Schlußfolgerung: Die vorgestellte MR-Cholangiopankreatikographie in Einzelschußtechnik kann als schnelle, nichtinvasive Bildgebung die i.v. Cholangiographie ersetzen und die ERCP auf therapeutische Indikationen und Problemfälle beschränken.

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.

Der CO2-Laser eignet sich in der Chirurgie insbesondere zum Schneiden, der ND:YAG Laser im “non-contact” Verfahren zur Koagulation. Da die Blutstillung bei Verwendung des C02-Lasers nicht den Erwartungen entsprach, war man bestrebt, beide Systeme in einem Strahl zu vereinigen, um die Eigenschaften beider kombiniert in der Chirurgie einsetzen zu können.

Das pharmakokinetische Verhalten von 5-Fluorouracil (5-FU) wurde nach alleiniger Bolusgabe und in Kombination mit Interferon alpha 2b (IFN) geprüft. 13 Patienten mit fortgeschrittenem kolorektalen Karzinom erhielten eine i.v. Bolusinjektion von 5-FU 750 mg/m2 und IFN 5 Millionen Einheiten (MU) 3mal wöchentlich subkutan. 5-FU-Plasmaspiegel wurden mittels HPLC über einen Zeitraum von 1 Stunde am Tag 1 vor Interferongabe sowie in der 2. oder 3. Behandlungswoche jeweils 1 Stunde nach der letzten Interferoninjektion bestimmt. Dabei zeigten die Pharmakokinetikparameter von 5-FU unter dem Einfluß von IFN eine signifikante Änderung, indem die fiktive Initialkonzentration (C0) um 60% sowie die Fläche unter der Kurve (AUC) um 56% anstieg und die totale Plasmaclearance (Cltot) um 55% reduziert wurde. Diese Daten liefern eine teilweise Erklärung für den für die Kombination IFN und 5-FU postulierten Synergismus, sowohl hinsichtlich erhöhter therapeutischer Wirkung wie auch verstärkter Toxizität.

Hepatic artery chemotherapy was given to 36 patients, using totally implantable devices consisting of a port and external pump. Twenty‐seven patients had inoperable liver metastases of colorectal origin. The infusion system was inserted by laparotomy into the hepatic artery via the gastroduodenal artery. There was no operative mortality. Thirteen infusion systems could not be used for chemotherapy due to dislodgement, early death and lack of follow‐up. FUdR was infused every two weeks. There were minor local complications like thrombosis of the system and dislodgement of the port. Toxic effects could be managed by reducing the dose. Response to chemotherapy was evaluated by survival, clinical condition, CEA, ultrasound and CT six months after onset of arterial chemotherapy. Ten/twenty‐three patients (43%) responded to therapy, eight of them died on the average 19 months after initial chemotherapy. Six patients were non‐responders, seven had stable disease. Five/ten patients developed extrahepatic metastases. Mean survival time was 13.1 months, mean interval until relapse 10.6 months.

Es wird über 2 Fälle iatrogener intraoperativer Gefäßverletzungen berichtet.