Purpose The association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation. Methods In this retrospective single-center study, all patients who underwent KT (01/2013–12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC). Results During the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m 2 vs. 25.0 kg/m 2 ; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower ( p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic. Conclusions At the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.

Die World Society of Emergency Surgery (WSES) und die American Association for the Surgery of Trauma (AAST) haben 2019 im Rahmen der WSES-AAST-Konsensuskonferenz in Parma, Italien die Erstauflage der Leitlinie zur Diagnostik und Therapie anorektaler Notfälle verabschiedet und 2021 publiziert. Dabei handelt es sich um die erste globale Leitlinie zu diesem für den Chirurgen so relevanten Thema. Dabei wurden sieben Erkrankungen diskutiert und die entsprechenden Therapieempfehlungen nach dem GRADE-Konzept (Grading of Recommendations Assessment, Development and Evaluation) ausgesprochen.

In 2019, the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) generated consensus recommendations for the treatment of anorectal emergencies in Parma, Italy, and published a guideline in 2021. This is the first global guideline dealing with this important topic for surgeons' everyday work. Seven anorectal emergencies were discussed and the guideline recommendations were given according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

The first edition of the World Society of Emergency Surgeons (WSES) guidelines on the indications and treatment of open abdomen in trauma as well as in non-trauma patients was published at the end of 2018. Publications from 1980 to 2017 were included in the evaluation. Based on the GRADE system each publication was checked for its evidence and evaluated in a Delphi process. In this article the aspects of the guidelines are presented and commented on.

Ende 2018 erschien die Erstauflage einer Leitlinie der World Society of Emergency Surgeons (WSES) zur Indikation und Behandlung des offenen Abdomens sowohl bei traumatischen als auch nichttraumatischen Patienten. Publikationen der Jahre 1980 bis 2017 gingen in die Auswertung ein. Jede Publikation wurde anhand des GRADE-Systems auf ihre Evidenz hin überprüft und im Delphi-Prozess bewertet. Im Beitrag werden die Aspekte der Leitlinie dargestellt und kommentiert.

Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon’s experiences and small case series in the literature. Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.

Die Diagnose der Appendizitis ist eine Herausforderung in der täglichen klinischen Praxis und weiterhin bestehen hohe Negativappendektomieraten (NAR) mit durchschnittlich 15%. Daher wird in einigen Ländern bei fast allen Patienten mit rechtseitigen Unterbauchschmerzen eine Computertomografie (CT) zur Diagnostik durchgeführt, was aufgrund der hohen Strahlenbelastung kritisch zu bewerten ist.

Die seit etwa 60 Jahren bekannte nicht-operative, antibiotische Therapie der akuten Appendizitis wird in Folge mehrerer randomisierter Studien seit 2006 intensiv wissenschaftlich diskutiert. Erste Langzeitergebnisse liegen vor. Es ist weitgehend unbekannt, ob diese Therapie in der alltäglichen klinischen Praxis in Deutschland Anwendung findet.