key: cord-0031210-2g46y1v2
authors: nan
title: 63rd Annual Meeting of the Austrian Society of Surgery
date: 2022-05-11
journal: Eur Surg
DOI: 10.1007/s10353-022-00763-x
sha: 91ebd7735a51d777653f7a3a1b5fea7866432532
doc_id: 31210
cord_uid: 2g46y1v2

nan

Neckdissection beim Schilddrüsenkarzinom -standardisiertes Vorgehen bei der lateralen Halsdissektion Hermann M 1 1 Rudolfstiftung -Klinik Landstraße, 1030 Wien, Österreich Ziel: Die zentrale Halsdissektion (Level VI und VII nach Robbins) ist zentraler Bestandteil der Chirurgie des papillären und medullären Schilddrüsenkarzinoms. Die laterale Halsdissektion (sog. Neckdissection) stellt die Erweiterung der Lymphadenektomie außerhalb der Schilddrüsenloge in Level II bis V dar.

Methoden: Die Operation erfordert eine besondere Kenntnis der Halsanatomie und ein standardisiertes operatives Vorgehen. Zugangswege und Ablauf der Operation werden in einzelnen OP-Schritten anhand von OP-Bildern dargestellt.

Ergebnisse: Alternativ zum hochgezogenen Schnitt zum Kieferwinkel kann ein horizontal erweiterter Kocherscher Kragenschnitt als Zugang gewählt werden. Der Vorteil ist ein wesentlich besseres kosmetisches Ergebnis, der Nachteil eine schwierigere Exploration des Kieferwinkels bzw von Level II. Speziell dargestellt wird die laterale Halsdissektion der Level II bis V mit Aufsuchen und Neuromonitoring des N. phrenicus, N. accessorius, N. hypoglossus und N. laryngeus superior (Ramus externus), des Plexus cervicalis und brachialis. Die Revision des Level I steht zur Diskussion. Tipps und Tricks zur Radikalität und Vermeidung von Komplikationen werden präsentiert.

Schlussfolgerungen: Eine subtile prophylaktische oder therapeutische Level II-V Dissektion am lateralen Hals ist die Voraussetzung für eine Sanierung der Tumorerkrankung und Vermeidung von komplikationsträchtigen Reoperationen. Der Schilddrüsenchirurg sollte diese Technik routiniert beherrschen, auch um nicht auf andere operative Disziplinen angewiesen zu sein.

Ziel: Die Resektion von Lungenmetastasen ist Teil eines etablierten Konzept in der interdisziplinären Behandlung kurativ zu versorgender onkologischer Patienten. The International Registry of Lung Metastases hat sich zur Aufgabe gemacht prognostische Faktoren und Leitlinien zur Lungenmetastasenchirurgie zu erstellen. Es stellt sich nun die Frage ob bei allen Tumorentitäten die Kriterien der Metastasenchirurgie an der Lunge anzuwenden sind. Diese müssen resektabel sein, das allgemeine und funktionelle Operationsrisiko muss vertretbar sein und der Primärtumor sollte behandelt oder behandelbar sein. sen wird und so die Versorgung in einem Zentrum für peritoneale Neoplasien geplant werden kann.

Methoden: Rückblick auf die Behandlung von PatientInnen mit Pseudomyxoma peritonei in der Zeitspanne 2015 bis 2022.

Ergebnisse: Anhand von unseren Erfahrungen und durch Fallberichte aus unserem Zentrum zur Behandlung von peritonealen Neoplasien soll gezeigt werden, wie Patienten und Patientinnen, die an einem Pseudomyxoma peritonei erkrankt sind, eine entsprechende onkologisch operative Therapie mit guter Langzeitüberlebensprognose erhalten können.

Schlussfolgerungen: Egal, ob das Pseudomyxoma peritonei durch primäre Versorgungszuweisung an ein Peritonealcarcinosezentrum oder durch Folgezuweisung nach unerwartetem Operationssitus behandelt wird, sind die Therapieerfolge durch adäquate zytoreduktive Chirurgie kombiniert mit hyperthermer intraperitonealer Chemotherapie ( HIPEC) am besten.

Is the CTS5 a helpful decision-making tool in the extended adjuvant therapy setting?

Patienten/innen (45 %) therapeutisch (endoskopisch nicht suffizient stillbare Blutung). Eine Operation war bei 6 Patienten/ innen (10,3 %) nach Embolisation nötig (Stenose 1×, Perforation 1×, persistierende Blutung 3×, Ileus 1×). Zu einer Re-Blutung kam es bei insgesamt 6 Patienten/innen (10,3 %) , wobei 3 Patienten/innen operativ versorgt werden mussten. Insgesamt liegt die Mortalitätsrate bei 15,5 %, welche mit steigendem Alter signifikant erhöht ist (p = 0,011). Frauen verstarben postinterventionell eher (p = 0,051).

Schlussfolgerungen: Zusammenfassend hat sich die transarterielle Embolisation als wertvolle Methode zur Hämostase im oberen Gastrointestinaltrakt bei endoskopisch nicht stillbarer Blutung etabliert. Alter und Geschlecht zeigen einen signifikanten Zusammenhang mit einer erhöhten Mortalität. Diese Tendenz zeigt sich auch bei steigendem Rockall-Score.

Endoskopisch-interventionelles Management der akuten Ösophagusperforation nach Bolusgeschehen Aigner C 1 , Klimbacher G 1 , Shamiyeh A 1 1 Kepler Universitätsklinikum, Klinik für Allgemein-und Viszeralchirurgie, Linz, Österreich Ziel: Das akute ösophageale Bolusgeschehen beim Erwachsenen erfordert häufig eine notfallmäßige endoskopische Intervention, diese sollte innerhalb von 2 bis höchstens 6 Stunden erfolgen, bei zeitlicher Verzögerung kommt es zu einem Anstieg der Komplikationsrate. Eine eosinophile Ösophagitis kann ursächlich für ein Bolusgeschehen sein und liegt bei bis zu der Hälfte der akut interventionsbedürftigen Patienten vor.

Methoden: Eine 33-jährige Patientin wurde aufgrund des Verdachts einer Ösophagusperforation nach akutem Bolusgeschehen ins Kepleruniklinikum überwiesen. Es erfolgte eine akute CT des Thorax und Abdomen in der sich freie Luft im Mediastinum, an den Halsweichteilen und bis nach intraabdominell reichend zeigte. In der Notgastroskopie zeigte sich eine tiefe Ösophagusläsion am oberen Ösophagussphinkter. Es ergab sich makroskopisch der Verdacht einer eosinophilen Ösophagitis. Therapeutisch erfolgte die Anlage einer Magensonde sowie eines Endo-VAC-Systems. In der Kontroll-CT 4 Tage nach der Anlage des VACs zeigte sich die freie Luft rückgebildet. Endoskopisch zeigte sich eine gute Granulation. Das System konnte somit bereits am 4. Tag entfernt werden. Ein Schluckaktröntgen am Folgetag ergab keinen Kontrastmittelaustritt. Der weitere Verlauf gestaltete sich komplikationslos. In wiederholten Biopsien konnte der Verdacht auf eine eosinophile Ösophagitis nicht bestätigt werden. Es lag ursächlich eine Refluxösophagitis vor.

Schlussfolgerungen: Bei akuter Ösophagusperforation nach Bolusgeschehen sollte die Versorgung durch ein Schwerpunktkrankenhaus erfolgen -eine endoskopisch interventionelle VAC-Therapie kann in geeigneten Fällen rasch zur Abheilung führen. Eine Abklärung der Ursache mittels Kontrollendoskopie und Gewinnung einer Histologie im Intervall erscheint sinnvoll um rezidivierende Ereignisse zu vermeiden.

Ziel: Choledochuszysten sind seltene Erweiterungen des Gallenwegssystems und stellen <1 % aller benignen Gallenwegserkrankungen dar. Sie werden nach Todani in fünf Typen entsprechend ihrer Lokalisation eingeteilt. Choledochuszysten Typ III entsprechen einer Dilatation des Ductus hepatocholedochus im intraduodenalen Verlauf und werden auch als Choledochozelen bezeichnet. Sie stellen etwa 1,4-4,5 % aller Choledochuszysten dar.

Methoden: Eine 23-jährige gesunde Frau wird in der 11. Schwangerschaftswoche akut wegen heftigster Oberbauchkoliken vorstellig. Sonographisch findet sich eine Sludge-gefüllte Gallenblase und der DHC erweitert (9 mm). Das Cholestaselabor ist erhöht. Von einer Choledocholithiasis wird primär ausgegangen.

Ergebnisse: Unter konservativer Therapie entwickelte sich laborchemisch im Verlauf eine biliäre Pankreatitis. Die MRCP in Nativtechnik zeigte eine 9 mm messende zystoide Erweiterung der Pankreasgang-oder Choledochusmündung in der medialen Duodenalwand. Bei anhaltenden Koliken trotz spasmolytischer Therapie und Analgesie wurde eine ERCP indiziert. Aus einer 15 × 12 mm messenden zystischen Impression der medialen Duodenalwand entleerte sich nach Precut-Papillotomie klare Gallenflüssigkeit, die gesamte Choledochuszyste konnte durch eine vollständige Papillotomie eröffnet werden. Die Patientin war unmittelbar anschließend beschwerdefrei.

Schlussfolgerungen: Die MRCP gilt als nicht invasiver Goldstandard in der Diagnostik von Gallengangspathologien. Die genauste Untersuchungsmethode stellt die ERCP dar. Sie bietet bei Choledochuszysten Typ III zudem die therapeutische Option der Sphinkterotomie (zur Optimierung des transpapillären Galleabflusses) und kann von erfahrenen EndoskopikerInnen auch in der Schwangerschaft durchgeführt werden.

Endoskopisches und interventionelles Management von nicht-varikösen Blutungen im oberen Gastrointestinaltrakt: Erfahrungen mit transarterieller Embolisation eines Single Centers 1 Universitätsklinik für Allgemeinchirurgie, Klinische Abteilung für Viszeralchirurgie, Medizinische Universität Wien, Vienna, Austria Aim: Neoadjuvant treatment is increasingly utilized in patients with pancreatic ductal adenocarcinoma ( PDAC). While kationsform der Energieflussdichten. Dabei betrug die Gesamt-Energie, die zum erfolgsreichen Therapieeffekt führt, 180mJ.

Ergebnisse: Nach der Applikation hochenergetischer extrakorporaler Stoßwellen profitierten die Patienten insofern, dass die Beschwerde-Symptome sofort nach der Therapie verschwanden und im Laufe weiterer 3-6 Sitzungen die Gehstrecken von 20 bis 50 m auf 0.5-5Km verlängert werden konnten. Nachfolgeuntersuchungen mit der Angio-MR zeigten eine ausreichende Bildung von Kollateralen um die Stenose und der Ankle-Bein-Index verbesserte sich von 0,3 bis auf 0,9 nach sechs beschwerdefreien Monaten.

Schlussfolgerungen: Die Wertigkeit der ESWT stellt, aus physikalisch-medizinischer Perspektive betrachtet, eine Therapieform, evtl. ergänzend zum konservativ chirurgischen Verfahren und der Strahlentherapie, dar. Da keine Nebenwirkungen bzw. Komplikationen der ESWT, weder bei der Durchführung noch beim posttherapeutischen Verlauf bekannt sind, dies zumindest bei korrekt durchgeführten Therapien, wird sie in zukünftigen Überlegungen bei vielen Pathologien erste Wahl der Therapie sein. Das Spektrum von möglichen Erkrankungen, die durch ESWT geheilt werden können, wird sehr weit und breit aus medizinisch -physikalischer Perspektive sein, seien es banale orthopädische chronische Erkrankungen oder bis zu onkologischen nicht therapierbaren.

Referenzen : 

Kontrastmittel-verstärkte Magnetresonanztomographie mittels Sekretinstimulierter MRCP zur Unterscheidung benigner und maligner solider Raumforderungen der Bauchspeicheldrüse Kristic A 1 , Bastati N 1 , Poetter-Lang S 1 , Messner A 1 , Muehlbacher J 1 , Ba-Ssalamah A 1 , Sahora K 1 , Schindl M 1 1 Medizinische Universität Wien, Wien, Österreich Ziel: Das Pankreaskarzinom stellt nach wie vor weltweit eine lebensbedrohliche Erkrankung dar, welche so früh wie möglich, rasch und genau diagnostiziert sowie adäquat behandelt werden muss, um eine Überlebenschance zu ermöglichen. Für eine Pankreasresektion ist eine histologische Diagnosesicherung nicht zwingend erforderlich, sofern die Verdachtsdiagnose mit hoher Wahrscheinlichkeit gestellt wird, der Tumor bildmorphologisch resektabel und ohne Hinweis auf Fern-Metastasierung erscheint. Daher ist eine zuverlässige Bildgebung zur individuellen Behandlungsplanung bei umschriebenen Raumforderungen der Bauchspeicheldrüse von besonderer Bedeutung. In der vorliegenden Studie soll untersucht werden, ob eine korrekte Unterscheidung zwischen bösartiger und gutartiger bzw. entzündlicher, umschriebener Raumforderung der Bauchspeicheldrüse mittels Kontrastmittel-verstärkter Magnetresonanztomographie ( KM-MRT) und Sekretin-stimulierter MRCP (S-MRCP) verlässlich, möglich ist. 63rd Annual Meeting of the Austrian Society of Surgery 1 3 11.3 ctDNA in der liquid biopsy -eine neue Möglichkeit zur Früherkennung subklinischer Fernmetastasen oder eines Rezidivs beim Pankreaskarzinom Kirchweger P 1,2,3 , Rumpold H 2,3 , Wundsam H 1 , Biebl M 1,3 1 Ordensklinikum Linz -Department of Surgery, Linz, Österreich 2 Ordensklinikum Linz -Gastrointestinal Cancer Center, Linz, Österreich 3 JKU Linz -Medical Faculty, Linz, Österreich Ziel: Das minimalinvasive Detektieren von Tumorzellen (CTCs) und deren zellfreie (cfDNA) bzw. zirkulierende DNA (ctDNA) durch simple Blutabnahmen (liquid biopsy) bietet eine einfache Möglichkeit kontinuierliche Krankheitsveränderungen in Echtzeit (auch seriell) von der gesamten Tumorlast zu visualisieren. Abgesehen vom unabhängigen prognostischen Wert ( OS, PFS), könnte ctDNA zur Früherkennung subklinischer Disseminierung und somit zur Risikostratifizierung und Therapieentscheidungshilfe herangezogen werden. So ein Marker ist speziell beim Pankreaskarzinom mit seiner hohen Rezidivwahrscheinlichkeit und relativ hohem Anteil an im konventionellen Staging undetektierten Metastasen (bis zu 25 % erst in der Laparoskopie oder explorativen Laparotomie detektiert) von großem Interesse.

Methoden: An unserem Zentrum wurde prospektiv ctDNA mittels liquid biopsy bei gastrointestinalen Tumoren (Pankreas, Kolorektal, Upper GI) gesammelt, wobei bisher über 250 Patienten (ca. 200 Patienten mit seriellen Messungen) untersucht wurden. In einer rezenten Arbeit haben wir prospektiv die ctDNA von 107 Pankreaskarzinompatienten (60 lokalisiert, 47 metastasiert) vor Einleitung der Therapie ( OP bzw. Systemtherapie) mittels ddPCR (digital droplet polymerase chain reaction) untersucht und mit dem Tumorvolumen, Rezidiv-und Überlebensraten korreliert. Theoretisch wäre das PDAC ein ideale Tumorentität für Screening PCRs ohne zuvor das Target ( NGS aus FFPE-Gewebe) zu kennen, da über 90 % eine KRAS Mutation (meist KRAS G12/13 oder Q61) aufweisen.

Ergebnisse: Die tatsächlichen Detektionsraten in der Peripherie (liquid biopsy) sind deutlich niedriger, hängen stark von der tatsächlichen Tumorlast ab und weisen eine große Streuung in der Literatur auf ( UICC I-II: ca. . In der eigenen Kohorte fanden wir die Mutation in 10 % der lokalisierten (lPDAC) und 64 % der metastasierten Pankreaskarzinome (mPDAC). Prognose: ctDNA Positivität ist ein unabhängiger prognostischer Marker für PDAC unabhängig vom Tumorstadium ( OS HR = 2.093, p = 0.028; DFS HR 4.543, p = 0.006). Patienten mit lPDAC, welche nach der neoadjuvanten Chemotherapie ctDNA positiv bleiben, leiden zu 100 % an einem Frührezidiv ( DFS 3, 3 vs. 18, 1 Monate, OS 5, 8 vs. 16, 3 Monate) . Dasselbe gilt für die postoperativ persistierende Detektion. Therapieüberwachung: Liquid biopsy zeigt Frührezidive mit einer Lead-Time von 1-2 Monaten im Vergleich zum bisherigen Goldstandard ( CA 19-9 und Computertomografie). In der eigenen Kohorte (n = 71 mPDAC) konnten wir das Ansprechen auf die Chemotherapie bereits nach 2 Wochen zeigen (Sens. ca. 95 %). Herkunft der ctDNA: Eine volumetrische Subsetanalyse in unserer Kohorte zeigte eine Korrelation von ctDNA mit lokoregionalen Lymphknoten (lPDAC), Metasta Herkunft der ctDNA: Eine volumetrische Subsetanalyse in unserer Kohorte zeigte eine Korrelation von ctDNA mit lokoregionalen Lymphknoten (lPDAC), Metastasenvolumen insbesondere der neoadjuvant treatment is the only chance for successful conversion surgery in patients with locally advanced tumors, the main rationale for neoadjuvant treatment in borderline resectable PDAC is to increase the chance for microscopic tumor clearance. The resection margin (R) status has been identified as an independent prognostic factor of survival in patients undergoing upfront resection for PDAC. The prognostic significance of the R status in patients with PDAC undergoing resection following neoadjuvant treatment is poorly investigated. The aim of this cohort study and meta-analysis was to investigate the prognostic significance of R status in PDAC patients treated with neoadjuvant therapy.

Methods: Cohort studies investigating associations between resection margins and survival in PDAC patients undergoing resection following neoadjuvant treatment were searched in Medline, Web of Science, and the Cochrane Central Register of Controlled Trials ( CENTRAL). The search was limited to studies published between 2010 and 2022. Hazard ratios ( HR) were pooled using a random-effects model meta-analysis and the results presented with the corresponding 95 % confidence interval ( CI). Subgroup analyses were performed to account for inter-study heterogeneity regarding the definition of margin status, and inter-study differences in methodological quality. Additionally, consecutive patients with PDAC undergoing resection after neoadjuvant treatment were identified from an institutional registry. R status was categorized as R0 ≥1 mm, R1 <1 mm, and R1 direct (microscopic tumor infiltration at margin). Margin categories were compared between these groups and tested for survival prediction. Results from proportional hazards regression (Cox model) analysis were included in metaanalysis.

Results: Of 2,347 abstracts screened, 21 studies were included in the final qualitative and quantitative synthesis. The total number of patients was 4,941, including 61 patients identified from the institutional registry. R1 direct rate was 8 %, R0 rate 32 %, R0 ≤1 mm rate 11 %, and R0 ≥1 mm rate 48 %, respectively. R0 resection was associated with prolonged overall survival compared to combined R1 direct resections ( HR 1.38, 95 % CI 1.01 to 1.90, p = 0.04) using univariable data. No independent associations between different definitions of the R status and survival could be observed. Subgroup analyses including only data from high quality studies did not substantially alter the results.

Conclusions: The results from this meta-analysis including unpublished data from the authors' institution show that R status is a significant prognostic factor of overall survival in PDAC patients undergoing resection after neoadjuvant treatment. Pooled data from multivariable analysis, however, did not confirm R status as an independent prognostic factor. Difficulties in pathological assessment of specimen after neoadjuvant treatment combined with the limited number of studies and nonstandardized pathology protocols hamper inter-study comparability. Uniform and internationally accepted definitions of margin status are urgently needed.

63rd Annual Meeting of the Austrian Society of Surgery 1 3

Portal vein resection in pancreatic cancer surgery: risk of thrombosis and radicality determine surviva Klaiber U 1 , Strunk S 2 , Hinz U 2 , Strobel O 1 , Büchler MW 2 , Hackert T 2 1 Universitätsklinik für Allgemeinchirurgie, Klinische Abteilung für Viszeralchirurgie, Medizinische Universität Wien, Vienna, Austria 2 Chirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany Aim: Radical surgery combined with systemic treatment offers the only chance for cure in pancreatic cancer. Resection of the portal vein is often required to achieve complete tumor clearance in borderline resectable or locally advanced tumors after neoadjuvant treatment. Even though increasingly performed, portal vein resection still represents a challenging extension to an already demanding operation as it is associated with potentially increased perioperative morbidity and mortality. Differences in outcomes among the four types of venous resection as defined by the International Study Group of Pancreatic Surgery ( ISGPS) have been poorly investigated to date. The primary aim of this study was therefore to evaluate the outcomes of surgery for pancreatic cancer with concomitant portal vein resection, focusing on the type of venous resection according to the ISGPS. Secondary objective was to identify prognostic factors of survival in these patients.

Methods: This is a single-center, comparative cohort study of a prospectively collected pancreatic database. Consecutive patients with pancreatic cancer operated between January 2006 and January 2018 were included in this study and followed until death or last follow-up. Clinicopathological characteristics and outcomes were analyzed and tested for survival prediction using proportional hazards regression (Cox model) analysis. Tumor-free margin >1 mm was classified as "R0", while tumorfree margin ≤1 mm and direct microscopic tumor invasion of the resection margin were classified as "R1" resection.

Results: Of 2,265 resections for pancreatic cancer, 1,571 (69.4 %) were standard resections and 694 (30.6 %) were resections with portal vein resection, including 149 (21.5 %) tangential resections with venorrhaphy ( ISGPS type 1), 21 (3.0 %) resections with patch reconstruction ( ISGPS type 2), 491 (70.7 %) end-to-end anastomoses ( ISGPS type 3), and 33 (4.8 %) resections with graft interposition using prosthesis or allogeneic vein grafts ( ISGPS type 4). The 90-day mortality rate was 2.6 % after standard resection and 6.3 % after resection with portal vein resection (p < 0.0001). Postoperative portal vein thrombosis and pancreas-specific surgical complications including postoperative pancreatic fistula, postpancreatectomy hemorrhage and delayed gastric emptying most frequently occurred after portal vein resection with graft interposition (21.2 % and 48.5 %, respectively). In multivariable analysis, age ≥70 years, American Society of Anesthesiologists ( ASA) stages 3 and 4, increased preoperative serum CA 19-9 levels, neoadjuvant treatment, total pancreatectomy, portal vein resection, advanced tumor stage (as defined by the Union for International Cancer Control, UICC), and R1 resections were significant negative prognostic factors for overall survival. Radical R0 (>1 mm) resection resulted in 23.3 months median overall survival after pancreatic resection combined with portal vein resection compared to 46.2 months after standard resection (5-year survival rates 20.4 % versus 43.5 %, p < 0.0001).

Leber (mPDAC) und Gesamt-(mPDAC), jedoch keine Korrelation mit dem Primärtomurvolumen (lPDAC, mPDAC) .

Schlussfolgerungen: Die Detektion von ctDNA mittels liquid biopsy ist bereit für den Einsatz in der klinischen Routine. Dort könnte sie als äußerst sensitiver Marker für die Prognose, Risikostratifizierung und Therapieüberwachung unabhängig vom Tumorstadium dienen. Sie bietet die Möglichkeit zum frühen Ändern der Chemotherapie (mPDAC) oder der Extensivierung der neoadjuvanten Therapie (lPDAC), da eine präoperativ positive ctDNA beim lPDAC meist subklinische Lebermetastasen oder eine extensive Lymphknotenbeteiligung anzeigt. Eine nicht detektierbare ctDNA ist jedoch nur eingeschränkt aussagekräftig, da eine mögliche Mutation in der Peripherie je nach Tumorlast in 30-90 % ( UICC IV-I) nicht nachweisbar oder nicht vorhanden ist. Jene, die jedoch positiv sind, sollten besonders evaluiert werden.

The rate of avoidable pancreatic resections at a high-volume center: an internal quality control and critical review Aim: The incidence of benign diseases among pancreatic resections for suspected malignancy still represents a relevant issue in the current surgical practice. This study aims to identify and review the preoperative pitfalls that led to unnecessary surgeries at a single Austrian center over the last twenty years.

Methods: All patients undergoing surgery for suspected pancreatic/periampullary cancer or neuroendocrine tumor between 2000 and 2019 at the Linz Elisabethinen Hospital were included. Outcomes considered were the rate of "mismatches" between the clinical suspicion and the definitive histology. All cases that -despite the benign diagnosis -fulfilled the indication criteria for surgery were defined as minor mismatches ( MIN-M) . Conversely, the true unnecessary and avoidable surgeries were identified as major mismatches ( MAJ-M) .

Results: Among the 430 included patients, 15 (3.5 %) presented with benign lesions at definitive pathology. The rate of MAJ-M amounted to 2 % (n = 9), and the most frequent causes of misdiagnoses were autoimmune pancreatitis ( AP, n = 4) and intrapancreatic accessory spleen ( IPAS, n = 2). In all cases of MAJ-M, various inaccuracies or mistakes within the preoperative workout were detected: lack of a multidisciplinary discussion of cases (n = 7, 78 %); inappropriate preoperative imaging (n = 4, 45 %); non-measurement of specific blood markers (n = 7, 78 %). The overall morbidity and mortality rates for MAJ-M patients were 46.7 % and 0, respectively.

Conclusions: All avoidable surgeries were the result of an incomplete pre-operative workout. The adequate identification of the underlying pitfalls and errors could lead to minimize and, potentially, overcome this phenomenon, leading to a concrete optimization of the whole surgical-care process.

Ziel: Seit der Einführung des Operationsmikroskops in die Neurochirurgie in den späten 1950er stellt das Operationsmikroskop den Standard zur intraoperativen Visualisierung dar. Durch die Verbesserung der Ausleuchtung, der Stereoskopie und der Vergrößerung des Operationsmikroskops konnten völlig neue Operationen durchgeführt werden. In den letzten Jahren haben verschiedene Anbieter Alternativen zu dem klassischen Operationsmikroskop auf den Markt gebracht. Durch diese Exoscope ergeben sich neue Möglichkeiten in der Neurochirurgie, aber vielleicht auch in anderen chirurgischen Fachdiszilipnen.

Methoden: Wir haben in den letzen Monaten ingesamt vier unterschiedliche Exoscope testen können und somit einen Vergleich zu den altbewährten Operationsmikroskopen stellen können. Alle vier Exoscope, von unterschiedlichen Firmen, haben als Gemeinsamkeit, dass es im Vergleich zum klassischen Operationsmikroskop kein Okular mehr gibt, sondern das Bild von einem digitalen Sensor erfasst wird, digital verarbeitet wird und dann auf unterschiedliche Weise zur Darstellung gebracht wird. Das RoboticScope der Firma bis arbeitet mit einem Helmsystem, wobei sich die Monitore direkt vor den Augen befinden. Die restlichen 3 Systeme arbeiten mit Monitoren und 3D Brillen zur Erzeugung eines stereoskopischen Bildes. Ein weiterer Unterschied im Vergleich zum Operationsmikroskop ist die Steuerung der Exoscope. Zwei Exoscope werden über einen Robotorarm gesteuert (RoboticScope und Aeos). Das Orbeye der Firma Olympus bietet eine semirobotische Steuerung und das Vitom der Firma Store bietet eine mechanische Steuerung.

Ergebnisse: Jedes der getestet Exoscope wurde bei diversen neurochirurgischen Eingriffen getestet werden. Aufgrund der unterschiedlichen Visualisierung im Vergleich zum Mikroskop musste für ein jedes System ein Konzept zur Positionierung des Exoscops und des, oder der Monitore erarbeitet werden. Dieses Konzept musste an spinale und diverse kraniale Eingriffe angepasst werden. Prinzipiell konnten sich alle Chirurgen relativ schnell auf das Exoscope umstellen. Trotz der verschieden Konzerte der Exoscope, gibt es einige gemeinsame Vorteile gegenüber den klassischen Operationsmikroskopen. Alle Exoscope bieten im Vergleich zum Operationsmikroskop ein verbesserte Tiefenschärfe was zu einer kürzen Operationszeit führt, da seltner fokussiert werden muss. Die verwendeten LED Lichtquellen bieten eine bessere Ausleuchtung des Op Gebietes als die noch weit verbreiteten Xenon Lichtquellen in den Operationsmikroskopen. Durch die Entkopplung von optischen Sensor und darstellenden System erlauben die Exoscope neue Blickwinkel, die mit einem klassischen Operationsmikroskop nicht möglich sind. Ebenfalls kommt es durch diese Entkopplung zu einer verbesserten Ergonomie des Chirurgen. Im wesentlichen konnten wir auch feststellen, dass das Bild am Monitor die Augen wegen der ermüdet, als wir es von Eingriffen mit dem Mikroskop gewohnt sind.

Schlussfolgerungen: Nach unseren Erfahrungen mit diesen Exoscopen sind wir uns sicher, dass exoskopische Systeme das klassische Operationsmikroskop in den Jahren ersetzten wird. Wir befinden uns erst am Anfang einer Entwicklung. Die digitale Bildverarbeitung, die robotische Steuerung stellen klare Vorteile zum klassischen Operationsmikroskop dar. Die Einbindung der Systeme in die Neuronavigation, von Fluoreszenz gestützter Chirurgie sind weitere essentielle Schritte in der Entwicklung.Wir sehen das Potential dieser Technik aber nicht nur in der Neurochirurgie, sondern auch in anderen chirurgischen Fachrichtungen, die bis jetzt ohne Operationsmikroskop gearbeitet haben. Die verbesserte Ausleuchtung, die verbesserte Tiefenschärfe zusammen mit der Vergrößerung und der verbesserten Ergonomie könnte eine neue Dimension für viele chirurgische Eingriffe bedeuten.

Conclusions: This is the largest single-center study analyzing the surgical and oncological outcomes of pancreatic resections with concomitant venous resection. The results of this study show that a type 4 reconstruction should be avoided whenever technically feasible due to an increased risk of early thrombosis. A "true" R0 resection with a margin clearance >1 mm is of prognostic relevance and therefore, a radical surgical approach is essential to achieve this. The ideal management of borderline resectable tumors regarding neoadjuvant therapy remains controversial. The results from upcoming randomized controlled trials addressing this topic will bring further insights into the best treatment strategy for patients with these tumors.

Continuous lavage in prevention of clinically relevant postoperative pancreas fistula Varga M 1 , Pölsler L 1 , Presl J 1 , Gantschnigg A 1 , Gruber R 1 , Hutter J 1 , Emmanuel K 1 , Koch O 1 1 Universitätsklinik für Chirurgie, SALK, Salzburg, Austria Aim: Clinically relevant postoperative pancreatic fistula ( CR-POPF) remains the weak point of pancreas surgery affecting approximately 15 % of patients and is associated with increased rate of postoperative bleeding, infectious complications and mortality. In clinical praxis, CR-POPF evolves usually from initial biochemical leak to grade B and C fistula. Continuous lavage of the pancreas juice via drainage placed to anastomosis intraoperatively could reduce its local concentration and subsequent development of CR-POPF and complications.

Methods: All patients who underwent pancreas head resection between January 01Th 2018 and December 31Th 2020 were analyzed. Group A became lavage catheter and Group B became standard drainage intraoperatively to pancreas. Continuous lavage was started in Group A by positive amylase in drain (over 1000 U/l) on postoperative day 1 and flow was adapted between 10 to 100 ml 0,9 % NaCl/hour until the reduction of concentration under 1000 U/ l. The results were than compared with control Group B.

Results: From 118-pancreas resection 53 matched study criteria. Analyzed were 15 patients in Group A and 38 in Group B. Incidence of biochemical leak was 7 (46 %) and 13 (34 %) and lavage was started in all these patients in Group A. Incidence of CR-POPF was 0 (0 %) and 5 (13 %) (p = 0,46, Not significant), mortality was 0 (0 %) and 2 (5 %).

Conclusions: Continuous lavage of the pancreas juice by biochemical leak seems to reduce incidence of clinically relevant postoperative pancreatic fistula. To draw firm conclusions a prospective trial is mandatory.

Exoscope -eine neue Dimension in der Chirurgie Regatschnig R 1 , Schweiger S 1 , Himmelbauer E 1 , Burtscher J 1 1 Lk Wiener Neustadt, Wiener Neustadt, Österreich 63rd Annual Meeting of the Austrian Society of Surgery MN, USA) stellt eine Weiterentwicklung der NIRAF dar, die sich von bisherigen Produkten durch eine zusätzliche Anpassung der Intensität des Anregungslichtes und einer Nahinfrarot-Überlagerung unterscheidet. Ziel dieser prospektiven Studie ist die Definierung von Standards für die Verwendung von Elevi-sion™ und der sich daraus stellende klinische Nutzen.

Methoden: Insgesamt wurden 113 PatientInnen (weiblich = 78(69 %)), bei welchen Elevision™ von Januar bis November 2021 mindestens zur intraoperativen Visualisierung einer Nebenschilddrüse eingesetzt wurde, in diese prospektive Studie eingeschlossen. Ob die primäre Darstellung der Nebenschilddrüsen durch den Chirurgen oder durch die Elevision™ erfolgt, wurde dokumentiert. Die ideale Distanz und Infrarot-Intensität ( IR%) bei den Messungen wurden ebenfalls dargestellt. Nach Durchführung einer Thyreoidektomie wurde das Präparat mittels Overlay-Ansicht nach weiteren Nebenschilddrüsen untersucht.

Ergebnisse: Insgesamt wurden 311 Nebenschilddrüsen mit 191 nerves at risk analysiert. Bei 65 (57,5 %) PatientInnen konnte die gleiche Anzahl der Nebenschilddrüsen durch den Chirurgen und mittels Overlay-Ansicht lokalisiert werden. Bei 33 (29,2 %) PatientInnen konnte der Chirurg mehr Nebenschilddrüsen lokalisieren und bei 15 (13,3 %) PatientInnen konnten mehr Nebenschilddrüsen mittels Elevision™ detektiert werden. Die ideale Distanz bei den Messungen umfasst einen Bereich von 8 bis 11 cm mit einem mittleren IR% von 42,5 % (±17).

Schlussfolgerungen: Im Gegensatz zu den restlichen NIRAF-Bildgebungsverfahren ermöglicht die Overlay-Ansicht eine intraoperative Echtzeit-Bildgebung. Unter Berücksichtigung der Limitationen, wie die unterschiedlichen Autofluoreszenzmuster, Einfluss der Lage und des umgebenden Gewebes der Nebenschilddrüsen, dient es dem Chirurgen als intraoperatives Hilfsmittel zur Lokalisierung der Nebenschilddrüsen.

Anzahl der zentralen Kompartment-Lymphknoten bei Autoimmun-versus Nicht-Autoimmun-Erkrankungen der Schilddrüse: Analyse anhand der OP-Präparate von Schilddrüsenkarzinomen nach zentraler Halsdissektion Manhartsgruber Y 1 , Kurtaran A 2 , Wicher AS 2 , Hermann M 2 1 Sigmund Freud Privatuniversität -Medizinische Fakultät, Wien, Österreich 2 Klinik Landstraße, Wien, Österreich Ziel: Die Hashimoto-Thyreoiditis ( HT) ist die häufigste entzündliche Erkrankung der Schilddrüse. Das Ziel dieser Arbeit war es, herauszufinden, ob es Unterschiede in der Anzahl der zentralen Halslymphknoten bei Hashimoto-Thyreoiditis im Vergleich zu "nicht -autoimmunen" Erkrankungen der Schilddrüse gibt.

Methoden: Patient* innen mit einem papillären Schilddrüsenkarzinom wurden retrospektiv untersucht. Sie wurden in eine HT-und eine Nicht-HT-Gruppe unterteilt. Als Kriterium für HT wurde der histo-pathologische Befund bzw die lymphocytäre Infiltration der Schilddrüse herangezogen. Alle Patient* innen der Studie wurden einer beidseitigen zentralen Halsdissektion unterzogen. Es wurden die Anzahl der zentralen Lymphknoten ( LK) und der zentralen LK-Metastasen, sowie schilddrüsenspezifische Antikörper analysiert und zwischen den beiden Gruppen verglichen.

14. I. S. D. S.: Rektumchirurgie

Wait & Watch Konzept bei Komplettremission eines Rektumkarzinoms nach Radiochemotherapie anhand von 3 Patientenfällen Raab S 1 , Shamiyeh A 1 1 Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Vienna, Austria 2 Medizinische Universität Wien, Vienna, Austria Aim: Background Since 2017, switching from lateral transperitoneal laparoscopic( LTA), posterior retroperitoneoscopic adrenalectomy( RPA) is used as standard procedure in our institution. Aim of this study was to compare both techniques regarding operative time, length of stay and safety of the procedures.

Methods: Methods All patients operated in our institution for adrenal tumours were prospectively documented in the Ergebnisse: Insgesamt wurden 177 Patient* innen eingeschlossen, 14 davon hatten eine HT (8 %) . Es gab mehr weibliche Patientinnen (86,7 %) in der HT-Gruppe als in der Nicht-HT-Gruppe. Die Patient* innen der histologisch verifizierten HT-Gruppe hatten einen signifikant höheren Thyreoperoxidase-Antikörper ( TPO-AK) Serumspiegel mit durchschnittlich 397 U/ml als in der Nicht-HT-Gruppe mit 43 U/ml. Es gab einen statistisch signifikanten Unterschied zwischen der HT-Gruppe und Nicht-HT-Gruppe in der Anzahl der zentralen Lymphknoten (p-Wert = 0,03). Durchschnittlich gab es in der HT-Gruppe 20 LK im Vergleich zu 15 LK in der Nicht-HT-Gruppe. Bezüglich einer Differenz in der Anzahl der zentralen LK-Metastasen gab es keinen signifikanten Unterschied.

Schlussfolgerungen: 1) Die Anzahl der zentralen Lymphknoten ist in der HT-Gruppe höher als bei der Nicht-HT-Gruppe (20 versus 15). Das kann als Zielwert für eine zentrale Kompartementlymphadenektomie angesehen werden. 2)Die Vermutung liegt nahe, dass eine konstitutionell höhere Anzahl an Lymphknoten ein Trigger für den Autoimmunmechanismus ist.

Neck dissection beim Schilddrüsenkarzinom -628 laterale Halsdissektionen aus über 42.000 Operationen der Jahre 1979 bis 2020

Wicher AS 1 , Jarosz M 1 , Plötzl A 1 , Schneider M 1 , Passler C 1 , Hermann M 1 1 Klinik Landstraße, Wien, Österreich Ziel: Die zentrale Halslymphknotendissektion gehört zum Standardvorgehen bei papillären und medullären Schilddrüsenkarzinomen. Die laterale Halsdissektion (sogenannte Neck dissection) stellt eine zu begründende Erweiterung des Operationsfeldes zu den Level II bis V dar. Sie erhöht das Morbiditätsrisiko bei der Operation.

Methoden: Die Auswertung erfolgte über einen 42-Jahreszeitraum zwischen 1979 und 2020. Analysiert wurde die Inzidenz der Neck dissection in Bezug auf die Histologie des Primärtumors und die Indikation zum beidseitigen Vorgehen. Auch wurde die Beobachtung im Zeitverlauf durchgeführt.

Ergebnisse: Bei über 42.000 Operationen fanden sich 628 laterale Halsdissektionen, das sind 1,65 % des Schilddrüsen-Gesamtkrankenguts, jährlich zwischen 0,5 und 4,0 %. Innerhalb der letzten 5 Jahre zeichnete sich ein Anstieg auf 2,6 % ab. Der Primärtumor betraf in 311 Fällen papilläre Karzinome, 132 medulläre, 74 follikuläre und 34 undifferenzierte Malignome und 39 andere Primärhistologien bzw. Indikationen. 69 Neck dissections erfolgten beidseits.

Schlussfolgerungen: Im Schilddrüsenkrankengut ist mittlerweile in über 2 % mit der Indikation einer Neck dissection zu rechnen, deshalb sollte an Abteilungen, die spezialisiert Schilddrüsenchirurgie betreiben, nicht nur die Kenntnis der zentralen, sondern auch der lateralen Halsdissektion beherrscht werden. In jedem Fall ist diese erweiterte Lymphknotenchirurgie notwendig bei sonographischem Hinweis oder zytologischen bzw. TG-Washout bewiesenen Lymphknotenmetastasen papillärer Karzinome und beim C-Zellkarzinom. 

Laparoscopic Liver Resection is feasible even for very large tumors Stavrou GA 1 1 Klinikum Saarbrücken, Saarbrücken, Germany Aim: Laparoscopic liver surgery ( LLR) is evolving quickly. Difficulty scores are well validated, but they cannot not cover all aspects surgeons are focussed with. Especially very large tumors in obese and sick patients can be difficult to resect -but LLR seems also feasible in these cases and probably even easier than an open approach.

Methods: Video presentation of 2 full laparoscopic cases requiring extended right liver resection for very large tumors (1 HCC, 1 CCC) covering the right liver without possibility for mobilization of liver, Anterior approach without a hanging maneuver is used to fascilitate laparoscopic resection. Furthermore 1 full laparoscopic case ( HCC) with a large tumor requring extended left resection using a dorsal approach is used to complete resection.

Results: All cases are challenging procedures but are manageable after training and experience in LLR. The anterior approach seems the most feasibile strategy in cases requiring right hepatectomy as there is no other option for mobilization. The dorsal approach from below and above the Vena cava seems best if extended left resection is required. All cases were completed laparoscopically with good outcome and no serious complications Conclusions: LLR is even feasible for very large tumors.

TAMIS Resektion eines Rektum-GIST Seitinger G 1 , Aigner F 1 1 Barmherzige Brüder Krankenhaus, Chirurgische Abteilung, Graz, Österreich

Ziel: Gastrointestinale Stromatumore ( GIST) gehören zwar zu den häufigsten mesenchymalen Neoplasien des Verdauungstraktes, sind aber im Rektum und Spatium rektovaginale mit 5 % eher selten. Von der WHO grundsätzlich als maligne eingestuft ist als Therapiestandard die onkologische R-0 Resektion anzustreben, was gerade im Enddarmbereich eine besondere chirurgische Herausforderung hinsichtlich Funktion und Lebensqualität für den Patienten darstellt.

Methoden: In dem vorgestellten Video wird bei einem 67jährigen, männlichen Patienten ein 2,5 cm grosser GIST mit niedriger Mitoserate im Rahmen eines transanalen mikrochirurgischen Eingriffes ( TAMIS) entfernt. Für den transanalen Zugangsweg wird eine GelPOINT® Path Transanal Access Platform verwendet. Die Exzision erfolgt mit monopolarem Kauterhäkchen und einem kombinierten Dissektions-und Versiegelungsgerät welches über Hybridtechnologie (Ultraschall/ bipolarer Strom) verfügt (Thunderbeat Type S®). Der sichere Verschluß des Vollwanddefektes wird mit einem monofilen, selbstarretierenden Faden (V-Loc™) gewährleistet.

Ergebnisse: Unauffälliger postoperativer Verlauf. Entlassung des beschwerdefreien Patienten am 4. postoperativen Tag. EUROCRINE-database and retrospectively analysed. Sex, age, body mass index( BMI), indication, operative time, conversion and complication rates, hospital stay and tumor-size were analyzed.

Results: Results 105 RPAs and 117 LTAs were performed in a 8-year period. No difference was seen in age, sex and tumor localization. Adenoma(n = 95) and phaeochromocytoma(n = 53) were the most common indications for surgery. Other indications were hypercortisolism(n = 33), hyperaldosteronism(n = 25) and adrenocortical carcinoma(n = 15). Compared to the LTA group, the RPA group had shorter operative time with a median of 50minutes (15-380) vs. 122.4minutes (25-420) and shorter hospital stay with a mean of 3.87 days(±4.7) vs. 8.3 day (±2.47) . The decrease of the median operative time in RPA group, visualizing the learning curve of the procedure, was from 60 minutes(2017) to 45 minutes(2020). 4 conversions from RPA to open adrenalectomy had to be performed due to bleeding, whereas 15 LTA procedures had to be converted due to bleeding(n = 5), unclear anatomy n = 4), adhesions(n = 2) or difficult access(n = 4). 4 patients suffered from superficial wound infections in both groups, no other complications were administered.

Conclusions: Conclusion RPA could be safely introduced with reduced operative times and shorter length of hospital stay compared to LTA.

Feasibility of posterior retroperitoneoscopic adrenalectomy for tumors >6 cm Feka J 1 , Soliman B 2 , Arikan M 1 , Hargitai L 1 , Scheuba C 1 , Riss P 1 40-jährigen Patienten. Die notfallmäßige stationäre Aufnahme erfolgte aufgrund eines akuten Abdomens bei Zustand nach laparoskopischer Hemikolektomie rechts wegen eines Zökumkarzinoms vor 7 Monaten. Intraoperativ zeigte sich ein Clip im Lumen der Pars inferior duodeni mit Fistelbildung zwischen Anastomosenregion und Duodenum, bei CT-morphologisch verifiziertem, chronisch aufflammenden, intraabdominellen Abszess, jedoch ohne Anastomoseninsuffizienz.

Ergebnisse: Es werden verschiedene Methoden zur Gefäßabsetzung bei der laparoskopischen Hemikolektomie verwendet: Metallclips, Polymerclips, Stapler. Es gibt bisher keine klaren Empfehlungen oder Richtlinien zur Gefäßabsetzungstechnik dieser häufig, durchgeführten Operation. Die Gefäßabsetzung mit Clips wird in unserer Abteilung bei laparoskopischen oder roborter-assistierten Eingriffen standardmäßig angewandt. Komplikationen durch Migration in umgebende intraabdominelle Strukturen sind äußerst selten. Unabhängig vom verwendeten Produkt besteht an Fremdmaterial die Gefahr einer bakteriellen Kontamination. Die Kombination aus adjuvanter Chemotherapie, assozierter Immunsuppression und rezidivierend aufflammenden Entzündungsreaktionen können zu Gewebenekrosebildung, Ablösung des Clipmaterials und Migration in nahegelegene Hohlorgane mittels Fistelbildung führen.

Schlussfolgerungen: Letztlich bleibt der Nachweis des Pathomechanismus der Clipmigration aufgrund der geringen Fallzahlen ungeklärt. Eine endoskopische Bergung kann bei fehlenden lokalen Komplikationen durchgeführt werden. Im genannten Fall blieb der Patient nach durchgeführter Notfalloperation beschwerdefrei.

Laparoscopic living donor kidney transplantation in Linz during the pandemic of SARS-CoV-2 Roth N 1 1 

Aim: Transplant patients are more susceptible to viral and bacterial infects because of their immunosuppression. A potential deadly new virus haunted us 2020: SARS-CoV-2 Methods: After the complete lockdown in Spring 2020 our transplant Center in Linz continued the living donor laparoscopic nephrectomy. 5 living kidney transplantations have been carried out from June to September 2020. We compared these data with the outcome in the three previous years and the following year 2021.

Results: From June 4, 2020, till September 9,2020, five kidney living donor transplantations have been performed. All donors and recipients have been screened for COVID 19 infection by PCR test. They were fully informed about risks of surgery and immunosuppression during the pandemic. All recipients and donors remained COVID negative during the follow-up of 10 months. Now all of them are already vaccinated. The number of living transplants has been constant to the same months of 2017, 2018 and 2019.

Conclusions: Living donor kidney transplantation should be continued. Donors and recipients should be carefully selected. They have to be informed about all risks.

Der histopathologische Befund ergibt einen niedrig-malignen GIST mit 2,5 cm Durchmesser, 3 Mitosen/5qmm, Ki67 2 %, zur Prostata hin bindegewebige Verschiebeschicht <1 mm, "no ink on tumor". Tumorboard-Empfehlung: Einbringung in ein GIST-Register, Rektoskopie-Kontrolle in 6 Monaten Schlussfolgerungen: Die primäre onkologische R-0 Resektion mittels TAMIS ist beim Rektum-GIST technisch möglich. Falls eine R-0 Resektion präoperativ fraglich oder nur mit Organverlust möglich erscheint ist ein Downsizing mit Imitinab für 6-12 Monate empfohlen.

Clipmigration und Abszesseinbruch in die Pars inferior duodeni nach laparoskopischer Hemikolektomie rechts -Case Report

Laparoskopische Colonchirurgie -Wirtschaftliche Aspekte im Vergleich zur offenen Colonchirurgie Huber E 1 1 Kepleruniklinikum, Linz, Österreich Ziel: Die laparoskopische Operationstechnik wird seit über 30 Jahren angewandt und hat sich als Standard in der Chirurgie etabliert. Die Vorteile der laparoskopischen Chirurgie für die Patienten sind medizinisch gefestigt. Aufgrund der immer mehr geforderten Sparmaßnahmen müssen die Kliniken das richtige Maß zwischen Medizin und Ökonomie finden. Die auftretenden Kosten bei der Verwendung der Einmalgeräte bei den laparoskopischen Coloneingriffen sind höher als die bei den offenen Colonoperationen. Ohne Zweifel gestaltet sich die Dauer des Krankenhausaufenthaltes für offen operierte Patienten länger. Auch für die körperliche Regeneration und die Wiedereingliederung in den beruflichen Alltag benötigen sie mehr Zeit.

Methoden: Patienten, welche sich im Zeitraum von Jänner 2018 bis Dezember 2020 im Kepleruniklinikum an der Abteilung für Allgemein-und Viszeralchirurgie einer Hemikolektomie rechts aufgrund eines Carcinoms unterziehen mussten, wurden retrospektiv erfasst. Umstiege als auch Patienten, die sich von Vornherein aufgrund von Voroperationen oder Kontraindikationen nicht für die minimal invasive Operation eigneten wurden ausgeschlossen.

Ergebnisse: Die Auswertung betreffend Aufenthaltsdauer und Operationszeit ergab einen eindeutigen Vorteil für die laparoskopisch resezierten Patienten. Die durchschnittliche Operationszeit für die laparoskopischen Operationen betrug 98 Minuten, demgegenüber 127 Minuten für die offenen Operationen. Minimal invasiv operierte Patienten verweilten durchschnittlich 13 Tage im Spital, die anderen durchschnittlich 6 Tage länger. Demgegenüber waren die Materialkosten für die offen resezierten Patienten niedriger, weiters brachten diese auch mehr LKF Punkte. Positiv bezüglich Kostenersparnis wirkt sich für die laparoskopische Gruppe die Leistungskomponente aus. Diese war für sie deutlich höher, weil für aufwändigere Operationen die höheren Materialkosten berücksichtigt werden.

Schlussfolgerungen: Einerseits sind die Materialkosten für die Laparoskopie immer noch etwas höher, aber dies wird auch in der erhöhten Leistungskomponente berücksichtigt. Neben den klinischen Vorteilen für die Patienten, sind auch die kürzeren Krankenhausaufenthalte und die kürzeren OP-Zeiten in unserem Patientenkollektiv für die Laparoskopie positiv zu werten. Zusammenfassend sprechen nicht nur medizinische, sondern auch immer mehr wirtschaftliche Aspekte für die Laparoskopie.

63rd Annual Meeting of the Austrian Society of Surgery cause for postoperative morbidity and mortality. Obesity itself is an independent risk factor for VTE.

Methods: We conducted a retrospective data analysis of patients who underwent sleeve gastrectomy ( SG), one-anastomosis-gastric-bypass ( OAGB) or Roux-en-Y gastric bypass ( RYGB) at our institution from 01/2015 to 09/2021. All patients received low molecular weight heparin for 2 weeks after discharge.

Results: Complete data was available in 536 patients. The most common type of surgery was OAGB (48 %), followed by SG (29 %) and RYGB (23 %). 71 % were female. 43 patients (8 %) showed a history of VTE and/or intake of coagulation modifying drugs at the time of surgery. VTE occurred in 4 women (0,7 %). One patient had a severe pulmonary embolism ( PE) after one week and died. One patient had a PE after 2 weeks, one at 3 months and one after two years. Only one of these patients had a history of previous VTE. Patients with postoperative VTE had a higher mean BMI with 49,2 kg/m 2 and a longer mean operating time (181 minutes) compared to patients without a postoperative VTE (mean BMI 43 kg/m², mean operating time 135 minutes).

Conclusions: VTE are rare, but potentially life threatening events after BS. Patients with previous history of VTE and/or intake of coagulation modifying drugs seem to have a higher risk (2,3 %) compared to patients without (0,6 %).

Portalvenöse Thrombosen nach laparoskopischer Sleeve-Gastrektomie -Fallbericht und Literaturübersicht 

Thromboembolic events after bariatric surgery -a retrospective data analysis Aim: Roux-en-Y-gastric bypass ( RYGB) and one-anastomosis-gastric bypass ( OAGB) are effective methods to achieve sustainable weight loss with a good safety profile. Marginal ulceration ( MU) is a known complication and can lead to perforation, bleeding or stenosis. Non-steroidal-anti-inflammatory-drugs, smoking and Helicobacter pylori infection are risk factors for MU.

Methods: We conducted a retrospective data analysis of patients who underwent RYGB or OAGB at our institution from 01/2015 to 09/2021. All patients had at least a follow-up of three months. Non-smokers received proton-pump inhibitors for three months and smokers for one year postoperatively. All patients had a Helicobacter pylori treatment before surgery when tested positive.

Results: Complete data was available in 370 patients. RYGB was performed in 30 % and OAGB in 70 %. 77 % were female. Overall, 26 patients (7 %) developed MU at a mean follow up of 11 months. 9 patients (34,6 %) needed re-operation, 3 patients because of a perforation. 2 patients had recurrent MU afterwards. 12 patients (46 %) with MU were smoking and 6 (23,1 %) were tested positive with Helicobacter pylori. In comparison 120 patients (33,9 %) without MU were smoking and 56 (15,8 %) had positive Helicobacter pylori results. Referring to the type of bypass 6 patients after RYGB (5,4 %) and 20 patients after OAGB (7,8 %) developed MU. Reoperation rate was the same in both groups.

Conclusions: MU is a frequent complication after gastric bypass with a high reoperation rate. In our study MU rate was slightly higher after OAGB compared to RYGB.

SADI-S, frühe Ergebnisse einer ersten Serie eines OÖ Zentrums (marginal ulcer) . Eighteen of the 103 SLGs (17.5 %) were done in patients after they had their AGB removed (38.6 % of all AGB removals; 17 were done at our center and one patient had the AGB removed elsewhere). Demographic and clinical data of this study group were prospectively recorded and outcome was retrospectively analyzed.

Results: AGB removal was done for dysphagia in all cases; two patients had a slipped AGB. Fifteen AGB removals were done laparoscopically in two cases a robotic assisted approach was used. SLG was done laparoscopically in 13 and robotic assisted in 5 cases Median age of the 13 females and 5 males at time of SLG was 55.1 (range 42.3 to 67.61) years. Almost all patients had their AGB for more than 10 years in place and all had experienced initially weight loss but 60 % had significant weight regain. All patients had their AGB completely emptied prior to the AGB removal due to difficulties swallowing and all had an upper GI study showing various degrees of esophageal dilatation and dysmotility. Median weight at AGB removal was 233 (range 152 to 328) pounds with 83 % experiencing significant weight gain after device removal. Median time from AGB removal to SG was 5.7 (2.1-120) months Median weight at SG was 252 (range 175 to 319) pounds. After a median follow up of 438 (43-791) days, median weight was 209 (range 166 to 320) pounds and in all patients initially a good weight loss had been seen. At last follow up, only one gained weight and 17 patients (94 %) experienced weight loss. This includes one patient with severe proximal gastric dilatation who developed severe GERD and underwent conversion to a RYGBP after which his GERD dramatically improved and good weight loss was achieved. Main complications were seroma and hernias at the port site after AGB removal.

Conclusions: Patients undergoing revisional bariatric surgery after removal of a gastric band due to complications (mainly dysphagia) remain a challenge. In patients with esophageal dysmotility a two stage approach seems advisable to give the esophagus time to recover. Additional revisions may be required in some of these patients including conversion to a RYGBP with a good perspective of success. The Davinci platform was found of great benefit for SLG but is not needed for most AGB removals.

Intrathorakale Pouchmigration bei Omega-Loop Magenbypass mit und ohne Hiatoplastik -eine 3D-Volumetrie Studie option but it remains unclear if this should be done as a single or staged procedure.

Methods: A total of 151 bariatric procedures performed between the 11/2018 and 12/2021 including 44 adjustable gastric band ( AGB) removals, 103 sleeve gastrectomies ( SLG), 2 gastric bypasses (both conversions from sleeve gastrectomy), and two revisions of gastrojejunostomy (marginal ulcer). Eighteen of the 103 SLGs (17.5 %) were done in patients after they had their AGB removed (38.6 % of all AGB removals; 17 were done at our center and one patient had the AGB removed elsewhere). Demographic and clinical data of this study group were prospectively recorded and outcome was retrospectively analyzed.

Results: AGB removal was done for dysphagia in all cases; two patients had a slipped AGB. Fifteen AGB removals were done laparoscopically in two cases a robotic assisted approach was used. SLG was done laparoscopically in 13 and robotic assisted in 5 cases Median age of the 13 females and 5 males at time of SLG was 55.1 (range 42.3 to 67.61) years. Almost all patients had their AGB for more than 10 years in place and all had experienced initially weight loss but 60 % had significant weight regain. All patients had their AGB completely emptied prior to the AGB removal due to difficulties swallowing and all had an upper GI study showing various degrees of esophageal dilatation and dysmotility. Median weight at AGB removal was 233 (range 152 to 328) pounds with 83 % experiencing significant weight gain after device removal. Median time from AGB removal to SG was 5.7 (2.1-120) months Median weight at SG was 252 (range 175 to 319) pounds. After a median follow up of 438 (43-791) days, median weight was 209 (range 166 to 320) pounds and in all patients initially a good weight loss had been seen. At last follow up, only one gained weight and 17 patients (94 %) experienced weight loss. This includes one patient with severe proximal gastric dilatation who developed severe GERD and underwent conversion to a RYGBP after which his GERD dramatically improved and good weight loss was achieved. Main complications were seroma and hernias at the port site after AGB removal.

Conclusions: Patients undergoing revisional bariatric surgery after removal of a gastric band due to complications (mainly dysphagia) remain a challenge. In patients with esophageal dysmotility a two stage approach seems advisable to give the esophagus time to recover. Additional revisions may be required in some of these patients including conversion to a RYGBP with a good perspective of success. The Davinci platform was found of great benefit for SLG but is not needed for most AGB removals.

Conversion from adjustable gastric banding to sleeve gastrectomy in patients with dysphagia Bonatti H 1 1 

Aim: Adjustable gastric banding ( AGB) was a popular bariatric procedure in the past but is associated with limited weight loss long term and development of esophageal dysmotility long term. Conversion from AGB to sleeve gastrectomy ( SG) is a good option but it remains unclear if this should be done as a single or staged procedure.

Methods: A total of 151 bariatric procedures performed between the 11/2018 and 12/2021 including 44 adjustable gastric band ( AGB) removals, 103 sleeve gastrectomies ( SLG), 2 gastric bypasses (both conversions from sleeve gastrectomy), and two Aim: Crohn's disease ( CD), a chronic inflammatory bowel disease, can affect the entire intestinal tract and result in complications such as stenoses, perforations or fistulas. Despite novel available therapies, a significant proportion of patients requires surgery due to these complications. Histologically, one of the hallmarks of CD, beside transmural inflammation, is mesenteric thickening and fat wrapping of the gut, accompanied by granuloma formation within the intestinal wall as well as the mesentery. While the presence of granulomas within the mesentery has been recognized as risk factor for postoperative recurrence1, further investigations on pathophysiologic relevance are lacking. Descriptive studies imply that CD20+ B cells accumulate within the granulomas, and that granulomas can occur even outside lymphatic vessels, but little evidence on further characterization is available. Additionally, increased IgG binding on commensal bacteria in CD patients compared to healthy controls has been described, but the chronology of events remains unclear2. Thus, whether granuloma formation and antibody responses are a cause or consequence of intestinal barrier disruption and subsequent inflammation remains to be elucidated. Therefore, we investigate the immunological B cell response within the mesentery and compared affected and unaffected draining lymph nodes ( LN) in patients undergoing intestinal resection due to CD.

Methods: LNs of affected and adjacent unaffected intestinal segments of patients undergoing surgery due to CD complications were processed to single cell suspensions and stained for flow cytometry in n = 11 subsequent patients to investigate differences in immune cell composition (acquisition: BD LSRFortessa). Histological analysis was performed to investigate size and number of germinal centers within LNs in n = 10 patients. Finally, B cell receptor ( BCR) sequencing was performed in n = 24 subsequent patients after RNA isolation as well as cDNA and sequencing library preparations (Illumina). Libraries were sequenced using 300 bp paired-end sequencing on a MiSeq (Illumina). The study was approved by the local ethics committee ( EK #1480/2016) and all patients prospectively gave their written informed consent to participate in the study.

Results: Affected draining LNs showed a significantly increased fraction of CD45+CD19+ B cells (unaffected LNs: 20.8 ± 9.7 %; affected LNs: 31.5 ± 13.8 %; p = 0.017) at the cost of a reduction in CD45+CD3+ T cells (unaffected LNs: 67.4 ± 13.2 %; affected LNs: 61.5 ± 16.1 %; p = 0.022). Additional analyses of dendritic cells and macrophages did not reveal any differences in abundance in affected or unaffected LNs (data not shown). Histological analysis revealed an increase in the numbers of germinal centers, but no substantial difference in germinal center size. BCR sequencing of the BCR heavy chain demonstrated a reduction in IGHA1/2, and a significant increase in IGHG1/2 as well as IGHG3 in affected LNs compared to unaffected LNs.

Ziel der Studie ist, herauszufinden, welche der beiden Operationsmethoden, OAGB oder OAGB + Hiatoplastik, ein größeres Risiko von ITM und somit gastroösophagealem Reflux ( GERD) hat.

Methoden: Fünfzig Patienten (Gruppe 1: 25 × primärer OAGB; Gruppe 2: 25 × primärer OAGB + Hiatoplastik), wurden in die Studie eingeschlossen. Ermittelt wurde Gewichtsverlauf, GERD, Lebensqualität sowie Pouchvolumen und ITM mittels 3D-Volumetrie CT.

Ergebnisse: Zwischen den beiden Gruppen gab es keinen Unterschied der Patientencharakteristik oder im Gewichtsverlauf und Pouchvolumen oder Lebensqualität. ITM wurde in Gruppe 1 bei 60 % (n = 15) der Patienten und in Gruppe 2 bei 76 % (n = 19) der Patienten gefunden. Die Länge der ITM war mit 0,9 cm in Gruppe 1 zu 1,8 cm in Gruppe 2 signifikant niedriger. Bezüglich GERD gab es keinen Unterschied zwischen den beiden Gruppen, allerdings hatten signifikant mehr Patienten GERD, bei welchen ITM gefunden wurde (38,2 %; n = 13) als Patienten ohne ITM (6,3 %; n = 1).

Schlussfolgerungen: Bei primärem OAGB wurden in dieser Studie durch eine zusätzliche Hiatoplastik keine erhöhten Raten an ITM oder GERD gefunden. Falls ITM auftritt, kann diese allerdings zu GERD führen. 3D-Volumetrie ist eine geeignete Methode, um ITM nach bariatrischer Operation darzustellen.

Let's talk about sex − Proctitis caused by sexually transmitted infections Sadoghi B 1 , Tripolt-Droschl K 1 1 Universitätsklinik für Dermatologie und Venerologie, MUG, Graz, Austria Aim: Sexually transmitted infections (STIs) are on the rise. The World Health Organization estimates that one million people get infected daily. Proctitis is a common reason for patients presentation to various specialized physicians, including general practitioners, gastroenterologists, surgeons, and those working in the field of infectious diseases.

Methods: We would be honoured to present orally the most common pathogens causing distal proctitis from a venereological point of view. Each relevant pathogen will be discussed, including Neisseria gonorrheae, Chlamydia trachomatis, Herpes simplex virus and Treponema pallidum.

Results: Pit-falls (including those STIs who mimick other diseases, like neoplasia, or inflammatory bowel diseases), relevant juridical background information, recommended diagnostic algorithms and guideline-based treatment will be discussed.

Conclusions: After this session, participants will be informed about relevant sexually transmitted bacteria and viruses that cause distal proctitis, where and how to treat those infections and if control visits or other diagnostic procedures have to be performed. 63rd Annual Meeting of the Austrian Society of Surgery 1-year mortality rate was comparable in both groups with 13.1 % (n = 32). Kidney function based on serum creatinine was significantly improved with anti-CMV IGs at 1 year after LT.

Conclusions: While Valgancyclovir protected nicely CMV positive recipients from CMV viremia the effect of anti-CMV IGs was inferior in this constellation without any impact on CMV disease; however, anti-CMV IGs are in favor to a better side effect profile especially concerning renal function and thus it should be the preferred prevention strategy.

Intraoperative Evaluation of the HEPatic ARtery Blood FLOW during Pancreatoduodenectomy -Results from the prospective HEPARFLOW Study Institute of Medical Biometry and Informatics ( IMBI), Heidelberg University Hospital, Heidelberg, Germany Aim: A partial or total pancreatoduodenectomy is the only curative treatment option for many tumours affecting the pancreas and the periampullary region. While postoperative mortality has declined below 5 % in specialized institutions, ischemia-related complications even though rare are still serious and potentially life-threatening adverse events after surgery. Mainly affected are visceral organs depending on the blood supply of the celiac axis. In patients with stenosis of the celiac axis, transection of the gastroduodenal artery may result in critical malperfusion of the liver resulting in liver ischemia and subsequent liver failure. It is, therefore, crucial to ensure liver perfusion during pancreatoduodenectomy before irreversible surgical steps are performed. Data on intraoperative measurement of liver perfusion during pancreatoduodenectomy do not exist. The primary aim of this study was to examine hepatic artery blood flow during pancreatoduodenectomy. Secondary aims were to identify factors influencing liver perfusion such as the anatomy and morphology of the hepatic artery(ies) and the celiac axis and to investigate the association of the measured flow rates with the postoperative outcome.

Methods: HEPARFLOW (German Clincal Trials Register (DRKS00014620)) was a prospective, observational, single-center pilot study. Between April 10th, 2018, and December 16th, 2018, 275 consecutive patients who presented for an elective pancreatoduodenectomy were screened. 216 patients fulfilling eligibility criteria were finally included to reach a sample size of 100 patients with complete data. Preoperative contrast-enhanced computed tomography ( CT) scans were evaluated to classify the anatomy of the arteries supplying the liver as proposed by Michels and to assess the presence and grade of stenosis of the celiac axis. Liver perfusion was measured during surgery by recording the flow rates of the vessels supplying the liver (proper hepatic artery, gastroduodenal artery, aberrant or accessory hepatic arteries and portal vein) using intraoperative doppler No changes in frequencies were seen in IGHE, or IGHM, indicating a pathological expansion of IgG B cells within the mesentery itself which is in contrast to findings from PBMCs in CD3. Further analysis of somatic hypermutation of BCRs of paired clones showed a significant increase in mean somatic hypermutation in affected compared to unaffected LNs (p < 0.001). Diversity analysis showed less evidence for clonal expansion for IGHG1/2, but not for IGHA1/2. Finally, there was no evidence of extensive clonal sharing between patients.

Conclusions: Our data indicates a significant expansion of B cells within affected draining lymph nodes of patients with Crohn's disease. Additionally, BCR sequencing demonstrates a pathological IgG response only at sites of active inflammation. In conclusion, these data indicate that a pathological IgG response in patients with severe disease may contribute to disease recurrence by aggravating inflammation directed against commensal bacteria passing through the intestinal barrier. Further investigations are needed to investigate kinetics and specificity of IgG antibodies towards commensal bacteria.

References : 

Prevention strategies against CMV-infection after liver transplantation Belarmino A 1 , Kniepeiss D 1 , Fleischhacker M 1 , Riedl R 2 , Mandl-Pohl A 2 , Müller H 1 , Schemmer P 1 1 General, Visceral and Transplant Surgery, Graz, Austria 2 Institut für medizinische Informatik, Statistik und Dokumentation, Graz, Austria Aim: There is a variety of prevention strategies against cytomegalovirus ( CMV) viremia/disease after liver transplantation ( LT). Thus, this retrospective cohort study performed in a prospective manner with a 1-year follow-up has been performed comparing anti-CMV immunoglobulins (IGs) with Valganciclovir.

Methods: A total of 257 patients underwent LT between January 2008 and May 2020. While 134 patients received anti-CMV-IGs (7500 IU for 4 days) between 2008 and October 2016, 111 patients were treated with Valganciclovir (up to 900 mg/d for 3-6 months dependent on renal function and side effects) since November 2016. Patients with viremia in both groups were treated at least for 14 days with Ganciclovir or Valganciclovir. Primary endpoint of the study was CMV viremia within 1 year after LT. Secondary endpoints were leukopenia, renal function, patient and graft survival.

Results: Demographics were comparable in both groups (i. e. age (56.6 +/-11.2 years), gender (78.8 % male)). Viremia was 36.7 % (n = 90) within 1 year after LT with 43.3 % (n = 58) after anti-CMV IGs vs. 28.8 % (n = 32) after Valganciclovir (p > 0.05). The incidence of viremia was dependent of the donor-recipient match with 39.6 % (n = 21) and 60,6 % (n = 20) in D-/R+ and D+/ R+ after anti-CMV IGs, and 12.0 % (n = 3) and 25,7 % (n = 9) after Valganciclovir (p = 0.018; p = 0.007), respectively. The overall Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, United States Aim: Surgical resection of the cancerous tissue represents one of the few curative treatment options for neoplastic liver disease. Such partial hepatectomy (PHx) induces hepatocyte hyperplasia to restore liver function. PHx is associated with bacterial translocation, leading to an immediate immune response involving neutrophils and macrophages, which are indispensable for the priming phase of liver regeneration. Additionally, PHx induces longer-lasting intrahepatic apoptosis. Here, we investigated the effect of apoptotic extracellular vesicles (aEVs) on neutrophil function and their role in this later phase of liver regeneration.

Methods: Ninety-three patients undergoing PHx were included in this study. Blood levels of the apoptosis marker caspase-cleaved cytokeratin-18 (M30) and circulating aEVs were analyzed pre-operatively and on the first and fifth post-operative days. Additionally, the in vitro effects of aEVs on the neutrophil secretome, phenotype and functions were investigated.

Results: Circulating aEVs increased at the first postoperative day. This was associated with higher concentrations of M30, which was only observed in patients with complete liver recovery. Efferocytosis of aEVs by neutrophils induced an activated phenotype (CD11bhighCD16highCD66bhighCD62Llow), however, classical inflammatory responses such as NETosis, respiratory burst, degranulation, or secretion of pro-inflammatory cytokines could not be observed. Instead, efferocytosing neutrophils released various growth factors including fibroblast growth factor-2 and hepatocyte growth factor ( HGF). Accordingly, we observed an increase of HGF+ neutrophils after PHx and a correlation of plasma HGF with M30 levels. Associating liver partition and portal vein ligation ( ALPPS) patients showed significant intrahepatic apoptosis in the liver lobe left in situ, persistently elevated M30 levels upon postoperative day 5 and sig-sonography (Medistim QuickFitTM TTFM Probes). The measured flow rates were then related to liver volume. Postoperative surgery-related complications, primarily liver perfusion disorder (transaminases ≥ 100 units/L), were recorded and correlated with the measured flow rates. Descriptive statistical analysis served to generate reference data for the intraoperative blood flow of the hepatic vessels.

Results: The mean arterial flow increased by 117.12 % from 0.15 ± 0.10 ml/(min x cm3) to 0.24 ± 0.13 ml/(min x cm3) during the surgery. The mean portalvenous flow decreased by 14.71 % from 0.47 ± 0.23 ml/(min x cm3) to 0.37 ± 0.17 ml/(min x cm3). In the study population, 23 % of patients showed hepatic artery variations. On intraoperative flow measurement, patients with an aberrant and/or accessory hepatic artery had a significantly increased total arterial flow rate ( TAF) compared to patients with regular anatomy (0.29 ± 0.13 ml/(min x cm3) vs. 0.23 ± 0.13 ml/(min x cm3), p = 0.029), and a comparatively reduced proper hepatic artery flow rate ( PHAF) (0.12 ± 0.08 ml/ (min x cm3) vs. 0.23 ± 0.13 ml/(min x cm3), p = 0.001). Stenosis of the celiac axis was present in 39 % of patients. These patients had a compromised TAF and PHAF compared to patients without stenosis ( TAF: 0.20 ± 0.11 ml/(min x cm3) vs. 0.27 ± 0.14 ml/ (min x cm3), p = 0.031; PHAF: 0.16 ± 0.09 ml/(min x cm3) vs. 0.23 ± 0.14 ml/(min x cm3), p = 0.039). With increase in stenosis, blood flow in the gastroduodenal artery decreased to the point of flow reversal. TAF ≤0.065 ml/(min x cm3) in the final phase of surgery resulted in a higher incidence of liver perfusion disorder ( AST 450.8 ± 705.1 U/l vs.113.6 ± 94.0 U/l, p = 0.028; ALT 240.5 ± 255.5 U/l vs. 126.9 ± 129.8 U/l, p = 0.048). The chi-square test showed a correlation between the development of liver perfusion disorder and the occurrence of serious complications (p = 0.013).

Conclusions: HEPARFLOW is the first study establishing reference data for assessment of liver perfusion by doppler sonography (Medistim QuickFitTM TTFM Probes) during pancreatoduodenectomy. The results show that in the presence of an aberrant and/or accessory hepatic artery, more arterial blood volume is directed to the liver. Therefore, an aberrant or accessory hepatic artery may be a protective factor for postoperative liver perfusion. The high proportion of patients with celiac axis stenosis in the study population indicates that it is an underestimated morphological abnormality, that can critically affect liver perfusion after pancreatoduodenectomy. In addition to a detailed preoperative CT-based analysis, intraoperative blood flow measurement is a useful tool to ensure liver perfusion and to show the clinical relevance of risk factors for ischemia-related complications. This can serve as an instrument to prevent severe intra-and postoperative complications and thus increase patient safety when performing pancreatoduodenectomy.

63rd Annual Meeting of the Austrian Society of Surgery appeared similar between groups. DUSP4, as critical regulator of inflammation in LSECs, was found to be significantly reduced in patients developing postoperative LD.

Conclusions: While inflammation has been thought to promote liver regeneration, our analyses suggest that in humans an unregulated overwhelming inflammatory response is associated with post-operative liver dysfunction. Baseline differences in LSEC DUSP4 did predict post-operative liver functional outcomes and were associated with postoperative neutrophil activation; implying a mechanistic role of DUSP4 in overwhelming inflammation.

Inhibition of platelet activation and alpha-granule depletion negatively impact liver regeneration after partial hepatectomy in mice Aim: Growing evidence suggests an effect of intrahepatic platelet granule release on early liver regeneration in humans after hepatic resection. Intraplatelet serotonin as well as platelet alpha-granule secreted molecules show an association with postoperative liver regeneration and the development of posthepatectomy liver failure. While the role of platelets as key factors in liver regeneration could be shown, the physiology of platelet mediated liver regeneration remains unclear. With this study we aim to provide evidence for an effect of platelet degranulation on liver regeneration in different mouse stems undergoing partial hepatectomy (pHx).

Methods: Two mouse stems were used in this study: Wild type mice ( WT) were treated with R300, a CD42b antibody, leading to platelet clearance without platelet degranulation. Treatment happened either prior to the operation (preOP) (N = 8) or 30 minutes after pHx (N = 8), with WT controls being transfused with sodium-chloride preOP (N = 6). The phenotype of Nbeal-2 knockout mice (Nbeal2-/-) exhibits deficient platelet alpha granules, with other compartments of platelets not being significantly altered. Nbeal2-/-(N = 11) and Nbeal-2 wildtype litter mates (Nbeal2+/+) (N = 10) as controls underwent pHx. As Nbeal-2 knockout also has an effect on neutrophil granule formation, we included a phenotype rescue into our study. Nbeal2-/-mice either receiving Nbeal2+/+ platelets (N = 7) or phosphate buffered saline (N = 7) preOP underwent pHx. Harvest of operated mice happened 48 hours after surgery in all pHx cohorts. Liver regeneration was assessed via mitotic figure index ( MFI) and liver-to bodyweight ratio.

Results: Application of R300 and subsequent platelet clearance was found to have a significant effect on liver regeneration. MFI was significantly higher after pHx in WT controls compared to WT mice treated with R300 at both timepoints (control vs. R300 pre, p < 0.05; control vs. R300 post, p < 0.05). There was no difference in liver-to bodyweight between WT controls and mice treated with R300 preOP or after pHx (p = 0.410). Nbeal2-/-mice showed significantly lower MFI when compared with nificantly higher HGF levels on this day as compare to standard major hepatectomies.

Conclusions: These data suggest that the clearance of PHxinduced aEVs leads to a population of non-inflammatory, but regenerative neutrophils, which may support human liver regeneration. Particularly, our data suggest that the continuous release of apoptotic vesicles in ALPPS patients, by the liver lobe left in situ, utilizes this process to mediate accelerated liver regeneration in these patients.

Acute overwhelming inflammation as a mechanism driving postoperative liver failure in humans Surgical Department, Clinic Landstraße, Vienna, Austria Aim: While extensive experimental evidence on the process of liver regeneration exists, in human validation of these mechanism is largely missing. Within this project we aimed to systematically assess early transcriptional changes during liver regeneration in humans to explore I) if previously identified regulators of murine liver regeneration are altered in humans as well, II) how these processes differ in patients with impaired postoperative liver regeneration, and III) what baseline differences are associated with ineffective liver regeneration ultimately leading to postoperative liver failure.

Methods: RNA sequencing was performed in liver tissue of 21 patients prior as well as 2 hours after induction of liver regeneration. Circulating cytokines were assessed in 129 additional patients. Immunofluorescence was used to quantify intrahepatic neutrophil adhesion and confirmed by electron microscopy. Liver sinusoidal endothelial cells were isolated from a mouse NASH model.

Results: Within only 2 h after induction of liver regeneration, we observed striking changes in transcriptional activity in liver tissue. The majority of involved pathways were inflammatory responses. Patients suffering from post-operative liver dysfunction ( LD) showed an overall higher inflammatory response upon induction of liver regeneration, higher ICAM-1 induction, as well as intrahepatic neutrophil accumulation. Patients with LD showed increased levels of MPO as neutrophil degranulation marker, while other ciruclating cytokines 63rd Annual Meeting of the Austrian Society of Surgery plasma concentrations in patients with major resections and Spearman test to correlate GLP-2, BA and CRP concentrations.

Results: Patients who received major resections and developed PHLF displayed no preoperative differences in plasma GLP-2 concentration (n = 19; 3.49 ± 1.34 vs. 2.72 ± 1.14 ng/ ml; p = 0.167), but a significant increase could be observed on POD1 (n = 19; 10.56 ± 8.93 vs. 4.98 ± 3 .74 ng/ml; p = 0.017) and on POD5 (n = 18; 12.05 ± 7.65 vs. 4.27 ± 2.62 ng/ml; p = 0.003), compared to patients with a normal postoperative course. DPP4 plasma concentrations preoperatively, on POD1 and POD5 did not differ significantly in those groups (n = 16; 197.50 ± 72.03 vs. 346.34 ± 173.84 ng/ml; p = 0.090), (n = 16; 210.87 ± 88.00 vs. 252.50 ± 107.33 ng/ml; p = 0.510) and (n = 16; 170.18 ± 64.31 vs. 231.51 ± 112.22 ng/ml; p = 0.267) respectively. GLP-2 concentrations did not correlate with DPP4 concentrations postoperatively (n = 16; R = −0.82; p = 0.762 and n = 15; R = −0.239; p = 0.390) on POD1 and POD5, respectively. GLP-2 concentrations correlated with BA concentrations preoperatively (n = 40; R = 0.273; p = 0.044) and on POD1 (n = 41; R = 0.270; p = 0.44), and with CRP concentrations on POD1 (n = 45; R = 0.334; p = 0.012) and on POD5 (n = 46; R = 0.525; p = 0.000).

Conclusions: Plasma GLP-2 concentrations increased in patients developing PHLF from postoperative day one, compared to patients who did not develop PHLF. GLP-2 plasma concentrations correlate with BA concentrations pre-and early postoperatively (POD1), as BA seem to be the major stimulus for GLP-2 secretion at these timepoints. The postoperative CRP elevation from POD1 to POD5 correlates with the GLP-2 plasma concentration, leading to the conclusion, that possibly bacterial translocation through leakage of the mucosal barrier, caused by the operative trauma, is the predominant stimulus for GLP-2 secretion postoperatively. Perioperative DPP-4 level did not correlate with GLP-2 plasma concentrations, indicating that degradation is not the cause of GLP-2 elevation in these patients. We hereby state that postoperative GLP-2 level elevation reflect not only the severity of the postoperative trauma but indicates an extrahepatic effector of the gut-liver axis in impaired postoperative liver regeneration to rescue liver function.

Orthotope Hinterbeintransplantation in der Maus: Vorstellung eines neuen Antikoagulationsprotokolls zur Verbesserung des Gesamtüberlebens Nbeal2+/+ mice after 48 hours (p < 0.005). Nbeal2-/-and Nbeal2+/+ did not show a difference in liver-to bodyweight after 48 hours (p = 0.962). Interestingly in the phenotype rescue model we could observe a positive correlation of transfused platelets with liver weight to body weight (r = 0.857, p = 0.014).

Conclusions: With this study we can present data showing an association of platelet degranulation with liver regeneration. Platelet clearance through CD42b antibody treatment as well as depletion of alpha-granules in Nbeal2-/-knockout mice lead to inhibited liver regeneration. Lack of a significant difference in liver-to bodyweight ratio in the R300 treatment group and in Nbeal-2 mice undergoing pHx could be attributed to transient steatosis in mice after pHx. The phenotype rescue in Nbeal2-/-mice however, provides novel data, further substantiating the relevance of alpha granules in the context of liver regeneration, as transfused platelets correlate positively with liver-to bodyweight ratio. To summarize our data, platelets and their granules, alpha-granules in particular, influence liver regeneration post pHx.

Glucagon-like peptide-2: a gut derived actor in liver regeneration Ammann M 1 , Pereyra D 2 , Santol J 2 , Viragos-Toth I 1 , Längle F 1 , Starlinger P 2 1 LK Wiener Neustadt, Wiener Neustadt, Austria 2 Universitätsklinik für Allgemeinchirurgie, Vienna, Austria Aim: Posthepatectomy liver failure ( PHLF) is considered a condition of impaired liver regeneration after liver resection, when normal liver function cannot be maintained. PHLF is associated with increased morbidity and mortality. GLP-2 is a glycoprotein, co-secreted with GLP-1 in equimolar amounts from the intestinal enteroendocrine L-cells in response to bile acids binding to the luminal TGR5 receptor. Another secretory stimulus is due to basolateral Toll-like receptor-4 ( TLR-4) activation, in case of a leaky mucosal barrier and bacterial lipopolysccharide translocation, as could be observed in rodent and human studies. The short plasma half-life of GLP-2 of 3-4min is caused by its degradation via the Dipeptidyl peptidase IV ( DPP-4), which occurs membrane-bound and in a soluble form in the plasma. GLP-2s trophic effects on the intestinal mucosa are well known yet, whereas its effect on liver regeneration has to be studied in more detail. In a partial hepatectomy mouse model, GLP-2 admission showed a significant improvement in liver regeneration. Also its therapeutic use to prevent deterioration of liver function in short bowel syndrome, is pointing out its possible significance in the gut-liver axis. We wanted to know, if the endogenous GLP-2 concentration shows any dynamic in the perioperative course and if alterations are associated with the development of PHLF.

Methods: Fastening plasma with adequate amount of DPP-4 inhibitor from patients undergoing liver resections was collected preoperatively in 45 patients (major resections n = 19, minor resections n = 26, according to the Brisbane classification: major resection ≥ 3 segments), on postoperative day ( POD) 1 and POD5. GLP-2 and DPP-4 plasma concentrations were determined by ELISA. Routine laboratory parameters were used to define patients, who developed PHLF (n = 7), according to the definition of the ISGLS (Bilirubin >1.2 mg/dl and PTZ <70 % beyond postoperative day 7). Bile acids ( BA) and CRP were also determined preoperatively and in the post operative course. Non-parametric statistical tests were used for comparison of 63rd Annual Meeting of the Austrian Society of Surgery 1 3 7 Medizinische Universität Graz, Graz, Austria Aim: As 70 % of colorectal cancer ( CRC) patients will eventually develop metastatic relapse, systematic treatments and continuous monitoring of patients are of high clinical relevance. In this context, the analysis of circulating tumour DNA (ctDNA) represent a useful prognostic and predictive biomarker. But the underlying mechanisms for release of ctDNA remain obscure.

Here we aim to implement in situ sequencing ( ISS), a new type of nucleic acid analysis performed directly on tissue sections, preserving the spatial information of point mutations and specific transcripts in tumor tissues and its microenvironment. We aim to use ISS to investigate release mechanisms of ctDNA.

Methods: Resection specimens from 18 treatment naïve CRC patients with stage I-II colorectal cancer were comprehensively characterised at various levels: i) Molecular profiling using the TruSight Oncology 500 platform on tumour tissue and plasma. ii) ISS to read out complex cancer-related processes, cellular phenotypes and genetic perturbations in a spatial context. Patients specific mutations detected in tumour and blood were tracked in tumour sections to assess the mutations' spatial distribution across the tissue. ISS panels covering 12 biological pathways (104 genes) and 25 cell subtypes of epithelial cells, tumour-associated stromal cells and immune cells (101 genes) were performed.

Results: Data analysis of the ISS phenotyping was performed using CellProfiler (v.2.1.1) and MatLab. The various biological pathways/processes were linked to spatial heterogeneity of specific mutations in tissues, which are also present in ctDNA in blood. Selected parameter were used to develop a scoring normalised to expression per cell in the respective tissue area. Descriptive statistics and correlation analyses (and regression analysis), along with measures of association constructed from ISS data were used. Tissues from 18 patients were forwarded to molecular profiling. In a subset of patients, tumour-specific mutations were identified in plasma and tracked back to specific regions of the primary tissue. ISS analyses of tissue sections revealed spatial information of biological processes such as proliferation, energy metabolism, angiogenesis, or hypoxia to be increased in neoplastic compared to non-neoplastic tissues. Molecular findings were matched with clinical parameters (e. g. tumour stage). Granzyme B-expressing cytotoxic T cells that account for rapid induction of DNA fragmentation, were homing to tumour areas more frequently than to non-neoplastic areas.

Conclusions: Our preliminary data demonstrate that the reconstruction of the spatial organisation of primary tumours with respect to complex cellular phenotypes and genetic perturbations using ISS is feasible. Specific mutations can be traced by tissue sections. Correlation analyses of these data with the presence and levels of ctDNA even in early colorectal cancer will provide insights into mechanisms related to tumour burden and response to therapies. Data generated in this study link the genetic make-up of a tumour with cell type-specific colonisation and biological processes that contribute to ctDNA release, an urgent need for improving liquid biopsy strategies and a better understanding of tumour biology. der experimentellen Forschung. Leider ist der Erfolg dieses Modells aufgrund von Transplantatversagen durch Gefäßthrombosen begrenzt. Unter Berücksichtigung des 3R-Prinzips, welches eingeführt worden war um den Umgang mit Labortieren zu verbessern und die Qualität der experimentellen Daten sicherzustellen, wurde ein neuartiges Antikoagulationsprotokoll verwendet, um die Überlebensrate von Tieren und Transplantaten zu steigern.

Methoden: Insgesamt wurden 50 Hinterbeintransplantationen durchgeführt. Die Tiere wurden in fünf Gruppen mit unterschiedlichen Antikoagulationsprotokollen aufgeteilt. Alle Transplantate wurden mit einer Heparin-Kochsalzlösung in unterschiedlichen Konzentrationen gespült. In zwei Gruppen wurde zusätzlich ein Schema mit niedermolekularem Heparin ( NMH) angewendet.

Ergebnisse: Transplantatversagen durch Gefäßthrombosierung wurde in Gruppen beobachtet, in denen Spüllösungen mit Heparinkonzentrat von 50 IE/10 ml NaCL und 75 IE/10 ml verwendet wurden bzw. bei Verwendung von Spüllösung mit 50 IE/10 ml in Kombination mit einem niedrig dosierten NMH-Injektionsprotokoll (p = 0,03). Blutungsepisoden mit tödlichem Ausgang über die Knochenosteotomie waren signifikant höher in Gruppen bei denen Spüllösungen mit Heparinkonzentrat von 75 IE/10 ml bzw. 100 IE/10 ml verabreicht wurden, verglichen mit allen anderen Gruppen (p < 0,0001). Tiere, die mit einem moderaten NMH-Injektionsprotokoll plus Spüllösung von 50 IE/10 ml behandelt wurden, zeigten das beste Gesamtüberleben mit einer Erfolgsrate von 100 % ohne Tier-oder Transplantatverlust (p < 0,0001) Schlussfolgerungen: Unter Berücksichtigung des 3R-Prinzips berichten wir über das erste hocheffektive Antikoagulationsprotokoll, welches perioperativ bei muriner Hinterbeintransplantation eingesetzt wurde, um eine optimale Transplantatdurchblutung nach erfolgter Reperfusion zu gewährleisten. Sowohl Tranplantat-als auch Gesamtüberleben konnten folglich signifikant verbessert werden.

Tumour phenotyping and spatial mutation analyses in localised colorectal cancer to identify factors that contribute to ctDNA release 

After resection of the fistula and simultaneous appendectomy, the postoperative course was uneventful.

Conclusions: In summary, this case is a good example to show the pitfalls of very common diseases like diverticulitis and appendicitis, the importance of a sophisticated anamnesis, and the overestimated reliability of radiology.

References: AWMF S3 Leitlinien für Divertikulitis WSES Jerusalem guidelines 22a.5

Surgery timing and risk assessment in acute cholecystitis -a retrospective study Nichita M 1 , Bareck E 1 1 A.ö. KH Oberpullendorf, Oberpullendorf, Austria Aim: Laparoscopic cholecystectomy ( LC) is the gold standard in treatment of acute cholecystitis, timing however is still highly debated. In our hospital two main therapy types exist: either early cholecystectomy ( EC) -preferably within 72 hours after begin -or delayed intervention after initial antibiotic treatment (delayed cholecystectomy = DC). The aim of our study is define the proper timing and analyze whether determining a number of risk factors could contribute to an optimal planning of these operations.

Methods: We analyzed separately the EC (n = 72) and DC (n = 33) patients between 2016-2020. Elective surgeries or patients with incomplete data were excluded from our study. In both of these categories patients were divided in study and control groups ( SG and CG). Patients in the study group presented complications intra-/postoperatively or had a prolonged hospitalization or needed intensive care ( ICU). We assessed our data for risk factors by calculating OR and the p value from chi square contingency table. In a second part of the study surgeons were compared, thus could we differentiate between low volume surgeons ( LVS<5 laparoscopic cholecystectomy in acute setting) and high volume surgeons ( HVS >5).

Results: In our EC group age ( OR 9,47 p 0,002) and ASA of III or IV ( OR 5,05 p 0,005) were significant, they present a lower sensitivity in the DC group. Anamnestic assessment of patients and relating to the general health condition in deciding whether or when to perform a surgery seem to be a key factor. Preoperative tests such as inflammatory markers and liver enzymes are inconsistent in many cases, as higher values not always bring a worse outcome. In both groups was the attending surgeon an important factor, LVS presenting a risk for a bad outcome (p = 0,009 and p = 0,036). Morbidity, conversion rates and prolonged hospitalization are more frequent if the attending is LVS. In the EC group the preoperative waiting time was not a sensitive factor, definitely over 72 hours in most cases (median in CG 93,4 hours; median in SG 102,3 hours; p > 0,05).

Conclusions: Our study aims to define a better approach for timing of a laparoscopic surgery in acute cholecystitis. Data show that laboratory findings or imaging can not always predict a bad outcome and delaying the surgery -even beyond 72 hours -in favor of a more suitable surgical team ( HVS as attending) will benefit the patients. Schlussfolgerungen: Neben der maximalinvasiven Ösophagektomie mit Rekonstruktion sowie der endoskopischen Variante mit Versorgung mittels Stenting, kann eine VAC Therapie mit Ösophaguserhalt angeboten werden.

Diverticulitis with enterocolic fistula mimicking appendicitis with perityphlitic abscess. An uncommon presentation of a common diseasecase report Singh J 1 , Gasteiger S 1 , Kafka-Ritsch R 1 , Öfner D 1 , Perathoner A 1 1 Medizinische Universität Innsbruck, Innsbruck, Austria Aim: Diverticulitis is a common disease with a characteristic clinical presentation depending on the stage of the disease. Cross-sectional imaging is mandatory to establish a diagnosis and initiate optimal treatment. We present the case of a young patient, who was treated for obscure intraabdominal abscesses presumably because of gangrenous appendicitis, the intraoperative exploration notwithstanding showed a normal appendix and an enterocolic fistula as a result of a delayed and unknown perforated diverticulitis.

Methods: Case presentation: Results: A 42-year-old man was referred to the surgical department with lower abdominal pain and fever. The outpatient abdominal MRI showed numerous intraabdominal abscesses in the right hemiabdomen and no appendix vermiformis. Thus, the logical diagnosis was perityphlitic abscess following untreated gangrenous appendicitis. Nonoperative management with antibiotics was initiated and the abscesses were evacuated with CT-guided percutaneous drains. However, stool was seen in the drain after a few days, and surgical intervention was indicated assuming insufficiency of the appendiceal stump. Surprisingly, laparoscopic exploration showed an unremarkable appendix and an ileosigmoid fistula due to undetected and untreated diverticulitis. Postoperative profound re-anamnesis revealed characteristic symptoms already three months before. 

Comparative study of two abdominal negative pressure systems in clinical use. -Is the development of abdominal negative pressure therapy already completed? Sauseng S 1 , Delcev P 1 , Imamovic A 1 , Mayerhofer M 1 , Schemmer P 1 , Mischinger H 1 , Auer-Schönbach T 1 1 Abteilung für Allgemein-, Viszeral-und Transplantationschirurgie Universitätsklinikum Graz, Graz, Austria Aim: Since the first use of abdominal negative pressure therapy ( NPT) by Brooks in 1995, this form of therapy has developed into a standard therapy option for the treatment of secondary peritonitis or abdominal compartment syndrome at many centers. On the other hand, this form of therapy is often viewed critically due to the accompanying dangers. Critics probably rightly note, that there are no standardized treatment guidelines and therapy algorithms. This and recurring reports of an increased fistula formation rate and tertiary peritonitis often lead to uncertainty among users. As part of a prospectively randomized comparative study of two different negative pressure systems, drainage quantities, laboratory parameters, fistula rates and the abdominal-fascia-closure rate were evaluated and compared with each other.

Methods: Over a period of 2.5 years, 34 patients were recruited. These patients were randomized to the two treatment arms. Thus, 17 patients were treated per system. At the beginning of the treatment, the Mannheim Peritonitis Index was collected. Furthermore, laboratory parameters (leukocytes, CRP, PCT), drainage quality and quantity as well as other parameters (Amended -classification, therapy-associated organ damage) were collected on the defined therapy days 0,2,4,7,14,21 and 28. The planned re-operations were performed on the 2nd and 4th day and then every 2-3 days. The primary endpoint was the occlusion of the abdominal fascia before day 28. As a secondary endpoint the collected Daten was defined.

Results: The laboratory parameters leukocytes and CRP showed a comparable regredient course for both systems. Differences were found mainly in the duration of treatment (not significant) and in the amount of drainage-fluids (significant). A difference with statistical significance resulted in the improvement of the "Amended-classification" during therapy. In 27 patients, the abdominal-wall-fascia was closed (88.6 % vs. 70 %). The mortalitiy for both groups was 11.76 % (n = 4)

Conclusions: With a consistent and structured application of a negative pressure system for the treatment of abdominal sepsis, a significantly higher fascia-closure rate (79 % vs. 12-24 %) and a low mortality (11.76 % vs. 17-44 %) compared to a conventional therapy strategy can be achieved. In addition, there are interesting system-specific advantages. These differences ultimately show that the continuous further development of the negative pressure systems and the expansion of the indications are far from being completed yet.

References Methoden: Ein 53-jähriger Patient präsentierte sich mit Oberbauchschmerzen. Eine nekrotisierende Pankreatitis mit infizierter Pseudozyste wurde diagnostiziert. In der initialen Endosonographie zeigte sich bereits eine hochgradige Magenwandischämie, jedoch ohne Zeichen der transmuralen Perforation. Nach Ausschluss eines arteriellen Gefäßverschlusses im Oberbauch mittels Angio-CT erfolgte die endosonographisch gezielte, transgastrale Implantation eines lumemapproximierenden Metallgitterstents. Bei zunehmender Magenwandischämie mit Fundusnekrose erfolgte zunächst die Magensleeveresektion und im weiteren Verlauf die totale Gastrektomie mit Ösophagojejunostomie und Roux-en-Y-Rekonstruktion. Aufgrund von freier Luft und steigenden Entzündungsparameter wurde der Patient 2 Tage postoperativ neuerlich gastroskopiert und es zeigte sich eine Insuffizienz der Oesophagojejunostomie, eine intrakavitäre Unterdrucktherapie ( UDT) wurde eingeleitet und führte zu einer vollständigen Abheilung der Anastomoseninsuffizienz. Im Verlauf trat zusätzlich eine Insuffizienz des Jejunumblindstumpfes auf und auch hier erfolgte parallel die UDT.

Ergebnisse: Im Rahmen der Wechsel konnten über diesen Blindstumpf Nekrosektomien aus der Pancreasnekrosehöhle durchgeführt werden. Zur besseren Zugänglichkeit erfolgte die Stentimplantation in die Insuffizienz des Jejunumblindstumpfes und hierüber regelmäßige retroperitoneoskopische Nekrosektomien. Die Nekrosehöhle bildete sich so vollständig zurück und der Stent konnte im ambulanten Setting entfernt werden.

Schlussfolgerungen: Wir präsentieren hier einen Fall, in dem sowohl die WOPN als auch postoperative Komplikationen parallel endoskopisch therapiert werden konnten. Komplikative Krankheitsverläufe einer nekrotisierenden Pankreatitis benötigen individuell angepasste Therapien, endoskopisch erfolgen diese Interventionen minimal invasiv und zeigen sehr gute Ergebnisse, verlangen jedoch eine hohe Expertise und sind in Zentren durchzuführen.

63rd Annual Meeting of the Austrian Society of Surgery 2.687, p < 0.001). Within the second trial [2] the fistula rate in total was 19.2 % (23 out of 120 patients) in the unmatched base population. Considerably, more fistulae occurred in the control group than in the treatment group with visceral protection [22 (25.9 %) as opposed to 1 (2.9 %); P ¼ 0.00]. This significant difference remained even after matching. Enteroatmospheric fistulae formed on average on the 27th day after the initiation of open abdomen treatment (5th-60th day, SD 21.99, median 25). In the logistic regression model, the enteroatmospheric fistula formation was dependent on the use of a visceral protective layer, as it shows a highly significant protective effect with an odds ratio ( OR) of 0.08 (95 % CI 0.01-0.71, p = 0.02). This finding thus demonstrates that the use of visceral protective layder resulted in a relative risk reduction of 89.1 % for enteroatmospheric fistula formation.

Conclusions: The register-based, multi-center collection of data is essential, especially for rare treatments such as open abdomen therapy. The outcome during and after open abdominal treatment can be relevantly influenced by surgical means. These are the use of negative pressure wound therapy, the use of dynamic fascial traction techniques and the use of a visceral protective layer for fistula prevention.

References: [1] 

Damage Control Surgery improves outcome in perforated diverticulitis, especially ‚out of hours' Gasser E 1 , Perathoner A 1 , Öfner D 1 , Kafka-Ritsch R 1 1 Universitätsklinik für Visceral-, Transplantations und Thoraxchirurgie Innsbruck, Innsbruck, Austria Aim: Perforated sigmoid diverticulitis with generalized peritonitis remains a life-threatening condition requiring immediate surgical intervention. There are different treatment strategies for perforated sigmoid diverticulitis, including primary anastomosis and Hartmann's procedure. In our institution Damage Control Surgery ( DCS) with negative pressure therapy ( NPT) was implemented in 2006 as a novel therapeutic option. The DCS concept entails rapid sepsis control and limited resection of the deceased tissue. Following DCS a second look surgery (ideally with presence of a certified colorectal surgeon) is scheduled to decide about definitive treatment. This approach aims to reduce stoma rates and improve survival. The aim of this retrospective study is to analyze whether the DCS with NPT approach improves patient's mortality, morbidity, and stoma rate at discharge in comparison to definitive treatment at first look surgery. Furthermore, it was assessed whether timing of the surgery (regular working hours vs out of hours) and presence of a colorectal specialist had an impact on patient mortality and morbidity. respondent Author), Pavle Delcev (Third Author), Peter Kohek (Senior Autor)

Evidence based open abdominal therapy -study results from the open abdomen registry of the EHS Willms AG 1 , Schaaf S 1 1 Bundeswehrzentralkrankenhaus Klinik für Allgemein-, Visceral-und Thoraxchirurgie, Koblenz, Germany Aim: Open abdomen therapy is a procedure that is rarely required, but which has meanwhile become an established tool in the management of critically ill patients in abdominal surgery. On average, it is used in German clinics for five to ten patients per year. The main indications are, in order of frequency, secondary peritonitis, abdominal compartment syndrome and the most severe abdominal trauma. In addition to the advantages of the procedure, such as decreasing intraabdominal pressure with an consecutive improvement in perfusion of the abdominal organs, facilitating ventilation and easier accessibility for revisions and lavages, the procedure also harbors some possible risks. It is a certain challenge to close the abdomen again anatomically and without tension after pathophysiological restitution and the end of the open abdomen therapy. It is also important to avoid serious complications such as the development of enteroatmospheric fistulas or gigantic ventral hernias, as these are associated with significantly increased morbidity and mortality, lengthen the hospital stay and require further surgical interventions. Due to the relative rarity of the procedure, there is no alternative to multi-center data collection in the form of a register for further improvement and risk reduction.

Methods: The register forms a large data set for open abdomen therapy. From May 1, 2015 to December 31, 2020, the register was found under the umbrella of the EuraHS register (hernia register of the EHS) as the "open abdomen route". During these years, 913 cases from 29 clinics in eight European countries were entered. Two published studies are presented with analyses from the registry data. In a subgroup analysis from the registry, the impact of visceral protective layer on EAFs incidence was evaluated. A total of 120 peritonitis patients with secondary peritonitis as a result of a perforation of a hollow viscus or anastomotic insufficiency who had undergone open abdomen therpay were included. Propensity Score matching was performed. The 1st study is a multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i. e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in analysis. Finally, the register was evaluated to determine the influencing factors for achieving fascial closure at the end of the open abdominal treatment [1] . The 2nd study evaluated the role of visceral protection with regard to the development of EAFs. The cases in the registry with and without a visceral protective film were compared using propensity score matching [2] Results: In 2020 Willms et al. 2020 [1] published a trial in which 630 cases from 11 clinics in 6 European countries were analyzed. The overall rate of fascial closure was 57.5 % (intention to treat) and 71.0 % (per-protocol). A multivariate analysis revealed an association of achieved fascial closure with negative pressure wound therapy (odds ratio: 2.496, p < 0.001), with the use of dynamic fascial traction techniques/systems (odds ratio: 

Etablierung eines flexiblen Single Port Systems in der transoralen endoskopischen Thyroidektomie über den vestibulären Zugang ( SP-TOETVA) Methods: All patients with emergency laparotomy for perforated diverticulitis at our institution from January 2008 to August 2021 were included in this study. Patient records were retrospectively analyzed.

Results: A total of 153 patients (51.6 % female) with a median age of 70 (27-90) years, median BMI 25 (15-39.6) kg/m 2 and in 81.7 % ASA ≧ 3 respectively met the study inclusion criteria of emergency surgery for sigmoid perforation. Peritonitis was classified intraoperatively as Hinchey III in 120 (78.4 %) and Hinchey IV in 33 (21.6 %) patients. 110 patients (71.9 %) were subjected to DCS with limited resection of the diseased colonic segment and NPT for a mean of 2 (1-6) days and delayed anastomosis (n = 74; 67.3 %) or stoma creation (n = 35; 31.8 %), one patient died before second look operation. 43 patients (34.5 %) had definitive surgery and were treated with bowel reconstruction (n = 24; 55.8 %), Hartmann's procedure (n = 18; 41.9 %) or a laparoscopic lavage (n = 1; 2.3 %). Most emergency operations (n = 122; 79.7 %) were performed out of regular working hours or on weekends. Survival analysis showed an improvement inhospital mortality for patients operated with the DCS concept (18.6 % vs. 13.6 %; p = 0.053). In addition, in-hospital mortality was lower if bowel reconstruction was performed during regular working hours (19.7 % vs, 11.1 %; p = 0.065). There was a trend towards decreased ostomy rates in patients, where colorectal surgeon performed the second look operation (34.8 % vs. 65.2 %; p = 0.181).

Conclusions: This retrospective analysis of all consecutive patients with emergent operation for perforated diverticulitis indicates that DCS is a feasible concept and emends in-hospital mortality even when surgery is performed out of regular working hours.

Erste Ergebnisse in der transoral endoskopischen Schilddrüsenchirurgie ( TOETVA) der CAEK-Arbeitsgruppe Ziel: Die Wahrscheinlichkeit der Entwicklung einer Cholezystolithiasis nach gewichtsreduzierenden Eingriffen ist mit bis zu 50 % gegenüber der Normalbevölkerung (19 %) deutlich erhöht. Bis zu 10 % der postbariatrischen Gallensteinpatienten entwickeln eine Choledocholithiasis. Nach einem Roux-Y-Magenbypass ist die Therapie der Cholestase durch den veränderten Zugangsweg zur Papilla Vateri deutlich erschwert. Die transgastrische endoskopische retrograde Cholangiopankreaticographie ( TG-ERCP) hat sich als ideale Methode für diese Indikation erwiesen.

Methoden: Die laparoskopisch assistierte transgastrische endoskopische retrograde Cholangiopankreaticographie wird anhand eines Videos demonstriert.

Ergebnisse: Sowohl der laparoskopische Zugang zum Magen als auch die erfolgreiche Extraktion des Gallengangsteines und der gute Abfluss danach lassen sich sowohl endoskopisch als auch radiologisch gut darstellen.

Schlussfolgerungen: Die transgastrische laparoskopisch assistierte ERCP ist eine gut geeignete minimalinvasive Methode zur Behandlung der Choledocholithiasis nach einem Roux-Y Magenbypass. Eine gute interdisziplinäre Zusammenarbeit zwischen erfahrenem Endoskopiker und bariatrischem Chirurgen ist die Voraussetzung für eine erfolgreiche Therapie.

Schlussfolgerungen: Die Ergebnisse der Umfrage zeigen eindeutig die Notwendigkeit auf, die Ausbildungsqualität für schwangere Ärztinnen zu optimieren. Im Einklang mit dem erhobenen Stimmungsbild in Deutschland, sprechen auch die vorliegenden Daten für den Wunsch, dass Ärztinnen, unter Einhaltung von Schutzbestimmungen, operativen bzw. invasiven Tätigkeiten in der SS nachkommen dürfen. Dies würde einerseits ein kontinuierliches und rascheres Vorankommen in der operativen Ausbildung bedeuten, andererseits dem Trend, Schwangerschaften verzögert zu melden um länger operativ (ohne Schutzmaßnahmen) tätig bleiben zu können, entgegenwirken.

Referenzen : 

Die Frau in der Chirurgie -ein Erfahrungsbericht Ergebnisse: Aufgrund der gewählten Operationsmethode war der Patient schnell beschwerdefrei und konnte am 2. postoperativen Tag entlassen werden.

Schlussfolgerungen: Der vorliegende Fall zeigt, wie wichtig es ist, gerade Patienten, die im Ausland operiert wurden, präoperativ gut abzuklären um eine fachlich fundierte Grundlage für eine Reoperation zu haben.

Auswirkungen bariatrisch-metabolischer Chirurgie bei Vorliegen einer nichtalkoholischen Fettlebererkrankung ( NAFLD) auf die pankreatische Betazellfunktion und Insulinresistenz Methoden: Es erfolgt die detaillierte Beschreibung der Diagnosestellung und des intraoperativen Vorgehens.

Ergebnisse: Ein 55-jähriger männlicher Patient mit seit der Jugend bestehendem Übergewicht und einem BMI von 46.4 kg/ m² wurde entsprechend der IFSO Kriterien zur Laparoskopischen Roux-Y-Bypass Anlage freigegeben. Während der Primäroperation wies der Patient entsprechend der Grunderkrankung eine exzessive intraabdominale Fettverteilung auf, so dass eine aberrante Anatomie nicht identifiziert wurde. Man ging von einer regulären Anlage des Roux-Y-Bypass aus. Postoperativ erholte sich der Patient nicht wie erwartet und litt unter konstanter Übelkeit und rezidivierendem Erbrechen. Bei Verdacht einer Stenosierung der Jejunojejunostomie in der Funktionsröntgendiagnostik, erfolgte die laparoskopische Neuanlage der distalen Anastomose. Da der Pat weiterhin unter denselben Beschwerden in zunehmender Intensität litt, wurden weitere diagnostische Schritte eingeleitet. Eine CT-Diagnostik offenbarte eine intestinale Malrotation (Subtyp Non-Rotation). Die Indikation zur operativen Revision war somit gegeben und wurde konsekutiv erneut laparoskopisch durchgeführt, der Y-Roux Bypass wurde nun in spiegelbildlicher Weise angelegt. Retrospektiv kam es in der Primäroperation zur Verwechslung der Flexura duodenojejunalis mit der Ileozökalklappe. Dementsprechend erfolgte die Bypass-Anlage 100 cm oral der Ileozökalklappe und entgegen der Peristaltik von oral. Der weitere postoperative Verlauf gestaltete sich unkompliziert, der Patient war sofort beschwerdefrei. Die Entlassung erfolgte am 7. postoperativen Tag.

Schlussfolgerungen: Der vorliegende Fall zeigt, wie schwierig es selbst für in der bariatrischen Chirurgie erfahrene Chirurgen sein kann, bei massiver intraabdominaler Adipositas eine unbekannte aberrante Anatomie intraoperativ zu identifizieren. Zeigen Patient:innen nach der Anlage eines Roux-Y-Bypass eine persistierende Passagestörung, sollte frühzeitig eine CT-Diagnostik in Erwägung gezogen werden. Wird eine intestinale Malrotation mit einer Fehlanlage des Bypass nachgewiesen, ist in erfahrenen Händen eine laparoskopische Neuanlage mit einer raschen postoperativen Rekonvaleszenz möglich.

Referenzen: 1. Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP. Intestinal malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002; 45(10) :1381-6. 2.Shockcor N, Nzara R, Pal A, Lo Menzo E, Kligman MD. Operative approach to intestinal malrotation encountered during laparoscopic gastric bypass. J Surg Case Rep. 2020;2020(12)rjaa466 3. Palepu RP, Harmon CM, 63rd Annual Meeting of the Austrian Society of Surgery den. Zusätzlich erhobene Parameter sind Alter und Geschlecht der PatientInnen, BMI, Operationsmethode (Sleeve-Gastrektomie, Omega-Loop-, Y-Roux-Magenbypass, SADI-S) Gewichtsverlust (gemessen in Excessive weight loss, EWL) zwischen den Messzeitpunkten, ELF-Test (enhanced liver fibrosis score) und präoperativer Grad der Lebererkrankung ( NAFLD/ NASH, Steatose S0-S3, Fibrose/Zirrhose F0-F4).

Ergebnisse: Zum aktuellen Zeitpunkt (Februar 2022) liegen die präoperativen Ergebnisse von 50 PatientInnen vor. Postoperative Daten liegen derzeit von 10 Patientinnen vor. Im Mittel lag der BMI bei 48,25 kg/m 2 (43,1-59), die Lebersteifigkeit bei 10,99kPa (3, 2kPa) Aim: Eine Gewichtsabnahme vor bariatrischen Eingriffen wird in vielen Adipositaszentren empfohlen und gewünscht. Ein Gewichtsverlust von 2 kg/m 2 reduziert das viszerale Fettgewebe und verringert das Lebervolumen, wodurch die Operation technisch leichter wird und das Komplikationsrisiko sinkt. Ziel der Studie war, die tatsächliche Gewichtsabnahme durch eine initiale Ernährungsberatung und ärztliche Aufklärung in der Zeit zwischen Erstgespräch und der stationären Aufnahme zur bariatrischen Operation zu untersuchen. Weight loss prior to bariatric surgery is recommended and desired in many obesity centers. A weight loss of 2 kg/m 2 reduces visceral fat and liver volume, making the operation technically easier and reducing the risk of complications. The aim of the study was to investigate the actual weight loss through initial nutritional advice and medical information in the period between the initial consultation and admission to the hospital for bariatric surgery.

sive NASH-detection score ( NI-NASH-DS) berechnet. Klinische Parameter wie BMI, Plasmaglukose, Insulin, C-Peptid, Leberund Pankreasenzyme, Triglyceride, Albumin, Leptin sowie Adiponectin wurden über einen Follow-up Zeitraum von bis zu 4 Jahren erhoben. Die Betazellfunktion und Insulinresistenz wurden mithilfe des HOMA2-%B-Index (Homeostasis model assessment of b-cell-function) und "HOMA2 of insulin resistance" (HOMA2-IR) Index ermittelt.

Ergebnisse: 89 Patient/innen (78.8 %) wiesen Adipositasassoziierte Veränderungen des Lebergewebes auf, davon 60 (67.4 %) eine NASH und 29 (32.6 %) eine NAFLD. Bei Vorliegen einer NASH zeigte sich mit einem NAS von 4.28 ein signifikant schlechterer Score als bei NAFLD mit 2.07. Präoperativ wies diese Gruppe mit einem HOMA2-%B von 191.1 (vs. 264.1) und HOMA2-IR von 4.9 (vs. 4.7) eine deutlich schlechtere Betazellfunktion bei vergleichbarer Insulinresistenz auf (p < 0.05). Innerhalb der ersten vier postoperativen Jahre zeigte sich eine Reduktion des HOMA2-%B auf 134.5 bei NASH und 179.7 bei NAFLD sowie eine Verbesserung der Insulinresistenz mit einem HOMA2-IR von 3.1 bei NASH und 1.2 bei NAFLD. Der NI-NASH-DS konnte sowohl bei NASH (4.4 vs −9,7) als auch NAFLD (1.6 vs −9.6) verbessert werden. Insgesamt konnte im postoperativen Follow-up bei beiden Gruppen eine Optimierung der metabolischen Stoffwechsellage erreicht werden.

Schlussfolgerungen: Die bariatrische Chirurgie stellt eine effiziente Behandlungsoption dar, um den für die therapeutische Wirkung erforderlichen Gewichtsverlust zu erreichen und aufrechtzuerhalten. Es konnte gezeigt werden, dass Patient/ innen mit NASH bei gleicher Insulinresistenz eine signifikant schlechtere Betazellfunktion aufweisen. Diese Ergebnisse lassen vermuten, dass die endokrine Pankreasfunktion einen Risikofaktor für das Vorliegen einer NASH darstellen könnte. Demnach scheint der Mechanismus hinter der Verbesserung der NASH in der Verbesserung bzw. Erhalt der pankreatischen Betazellfunktion zu liegen.

Vergleich der Lebersteifigkeit vor und 3 Monate nach bariatrischem Eingriff durch Scherwellen Elastographie mit dem ACUSON Sequoia® Ultraschallsystem Nixdorf L 1 , Jedamzik J 1 , Richwien P 1 , Felsenreich M 1 , Gensthaler L 1 , Bauer D 1 , Reiberger T 1 , Langer F 1 , Prager G 1 1 

Ziel: Die Punkt-Scherwellen Leber-Elastographie (pointshear-wave elastography pSWE) ist ein nichtinvasives Verfahren zur Messung der Lebersteifigkeit, welche in dieser klinischen Studie mittels ACUSON Sequoia® Ultraschallsystem durchgeführt wird. Die Ergebnisse lassen Rückschlüsse auf die Lebergesundheit der Individuen zu. Insbesondere die Diagnose der nicht-alkoholischen Fettleber Erkrankung ( NAFLD/ NASH), Lebersteatose und Leberfibrose ist bei PatientInnen mit Adipositas von großer Bedeutung. Der Grad der Lebererkrankung kann durch Gewichtsreduktion nach bariatrischem Eingriff reduziert werden. In welchem Ausmaß dies möglich ist, soll in dieser klinischen Studie untersucht werden.

Methoden: Im Rahmen dieser Studie sollen insgesamt 50 PatientInnen, die aufgrund von Adipositas einen bariatrischen Eingriff an unserer Klinik erhalten, vor der Operation und 3 Monate nach erfolgter Operation einer Schwerwellen basierten Lebersteifigkeits-Messung (pSWE) unterzogen wer- Aim: The WHO estimates that over 2.1 billion people worldwide are overweight and 670 million are obese. Acupuncture is part of Traditional Chinese Medicine ( TCM) and works by stimulating the autonomic nervous system and releasing neurotransmitters in the hypothalamus and in several cranial nerve nuclei. It has been confirmed in numerous studies and 15 metaanalyses. Liver fasting according to Dr. Worm uses protein shakes to improve liver metabolism. This allows weight to be reduced and maintained in the long term. The aim of the study is to determine the effect of acupuncture (body and ear acupuncture) on BMI loss in combination with preoperative liver and interval fasting.

Methods: BACULIFE-BMI is a retrospective interim analysis of a prospective randomized, controlled single center study. 72 patients (52 women: 72.2 %) were evaluated for preoperative weight loss and 6 patients (6/72: 8.3 %) dropped out of the study. 20 patients with acupuncture + formula diet (Group A), 20 patients with formula diet (Group B) and the control group of 26 patients without treatment (Group C) underwent a 8-week investigation before bariatric surgery. The integrative treatment combination was assessed using objective metric ( BMI, body weight, bio-impedance analysis) & laboratory (cholesterol, triglycerides, total protein, albumin) and subjective parameters using quality of life questionnaires ( WHOQOL-BREF, BAROS, BARAQOL).

Results: The highest reductions in weight (−7.7 kg) and BMI (−2.5 kg/m 2 ) were found in Group A compared to groups B (−6.3 kg/−2.0 kg/m 2 ) and C (−1 kg/−0.4 kg/m 2 ). Acupuncture had no significant impact on weight (Group A vs. B: p = 0.18) and BMI (Group A vs. B: p = 0.20) in the diet groups. Both diet groups had significant weight and BMI changes compared to the control cohort (all p < 0.001). Nearly all parameters of the Bio-Impedance Analysis were significantly improved in the diet groups compared to the control (all < 0.001). The Fat Liver Index ( FLI) loss rate was highest in Group A (94.4 %) compared to Group B (77.8 %) and C (47.4 %). Quality of life was significantly higher in the diet groups compared to control (all < 0.001).

Conclusions: Formula diets are efficient and evidencebased supports for preoperative weight loss. Acupuncture as concomitant therapy option has proved to increase objective and subjective parameters in obese patients before bariatric surgery. As acupuncture is cost-effective and has minor side effects, the regulation therapy can be offered as part of a multimodal treatment strategy to fight the global obesity pandemic.

Ziel 6, 40 ; p = 0,018) und BMI ( RR: 6,81; p = 0,013) waren ein niedriger BMI < 40 kg/m 2 und eine längere präoperative Zeitspanne bis zur bariatrischen Operation von mehr als einem halben Jahr (Körpergewicht: RR: 1,10; p < 0,001/ BMI: RR: 1,12; p < 0,001). Ein hoher BMI ≥ 50 kg/m 2 , insbesondere bei Männern, verringerte das Körpergewicht ( RR: 0,36; p = 0,020) und den BMI ( RR: 0,38; p < 0,031) im präoperativen Verlauf signifikant. Over a quarter of the cohort (153/554: 27.6 %) managed to lose a median of 3 kg preoperatively [Q1; Q3: -5; -1], one quarter (131/554: 23.6 %) was able to keep the initial weight stable and half (270/554: 48.7 %) of the patients gained a median of 3 kg [Q1; Q3: +2; +5]. Significant risk factors for preoperative increase of Body weight ( RR: 6.40; p = 0.018) and BMI ( RR: 6.81; p = 0.013) were a low BMI< 40 kg/m 2 and a prolonged preoperative time span to bariatric surgery of more than half a year (body weight: RR: 1.10; p < 0.001/ BMI: RR: 1.12; p < 0.001). A high BMI ≥ 50 kg/m 2 , especially in men, significantly decreased Body weight ( RR: 0.36; p = 0.020) and BMI ( RR: 0.38; p < 0.031) in the preoperative course.

Conclusions: Trotz Ernährungsberatung und ärztlicher Aufforderung zur präoperativen Gewichtsabnahme, nahm nur ein Viertel der PatientInnen im Median 3 kg ab. Ergänzende multimodale Maßnahmen wie personalisierte Ernährung, Therapie des Mikrobioms und begleitende Akupunktur sind vielversprechende Optionen, die es anhand von prospektiven Studien zu evaluieren gilt. Despite nutritional advice and a doctor's request for preoperative weight loss, only one quarter of the patients lost a median of 3 kg. Additional multimodal measures such as personalized nutrition, therapy of the microbiome and accompanying acupuncture are promising options that need to be evaluated using prospective studies.

63rd Annual Meeting of the Austrian Society of Surgery aufnahmen mit Aufarbeitung der OP-Technik( LGBP, Sleeve), der Anastomosentechnik, der intraoperativen Komplikationsrate und der weiterführenden Diagnostik.

Ergebnisse: Im Zeitraum 2019-2021 wurde im Krankenhaus der Barmherzigen Schwestern Wien bei 378 Patienten eine bariatrische Operation durchgeführt. Insgesamt wurden 24 Patienten (6,3 %) innerhalb der ersten 30 Tage nach dem Eingriff erneut stationär bei uns aufgenommen.

Schlussfolgerungen: Die Rate an direkten postoperativen Komplikationen und Wiederaufnahmen nach bariatrischen Eingriffen ist gering, jedoch ist jede einzelne kritisch aufzuarbeiten um Strategien zu Verminderung der Rate erarbeiten zu können.

Kriwanek S 1 1 Klinik Donaustadt, Wien, Österreich Ziel: Eine Vielzahl von Verfahren werden derzeit in der bariatrischen Chirurgie eingesetzt. In Österreich stehen die Bypass Verfahren (Roux Y Bypass, Ein Anastomosen Bypass) und die Sleeve Gastrektomie im Vordergrund. Es stellt sich die Frage, ob es für die Wahl einzelner Verfahren Evidenz basierte Indikationen gibt.

Methoden: Übersicht über die publizierten Untersuchungen zur Sicherheit, Wirksamkeit und Langzeitfolgen verschiedener bariatrischer Operationen mit besonderer Berücksichtigung von randomisierten Studien und Publikationen großer Patientenkollektive mit langem Follow-up sowie Registerstudien.

Ergebnisse: Die Analyse der publizierten Studien zeigt für einzelne Indikationen (z. B. erhöhtes Operationsrisiko, gastroösophagealer Reflux, Diabetes mellitus, BMI > 50, Notwendigkeit der Einnahme von Medikamenten mit schmaler therapeutischer Breite) eine akzeptable Evidenz für die Wahl spezifischer Verfahren. Das heißt, dass es für ca. 50 % der Patientinnen und Patienten möglich ist, Evidenz-basierte Empfehlungen zu geben. Für alle anderen Patienten muss nach Darstellung der potentiellen Risiken und Benefits eine gemeinsame Entscheidung von Operateuren und Patienten erfolgen.

Schlussfolgerungen: Die derzeit vorliegende Literatur erlaubt es, bei der Hälfte der Patienten Evidenz-basierte Empfehlungen für die Verfahrenswahl einzusetzen. Bei allen anderen Patienten muss eine individualisierte gemeinsame Entscheidung von bariatrischen Chirurgen und Patienten erfolgen. tem und Freisetzung von Neurotransmittern im Hypothalamus und in mehreren Hirnnervenkernen und wurde in zahlreichen Studien und insgesamt 15 Meta-Analysen bestätigt. Das Leberfasten nach Dr. Worm verwendet Protein-Shakes, um den Leberstoffwechsel zu verbessern. Dadurch lässt sich langfristig das Gewicht reduzieren und auch halten. Ziel der Studie ist, den Effekt von Akupunktur (Körper-und Ohr-Akupunktur) in Kombination mit präoperativem Leberfasten mit nachfolgendem Intervallfasten auf eine BMI-Reduktion zu evaluieren.

Methoden: BACULIFE-BMI ist eine retrospektive Zwischenanalyse einer prospektiv randomisierten, kontrollierten Single-Center-Studie. 72 Pat. (52 Frauen: 72,2 %) wurden für die präoperative Gewichtsabnahme evaluiert und 6 Pat. (6/72: 8,3 %) schieden aus der Studie aus. 20 Pat. mit Akupunktur + Formuladiät (Gruppe A), 20 Pat. mit Formuladiät (Gruppe B) und die Kontrollgruppe von 26 Pat. ohne Therapie (Gruppe C) wurden vor einer bariatrischen Operation einer 8-wöchigen Evaluierung unterzogen. Die integrative Behandlungskombination wurde anhand von objektiven biometrischen ( BMI, Körpergewicht, Bioimpedanzanalyse) und Laborwerten (Cholesterin, Triglyceride, Gesamtprotein, Albumin) und subjektiven Parametern mit Fragebögen ( WHOQOL-BREF, BAROS, BARAQOL) untersucht.

Ergebnisse: Die höchsten Gewichts-(−7,7 kg) und BMI-Verluste (−2,5 kg/m 2 ) fanden sich in Gruppe A im Vergleich zu Gruppe B (−6,3 kg/−2,0 kg/m 2 ) und C (−1 kg/−0,4 kg/m 2 ). Akupunktur hatte keinen signifikanten Einfluss auf das Gewicht (Gruppe A vs. B: p = 0,18) und den BMI (Gruppe A vs. B: p = 0,20) in den Diätgruppen. Beide Diätgruppen hatten signifikante Gewichts-und BMI-Änderungen im Vergleich zur Kontrollkohorte (alle p < 0,001). Nahezu alle Parameter der Bio-Impedanz-Analyse waren in den Diätgruppen im Vergleich zur Kontrolle signifikant verbessert (alle < 0,001). Die Verlustrate des Fettleber-Index ( FLI) war in Gruppe A am höchsten (94,4 %) im Vergleich zu Gruppe B (77,8 %) und C (47,4 %). Die Lebensqualität war in den Diätgruppen signifikant (alle p < 0,001).

Schlussfolgerungen: Formula-Diäten sind effiziente und evidenzbasierte Unterstützungen zur präoperativen Gewichtsabnahme. Akupunktur als begleitende Therapieoption verbessert nachweislich objektive und subjektive Parameter bei adipösen PatientInnen vor bariatrischen Eingriffen. Da Akupunktur kostengünstig und nebenwirkungsarm ist, kann die Regulationstherapie als Teil einer multimodalen Behandlungsstrategie zur Bekämpfung der globalen Adipositas-Pandemie angeboten werden.

Analyse der Wiederaufnahmerate innerhalb der ersten 30 Tage nach bariatrischer Operation der Jahre 2019-2021. Eine retrospektive Aufarbeitung aus unserem zertifizierten Adipositaszentrum Aim: Long-term normothermic machine perfusion ( NMP) of the liver could represent a novel platform with the potential for organ modification, regeneration and repair. As a prerequisite, detailed insights into the cellular metabolism and bioenergetic processes during the preservation are required.

Methods: Attempting to delineate the consequences of long-term organ procurement on mitochondrial integrity and function, a porcine model of 7-day liver NMP was applied. Liver biopsies were obtained before the initiation of perfusion, as well as on day 1, 5, 6 and 7, and analyzed by high-resolution respirometry ( HRR; O2k, Oroboros Instruments, Innsbruck, Austria). Tissue biopsies were homogenized, and the succinate-linked respiration was measured at 37 °C in MiR05-Kit medium in the absence and presence of ADP. The outer mitochondrial membrane was assessed by cytochrome c addition.

Results: OXPHOS capacity showed a continuous decline in throughout perfusion (day 0: 49.1 ± 24.4, day 1: 40.4 ± 23.7, day 7: 28.3 ± 6.3 pmol s-1 mg wet weight-1). Comparison of mitochondrial efficacy of ATP production before initiation of NMP and after 24 hours revealed an initial decline (P-L coupling efficiency on day 0: 0.84 ± 0.05 vs. day 1: 0.75 ± 0.10; p = 0.016). Importantly, ATP production efficiency recovered on day 5 (0.81 ± 0.03; p = 0.188) remaining stable on day 6 (0.8 ± 0.04; p = 0.125) and 7 (0.82 ± 0.04; p = 0,437). Potential damage to the outer mitochondrial membrane was assessed by analysis of the cytochrome c control factor. A discrete elevation was observed after 24 hours (day 0: 0.21 ± 0.11 vs day 1: 0.33 ± 0.06; p < 0.05). However, recovery from this initial damage was indicated by lowered levels after day 5 (0.19 ± 0.07; p = 0.625) of perfusion, remaining unaltered until day seven (day 7: 0.2 ± 0.07; p = 0.593).

Conclusions: Our data indicate that, mitochondrial integrity and function, can be maintained stable during NMP of several days. A time-dependent decrease of mass-specific respiration is counterbalanced by stable ATP production efficiency. Importantly, a discrete impairment after 24 hours reveals to recover in the long-term perfusion setting.

Serotonin drives tyrosine phosphorylation of YAP-1 in biliary epithelial cells during human liver regeneration Aim: Serotonin (also 5-hydroxytryptamin -5-HT) promotes liver regeneration in rodent models. Yet, the mechanism by which 5-HT affects liver regeneration is poorly understood. Experimental data suggested activation of yes associated protein ( YAP-1) as a potential downstream target of 5-HT.

Methods: 61 patients undergoing major liver resection were included in these analyses. Tissue samples prior as well as two hours after induction of liver regeneration were collected. Circulating levels of 5-HT and osteopontin ( OPN) were assessed perioperatively as well as in the portal and liver vein. YAP-1, its phosphorylation states, cytokeratin 19 ( CK-19) and OPN were assessed using immunofluorescence. Ultimately, stimulation of human biliary epithelial cells (BECs) with 5-HT were performed.

Results: We observed a significant induction of YAP-1 shortly after induction of liver regeneration (p = 0.025) predominantly in BECs. SSRI treatment, depleting intra-platelet 5-HT, was associated with abolished YAP-1 and OPN induction upon liver regeneration. Portal vein 5-HT levels correlated with intrahepatic YAP-1 expression upon regeneration (r = 0.703, p = 0.035). OPN colocalized with YAP-1 in BECs upon liver regeneration and its circulating levels increased in the liver vein already two hours after induction of liver regeneration (p = 0.017). Liver regeneration significantly increased tyrosinephosphorylated YAP-1 (p = 0.042). Stimulating cultured BECs with 5-HT resulted in YAP-1 downstream target increase, increased YAP-1 tyrosine-phosphorylation and OPN expression.

Conclusions: Here we present the first in human evidence that 5-HT seems to exert its pro-regenerative effects via YAP-1 tyrosine-phosphorylation in BECs and subsequent OPN dependent paracrine immunomodulation. This evidence is adding to accumulating evidence suggesting a critical role of BECs in mediating pro-regenerative effects of YAP-1 signalling during liver regeneration.

The fibrinogen-albumin-platelets score ( FAPS) is an independent prognostic indicator in upfront resected pancreatic ductal adenocarcinoma ( PDAC) Radosavljevic S 1 , Jomrich G 1 , Wilfing L 1 , Gruber ES 1 , Winkler D 2 , Sahora K 1 , Schindl M 1 1 Medizinische Universität Wien, Vienna, Austria 2 Wirtschaftsuniversität Wien, Vienna, Austria Aim: Nutritional status, systemic inflammation, and coagulation mechanisms are related to cancerogenesis and tumor progression. Herein, we examined the role of a novel score based on preoperative blood concentration of albumin and fibrinogen and platelet count in the prognosis of patients with primarily resected pancreatic ductal adenocarcinoma ( PDAC).

Methods: Patients with pancreatic ductal adenocarcinoma ( PDAC) who underwent pancreatic resection between 1996 and 2019 and had a complete set of data were included in the study. The fibrinogen-albumin-platelet score ( FAPS) was calculated by assigning one point each for fibrinogen (<150 or >450 mg/dl), albumin (<35 g/l) and platelets count (<150 or >450G/l). Scores were correlated with patients' survival and clinicopathological characteristics and a simple nomogram was developed for overall survival ( OS).

Results: In 423 out of 654 (64.7 %) patients sufficient data was available. 187 44.1 %) patients had a FAPS of 1, 71 (16.8 %) patients FAPS 2 and 4 (0.9 %) FAPS 3. In the univariate analysis, Cox proportional hazard model shows significant shorter OS ( HR 1.25; CI95% 1.08-1.45; p = 0.003) for patients with a preoperatively elevated FAPS of 2 and 3. An elevated FAPS remained a significant prognostic factor in multivariate analysis for OS ( HR 1.22; CI95% 1.05-1.42; p = 0.009) with tumor size, lymph node stage, tumor grading and gender as covariates.

Conclusions: Preoperatively elevated FAPS is an independent prognostic factor for patients with PDAC undergoing upfront resection.

Extrazelluläre Vesikel aus Blut als Alternative in der Nervenregeneration Aim: Pancreatic ductal adenocarcinoma ( PDAC) is associated with an extremely poor prognosis. Hence, there is an urgent need to identify new diagnostic markers and therapeutic targets. Recent findings suggest a critical role of the genus Malassezia ssp. in PDAC tumor progression.

Methods: We retrospectively analyzed formalin-fixed paraffin-embedded pancreatic specimens extracting fungal DNA using QIAamp DNA FFPE Tissue (Qiagen). PCR analysis was performed using both primers for the internal transcribed spacer ( ITS) of the nuclear ribosomal DNA of Malassezia ssp., as well as primers specific for different Malassezia species. Results were compared with demographic data, histologic features, and patients' risk factors.

Results: 19 specimens were analyzed, including 10 PDAC, 5 intraductal papillary mucinous neoplasms ( IPMN), 2 chronic pancreatitis, 1 autoimmune pancreatitis and 1 serous cystic neoplasm. Specimens included tumoral as well as peritumoral tissue. Male to female ratio was 11:8. The median age was 63 (range 30-81). No significant correlation was identified between sex and malignant entities. Also, the distribution of risk factors like smoke and alcohol did not differ significantly between malignant and benign samples. No gender specific differences were observed regarding fungal colonization of the samples and none of the considered risk factors were significantly associated with positivity for Malassezia. In all the 10 samples derived from malignant diseases positivity for Malassezia species was identified. In contrast, only 4 benign samples were positive (p = 0.006). Among the positive benign samples 3 of them were precursor lesions, 1 IPMN, 1 chronic pancreatitis and 1 pseudotumor by autoimmune pancreatitis. Of note, there was no correlation between preoperative invasive interventions and the presence of Malassezia spp.

Conclusions: We identified the presence of Malassezia spp. in the pancreatic tissue with a predominance in samples of PDAC as well as its precursor lesions. These findings open new scenarios for feature diagnostic as well as therapeutic interventions.

Ergebnisse: Insgesamt konnten wir 18 PatientInnen (w = 11, m = 7) mit BWD und 18 Kontrollen in die Studie inkludieren ( LS = 12, OM = 6). Es gab keine Unterschiede in der Spirometrie (VCmax, Tiffenau Index), Spiroergometrie, Sonographie der Bauchwand und Pedobarographie zwischen den PatientInnen und der Kontrollgruppe. In der gastrointestinalen bezogenen Lebensqualität ( GIQoL) und im Bereich der sportmotorischen Grundfähigkeiten konnten zwischen den beiden Gruppen ein statistisch signifikanter Unterschied gefunden werden. Patientinnen mit BWD zeigten eine signifikant schlechtere GIQoL ( BWD ø135,3 ± 6,9 vs. Kontrollen ø141,1 ± 4,6; p = 0,041) und eine signifikant schlechtere sportmotorische Fähigkeit ( BWD ø 3,4 ± 0.8 vs. Kontrollen ø 2,9 ± 0,6; p = 0,003) aufwiesen).

Schlussfolgerungen: Auch, wenn unsere Studie durch die kleine Fallzahl statistische Limitationen hat, so liefert sie doch valide Daten, dass PatientInnen mit BWD signifikant verminderte sportmotorische Fähigkeiten haben können und im Langzeitverlauf dahingehend betreut werden sollten. Dadurch können Defizite frühzeitig erkannt und gezielt durch Physiotherapie unterstützt werden, um sportmotorische Fähigkeiten und damit auch die Lebensqualität zu steigern.

Referenzen: [1] Ziel: Enhanced recovery after surgery ( ERAS) ist eine zukunftsweisende und evidenzbasierte Therapiestrategie, die an den besten chirurgischen Kliniken weltweit implementiert wurde. Das gesamte Konzept besteht aus ungefähr 20 Kernelementen [1, 2] , die in 4 Phasen eingeteilt werden können: Prä-Aufnahme, präoperative, intraoperative und postoperative Phase. Bei einer erfolgreichen Implementation werden sowohl die biomedizinischen Endpunkte (Morbidität, Mortalität, Krankenhausverweildauer) als auch die Lebensqualität-Outcomes wesentlich verbessert [ 3] .

Methoden: Es handelt sich um eine monozentrische retrospektive Studie. Die eingeschlossenen Patienten wurden im Zeitraum vom 1. Januar 2021 bis 31. Dezember 2021 wegen eines kolorektalen Karzinoms operativ behandelt. Die Patienten mit kleinen Eingriffen wie Port-Implantation, Stoma-Anlage und Polypabtragung und minderjährige Patienten wurden ausgeschlossen. Der primäre Endpunkt war Compliance mit einzelnen ERAS-Elementen.

Ergebnisse: Während der Studienperiode wurden 92 Patienten mit der Diagnose des kolorektalen Karzinoms operiert und 71 Patienten erfüllten die Einschlusskriterien. Das mediane Alter war 69 Jahre und mediane Aufenthaltsdauer betrug 13 Tage. Drei operative Zugänge kamen zur Anwendung: laparoskopischer (56.3 %), offener (32.4 %) und robotischer (11.3 %). Nur 13.3 % der minimalinvasiv operierten Patienten hatten keine epidurale Anästhesie. Die mediane Liegedauer der Magensonde war 3 (1; 8) Tage und des Urinkatethers 4 (1; 13) Tage. Die gesamte Compliance mit ERAS-Elementen betrug 25 %.

Schlussfolgerungen: "Warum ist der Patient heute noch im Krankenhaus?" Das ist die zentrale Frage, die wir beantworten müssen, um die outcome-relevanten Faktoren zu identifizieren. Es ist notwendig den "evidence to practice gap" zu minimieren und die bekannte Evidenz effizient zu implementieren. Die Grundvoraussetzungen einer erfolgreichen ERAS-Implementa-che Lernkurve und eine befürchtete höhere Komplikationsrate halten viele chirurgische Abteilungen von einer Implementierung dieser Technik ab. Zentrale Absetzung der Gefäße sowie erhaltene mesokolische Strukturen scheinen ein besseres onkologisches Langzeitergebnis zu haben. Die CME gehört laut S3 Leitlinie zur "Guten Klinischen Praxis".

Methoden: 50 operative Eingriffe der eigenen Abteilung (nach dem modifizierten "Open Book Modell") werden hinsichtlich Op Dauer und perioperativen Komplikationen retrospektiv anhand der Dokumentation untersucht.

Ergebnisse: Nach eingehender Aufarbeitung der postoperativen Dokumentation von 50 SIL Hemikolektomien in CME Technik zeigt sich, dass nach anfänglicher Lernkurve sowohl die OP Dauer als auch die perioperativen Komplikationen der herkömmlichen laparokopischen Technik ebenbürtig sind. Erste Ergebnisse zeigen eine nahezu ähnliche OP Dauer wie bei der SIL Methode. Auch Blutungskomplikationen sowie Anastomosendehiszenzen finden sich auf dem Niveau der SIL Technik (ohne CME).

Schlussfolgerungen: Die SIL Hemikolektomie rechts in CME Technik ist der laparoskopischen Methode ( SIL und Multiporttechnik) hinsichtlich OP Dauer und perioperativer Komplikationsrate ebenbürtig. Die Lernkurve ist flacher, auch wegen der hohen anatomischen Variabilität. Die Evidenz zeigt, dass die komplette Entfernung des Mesokolons bessere onkologische Langzeitergebnisse bringt.

Qualitätsstandards wissenschaftlicher Inhalte in der Chirurgie Methoden: Qualitätsabstufungen der wissenschaftlichen Evidenzen lassen sich grob in 3 Ebenen definieren: 1) Translationale wissenschaftliche Evidenz: Auf wissenschaftlicher Basis entwickelte Operationstechniken, die am Krankenbett ankommen("bench to bedside") und das Controlling der erzielten klinischen Ergebnisse mit denselben Untersuchungstechniken ("bedside to bench") um weitere Verbesserungen der Chirurgie zu erzielen. 2) Wissenschaftliche Evidenzen die zukünftig oder fraglich klinische Relevanz erlangen. 3) Anekdotische Evidenz, die nur dann als gültig anzusehen ist wenn Punkt 1 und Punkt 2 nicht vorliegen.

Ergebnisse: Der Grundsatz des Chirurgen "Ich habe nach dem Besten Wissen und Gewissen gehandelt/operiert" muss zu diesen Evidenzen im Bezug stehen. Gerade bei der Gestaltung der chirurgischen Therapieprotokolle, bei Komplikationen, nach unvorhergesehenen klinischen Situationen, und bei Aim: Today's dogma without clear evidence is that case volume correlates with patients' outcome after liver transplantation ( LT). Thus, we prospectively analyzed the outcomes in our low volume center, which is characterized with strong interdisciplinary and interprofessional concepts.

Methods: Our LT program was re-organized and re-structured in 2016 including a center-embedded interdisciplinary and interprofessional team concept with new clinical standards for the peri-, intraoperative and follow-up management of patients. Conclusions: Clearly defined standards developed within an interdisciplinary and interprofessional team concept result in best possible outcome quality of treatment after LT independent of caseload.

Initial results of proximal gastrectomy and Aikou-Nishi double tract reconstruction for adenocarcinoma infiltrating the esophagogastric junction Universitätsklinik für Strahelntherapie-Radioonkologie, Graz, Austria Aim: Recently new adjuvant therapy-options with immunomodulators for patients with a locally advanced esophageal cancer ( LAEC) were established. This enabled a significantly better outcome for patients without a complete response. However, data of patients' outcome with a complete response is limited. The aim of this multicenter study is to analyze the overall survival and the disease-free survival of patients with an LAEC who were able to achieve a complete response and to compare this data to current literature concerning the new therapy options with immunomodulators.

Methods: A retrospective analysis from the prospective databases at four different specialized centers in Austria (Salzburg, Innsbruck, Linz and Graz) of all patients with a squamosa or adenocarcinoma of the esophagus, who received a complete response after either neoadjuvant radio-chemotherapy or chemotherapy followed by esophagectomy between 2016 to 2021 was performed. Data was analyzed with regard to disease-freesurvival and overall-survival. In addition, data was compared to the data of current literature.

Results: Complete data was available for 69 patients. Gender distribution was 85,5 % male (59 patients) to 14,5 % (10 patients) female. The median age was 61,69 years. The median BMI was 26.02.1947,8 % suffered from an adenocarcinoma and 52,2 % from a squamosa cell carcinoma. In a median follow up time of 38,72 months (0-138 months) 21,7 % developed a recurrence. The median disease-free survival was 36,84 months (0-138 months). The median overall survival was 38,72 months. Patients with adenocarcinoma showed survival advantage over patients with squamous cell carcinoma (42,9 vs 34,8 months) .

Conclusions: Recurrence-Free-Survival and Over-All-Survival in Austria is comparable with international data. Whether this group of patients should also receive adjuvant immunomodulation therapy remains unclear and requires further prospective randomized studies.

Benchmarking esophagectomy: High volume leads to low complication and mortality rates. Performance indicators of 20 years of experience Kirchweger P 1,2,3 , Kratzer T 1 , Fabbri A 1 , Tschoner A 1 , Spaun G 1 , Wundsam H 1 , Zaglmair W 1 , Huber J 1 , Biebl M 1,3 1 Ordensklinikum Linz -Department of Surgery, Linz, Austria procedure sacrifices the entire stomach and the reconstruction bypasses the duodenum. This may cause nutritional deficiencies and impairment of QoL after surgery. Others postulated abdominothoracic esophagectomy with gastric pull-up as favorable procedure for AEG II cancers, despite this technique is more complex and requires an additional access in the chest. Stimulated by Japanese reports [Aikou T et al.] and by the European "renaissance" [Hölscher AH et al.] we collected initial experience with proximal subtotal gastrectomy with antropyloric preservation and double tract reconstruction ( DTR) in selected cases with adenocarcinoma involving the esophagogastric junction.

Methods: Between 2019 and 2021 we performed proximal extended subtotal gastrectomy and DTR in 18 patients. Patients, in whom transhiatal R-0 resection was not estimated feasible without esophagectomy, were excluded. Since 2 patients had other diagnoses than adenocarcinoma (1 NET; 1 stenosis), 16 patients (median age 70a; range: 54-83a; 9 men, 7 women) were included in the study. Proximal transhiatal extended subtotal gastrectomy was done with a D2 lymphadenectomy with preservation of station 6 and 4d. We aimed to keep a proximal resection distance of at least 3 cm in situ, measured by intraoperative flexible endoscopy. The minimum distance between the tumour and the distal resection margin was 6 cm and 8 cm in intestinal and diffuse Lauren type cancers, respectively. The preserved antrum was anastomosed with the alimentary Rouxen-Y limb by a handsewn side-end jejunoantrostomy approximately 20 cm distal to the esophagojejunostomy. Patients were followed at 3-month intervals after surgery by clinical evaluation, blood tests and imaging. Perioperative and follow-up data were recorded.

Results: Initial clinical staging was cTx (n = 2), c/uT1 (n = 4), c/uT2 (n = 2) and c/uT3 (n = 8). We suspected regional lymphnode ( NL) involvement in seven patients, plus three patients with unclear nodal involvement endosonographically (uNx). None had initial M1. 8/16 patients underwent perioperative chemotherapy ( FLOT: 5, FOLFOX: 1, FOLFIRI: 1, FLOT with switch to FOLFOX: 1). Mean duration of the procedures was 313 min (sd; 43 min). Median hospital stay was 13 days (range: 10-45 days). R-0 rate was 15/16 (93,8 %; in one patient lymphatic vessels containing tumor cells were seen at the lesser omentum resection margin). Mean count of examined NLL was 31. In 13 cases (81,3 %) more than 25 NLLs were examined. Pathological response rate was Becker 1b, 2 and 3 in three, two and three patients, respectively. Six patients experienced postop complications (Clavien-Dindo I: 0; II: 3; III: 3, IV: 0). Thus, major morbidity rate was 18,8 %. There was no hospital mortality. Median follow up (fu) period was 258 days (range: 44-569 days). Six patients initially reported reflux symptoms, three reported dysphagia and one had early dumping. In two cases cancer recurrence was observed (one patient with hepatic recurrence, one patient with multiple metastatic recurrence sites) during follow-up.

Conclusions: Early results of proximal subtotal gastrectomy and DTR indicate, that this procedure is a valuable alternative to standard gastrectomy for adenocarcinoma infiltrating the gastric cardia, especially in patients who would not accept the loss of the entire stomach. The number of examined NLL and R-0 rate indicate an adequate surgical technique. Despite jejunum interposition six patients initially reported reflux like symptoms. In the short term no recurrences within the remnant stomach nor at the preserved NLL stations 6 and 4d were encountered.

References: Aikou T, Natsugoe S, Shimazu H, Nishi M (1988) Antrum preserving double tract method for reconstruction following proximal gastrectomy. Jpn J Surg 18 (1) Aim: Despite negative intraoperative frozen section analysis, R1 resection may be detected in definitive histology. Apart from perianastomotic R1, microscopic tumor within less than 1 mm distance to the circumferential resection margin ( CRM) is a crucial feature which cannot be fully prevented by resection techniques.

Methods: Between January 2000 and December 2021, 499 patients with esophageal carcinoma underwent curative esophagectomy. 223 of these were pT3 tumors in 212 of which pertinent information about CRM was available. We did a retrospective analysis of N, G and histological subtype, neo-adjuvant or adjuvant treatment and CRM. Correlation with recurrence rate, tumor-free survival, survival following recurrence and overall survival was established.

Results: 152 patients (68,1 %) developed recurrence. 41 patients had R1 and 7 had R2 at the CRM. By univariate analysis R1 at the CRM correlated significantly with recurrence (p = 0.001) and with overall survival (p = 0.005) but had no influence on post-recurrence survival. By multivariable analysis the significant correlation of CRM to recurrence persisted independently of N, G and histological subtype. The 3-year recurrence free survival rate was 7.8 % with R1 positive CRM and 0 % with positive R2, compared to 32.2 % with free lateral margins. By multivariable analysis, N and CRM retained negative statistical significance (p = 0.027) on recurrence free survival, whereas adenocarcinoma subtype had a positive impact. Neo-adjuvant therapy had neither impact on overall nor on post-recurrence survival. Adjuvant treatment did not influence post-recurrence survival.

Conclusions: In pT3 tumors residual tumor at the CRM has a significantly negative impact on recurrence and overall survival, which is independent of stage, grading, histology and neoadjuvant therapy. Post-recurrence survival was not influenced by CRM, N, G, histology of the primary tumor or adjuvant treatment.

Ösophagusresektionen an der Klinik Ottakring -Erfahrung aus 10 Jahren Esophagectomy accompanies with a high incidence of postoperative complications (40-60 % Clavien Dindo > III) and mortality (5y survival 15-35 %) that could be decreased to mortalityrates of <2 % in international very-high-volume centers. Since its development in 2019, up to 36 esophagectomies a year were performed at the Esophagus Center at the Ordensklinikum Linz, an Austrian tertiary hospital.

Methods: Retrospective analysis of our prospective database containing more than 350 patients undergoing resection for esophageal cancer at the Ordensklinikum Linz from 2002-2021 to evaluate potential improvements in outcome and complication management. Definitive results will be provided at the congress after final evaluation in late February/March 2022. Therefore, we solely provide interim results in this abstract (currently 72.6 % of data analyzed).

Results: Curative intended surgery for esophageal cancer was performed in 254 patients (84.1 % male sex), thereof 69.5 % adenocarcinoma and 30.5 % squamous cell carcinoma. Neoadjuvant (radio)-chemotherapy was applied to 73.2 % of patients. 61.3 % of patients underwent minimally invasive surgery (including conversions and hybrid procedures). Tumors in AEG positions represented the majority (71.8 %), and colonic interposition was necessary in 2.7 % of patients. R0 resection was accomplished in 93.9 % (until 2018) of patients compared to 95.1 % since centralization (2019). The overall incidence of complications was 64.6 % and 45.1 % for major complications (Clavien Dindo ≥ III), that could be reduced to 39.4 % (p < 0.000) and 35.7 % (p < 0.000) in recent years. Modern interdisciplinary endoscopic complication management (EndoVac) improved failure-to-rescue rates further from 19.6 % to 11.1 % (p = 0.011). Overall, reoperation-rate (34.1 %), 30-(3.6 %), 60-(7.6 %) and 90-day (10.1 %) mortality could be reduced to 11.1 % (p = 0.003), 1.4 % (p = 0.000), 3.3 % (p = 0.001) and 3.3 % (p = 0.004) respectively. This resulted in a median overall survival for patients with esophageal cancer undergoing curative intended surgery of 35 months (95 % CI 28-42).

Conclusions: Centralization and interdisciplinary complication management leads to low mortality and morbidity rates in an Austrian high-volume Upper GI center with performance indicators comparable to high-end international benchmarks (30d mortality <2-2.5 %, FTR <20 %).

Recurrence and survival following surgery of T3 esophageal carcinoma with curative intent. Role of circumferential resection margin 34. Hot Topics der Refluxbehandlung

Laterales Release mit SERAMESH PA DRUM Netzaugmentation bei Hiatushernie 

The role of laparoscopy in the treatment of complicated Crohn's disease: long term results from a propensity matched cohort Kessler H 1 , Cengiz B 1 , Duraes L 1 , Steele S 1 , Connelly T 1 1 Cleveland Clinic, Department of Colorectal Surgery, Cleveland, Ohio, United States Aim: Laparoscopic surgery for complicated (Montreal B3/ penetrating) Crohn's disease ( CD) is often technically challenging. No difference in perioperative outcomes between patients undergoing laparoscopic vs open surgery for complicated CD has been previously demonstrated. Aim was to compare long term outcomes of 1) subsequent intraabdominal procedure, 2) symptomatic hernia requiring operative intervention and 3) stoma reversal rates between matched patients who underwent laparoscopic and open procedures for complicated CD.

Methods: A logistic regression model was used to assign a propensity score to each patient using laparoscopic approach as the outcome and age, body mass index ( BMI), gender, Crohn's medication use, indication (fistula vs. abscess), ASA classification (1-2 vs [3] [4] Methoden: Retrospektive Analyse anhand der Patientenakten Ergebnisse: Insgesamt wurden 121 Patient(inn-)en an der Univ. Klinik Innsbruck im Rahmen des 2010 begonnenen MIE-Programmes operiert. Der überwiegende Anteil der Patient(inn-)en hatte ein lokal fortgeschrittenes Stadium und wurde daher im Rahmen eines multimodalen Therapiekonzeptes operiert. Nach einer Hospitation in den USA begannen wir den Schlauchmagenhochzug zunächst mit der Hybridtechnik (Abdomen offen, thorakal minimal-invasiv in Linksseitenlage). In der zweiten Phase operierten wir geeignete (Tumorlokalisation) Patienten komplett minimal invasiv mit intrathorakaler (maschineller) E/ S-Zirkuläranastomose, jene mit hohem Tumorsitz in Hybridtechnik ( VATS, Abdomen offen) mit collarer (maschineller zirkulärer) E/ S-Anastomose. Der thorakale Teil wurde bis dahin mit einer U-förmigen Anordnung der 5 Zugänge von dorsal operiert. In der dritten Phase kam ein ventraler Zugang mit 3 Thorakozentesen zu Anwendung. In der vierten und bisher letzten Entwicklungsphase modifizierten wir die Anastomose mit händischer Einzelknopfübernähung und Deckung mit omentalem Fettlappen. Der Patient wurde in Semi-Prone-Position gelagert und wir nützten Fluoreszenzdarstellung der Durchblutung des Schlauchmagens. Collar setzten wir in dieser bislang letzten Phase standardisiert die Neurostimulation des N.laryngeus recurrens ein. Im Rahmen der Präsentation werden die operationstechnische Entwicklung, die onkologischen Ergebnisse und jene der chirurgischen und "medizinischen" Morbidität dargestellt incl. Überlegung Schlussfolgerungen: Die minimalinvasive Ösophagusresektion ist der offenen Operation zumindest ebenbürtig. Spezialisierung und Fallkonzentration in einem Zentrum scheinen obligat.

63rd Annual Meeting of the Austrian Society of Surgery (n = 26; 12.1 %) as main procedure. The vast majority of patients had already undergone at least one surgical intervention before undergoing intestinal resection (e. g. abscess incision, comfort drain) as only 39.1 % had never had any intervention. A total of 26 patients (12.1 %) suffered from severe complications, defined as Clavien Dindo >2. Interestingly, only young age at diagnosis (Montreal A, p < 0.01) had a significant impact on complications, while none of the other factors defined in the Montreal classification did impact perioperative outcomes (disease location (L), disease behavior (B) or perianal disease modifier (p)).

Conclusions: Despite advances in medical therapy and ideal timing of procedures, the majority of patients requiring surgical interventions undergo >1 intervention in their lifetime. Patient factors have the biggest impact on postoperative complications. Future studies need to identify strategies on how to better optimize these high-risk patients prior to surgery.

References : 

Predicting endoscopic recurrence in patients with Crohn's disease undergoing surgical resection Dengler T 1 , Schlager L 1 , Gabler C 1 , Riss S 1 , Bergmann M 1 , Stift A 1 , Unger LW 1 1 Medizinische Universität Wien, Vienna, Austria Aim: Crohn's disease ( CD), in contrast to ulcerative colitis, cannot be cured by surgical interventions. Nevertheless, a significant proportion of patients require surgery due to complications. While some patients suffer from fibrostenotic complications, others present acutely due to intestinal perforations or fistulas. Depending on the type of CD complication, treatment strategy significantly differs, and subgroups of patients that benefit most from surgical intervention have been identified in prospective head-to-head trials comparing anti-TNF therapy versus laparoscopic resection. Additionally, increasing evidence suggests that type of anastomosis and extent of resection can impact on endoscopic recurrence rates. However, several of the published studies fail to adequately report patient factors, and consider medical therapies as covariates. Thus, we set out to identify factors for postoperative endoscopic recurrence in a well-characterized cohort of patients undergoing standardized intestinal resection due to Crohn's disease.

Methods: All patients who underwent surgical resection of the intestine for CD between 01/2015 and 12/2020 in a tertiary referral center in Austria with available postoperative endoscopic reports were retrospectively analyzed. One independent researcher performed data collection, quality control was performed by two separate independent researchers. Data on preoperative comorbidities, perioperative characteristics as well as postoperative outcome were collected. Binary logistic regression analysis was performed to identify factors that influence model was performed for sequential operation by adjusting for postoperative medications.

Results: 386 patients were included in the analysis (193 open, 193 laparoscopic, 51 .3 % male, mean age 33.9+/-12.6). After adjusting for the use and type of postoperative medications, no association was found between operative approach and subsequent intra-abdominal operation or symptomatic incisional hernia requiring operation over a mean follow up of 9.82 years After adjusting for postoperative medication use, there was no significant difference in odds of undergoing a further abdominal operation between the cohorts ( OR 0.91, 95 % CI 0.51-1.61). Patents in the laparoscopic cohort were more likely to have their stomas reversed [83.4 % vs 72 % in the open cohort, OR 1.9 (1.2,3.1, p = 0.01)]

Conclusions: In the setting of complicated Crohn's disease, laparoscopic surgery has comparable symptomatic hernia and intraabdominal reoperation rates compared to open surgery. Patients undergoing laparoscopic surgery are more likely to have their stomas reversed. Limitation of this study is its retrospective design at a single institution.

Changes in risk factors for perioperative complications in Crohn's disease patients undergoing surgical resection Schlager L 1 , Dengler T 1 , Gabler C 1 , Riss S 1 , Bergmann M 1 , Stift A 1 , Unger LW 1 1 

Aim: Crohn's disease ( CD) is an inflammatory bowel disease characterized by transmural inflammation that can affect the whole gastrointestinal tract but most commonly occurs in the terminal ileum. Medical treatment led to improved control of disease activity over the last few years, but recent studies also suggested that surgery may be a good alternative to escalation of immunosuppressive therapy for limited disease of the ileocecal region (1) . Despite a general approach to limit surgical interventions to (i) medical treatment failures and (ii) emergencies such as perforations, the 10-year risk of surgical resection for CD is still approximately 50 percent (2). However, as new treatments have led to a significant improvement of the general fitness of CD patients over the last decades and minimally invasive approaches are more commonly utilized, risk factors for perioperative complications may have changed over time. Thus, the aim of our study was to evaluate risk factors for surgical complications in the era of novel immunosuppressive therapies.

Methods: All patients who underwent surgical resection of the intestine due to CD complications between 01/2015 and 12/2020 in our tertiary referral center were retrospectively analyzed. One independent researcher performed data collection and quality control was performed by two separate independent researchers. Data on preoperative comorbidities, perioperative characteristics as well as postoperative outcomes were collected. The study was approved by the local ethics committee and informed consent was waived by the committee due to the study's retrospective nature.

Results: In total, 215 patients were included in this study of which 42 % of the patients identified as female. Median BMI was 22.2 (Q1-Q3 19. 4-25.3) , which showed an increase to previously analysed cohorts in our centre (years 2000-2014: 21.5 (19.04-23.96 ; (3)). The majority of patients underwent ileocecal resection or right hemicolectomy (n = 87 and n = 16; 40.5 % and 7.4 %), followed by small intestinal segmental resections 63rd Annual Meeting of the Austrian Society of Surgery Results: The median age of the patients at the time of surgery was 32 years, with a median body mass index of 21.2. Twelve patients (86 %) received monoclonal antibodies (Infliximab, Adalimumab, Ustekinumab, Vedolizumab) at the time of surgery. In addition, four patients had two fistulas treated in the same surgical session. There was an overall median operative time of 20 minutes. No perioperative complications occurred. After a median follow-up of 87 weeks, the fistulas were closed in 57.1 % (n = 8) of treated patients.

Conclusions: Alofisel® represents a safe, minimally invasive surgical technique without significant perioperative complications. As a result, clinical success can be expected in about half of the patients treated.

References: (1) Schlussfolgerungen: In fast der Hälfte aller Fälle erfolgte in dieser retrospektiven Studie eine Konversion einer Laparoskopie zur Laparotomie bei PatientInnen mit Dünndarmileus. Die Laparoskopie kann dennoch als invasive Diagnostik mit therapeutischem Potential eine sinnvolle Therapieoption darstellen. Wichtig hierbei erscheint die schnelle und gründliche periope-endoscopic recurrence (Rutgeerts score: no endoscopic recurrence (i0-i1) and endoscopic recurrence (i2-4)). The study was approved by the local ethics committee and informed consent was waived by the committee due to the study's retrospective nature.

Results: In total, 99 patients were included in this study. A total of n = 45 patients (= 45.5 %) suffered from endoscopic recurrence (Rutgeerts score ≥i2). Interestingly, patient factors (Montreal classification) and perioperative factors such as prior operations, number of anastomoses performed, or occurrence of perioperative complications did not impact on endoscopic recurrence risk. However, smoking at the time of surgery was the strongest predictor of endoscopic recurrence ( OR 3.619, 95 % CI 1.431 -9.150, p = 0.007). Similar to perioperative complications, postoperative immunosuppressants did not impact on endoscopic recurrence risk (anti-TNF, steroids, mesalazine, anti-IL12/23, or azathioprine or analogues).

Conclusions: Larger cohorts are needed to collect adequate sample sizes to determine risk factors for endoscopic recurrence. Future studies also need to address whether evidence generated in medically managed patients hold true for patients with complicated disease requiring surgery and identify the optimal approach to treat this highly selected cohort.

References 

Efficacy of Cx601 (Darvadstrocel) for the treatment of perianal fistulizing Crohn's diseasea prospective nationwide multicentre study (1, 2) . However, due to limited clinical data, this multicenter study aimed to determine the Austrian-wide success rate of the surgical technique.

Methods: Fifteen applications in 14 patients (3 male, 11 female) with complex anal fistulas treated in three tertiary hospitals in Austria between October 2018 and April 2021 were included in the study. Injection of 120 million allogeneic expanded adipose-derived mesenchymal stem cells (Cx601 -Darvadstrocel, Alofisel®) was performed. Visible closure of the external fistula opening without secretion by compression was defined as success. Ziel: Die vollständige Mobilisation der linken Kolonflexur ist bei der vorderen tiefen Rektumresektion mit stammnahem Absetzen der A. mesenterica inferior unumgänglich für eine spannungsfreie kolorektale oder koloanale Anastomose. Bisher gibt es keinen Konsensus über das ob und wie die linken Kolonflexur mobilisiert werden sollte. Besondere Herausforderungen stellen dabei anatomische Variationen in der arteriellen Randarkade dar, die bei der schonenden Mobilisation für die Gewährleistung der optimalen Durchblutung des zu anastomosierenden Kolonschenkels berücksichtigt werden müssen.

Methoden: In diesem Video zweier minimal invasiver Methoden (reduced port und Multiport Technik) einer TME wird der transmesokolische Zugang (weiblich, 61 Jahre) und der Zugang durch das Lig. gastrocolicum (männlich, 72 Jahre) in die Bursa omentalis zur vollständigen Mobilisation der linken Kolonflexur demonstriert.

Ergebnisse: Wichtige anatomische Landmarken zur vollständigen Mobilisation der linken Kolonflexur sind das gastrolienale und das phrenicokolische Ligament. In Studien mit überwiegend Rektumkarzinomen des unteren Drittels wurde nur bis zu 30 % eine Mobilisation der linken Kolonflexur unternommen [1] . Eine generelle Empfehlung für oder wider Mobilisation der linken Kolonflexur bei der TME gibt es daher bis dato nicht. In unserem Beispiel einer 61-jährigen Patientin mit Rektumkarzinom 6 cm ab ano und Z. n. neoadjuvanter Radiochemotherapie stieß man beim transmesokolischen Zugang zur Bursa omentalis auf eine zentrale mesokolische Anastomose der Randarkade, die geschont und dadurch eine einwandfreie Durchblutung des Kolonschenkels gewährleistet werden konnte.

Schlussfolgerungen: Die vollständige Mobilisation der linken Kolonflexur ist essentiell für eine spannungsfreie Anastomose nach vorderer tiefer Rektumresektion. Ein standardisiertes Vorgehen beim minimal-invasiven Zugang von medial nach lateral ist unumgänglich. Pitfalls müssen berücksichtigt werden und die Kenntnis über mögliche anatomische Variationen in der arteriellen Randarkade ist entscheidend für den Erhalt einer suffizienten Durchblutung des zu anastomosierenden Kolonschenkels.

Referenzen: [1] Kuzu MA et al. Redefining the collateral system between the superior mesenteric artery and inferior mesenteric artery: a novel classification. Colorectal Dis. 2021 Jun;23 (6) 

The use of laparoscopy for T4b colon cancer -are we playing with fire?

Kessler H 1 , Connelly T 1 , Steele S 1 , Duraes L 1 1 Cleveland Clinic, Department of Colorectal Surgery, Cleveland, Ohio, United States Aim: The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, particularly for T4b tumors when local invasion occurs to adjacent structures, remains controversial. The aim of this study was to compare short and long-term outcomes in patients undergoing laparoscopic vs. open resection for T4a and T4b colon cancers.

Methods: A prospectively maintained, single institution database was queried to identify patients with pathological stage T4a and T4b colon adenocarcinomas electively operated on between 2000 and 2012. Patients were divided into 2 groups based on the use of laparoscopy. Patient characteristics, perioperative and oncologic outcomes were compared.

Results: 119 patients [41 laparoscopic (L), 78 open surgeries (O)] met the inclusion criteria. No difference was observed in age, gender, BMI, ASA, and procedure between both groups. Tumors treated by L were smaller than O (p = 0.003). No difference was observed in morbidity, mortality, reoperation or readmission between the groups. Length of hospital stay was shorter in L compared to O (6 vs 9 days, p = 0.005). Conversion to an open approach was necessary in 22 % of laparoscopic cases. However, when tumors were subdivided by pT4 classification, conversion was necessary in 4 of 34 (12 %) pT4a patients vs. 5 of 7 (71 %) pT4b patients. In the pT4b cohort (n = 37), more tumors were treated by open approach (30 vs 7). For pT4b tumors, the R0 resection rate was 94 % (86 % in L vs. 97 % in O, p = 0.249). The use of laparoscopy did not impact overall survival, disease-free survival, cancer-specific survival, or tumor recurrence overall in all T4 or in T4a and T4b tumors.

Conclusions: Laparoscopic surgery can be safely performed in pT4 tumors with similar oncologic outcomes as compared to open surgery. However, for pT4b tumors, the conversion rate is very high. The open approach may be preferable.

Übergangs Siewert-Hölscher II) wird eine Vielzahl von Operationstechniken beschrieben. Bei einer Länge des involvierten Ösophagus von < 2 cm kann eine transhiatal erweiterte proximale Gastrektomie mit Lymphadenektomie der Stationen 1, 2, 3a, 7, 8a, 9, 11p, 13 Methods: Analysis of all liver resections performed between 02/2020 and 02/2022, excluding hepatectomies for acute complication or trauma management. Prospective data was recorded including patient and disease characteristics, surgical details and postoperative complication rate. Besides descriptive non-matched outcome data below, matched comparison between the three techniques will be presented in the full report.

Results: A total of 92 liver resections were analysed, of which 15 were preformed robotically ( DV), 25 laparoscopically ( LSC) and 52 open ( OP). The rate of major resections (>3 Segments) was 11 %, 11 % and 78 %, respectively. After a short initial period of non-anatomical wedge resection cases, the advantageous robotic technique with a steep learning curve allowed us to quickly proceed to advanced procedures including hemihepatectomies (n = 3) and resections of tumours located in the right-posterior segments or caudate lobe (n = 6). More than half of DV patients presented with cirrhosis or previous liver surgery. There were no conversions, a median blood loss of 150 ml and operating time of 225 minutes. The 90-day morbidity rate was 33 %, and all complications were Clavien-Dindo grade I-II, with no 90-d-mortality. The median ICU and overall length of hospital stay was 1 and 4 days, respectively, with 1 readmission.

Conclusions: The robotic technique allows for meticulous surgical preparation with low blood loss and a fast learning curve when applied by a well-attuned team in a centre with experience in open and minimally-invasive liver surgery. Especially patients with previous hepatectomies and cirrhosis requiring technically challenging operations such as major resections or right-posterior/segment I procedures could potentially benefit in terms of reduced morbidity and hospital stay when compared to LSC and OP surgery.

Das Ovarialkarzinom entsteht in den Tuben: Was bedeutet das für chirurgische Fächer? 

Simultaneous laparoscopic hepatic metastasis and colorectal cancer resection is a safe procedure: A single center case series Dittrich L 1 , Krenzien F 1 , Schöning W 1 , Pratschke J 1 , Haase O 1 1 Charité Universitätsmedizin Berlin -Chirurgische Klinik CVK/ CCM, Berlin, Germany Aim: Synchronous hepatic metastases occur in approximately 15-20 % of patients with colorectal cancer. Optimal treatment consists of a multimodal surgical and oncological concept. Various data have shown that the concurrent resection of synchronous colorectal cancer and its liver metastases is a safe procedure in open surgery. Nevertheless, recent data lack of evidence for the simultaneous laparoscopic surgical treatment. The aim of this case series is to evaluate the outcome and complications of the laparoscopic approach for simultaneous resection.

Methods: A prospective database for patients with resection of colorectal hepatic metastases was used to analyze surgical and clinical outcome parameter. All patients included, underwent simultaneous laparoscopic resection of the primary colorectal cancer and its synchronous secondary liver malignancy between May 2015 and June 2021.

Results: Overall, 26 patients (53.8 % female) were included. The greatest part of the study population was diagnosed with rectal cancer (n = 10; 38.5 %) followed by cancer of the sigmoid (n = 6; 23.1 %). 46.2 % (n = 12) were affected by unilobar and 53.8 % (n = 14) by bilobar hepatic metastases. In 3 (11.5 %) cases a right hemi hepatectomy and in 6 (23.1 %) cases the resection of two or more segments was performed. Mean IWATE-Score of all hepatic resections was 6.5 (±2.3). Mean length of operation was 402.5 min (±125.2). Major complications (Clavien-Dindo III-V) occurred in 3 (11.5 %) patients and in one case conversion to open resection was required. Median length of hospital stay was 9 days.

Conclusions: We could demonstrate that simultaneous minimal invasive surgical resection of the primary colorectal cancer and the synchronous hepatic metastases is a safe procedure. Even extended colorectal and liver surgery can be performed simultaneously.

Introducing robotic liver surgery in an established hepatobiliary centre with conventional laparoscopic expertise: surgical learning curve and potential benefits for patients Primavesi F 1 , Trattner M 1 , Urban I 1 , Bartsch C 1 , Stättner S 1 1 Abteilung für Allgemein-, Viszeral-und Gefäßchirurgie, Salzkammergutklinikum, Vöcklabruck, Austria Aim: Robotic-assisted surgery is established in urology and gynaecology and on the rise in many general surgical subspecialities such as colorectal resections, abdominal wall hernia repair and gastrooesophageal resections. The number of publications on robotic liver resections is limited, and so far, no Austrian centre has reported their experience compared to laparo- 

Dual port eTEP technique -technical modification in already minimally invasive hernia repair Obrist C 1 1 Krankenhaus Barmherzige Brüder Salzburg, Salzburg, Austria Aim: Minimal invasive laparo-endoscopic techniques in abdominal wall repair become more popular especially to prevent extensive tissue trauma. Among these techniques, the eTEP (enhanced view totally extraperitoneal plasty) procedure is a perfect sample of innovation ensuring the progress in hernia surgery worldwide. A modification of this technique using only two trocars was established in our hospital.

Methods: A technical modification in the approach through two precostal incisions using multifunctional glove port system, was performed in 15 patients with primary and recurrent hernia. We show the procedural key steps and results of this modified technique in ventral hernia repair retrospectively.

Results: Six primary (mean hernia defect size 25 cm 2 ) and nine recurrent (hernia size 21 cm 2 ) midline hernias were successfully treated in dual port eTEP technique with a mean operation time of 137 minutes. One mini umbilical incision was made because of incarcerated preperitoneal fat. During our follow up no recurrences were observed in our series.

Conclusions: Hernia treatment in reduced port (dual port) eTEP technique through a minimal invasive approach is feasi-alkarzinom bei Frauen nach Salpingektomie. Diese Erkenntnisse haben viele Fachgesellschaften, so auch 2015 die OEGGG gemeinsam mit der ÖGPath veranlasst, die sog. opportunistische oder prophylaktische Salpingektomie bei entsprechenden elektiven gynäkologischen Operationen zu empfehlen.

Ergebnisse: Diese Empfehlung wird bei gynäkologischen Operationen gut umgesetzt. 2020 konnte gezeigt werden, dass die prophylaktische Salpingektomie im Rahmen einer laparoskopischen Cholezystektomie von Frauen gut angenommen und technisch gut durchführbar war ( Methoden: Die chirurgischen Varietäten umfassen laparoendoskopische, robotische, minimal-invasive, offene-oder Hybridzugänge mit unterschiedlichen Netzpositionen in Bezug auf die Bauchwandschichten. Die großflächige präperitoneale Netzverstärkung offen, transperitoneal laparoskopisch ( TAPP) oder endoskopisch extraperitoneal ( TEP, TES) erfährt die breiteste Zustimmung. Das nötige Ausmaß der medialen Netzüberlappung wird determiniert von der Distanz der medialen Defektbegrenzung zum lateralen Rand der geraden Bauchmuskulatur. Die seitliche prä-und retroperitoneale Dissektion kann durch laterale Inzision der hinteren Rektusscheiden in das homolaterale Retrorektus Kompartment ( RRK) bzw. durch Überkreuzung der Mittellinie hinter der intakten Linea alba bis ins kontralaterale RRK ausgedehnt werden.

Ergebnisse: Die "intraperitoneale onlay meshplastik" ( IPOM) ist nur für kleinere Defekte mit möglichem Defektverschluss ein geeignetes Verfahren, bleibt aber auch als "Exit Strategie" bei defektem Peritoneum wichtig.

Schlussfolgerungen: Individualisierte prähabilitative und präkonditionierende Maßnahmen sind ebenso wie die präoperative anamnestische und klinische Befund-und Risiko Einschätzung mit radiographischer Schnittbilddiagnostik wichtig.

Ergebnisse einer konsekutiven Fallserie von n = 31 offenen, hinteren Komponentenseparationen 

Technical performance of minimally invasive endoscopic anterior component separation-a retrospective review in our 45 cases of complex abdominal wall hernias Mosshammer V 1,2 , Obrist C 2 , Brunner E 2 , Schirnhofer J 2 , Mittermair C 2 , Kemmetinger V 2 , de Cillia M 2 , Hoi H 2 , Grünbart M 2 , Weiss H 2 1 Victoria Mosshammer, Grödig, Austria 2 Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria Aim: The repair of complex abdominal wall hernias is considerably challenging for every surgeon. A method to repair enormous abdominal wall defects is the endoscopic anterior component separation.

Methods: We retrospectively present our patient with complex abdominal wall defects that were treated with endoscopic anterior component separation. Therefor we created a special pathway for preoperative patient evaluation and moreover changed technical operative treatment by using minimally invasive Glove Port Systems. Our objective was to evaluate the postoperative outcomes in our series of 45 patient treated in our hospital.

Results: Overall endoscopic component separation and retromuscular mesh placement were completed in all 45 cases. The average hernia defect size was 130 cm². Two recurrences occurred within the first year of the initial operation. In three cases we notice wound infections. Hematoma or Seroma were detected by the follow-up examination of five patients. Average operation time was 123 minutes.

Conclusions: The endoscopic anterior component separation by using a dual Port System and Mesh sublay augmentation can be easily performed by creating a pathway for repair of complex abdominal wall hernias. The postoperative complication rate can be positively modified by following a standardized guideline in complex hernia surgery. 

Ovarian inguinal hernia complicated by ovarian torsion in a 7 month old infant Tepeneu NF 1,2 1 University of Medicine and Pharmacy ''V. Babes'' Timisoara, Timisoara, Romania 2 Abteilung für Kinder-und Jugendchirurgie, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria Aim: The most common congenital anomaly in pediatric patients is the indirect inguinal hernia, affecting males more than females (ratio varying between 1/4 and 1/10), and affecting premature infants more than infants born full term. In female patients, the most common herniated organ is the ovary, seen in up to 20 % of patients, occasionally involving the fallopian tube. In females, approximately 4 to 37 % inguinal hernias present with non-reducible ovaries at the time of surgery, of which 2 to 33 % are twisted and sometimes infarcted.

Methods: A female infant aged 7 month was brought by her parents to the Pediatric Emergency Department with the complaint of a palpable mass in the left groin.Her parents had noticed the mass while changing her diaper. The patient was neither lethargic nor vomiting, she had normal stools, normal als dann kombinierte Masse an, sie können dabei auch zwischen sich andere Objekte einschließen. Umfänglich berichtet ist hiervon vor allem bei Kleinstmagneten, die sich zwischen Darmschlingen einklemmen, und dort schlussendlich lokale Perforationen verursachen können. In unserem Fall berichten wir von einem Jungen mit einem verschluckten mehrteiligen Magnetspielzeug, dass dabei ganz neue geometrische Dimensionen angenommen hat.

Methoden 

Monochoriale-diamniote Zwillinge mit akuter intestinaler Obstruktion postpartal, verursacht durch eine Nabelschnurfehlbildung-ein Fallbericht Canigiani de Cerchi K 1 , Maier E 1 , Benkö T 1 1 Klinik Donaustadt, Wien, Österreich Ziel: Dieser Fallbericht beschreibt eine Darmverletzung postpartal von eineiigen weiblichen Zwillingen infolge einer nicht erkannten Nabelschnurhernie. Ob, wie in diesen beiden Fällen, bei zusätzlich singulär gegabelter Nabelschnur eine Verletzung des Darmes durch die gesetzten Nabelschnurklemmen verhindert werden hätte können, muss zur Diskussion gestellt werden. Morphologisch zeigt eine Hernie in die Nabelschnur eine normal konfigurierte Nabelschnur mit intakter Haut und einer normal konfigurierten Bauchwand (Mm. recti abdominis sind normal). Dies liegt daran, dass sich eine Hernia into the cord erst in der 10. Schwangerschaftswoche manifestiert, nachdem die supraumbilikale Bauchwand entstanden ist. Deshalb ist diese Fehlbildung nicht einfach zu erkennen. In der Literaturrecherche von Artikel (1) gab es mit unseren Zwillingen 33 temperature, managed to void well and did not show signs of septicemia. The patient's medical history was unremarkable, with no congenital anomalies or surgical procedures. She had been born by cesarean delivery with no complications, she took no medications and had no allergies. The patient appeared well on physical examination and had normal vital signs (temperature 36.1 °C, pulse 145 beats/min, respiratory rate 28 breaths/ min and oxygen saturation 98 -99 % on room air). Her skin was unremarkable (besides a erithema in the area of the left groin), and her extremities were well perfused. Her abdomen was soft, nontender and showed no organomegaly. A hard, non-reductible mass (approx. 3 × 2 cm) was palpable over the patient's left inguinal area.The patient became irritable upon palpation of the mass, and the mass was not reducible. With the suspicion of a incarcerated hernia containing the left ovary we ordered a ultrasound, which confirmed our suspicion.

Results: The patient was operated emergently. At operation a incarcerated left inguino-labial hernia with a torsion of the left ovary (3 × 360 degrees) was found. Unfortunately there was gangrene of the left ovary and adnexa. A resection of the left ovary and adnexa and repair of the inguinal hernia was performed. The histopathological report confirmed the intraoperative diagnosis. The postoperative course was uneventful, the patient was released from the hospital on the third postoperative day.

Conclusions: Inguinal hernias in female infants may contain critical organs, including the uterus and bilateral adnexa. Ultrasound is an essential tool for rapid diagnosis and evaluation of organ viability. Irreducible ovarian content in an inguinal hernia should prompt the clinician to consider the risk of torsion or strangulation.Unlike inguinal hernias involving the testes, strangulation by surrounding loops of intestine within the hernia sac is not thought to be the common mechanism of ovarian necrosis. Instead, the most noted primary pathological event is caused by torsion of the suspended ovary while in the hernia sac, similar to the "bell-clapper" anatomic variant that results in spontaneous testicular torsion, where there is insufficient fixation of the gonad. Pain elicited over the mass may represent early signs of decreased perfusion, and suspicion for a twisted ovary should be high. may be confused with other conditions such as septic arthritis, osteomyelitis and appendicular abscess. Pelvic abscess, though uncommon in children, presents with varied signs and symptoms, often resulting in delayed management. A suspicion of pelvic abscess requires a prompt diagnosis so that rapid management and treatment can be undertaken.

Methods: This case describes the presence of a pelvic abscess in a pediatric female patient aged 4 years presenting to the emergency department with fever, pain in her left hip and a limp. A trauma was denied. The patient's medical history was unremarkable, with no congenital anomalies or surgical procedures. The X-ray of the hip, femur and pelvis was normal, the ultrasound of the pelvis did not reveal any abnormalities or hip joint effusion. The paraclinical investigations showed a rise of inflammatory markers ( CRP = 147.01 mg/ L, Procalcitonin 1,17 ng/ml). The patient was admitted to the hospital for treatment and further investigations.

Results: A broad spectrum intravenous antibiotherapy (Ceftriaxone and Gentamicin) was started. The blood cultures did not reveal any pathogen. The nasal exudate showed a Staphylococcus aureus infection. A MRI of the pelvis was done and this showed a left pelvic abscess (affecting mainly obturator externus and internus muscles). The antibiotherapy was continued for 14 days in association with symptomatic therapy. The clinical status improved slowly and so did the laboratory parameters. By the 14th therapy day all laboratory parameters were in normal range, the patient was afebrile and could walk again without any pain. She was released from the hospital and continued oral antibiotherapy for another 14 days. At follow-up 2 weeks after release from the hospital the patient did not have any more complaints, the laboratory parameters were all in normal range. A subsequent MRI of the pelvis 2 month later showed no abscess or abnormalities.

Conclusions: Pelvic abscess is an uncommon condition in the paediatric population.Due to the variability in clinical presentation, imaging, and in particular, ultrasound and MRI play a vital role in the diagnosis of cases with a high suspicion of abscess formation. Accurate diagnosis leads to a rapid treatment plan, avoiding further insult. 

Pelvic abscess in a 4 year old child -a case report Methods: A 8 month old girl with a tetraventricular hydrocephalus, epilepsy and a ventriculoperitoneal shunt presented with deteriorated consciousness, vomiting and a elastic large abdominal mass. Ultrasound and computed tomography of the abdomen demonstrated a collection of homogenous fluid (11,5/7/9 cm) near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal cerbrospinal fluid ( CSF) pseudocyst, the peritoneal shunt catheter was secured and divided into two parts. The proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage, the distal part was removed. The CSF cyst was partially resected, the large omentum also partially resected and a adhesiolysis performed. The CSF culture revealed Candida albicans.

Results: The patient received antibiotic and antifungic treatment (Meropenem and Fluconazol) and had a slow but uneventful postoperative recovery. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-weeks extraventricular drainage management.

Conclusions: Every physician in care of pediatric patients should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.In addition to shunt malfunction signs like lethargy and headache, typical clinical presentation includes abdominal pain and/or palpable abdominal mass, distention, nausea, vomiting, and decreased appetite and fever, resembling acute abdomen. Cerebrospinal fluid pseudocyst treatment varies and no standards have been established. Treatment strategies should be adjusted for the patient's overall clinical status.

References : (7) 

Xanthogranulomatous Pyelonephritis -A rare differential diagnosis to Wilms Tumor Schlader F 1 , Kargl S 1 1 Kinderchirurgie, KUK, Linz, Austria Aim: The most common renal neoplasm in the pediatric population is Wilms tumor, nevertheless, depending on age, there are a few differential diagnoses to consider. We present the case of a child with a renal mass turning out to be xanthogranulomatous pyelonephritis ( XP). Based on this case we discuss the relevance of XP as a differential diagnosis to malignant renal tumors in children. [1, 2] Methods: We performed a retrospective case analysis on a 5-year old patient initially treated for Wilms Tumor.

Results: In a 5-year-old boy ultrasound examination because of colicky abdominal pain revealed a large left-sided renal mass. Laboratory findings were microcytic anemia and urine culture showed Proteus mirabilis. In MRI the mass was considered as left-sided WT stage III. Chemotherapy according to Umbrella protocol (Vincristin, Actinomycin) was started. Re-Staging after 4 weeks showed regression of the renal tumor and local lymphatic nodes. Left sided nephrectomy with resection of para-aortal LN was performed and post-operative course was uneventful. Surprisingly, histological examination revealed xanthogranulomatous pyelonephritis without signs of malignancy.

Conclusions: Xanthogranulomatous Pyelonephritis ( XP) is a rare and severe variant of chronic pyelonephritis in childhood. The exact pathomechanism is unclear; destruction of renal parenchyma and inflammation with fibrosis and lipidladen macrophages are found histologically. While the focal type of XP may be treated with antibiotics, the diffuse type necessitates nephrectomy. Correct diagnosis may be suspected preoperatively but is confirmed postoperatively and confusion with Wilms Tumor is not uncommon. Therefore XP should be considered as a rare differential diagnosis to WT in a child with renal mass.

References : 

Giant pancreatic hydatid cyst as a rare cause for acute pancreatitis in childhood 

Pancreas gone astray -unique case of a pelvic pancreatic pseudocyst Stockinger MS 1 , Kargl S 1 1 Kepler Uniklinikum, Linz, Austria Aim: We report the case of a 9-year-old girl with a painful, size-changing, hemorrhagic cyst in the pelvic region.

Methods: After several differential diagnoses including intestinal duplication, hematoma, (veno-) lymphatic malformation, malignancy and urogenital malformation, total exstirpation brought the solution to the problem: Histologic workup of the specimen revealed pancreatic tissue -exocrine as well as endocrine -with a large pancreatic pseudocyst.

Results: Although ectopic pancreas is occasionally found in the gastrointestinal tract, extraintestinal pancreatic tissue is exceedingly rare. Single cases of ectopic extraintestinal pancreas has been described in the retroperitoneal space and in the mediastinum [1, 2] . It is noteworthy that in children extrapancreatic pancreatoblastoma also has been described [3] . Ectopic pancreas may be asymptomatic but pseudocyst formation may necessitate surgical intervention leading to the correct diagnosis.

Conclusions: In elusive cysts in the pelvic region, the retroperitoneal space or the mediastinum, pseudocysts arising from extraintestinal ectopic pancreas may be considered as a differential diagnosis.

References: [1] Sakurai H, Kanesaka T, Ikezawa K. Mediastinal ectopic pancreas diagnosed by endoscopic ultrasonography-guided fine-needle aspiration. Dig Endosc. 2022 Jan;34 (1) Aim: Hydatid disease may develop in almost any part of the body. The location is mostly hepatic (75 %) and pulmonary (15 %), and only 10 % occur in the rest of the body. Primary pancreatic hydatidosis is a rare event and acute pancreatitis related to pancreatic hydatid cyst is extremely rare.

Methods: We present the case of a 8 year old male, living in the rural area, with an huge abdominal mass (18/15 cm diameter) situated in the epigastric and upper umbilical region, which presented to the hospital with abdominal pain, vomiting, diarrhea and fever. The laboratory studies showed mild anemia, a normal white blood cell count, no eosinophilia, inflammatory markers were positive, lipase levels were 11 times higher than normal range, the levels of vanilmandelic acid, lactate dehydrogenase, alpha-fetoprotein and ferritin were in normal range, Anti -Echinococcus granulosus and multilocularis antibodies type IgG were positive. The MRI exam showed a cystic formation connected to the pancreas, compressing the organs around it (stomach, liver, extra-hepatic biliary ducts). CT scans and X-rays did not reveal the presence of any other cysts. The patient underwent surgical treatment -partial pericystectomy (Mabit-Lagrot method) and peritoneal drainage, medicamentous treatment with antibiotics and albendazole.

Results: The postoperative evolution was favorable and the patient was released from the hospital two weeks after operation. There were no short-term or long-term complications.

Conclusions: Since hydatid disease is endemic in some regions, it should be considered as one of the underlying etiologies for infection or inflammation of the pancreas even in the pediatric population. Schlussfolgerungen: Aufgrund nur schwach signifikanten Vorteile der intrakutanen Fortlaufnaht im Hinblick auf die Narbenqualität, sowie andererseits der deutlich verkürzten Nahtzeit und Kostenreduktion durch Hautklammern, kann eine generelle Empfehlung für den Einsatz von Klammernähten diskutiert werden. Erwähnt bleiben muss jedoch das hohe Patientenalter, die geringe Fallzahl und die onkologische oder vitale Indikation zur medianen Laparotomie in dieser Studie.

Prinzipien in der Wiederherstellung des Lächelns bei Gesichtlähmung

Ziel: Die Reanimation des gelähmten Gesichts ist eine Herausforderung für Patient und behandelndes Personal. Um die besten Ergebnisse in der der rekonstruktiven Chirurgie zu erlangen bedarf es einer sorgfältigen Berücksichtigung der Bedürfnisse des Patienten als auch der klinischen Gegebenheiten.

Methoden: Es werden die Entwicklung des menschlichen Lächelns, die soziokulturellen Unterschiede und Implikationen des Lächelns, die Arten des Lächelns und die allgemeinen Aspekte, die bei der Planung der Reanimation des Lächelns bei langjähriger Gesichtslähmung berücksichtigt werden müssen, präsentiert.

Ergebnisse: Das Lächeln ist als einer der wichtigsten Gesichtsausdrücke ein Schlüsselziel bei der Rekonstruktion des gelähmten Gesichts. Lächeln bedeutet Freude, aber es ist auch ein Signalsystem, das sich evolutionär weiterentwickelt hat, um viele Arten von Informationen auf unterschiedliche Weise zwischen Kulturen zu kommunizieren. Die Arten des Lächelns kann nach Duchenne-und Nicht-Duchenne-Lächeln als auch Rubin klassifiziert werden. Der Zugvektor der oralen Kommissur von den mimetischen Muskeln, insbesondere dem Zygomaticus major, ist die Hauptreferenz für die angemessene Position des transplantierten Muskels bei der Gesichtsreanimation. Bei der Planung der Wiederherstellung des Lächelns soll die Auswahl der Operationstechnik (freier Muskel vs. regionaler Muskel), Spendermuskel, Art des Innervation (Nervus N. facialis, N. massetericus oder duale Innervation) und ein/zweizeitiges Verfahren evaluiert werden.

Schlussfolgerungen: In Kombination mit präoperativer Evaluation der Patientenbedürfnisse und der klinischen Gegebenheiten zum Zeitpunkt der Planung der Reanimation des gelähmten Gesichts wird ein individueller chirurgischer Therapieplan mit dem Patienten erstellt. Somit kann gewährleistet werden, dass die erzielten Reanimationsergebnisse auch die Patientenbedürfnisse erfüllen. Dies ist das oberste Gebot in der Reanimation des gelähmten Gesichts. Methoden: Das Ziel dieser randomisierten, kontrollierten, dreiarmigen Single Center Pilotsstudie mit 10 TeilnehmerInnen war der Vergleich des Outcomes nach Hautverschlüssen mit Klammernähten, Einzelknopfrückstichnähten und Intrakutannähten an einem standardisierten chirurgischen Zugang, der medianen Laparotomie. Hierzu wurden alle drei Verschlusstechniken an einer Wunde durchgeführt und miteinander verglichen. Hauptzielgröße war die Qualität der Narbe beurteilt mithilfe der Vancouver Scar Scale, ( VSS), Visual Analogue Scale ( VAS) und der Patient and Observer Assesment Scar Scale ( POSAS) 6 Monate postoperativ. Nebenzielgrößen waren das Auftreten von postoperativen Wundheilungsstörungen und Infektionen nach den aktuellen Kriterien der Centers for Disease Control and Prevention ( CDC) sowie ein Kostenvergleich. Eine Subgruppenanalyse befasste sich mit der Fragestellung ob ein Verschluss des subkutanen Fettgewebes sinnvoll ist oder nicht. Die Statistische Analyse der Hauptzielgröße wurde basierend auf der intention-to-treat-Population durchgeführt. Als Signifikanzniveau wurde p ≤ 0,05 festgelegt.

Ergebnisse: Die durchschnittliche Operationsdauer der 10 Operationen belief sich auf 195 Minuten mit einer Durchschnittlichen Länge der Medianen Laparotomie von 19,55 cm. 4 Männer und 6 Frauen nahmen an der Studie teil. Die Beurteilung der Narbenqualität mit dem VSS (p = 0,079) und VAS (p = 0,13) zeigten keine statistisch signifikanten Unterschiede zwischen den drei verschiedenen Verschlusstechniken. Der POSAS zeigte einen schwach signifikanten Vorteil (p = 0,04) zugunsten der intrakutenen Fortlaufnaht. Hochsignifikante Unterschiede zugunsten der Klammernaht wurden hinsichtlich der Nahtdauer (p = 0,002) und der Kosten (p = 0,001) sichtbar, da 63rd Annual Meeting of the Austrian Society of Surgery

Does preexisting anticoagulant therapy influence the postoperative course of hemothorax? Roj A 1 1 Abteilung für Thorax-und Hyperbare Chirurgie, LKH Graz, Graz, Austria Aim: Anticoagulation or platelet aggregation inhibition can lead to serious blood loss and complications. In case of hemothorax ( HT), initial blood loss may be aggravated. There is, however, little information about the impact of anticoagulative treatment ( AT) on the course of surgical patients with hemothorax.

Methods: We analyzed 104 patients treated for HT between 01/2009 and 12/2021, 61 of whom had no antithrombotic treatment. 6 patients had long-term medication with direct oral anticoagulants (DOACs), 16 with coumarins, and 20 with antiplatelet drugs ( PLT-), in three of them dual; in all cases the medication was paused immediately. In due course 101 patients were administered low molecular weight heparins. Treatment modalities, number of in-hospital days, chest-tube days, requirement of packed red blood cells, and need for stay at the ( ICU) were evaluated.

Results: Mean age was 62,8 years ( SD +/+17,8). 6,7 % of patients had conservative treatment only, 60,6 % required chest tube drainage, 19,2 % VATS and 13,5 % thoracotomy. 64 % required ICU stay, packed red blood cells were necessary in 16 %. AT had no influence on either treatment modality, ICU-stay or need for need for transfusion. Mean duration of in-hospital stay was 13.4 (±7.9) days without significant difference between patients with or without AT. Mean duration of chest-tube drainage was 8.4 (±4.9) days and not generally influenced by AT though duration of drainage was the shorter, the more time elapsed since the stop of AT (p = 0,001). In detail, therapy with DOACs resulted in a significant reduction of in-hospital stay (p = 0,031) and chest-tube days (p = 0,006). Therapy with PLT-provoked no significant effects on either category, whereas Coumarins caused significantly longer in-hospital stay (p = 0,035).

Conclusions: Overall, only few negative effects of AT on the course of HT were found. Therapy with DOACs and PLT-showed no adverse effects on the course of disease. With coumarins a prolongation of in-hospital stay was noticed.

Perioperative complications in esophagectomy for carcinoma are correlated to a higher recurrence rate 

Timing and pattern of recurrence following resection of esophageal carcinoma Results: 40 (15.3 %) had local, 221 (84,7 %) patients had distant recurrence. Initial manifestations of relapse involved multiple sites in 85 cases and single sites in 176. In univariable testing squamous-cell carcinoma significantly correlated with a short interval until recurrence in general (p = 0.001; HR: 1.63), and so did ASA-scores (p = 0.022; HR:1.25), pT-stage (p < 0.001; HR: 1.74), pN (p < 0.001; HR: 1.77), and grading (p < 0.001; HR: 1.77). In multivariable testing, all these features except grading again showed a significant effect (p < 0.01). For multi-site recurrence squamous cell carcinoma, pT, pN and grading correlated with a short interval to relapse in uni-and multivariable analysis. In single-site recurrence only peritoneal or pleural carcinosis had shorter tumor-free interval approaching significance (p = 0.053). Following distant recurrence 24 months survival rate for all cases was 13.6 % compared to 18.5 % after local recurrence only (not significant). In case of initial multiple sites 24-months survival was only 4.9 % (p < 0.001).

Conclusions: Squamous cell carcinoma, pT, pN and grading were the most relevant parameters indicating early relapse. Considering single-site recurrence, carcinosis occurred earlier than other distant metastases. Multiple sites of relapse were connected to a short post-recurrence survival.

Ergebnisse: In der Gesamtkohorte lag das rezidivfreie Überleben nach 3 Jahren bei 100 % und nach 5 Jahren bei 86 %. In unserem Kollektiv beschreiben wir 35 benigne und 10 maligne Fälle. Von den benignen Fällen hatte 1 (2.9 %) Patient ein Rezidiv nach >36 Monaten, von den malignen 5 (50 %) Patient*innen nach >36 Monaten. Der neuen WHO-Risikostratifizierung folgend hatte von 27 Patient* innen in der low risk Gruppe lediglich 1 (3.7 %) Patientin ein Rezidiv nach über 5 Jahren. In der intermediate risk Gruppe hatten von 4 Patient* innen 2 (50 %) ein Rezidiv nach >36 Monaten und in der high risk Gruppe hatten von 4 Patient* innen 3 (75 %) ein Rezidiv nach >36 Monaten.

Schlussfolgerungen: Mit Hilfe der neuen WHO-Risikostratifizierung wird ein SFTP hinsichtlich seines Rezidivrisikos beurteilt. Basierend darauf könnten in Zukunft die bildgebenden Kontrollintervalle je nach zugehöriger Risikogruppe (low/ intermediate/high) zeitlich gestaffelt werden. Damit wäre ein patient* innenorientiertes und kosteneffizientes Follow-up gewährleistet.

Roth N 1 1 

Aim: Symptomatic diaphragmal hernias are mainly found in infants, rarely in adults. It usually occurs on the left side and is common in males (62 %). The defect is in the posterolateral diaphragm localized. Lung compression with respiratory distress, emesis and abdominal pain can be observed.

Methods: Six different cases who admitted to emergency room are described. Mainly symptom was acut chest pain. Repair methods, thoracal and abdominal approaches are compared.

Results: CT scan and fast treatment consisted in laparoscopic or thoracoscopic approach due to irreducible bowel incarceration is treatment of choice. Simple suture versus hernia repair with mesh is possible.

Conclusions: In acute chest pain concomitant with abdominal symptoms diaphragmal defects with intrathoracal intestinum should be considered.

Prediction of morbidity and mortality after videoassisted thoracoscopic surgery for lung cancer Ponholzer F 1 , Chorazy K 1 , Groemer G 1 , Ng C 1 , Maier H 1 , Lucciarini P 1 , Öfner D 1 , Augustin F 1 1 

Aim: With rising numbers of surgically resectable early stage lung cancers, as lung cancer screening routines are established, surgeons constantly face the challenge to guide patients to the right and most successful treatment modalities. Herein, interdisciplinary teams have to assess possible risks for morbidity, often associated length of stay ( LOS), and even mortality for each patient individually. This assessment mainly relies on the evaluation of cardiac and pulmonary function, but in recent years various risk prediction models have been published including several additional comorbidities. Validity of such scores is 4 

Aim: Despite developments in surgical technique and perioperative care, esophagectomy for carcinoma is fraught with medical and surgical complications. Whereas single features like major anastomotic dehiscence or pneumonia have been identified as negative prognostic indicators, the general prognostic role of perioperative problems is still disputed.

Methods: Between January 2000 and December 2021, 499 patients with esophageal carcinoma underwent esophagectomy and two field lymphadenectomy with curative intent. Sufficient follow-up data were available from 480 patients (63 female, 436 males; mean age: 63,2; range: 22-88; adenocarcinoma: 311; squamous-cell carcinoma: 184; other: 5). During the observation time (mean: 80,8 months; range 1-280 months), 261 (52.3 %) developed relapse, 40 of which was local and 221 distant with 85 patients showing multiple sites at first diagnosis of recurrence. We studied the impact of perioperative complications graded according to the modified Clavien scale on the incidence of recurrence.

Results: 334 patients had complications with Clavien 1 = 21, Clavien 2 = 57, Clavien 3a = 177, Clavien 3b = 31, Clavien 4a = 40, Clavien 4b = 12. Clavien 5 (N = 35) was excluded from further analysis. The probability of local relapse was significantly increased with increasing Clavien (p = 0.031; HR: 1,24), in multivariable regression analysis only Clavien 4b (p = 0,001; HR: 9,5) remained as significant predictor. For distant relapse, there was no relationship to complications on the Clavien scale. Clavien 1 (p = 0,014; HR: 3,5) had a significant correlatioin to multiple relapse in multivariable analysis.

Conclusions: High as well as low grades of complications on the Clavien scale show statistically significant correlation with the development of local or distant recurrence, respectively. The underlying mechanisms are yet to be determined.

Solitär fibröse Tumoren der Pleura: prognostische Kriterien und Follow-up Aim: Colorectal cancer is the second most commonly diagnosed cancer in females and the third most frequently diagnosed cancer in males. Most patients are suitable for surgical resection, but despite advances in perioperative care in hospitals, complications remain a cause for significant postoperative morbidity. Preexisting comorbidities significantly impact patients' risk, and some factors can be influenced to reduce difficulty rates (1) . While minimally invasive surgery is increasingly utilized, extreme patient positioning may influence postoperative recovery and cardiovascular outcomes in high-risk patients. The Charlson Comorbidity Index ( CCI) (2) is a validated score predicting the 10-year survival of patients based on their comorbidities. In contrast, the Clavien-Dindo Score (3) is a validated score used to classify postoperative complications, including unplanned admission to the ICU and/or infectious complications. As the overall outcome is dependent on surgical complications and influenced by medical complications such as postoperative pneumonia or cardiovascular complications, we sought to evaluate whether the CCI can be used to identify patients who are likely to develop complications, as measured by the Clavien-Dindo Score.

Methods: All patients who underwent first oncological leftsided colon resections between 01/2015 and 12/2020 in two high-volume centers in Austria were retrospectively analyzed. Two independent researchers performed data collection, and two separate independent researchers conducted quality control. Data on preoperative comorbidities, perioperative characteristics, and postoperative outcomes were collected. Patients with recurrent disease or peritoneal carcinomatosis were excluded from the study. Logistic regression analysis was performed to identify factors that influence postoperative development (Clavien Dindo: minor complications (≤2) and severe complications (>2)). The local ethics committee approved the study, and the committee waived informed consent due to the study's retrospective nature.

Results: In total, 492 patients were included in this study. Most patients were male (64 %) and diagnosed with rectal or sigmoid cancer (67 % and 23 %). Patients with a CCI >6 were more likely to develop major complications (Clavien Dindo ≥3) (p = 0.001) Logistic regression analysis, however, did only identify a CCI >6 as risk factor for postoperative complications ( OR 1.083; 95 % CI 1.004-1.168; p = 0.040), while mode of surgery (laparoscopic versus open; p = 0.369), body mass index (p = 0.282), and smoking (p = 0.701) did not.

The results of this study show that the preoperative CCI was the only factor predicting postoperative surgical complications, irrespective of the surgical management. These results suggest more accurate screening for patients at a higher risk of postoperative complications. still up to debate. Aim of this study was to perform an external validation of available EuroLung ( EL) scores for prediction of morbidity and mortality with our video-assisted thoracoscopic surgery ( VATS) cohort. Moreover, our cohort was analyzed for further factors impacting morbidity and mortality, such as sarcopenia and mediastinal adipose tissue ( MAT).

Methods: The institutional database was queried for patients with primary lung cancer who were treated with primary surgery between 2009 and 2019. External validation was performed in accordance to the TRIPOD statement for Prediction Model Validation. Discrimination was analyzed with the area under the receiver operating characteristic curve ( AUROC), which was compared between various scores by using the DeLong test. Calibration was tested with calibration-in-thelarge ( CIL) and calibration slope. Correlation was analyzed by using the eta coefficient. Sarcopenia was defined according to Derstine et al. as a skeletal muscle index <34.4 cm²/m² for women and <45.4 cm²/m² for men.

Results: Overall complication rate was 10.45 %. Scores showed weak individual correlation with the parsimonious EL1(2019) having the most accurate prediction for the overall cohort (11.11 %) and highest correlation (η = 0.174). The EL1 app score showed the best discrimination for morbidity with a AUROC of 0.660. EL1 App score had significantly better discrimination than the parsimonious EL1(2019) (p = 0.032). CIL showed a graphical trend towards systematically too high predictions, while at the same time showing too extreme risk estimations in the calibration slope. The best CIL and tightest estimation spread was delivered by the EL1(2019) and parsimonious EL1(2019) (a = −0.007/−0.007; b = 0.935/0.911). Predicted postoperative forced expiratory volume in 1 second (ppo-FEV1%) was associated with increased complications in both EL1 and parsimonious EL1. Sarcopenia was a significant risk factor for morbidity and LOS. MAT had no impact on short or long-term morbidity. Thirty-day mortality was 0.7 % (predicted 1.10-1.40 %) and was associated with ppoFEV1% for both EL2 and parsimonious EL2 scores. The EL2(2016) showed the biggest AUROC with 0.673; there was no significant difference between AUROCs. Only a very weak eta correlation between predicted and observed mortality was found for both aggregate EL2, EL2(2016), EL2(2019), and parsimonious EL2(2016) (η = 0.025/0.015/0.011/0.009). Sarcopenia had a significant impact on five-year survival, but not thirty-day mortality. MAT showed no impact on both.

Conclusions: Available EL scores are useful for estimating postoperative morbidity in VATS patient cohorts and may be used to compare quality of care between institutions, but fail to reach sufficient individual discrimination between predicted and observed events. As the score provided acceptable calibration one should consider adding different factors into the model, such as sarcopenia. Sarcopenia, assessed by skeletal muscle index, showed to be a prognostic marker of postoperative morbidity, LOS and long-term survival in our cohort. Therefore, existing risk scores should not be used to preclude patients from primary surgical treatment for lung cancer, but rather be used as a retrospective quality control. Nevertheless, single risk factors, such as sarcopenia, might be used to optimize postoperative outcome by preemptively starting physical prehabilitation or nutritional counseling in the course of the preoperative workup.

left-sided colon surgery. Emergency patients can also benefit from this. This is of immense importance in view of the high mortality rate of such insufficiencies (up to 30 %) [1] .

References: [1] Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery ( SELECT trial) G Ergebnisse: Von 641 Patienten wurden 41 % laparoskopisch und 59 % offen rechtsseitig hemikolektomiert. 26 Patienten erhielten ein endständiges Ileostoma und wurden von weiteren Berechnungen ausgeschlossen (n = 615). In 3,9 % (n = 24) aller Patienten, die ein Anastomose erhielten, trat eine Anastomoseninsuffizenz auf. In 12,5 % (n = 3) wurde diese übernäht, in 50 % (n = 12) die Anastomose neu angelegt und in 37,5 % die Anastomose aufgelöst und ein endständiges Ileo-oder Jejunostoma (n = 8 vs. n = 1) angelegt. 33,3 % der insuffizienten Anastomosen waren händisch genäht, 66,7 % maschinell angefertigt worden. 62,5 % der Patienten waren männlich und 37,5 % weiblich. Im Subgruppenvergleich zeigten sich Unterschiede in der postoperativen Aufenthaltsdauer (p = 0,040*). Patienten To avoid this, the use of local decontamination had repeatedly been discussed. Not least due to the introduction of "fast track" concepts, these efforts receded into the background for several years. In recent years, this topic has experienced a renewed renaissance. Thus, in the SELECT Trail [1] published in 2019, a low rate of anastomotic leakage after antibiotic decontamination for oncological patients with colonic resections could be demonstrated. In a retrospective analysis of 260 patients operated within an elective setting, which was published in the "Chirurg" in 2020, Beltzer et al. were able to show in principle the equivalence of the application forms intestinal irrigation and oral administration for this procedure. A statement regarding a mixed elective and acute surgical patient population cannot be found in the recent literature. In particular, Enterococcus faecalis and Pseudomonas aeruginosa seem to contribute decisively to the development of anastomosis insufficiency due to collagenase inflation [3] .

Methods: As part of a study started in 2018, both in patients who underwent left-sided colon resection under elective conditions and in acute patients, in whom, among other things, such a resection was necessary, a decontamination in the sense of a local antibiotic, realized. Depending on the possibility, an oral application or an additional intestinal irrigation was used. A 3-fold antibiotic consisting of polymycin B, gentamycin and vancomycin was used for this purpose. All other treatment steps were identical to the standard treatment.

Results: Despite a clearly mixed patient population with elective and acute surgical intoxications, only seven anastomosis insufficiencies were found in 104 patients. Thus, this value is in the range of literature references for purely elective patient collectives (0.7-8.7 %) [2], (or 5-15 % for carcinoma patients) [1] . However, well below the expected values for a mixed patient population (from 8 to 40 %).

Conclusions: A local antibiotic with the triple combination polymycin B, gentamycin and vancomycin for colon decontamination seems to be a suitable and easy-to-apply remedy to keep the anastomosis insufficiency rate as low as possible after 63rd Annual Meeting of the Austrian Society of Surgery

Therapy of the septic abdomen: "A perpetual surgical challenge" Imamovic A 1 , Kresic J 1 , Belarmino A 1 , Mayerhofer M 1 , Mischinger H 1 , Schemmer P 1 , Sauseng S 1 1 Abteilung für Allgemein-, Viszeral-und Transplantationschirurgie Universitätsklinikum Graz, Graz, Austria

Aim: The septic abdomen shows a mortality rate of 20 % to 60 % and presents treating surgeons with immense challenges. In most cases, individual decisions must be made in extreme situations. The treating surgeon becomes a "case manager" through the primary surgical therapy decisions and intensive care medicine, nutritional support, infection management and surgical follow-up procedures must be coordinated with this. Often these decisions are determined by the individual experience of the practitioners. But is there also recent literature that can help to make the right therapy decisions in these complex situations? In this work, recent publications on this topic are presented.

Methods: On the basis of a literature review, an attempt was made to identify recent publications that deal with the surgical treatment of the septic abdomen and that lead to a therapeutically relevant conclusion. The topic of abdominal instillation therapy is the subject of a publication by Sibaia et al. [1] in the International Journal of Surgery. A publication by Coccolini et al. [2] in the World Journal of Surgery also deals with the possibilities of intra-abdominal instillation therapy. With regard to the long-term consequences after definitive fascia occlusion and pre-therapy with dynamic sutures and negative pressure therapy, we found a publication in Frontiers of Surgery by Hofmann et al. [3] . There are very few publications available dealing with enteral nutrition during the therapy of the septic abdomen. A review by Scott et al. [4] published in "Nutrition in clinical practice" could not make clear recommendations but showed possibilities for different patient-groups.

Results: Using a retrospective analysis of 48 patients, Sibaia et al. showed the possibilities of intra-abdominal fluid instillation as part of a negative pressure therapy. There was a superiority in terms of "complications during therapy" (none), mortality rate (8.3 %, n = 4/48), fascia occlusion rate (96 %) and length of hospital stay (average 24 days, intensive care unit 7.5 days) compared to available literature data. Coccolini et al. were able to determine the following differences with a prospective data analysis from the International Register of open Abdomen ( IROA) with 387 patients. Although the group of patients with instillation (n = 84) showed a higher fascia occlusion rate (78.6 %) than the group without instillation (n = 303), a significantly higher complication rate during therapy (72.6 % vs. 59.9 %). Interestingly, however, this susceptibility to complications does not affect mortality, fistula formation, or hospitalization. Hofmann et al. determined a 10-year follow-up using questionnaires. The response rate was 24. Three patients reported scar pain. 11 complained of a scar hernia, while 5 had undergone surgical rehabilitation in the meantime. Scott et al. tried to show the possibilities of enteral nutrition by means of a systematic review.

Conclusions: The authors agree in their remarks that the negative pressure therapy combined with a fluid instillation into the abdominal cavity increases and accelerates the definitive fascia occlusion rate. There is disagreement as to whether instillation therapy has a benefit in terms of complication rate. The 10-year follow-up shows a high incidence rate of scar her- Aim: There is limited data regarding the management and outcome of anastomotic leakage following right sided colonic resection.

Methods: A retrospective multicenter study was done focusing on elective right sided colonic resection with ileocolonic anastomosis performed between 2010 and 2019. Demographic and perioperative data of patients and two different strategies (fecal diversion or no diversion) were analyzed.

Results: Within the study period a total of 3465 (1739 female, 50.2 %) patients were operated using an open (n = 2299; 66.4 %) or laparoscopic (n = 1166; 33.6 %) approach. Overall anastomotic leak rate accounted for 3.6 % (125/3465). Leak rate following open and laparoscopic resection was similar (3.7 % vs. 3.4 %) . Leak treatment (e. g. oversewing, refashioning of anastomosis) without fecal diversion was done in 73 cases (58.4 %). In another 52 cases (41.6 %) a protective or end ileostomy was raised. Demographic data (age, BMI, ASA score) and time to reoperation were similar among subgroups. However, Hinchey score was higher (3 vs. 2) in patients receiving fecal diversion. Notably, multiple re-operations were more common (53.9 % vs. 38.4 %) and leak associated mortality was higher in diverted cases (21.2 % vs. 13.7 %). In patients following laparoscopic resection, time to re-operation in case of leakage was shorter compared to those operated with an open approach initially (6 vs. 8 days) , resulting in a lower leak associated mortality rate (7.5 % vs. 21.2 %). Overall mortality rate was lower in the laparoscopic group as well (1.0 % vs. 3.5 %) .

Conclusions: (Supplemental) fecal diversion for leak treatment following right sided colonic resection does neither reduce number of revisions nor mortality rate. Re-operation at an early stage seems to be key to reduce leak associated mortality. 63rd Annual Meeting of the Austrian Society of Surgery in around 15 minutes. Especially the updated Björck classification has been included [1] . The new register can be found at www.ehs-openabdomen.com. The registry is organized into the following nine categories of data: hospital information, patient information, co-morbidities, risk factors, underlying disease, open abdomen treatment, abdominal closure, discharge, and follow-ups after 3-months, 1-year, and 2-year. Compared to the previous version of the register, the core of the data collection, the survey of the procedure for treating the open abdomen, has been made simpler and more structured. The recording of the individual procedure is structured by three questions: Material with intestinal contact, procedure with fascia and was NPWT used?

Results: From 5/2015 to 12/2020 a descriptive data set was conducted. 913 cases from 29 clinics in 8 European countries were entered. Average age was 59.3 ± 16.5 years, average BMI was 28.3 ± 20.0 kg/m², 65.3 % were male, 69.6 % had comorbidities and 20.9 % anticoagulants. Indications for OAT were secondary peritonitis (37.2 %), abdominal compartment syndrome or burst abdomen (28.6 %), trauma (9.2 %). The initial surgery was an emergency in 66.7 %. The mean initial MPI was 16.1 ± 10.1, trauma patients showed a mean ISS of 36.8 ± 16.9. The APACHE II score was 19.2 ± 9.9. Catecholamines were administered for 6.7 ± 8.1 days. In 147 cases (16.1 %) red blood cells were transfused (12.2 ± 15.4 units), FFP in 56 cases (6.1 %) (15.0 ± 21.2 un.) and platelets were required in 39 cases (4.3 %) (4.8 ± 5.7 un.) .The mean open abdomen duration was 17.3 ± 22.9 days 'overall mortality was 28.7 %. Definitive fascial closure was achieved in 44.8 % (intention to treat/52.8 % per protocol). In 8.9 % complications ≥ Clavien-Dindo IV occurred. The fistula rate was 6.7 %. In 2017, after 120 days of registration, the first 82 cases were evaluated an published [2] . The causes of OAT were secondary peritonitis for 36 cases (44 %), burst of abdomen for 18 (22 %) cases, abdominal compartment syndrome for 15 cases (18 %), abdominal trauma with damage control surgery 10 cases (12 %). The overall mortality rate was 22 %. Primary fascia closure was achieved in 48 of 82 patients (58,8 % intention-to-treat; 75 % per protocol) .

Conclusions: The basic principle is that all clinics that enter cases and that are then evaluated in one of the studies can also act as co-authors or contributors in the manuscript. In addition, the register should actively promote exchange and not serve as an end in itself. Optimizing laparostomy management techniques to achieve low incidence of fistulation and high fascial closure rates is possible. The method that ensures the best possible outcome-based on current evidence-would involve fascial traction, visceral protection, and negative pressure. Under NPWT, small bowel fistulas developed in 8 of 82 patients (9.8 %) (6 cases in peritonitis, 2 cases in abdominal compartment syndrome). Especially for the group with visceral protection there was a marked difference in the fistula incidence rate compared to those without. The fistula incidence rate among the group with the use of a visceral protective layer was 5.5 % (3 of 55 patients). The fistula incidence rate without visceral protective layer, however, amounted to 18.5 % (5 of 27 patients). At p = 0.06, this difference remains below the level of significance. The open abdomen registry is a useful tool for quickly generating sufficient evidence for open abdomen treatment.

References: [1] (1) Methods: Key objectives include collection of data, quality assurance, standardization of therapeutic concepts and the development of guidelines. Since 2015, the registry was available as an online database called Open Abdomen Route of EuraHS. It included 11 categories for data collection, including three scheduled follow-up examinations. The register lives the European spirit and forms one of the largest data sets worldwide for open abdomen therapy. In 2021, all registers of the EuraHS platform were relocated to a new domain, considering the new European General Data Protection Regulation. In this context, the query items of the data set were fundamentally optimized, updated, and ultimately simplified so that a patient can now be entered 

Do we need x-ray-guided implantation technique for optimal electrode placement in sacral neuromodulation? -a cadaver study Dawoud C 1 , Reissig L 2 , Müller C 1 , Jahl M 1 , Weninger WJ 2 , Riss S 1 1 Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Vienna, Austria 2 Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien, Vienna Austria Aim: Sacral neuromodulation ( SNM) is a common treatment for patients with incontinence, refractory to conservative management (1, 2) . A close contact of the tined lead electrode to the targeted nerve, is considered to improve functional outcome (3). This is the first anatomical cadaver study to evaluate the position of the SNM lead in relation to the sacral nerve by comparing two different implantation techniques.

Methods: We dissected 10 cadavers after bilateral SNM lead implantation (n = 20), using two different standardized implantation techniques. The cadavers were categorized as group A (n = 10), representing the conventional guided implantation group and group B (n = 10), where SNM implantation was conducted with the novel fluoroscopy-guided "H"-technique. The primary goal was to assess the distance between the targeted sacral nerve and the lead placement. In addition, anatomical landmarks were described.

Results: The electrodes were inserted at a median angle of 58.5° (range 46-65°) in group A and 60° (range 50-65°) in group B, without reaching statistical significance. In 8 cadavers, the lead entered the S3 foramen successfully. Notably, in group A, the lead (n = 2) was located in the gluteal muscle. The median distance of the lead to the nerve did not show a significant difference between both groups (E0: 

Is direct negative pressure therapy ( NPT) damaging intraabdominal organs? -An animal experimental stress model Delcev P 1 , Sauseng S 1 , Wiederstein-Grasser I 2 , Preisegger KH 3 , Schemmer P 1 , Mischinger H 1 , Auer-Schönbach T 1 1 Abteilung für Allgemein-, Viszeral-und Transplantationschirurgie Universitätsklinikum Graz, Graz, Austria 2 Biomedical Research Institute Medical University of Graz, Austria, Graz, Austria 3 Institute of morphological analytics and human genetics Graz, Austria, Graz, Austria Aim: Since introduction of negative pressure for open abdomen treatment, questions arise whether direct suction on organs could be hazardous. Several studies suggest that it could induce direct damage or promote fistula formation if applied direct on bowel surface. A novel foil for intra abdominal use (Suprasorb CNP, Lohman und Rauscher) was designed to optimise fluid extraction and protect underlying organs. In this animal model we tested its effect on different abdominal organs using continuous negative pressure.

Methods: On 7 domestic pigs we performed conventional cholecystectomy, staple bowel anastomosis, bowel suture and exposed pancreas surface. Suction pads were wrapped with gauze and double layer foil and were positioned directly on those sites. Abdomen was covered with foil and negative pressure was applied for 8 hours. We divided probands in two groups, with negative pressure of 30 mm Hg and 60 mm Hg respectfully. After 8 hours the organs were harvested and were examined under microscope.

Results: The organs and tissues showed no signs of macroscopic and microscopic damage. Furthermore no signs of microvascular impairement was to be seen. Neither bowel surface, nor anastomosis sites, nor bowel suture sites developed fistula.

Conclusions: The use of CNP foil proved safe in this animal model. Direct suction on organs showed no signs of damage. Therefore it could be considered as alternative to common used negative pressure systems in humans.

References: The effect of negative pressure in the abdominal cavity with Suprasorb CNP on abdominal organs -an experimental study Auer T1., Wiederstein-Grasser I2., Sauseng S1.,Delcev P1.,Preisegger K.H3. Aim: Pediatric liver transplantation ( LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care and immunological, as well as infectious challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short-and long-term outcome of pediatric LT in our center.

Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤ 16 years) performed at the Department of Surgery, Charité Universitätsmedizin -Berlin between 1991 and 2021. Three historic cohorts (1991-2004, 2005-2014 and 2015-2021) were defined. Graft-and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board.

Results: Over the course of the 30-year study period, 212 pediatric LT were performed at our center. Median patient age was 2 years ( IQR 11 years). Gender was equally distributed (52 % female patients). Main indications for liver transplantation were biliary atresia (34 %), acute hepatic necrosis (27 %) and metabolic diseases (13 %). The rate of living donor LT was 25 %. Median cold ischemia time for donation after brain death ( DBD) LT was 9 hours and 33 minutes ( IQR 3 hours and 46 minutes). Overall donor age was 15 years for DBD donors and 32 years for living donors. Overall respective 1, 5, 10 and 30-year patient and graft survival were 86 %, 82 %, 78 %, 65 % and 78 %, 74 %, 69 %, 55 %. 1-year patient survival was 85 %, 84 % and 93 % in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12 % (n = 26), with 5 patients (2 %) requiring re-transplantation within the first 30 days.

Conclusions: Excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications. 

Subcutaneous "Epifascial Cap" as the pathognomonic imaging sign of subcutaneous granuloma annulare in childhood -first description! Beqo B 1 , Tschauner S 2 , Haxhija EQ 1 1 Dept. of Pediatric and Adolescent Surgery, Medical University Graz, Graz, Austria 2 Div. of Pediatric Radiology, Dept. of Radiology, Medical University Graz, Graz, Austria Aim: Subcutaneous granuloma annulare ( SGA) is a selflimiting granulomatous disease in children of unknown etiology. So far, the accurate diagnosis has mainly been established by surgical biopsy as no specific imaging characteristics were known [1] . This study aimed to find imaging clues for accurate diagnosis of SGA.

Methods: A retrospective review of all MRIs of children with confirmed histopathological diagnosis of SGA between 01.01.2001-31.12.2021 was performed.

Results: Eleven patients (9 girls) with the median age of 3.5 years (range 2-5 years) had a preoperative MRI. Locations of SGA were on the lower leg (n = 5), forearm (n = 2), head (n = 2), hand (1), and foot (1) . Initially, none of the MRIs was conclusive for SGA. A subcutaneous vascular anomaly was the main differential diagnosis considered in all MRI reports. Malignancy could not be excluded. A retrospective review of MR images showed a hallmark shape of SGA lesions, resembling an epifascial cap with a broad circular base laying on the fascia and the central peak of the cap in the subdermal/dermal tissue (Figure) . This typical appearance of SGA lesions was present in all MRIs of our patients showing an isointense signal relative to muscles in T1-weighted images and hyperintense signal in T2-weighted images.

Conclusions: We describe for the first time a pathognomonic imaging sign for SGA in children. To the best of our knowledge, there is no other known subcutaneous lesion presenting in the shape as just described. Therefore, recognition and awareness of this imaging sign should significantly reduce the need for surgery in children with SGA.

References : Ergebnisse: Weder in der Gruppe der einseitig-noch in der Gruppe der beidseitig operierten Kindern traten perioperativ kardiorespiratorische Komplikationen auf. Es kam bei keinem der 22 Patienten zu einer revisions-oder interventionspflichtigen Nachblutung. In beiden Gruppen trat je ein Fall einer behandlungsbedürftigen Wundkomplikation auf: In der Gruppe der einseitig operierten Kinder eine tiefe Transplantatnekrose, in der Gruppe der beidseitig operierten Kinder eine oberflächlichen Wundheilungsstörung. Die mittlere Aufenthaltsdauer betrug sowohl bei den beidseitig, als auch bei den einseitig operierten Kindern 1, 8 Nächte. Die Anzahl der postoperativen Kontrolle bis zum Abschluss der Wundheilung 2,6 versus 2,1. Der mittlere Nachuntersuchungszeitraum der betrug 20,6 Monate. Eine Verkürzung der Operationsdauer aufgrund der gleichzeitigen Operation an beiden Händen konnten aufgrund der unterschiedlichen Klassifizierung beim einseitigen Doppeldaumen (Wassel II, IV und VI) versus beidseitigem Doppeldaumen (Wassel IIV) und der geringen Fallzahl bei den einseitigen häutigen Syndaktylien nicht aussagekräftig dargestellt werden.

Schlussfolgerungen: Die einzeitige beidseitige Korrektur von Handfehlbildungen vermindert im Vergleich zur zweizeitigen Korrektur vor allem die Dauer des stationären Aufenthaltes und die Anzahl der Nachkontrollen. Daraus ergibt sich für die Eltern eine deutliche Verringerung der intensiven Nachbetreuungszeit und für die Kinder nahezu eine Halbierung der Arztkontakte. Die für das Eintreten eines Narkoseereignisses sensiblen Phasen -die Ein-und Ausleitung der Narkose -wird auf die Hälfte reduziert. Einzelne Operationsschritte wie die Entnahme eines Vollhauttransplantates und der Defektverschluss an den Fingern werden jedenfalls synchron durchgeführt, sodass die Operationszeit so kurz als möglich gehalten wird. Ein gehäuftes Auftreten von Wundheilungsstörungen oder Narbenkontrakturen konnte bei den beidseits operierten Kindern nicht festgestellt werden. 8, 12, 24, 36, 48, 96, 144, 168 und 196 

Rehbein, div. Modifikationen) wurden inzwischen Großteils von den minimal invasiven Verfahren ( MIRPE, OP nach Nuss) abgelöst. Diese gehen mit einem postoperativ stabileren Ergebnis, sowie einer verkürzten Operationszeit und geringerem Narbenbildungsrisiko einher [1] [2] [3] . Gerade bei moderat ausgeprägten symmetrischen Deformitäten erzielt man mit dieser Methode schöne und durchaus zufriedenstellende kosmetische Ergebnisse, allerdings stellen sehr ausgeprägte Formen (tiefe, asymmetrische Trichter, "Grand Canyon type") eine Herausforderung an die Technik dar. Dementsprechend haben sich in den vergangenen Jahren zahlreiche Modifikationen entwickelt, vor allem in Bezug auf Länge und Anzahl der implantierten Bügel. Wir berichten über die Erfahrungen an unserer Abteilung mit der von Prof. Mustafa Yuksel (Marmara Universität Istanbul, Türkei) modifizierten Nuss-Technik. Hierbei kommen ein oder mehrere kürzere Bügel (Short-bar-Methode) zum Einsatz, die horizontal, schräg oder gekreuzt positioniert werden können (als parallel-oder cross-bar), je nach Ausprägungsgrad. Besonders bei älteren PatientInnen mit rigiderem Brustkorb oder asymmetrischen Formen ist diese Technik von enormen Vorteil. Durch die zusätzlich ventrale Fixation der Stabilisatorplatte an der Thoraxwand ist der Bügel zudem deutlich stabiler.

Methoden: Wir berichten über den Einsatz und die Erfahrung der modifizierten minimal invasiven Trichterbrustkorrektur (Short-Bar-Methode) nach M. Yuksel an unserer Abteilung zwischen Jänner 2019 und Jänner 2022. In diesem Zeitraum wurden von 54 PatientInnen, welche mit der Diagnose einer Tricherbrust an der Univ. Klinik für Kinder-und Jugendchirurgie, Medizinische Universität Wien in Behandlung sind, insgesamt 23 PatientInnen einer solchen Trichterbrustkorrektur unterzogen. Darunter erhielten 5 PatientInnen je einen Bügel, 15 PatientInnen je zwei Bügel (entweder parallel oder gekreuzt) und weitere 3 Patienten insgesamt drei Bügel (einer parallel, zwei gekreuzt (cross-bar)). Es wurden damit sowohl symmetrische als auch asymmetrische Ausprägungen erfolgreich korrigiert, und auch die seltener vorkommende, aber schwer ausgeprägte "Grand Canyon-shaped"-Deformität, bei der ein tiefer, rinnenförmiger Trichter mit Rotation des Sternums vorliegt. Intraoperativ wurde bei allen Eingriffen eine Saugglocke (Vacuum-Bell) verwendet, um das Sternum temporär anzuheben und dadurch mehr Übersicht während des Tunnelierens zur erreichen, was die Sicherheit des Eingriffes bedeutend erhöht. Die klinischen Nachkontrollen erfolgten in regelmäßigen Abständen von 2 Wochen, 1, 3 und 6 Monaten postoperativ.

Ergebnisse: Von den insgesamt 23 operierten PatientInnen tolerierten alle den Eingriff hervorragend. Intraoperativ traten keine unerwünschten Komplikationen auf. Die durchschnittliche Operationszeit betrug 150 Minuten, der postoperative stationäre Aufenthalt im 

Korrektur der schweren und asymmetrischen Trichterbrust mittels minimal invasiver Short-und Cross-Bar Technik (modified NUSS-MIRPE) kationsrate einherging und somit eine mögliche Behandlungsalternative für Sinus pilonidalis darzustellen scheint.

Referenzen: [1] 

The choice of approach for the pyloromyotomy: open or laparoscopic? Malovanyy B 1 , Pereyaslov A 2 , Dvorakevych A 1 , Stenyk R 1 1 L'viv Regional Children's Clinical Hospital " OXMATDYT", L'viv, Ukraine 2 L'viv National Medical University, L'viv, Ukraine Results: There were no differences between both groups in age (p = 0.293), gender (p = 0.589), duration of illness (p = 0.793), and presence of electrolytes' disturbance (p = 0.992). The operation time was slightly shorter in open group, but this difference was insignificant (p = 0.124). Despite a slightly shorter operative time in OP group, these patients more often had postoperative vomiting (15.8 %) and significantly longer time to start oral intake (7.9 ± 1.7 hours, p < 0.001) compared with patients of LP group. There were no cases of incomplete myotomy in both groups. The perforation of mucosa was noted in one (4.5 %) child of LP group. The frequency of wound infection was almost the same in both groups of patients (p = 0.906). Incisional hernia (2.6 %) and adhesive bowel obstruction (2.6 %) were noted in case of OP.

Conclusions: Both technics are the safe and effective for the treatment of patients with IHPS. Laparoscopy has some advantages over open pyloromyotomy, without additional complications.

Schlussfolgerungen: Die modifizierte Short-Bar-MIRPE kombiniert die Vorteile der klassischen Nuss-Methode (kurze OP-Zeit, kürzere Spitalsaufenthalte, geringe Narbenbildung, weniger postoperative Schmerzen) mit zusätzlich verbesserten kosmetischen Resultaten. Überdies hinaus wird durch die ventrale Fixation der Stabilisatorplatte an der Thoraxwand eine besserer Stabilität des Bügels/der Bügel erreicht, was eine frühere Mobilisierung der PatientInnen ermöglicht und eine Bügeldislokation deutlich erschwert. Ein weiterer Vorteil dieser Technik ist, dass auch sehr ausgeprägte und/oder asymmetrische Deformitäten minimal invasiv korrigiert werden können.

Referenzen : 

Unsere Erfahrung mit E. P.Si.T (= Endoskopische Behandlung des Sinus pilonidalis) in Kindern und Jugendlichen Jenewein K 1 , Hechenleitner P 2 , Renz O 2 , Sanal M 2 1 Medizinische Universität Innsbruck, Innsbruck, Österreich 2 Universitätsklinik für Visceral-Transplantations-und Thoraxchirurgie, Kinder-und Jugendchirurgie, Innsbruck, Österreich Ziel: Der akute oder chronisch verlaufende Sinus pilonidalis bei Kindern und Jugendlichen ist eine erworbene Entzündung des subkutanen Fettgewebes, die meist durch steife Haarfragmente ausgelöst wird und vorwiegend in der Rima ani lokalisiert ist. Er äußert sich durch klassische Entzündungszeichen (Calor, Rubor, Tumor, Dolor) und wird meist zweistufig chirurgisch saniert durch Abszessentdeckelung und Versorgung des Abszesses nach Abklingen der Entzündung. Da die Rezidivrate jedoch hoch ist (je nach Studien bis zu 30 % [1, 2] ), sind neue chirurgische Herangehensweisen im Gespräch. Die E. P.Si.T (= Endoskopische Behandlung des Sinus Pinoidalis) stellt durch direkte Sicht der Fistelgänge und Abszesshöhlen eine sichere Behandlungsmethode dar. Im ersten Schritt werden Sinuskavität und -gänge inspiziert, im zweiten Schritt wird die Abszesshöhle ablatiert sowie die Fistelgänge obliteriert. Durch die direkte endoskopische Kontrolle und damit Sichtbarkeit aller Sinuskavitäten können sekundäre Abszesse identifiziert sowie eine Schädigung des kutanen Gewebes und des Sphincters vermieden werden. Bisherige Studien bei Erwachsenen deuten auf niedrige Rezidivraten, niedrige Infektionsraten, kleinere Wunden sowie schnellere Eingliederung in den Alltag hin. Einzig die Operationsdauer scheint etwas länger zu sein. [1] Das Ziel dieser Studie ist, eine Übersicht über die Patientinnen und Patienten zu geben, die bisher von uns mit der E. P.Si.T.-Methode behandelt worden sind.

Methoden: In unserer Serie berichten wir von 15 Patientinnen und Patienten mit Sinus pilonidalis (n = 15), die mit der E. P. Si.T-Methode in einem Zeitraum von 2 Jahren behandelt wurden. Die Daten wurden retrospektiv kontrolliert ausgewertet. Bei den PatientInnen handelt es sich um 4 Mädchen und 11 Buben, die bei der Behandlung zwischen 9 und 17 Jahren alt waren (Mittelwert = 14, 3) .

Ergebnisse: 13 der PatientInnen blieben rezidivfrei, 2 Pati-entInnen mussten revidiert werden.

Schlussfolgerungen: In unserer Serie zeigte sich, dass die E. P.Si.T. Methode mit einer niedrigen Rezidiv-und Kompli-63rd Annual Meeting of the Austrian Society of Surgery und Implementierung (Bildgebung, Planung, Registrierung) werden diskutiert.

Supermikrochirurgische Techniken zur Anlage lymphovenöser Anastomosen bei Durchmesserdiskrepanz der Gefäße Steinbacher J 1 , Tinhofer I 1 , Roka-Palkovits J 1 , Meng S 2 , Hüttinger N 1 , Metz A 1 , Tzou CJ 1 1 Göttlicher Heiland Krankenhaus, Wien, Österreich 2 Hanusch Krankenhaus, Wien, Österreich Ziel: Die Durchführung lymphovenöser Anastomosen ist eine gut etablierte Technik in der chirurgischen Therapie des Lymphödems. Große Fortschritte in der präoperativen Visualisierung der Lymphgefäße sowie geeigneter Begleitvenen haben die Operationsplanung revolutioniert und den intraoperativen Ablauf stark erleichtert. Dennoch bedarf es neben einem hohen mikrochirurgischen Geschick oftmals auch eines großen Repertoires an technischen Finessen um abseits der gängigen End-zu-End-Anastomose Erfolg zu haben.

Methoden: Am Göttlicher Heiland Krankenhaus wurden zwischen Januar 2010 und April 2021 insgesamt 234 lymphovenöse Anastomosen durchgeführt, 32 % davon an der oberen Extremität. Neben der klassischen End-zu End-Anastomose kamen die Oktopustechnik sowie die Doppelflinte zur Anwendung. Die Varianten wurden im abteilungsinternen Register vermerkt und in Hinblick auf ihre Häufigkeit ausgewertet. In vereinzelten Fällen wurde bei sehr kaliberstarken Venen das Lumen jenem des Lymphgefäßes durch eine Naht angepasst bzw. mehrere End-zu-Seit-Anastomosen an die Vene durchgeführt.

Ergebnisse: Bei gleicher Kaliberstärke und guter Qualität des Lymphgefäßes wurde stets End-zu-End anastomosiert. Bei starker Sklerosierung der Lymphgefäße mit unzureichendem Lumen wurden diese im Sinne einer Oktupustechnik in die Vene hineingezogen und fixiert. Bei deutlich stärkerem Durchmesser der Vene und gleichzeitigem Vorliegen zweier kaliberschwacher Lymphgefäße kam die Doppelflinte zur Anwendung. Das Verhältnis von End-zu-End: Doppelflinte: Oktopus-Technik betrug 3:1:2.

Schlussfolgerungen: Bei der Anlage lymphovenöser Anastomosen erfordern wechselnde Voraussetzungen ein hohes Maß an Flexibilität. Durch die Kenntnis der vorgestellten Techniken soll die erfolgreiche Durchführung lymphovenöser Anastomosen erleichtert werden

Die A. thoracica lateralis Lymphknoten-Lappenplastik als Therapiekonzept des Lymphödem bei postmastektomie Patientinnen Methoden: Die Rekrutierung erfolgte bei elektiv geplanten Patientinnen für eine autologe Brustrekonstruktion zur präoperativen Durchführung von MR-A/ CT-A, Oberflächenscan und Doppler zur Perforatoridentifizierung. Die Abweichungsgenauigkeit wurde anhand der Abstände zwischen den mit Doppler markierten Perforatoren im Oberflächenscan und den in der 3D-Rekonstruktion ( MRT) markierten Perforator-Durchtrittstellen an der Muskelfaszie bestimmt (n = 10). Die Anwenderakzeptanz des AR-Systems in Kombination mit der Doppler Untersuchung zur OP-Anzeichnung wurde mittels des System-Usability-Scale ( SUS: 25 % worst imaginable usability -100 % best imaginable usability) ermittelt (n = 7). Die Dauer und der Personalaufwand der Implementierungsschritte wurden in Software-Entwicklung (Berechnung Weichgebe, App-Design) und klinische Implementierung pro Fall (Datengenerierung, -bearbeitung und -übertragung bis zur Verfügbarkeit auf dem AR-System) aufgeteilt.

Ergebnisse: Der Abstand zwischen Doppler markierten Perforatoren und den auf die Hautoberfläche projizierten Perforatordurchtrittsstellen in der MR-A betrug 18.1 ± 7.0 mm( MW ± SD), wohingegen zwischen Doppler markierten Perforatoren und Perforatordurchtrittsstellen an der Muskelfaszie (= unter Einbezug des Fettgewebes) ein Abstand von 36.7 ± 4.4 mm( MW ± SD) ermittelt werden konnte. Die Anwenderakzeptanz ( SUS) betrug durchschnittlich 67 ±10 %( MW ± SD), was einer "guten" Bewertung entspricht. Die App-Entwicklung dauerte 1600 h (= Personenstunden), davon 730 h App-Konzept/Design, 570 h App-Programmierung, 300 h App-Anpassung. Die Berechnung des Weichgewebes erforderte 830 h, die Implementierungsdauer eines Falles bis zur klinischen Verfügbarkeit auf dem AR-System betrug insgesamt 173 Minuten.

Schlussfolgerungen: Wie zu erwarten, zeigten sich Unterschiede zwischen Doppler markierten Perforatoren und der MR-A. Aufgrund der aufwändigen Implementierungsschritte ist die zukünftige wissenschaftliche Bewertung der klinischen Anwenderfreundlichkeit essenziell. Die geringe Fallzahl und Variabilität erschweren jedoch dessen Beurteilbarkeit und andere Methoden zur Erhebung der Anwenderfreundlichkeit 63rd Annual Meeting of the Austrian Society of Surgery tungszeit betrug 23, 1 ± 8,5 bzw. 36,4 ± 4,4 Monate in der CDTbzw. VLNT-Gruppe. Die mittlere Umfangsreduktionsrate war in der VLNT-Gruppe (38,9 ± 2,5 %) signifikant höher als in der CDT-Gruppe (13,2 ± 10,1 %; p = 0,01). Nach einer mittleren Nachbeobachtungszeit von 36 Monaten verbesserte sich der LYMQOL-Gesamtscore von 3,8 ± 0,3 auf 7,5 ± 1,8 in der VLNT-Gruppe und von 4,7 ± 0,9 bis 5,0 ± 1,9 in der CDT Gruppe. In der Publikationsrecherche wurden insgesamt 23 Arbeiten in die Studie eingeschlossen und insgesamt 536 Lymphödempatienten mit 548 VLNTs überprüft. Es zeigte sich, dass die Gruppe mit distaler Empfängerstelle zuverlässigere und wirksamere Ergebnisse hatte als die Gruppe mit proximaler Empfängerstelle.

Schlussfolgerungen: Der VLNT zur distalen Empfängerstelle in Kombination mit postoperativer RMLD verbesserte die Umfangsreduktionsraten und LYMQOL-Scores signifikant.

NET der Lunge sind eine heterogene Gruppe von Tumoren. Fallbeispiel von synchron aufgetretenen low and intermediate grade Tumoren

Ziel: Ungefähr 20 bis 30 % aller NET finden sich in der Lunge und etwa 20 bis 25 % der invasiven pulmonalen Neoplasien der Lunge sind NET. Die WHO Klassifikation unterscheidet zwischen den low bis intermediate grade Tumoren, die in ein typisches Karzinoid und ein atypisches Karzinoid unterteilt werden, sowie den high graden Tumoren, zu denen das kleinzelliges Bronchialcarzinom und das großzellige neuroendokrine Karzinom zählen. Die Diagnostik stützt sich auf CT, PET und wenn möglich Punktion zur Histologiegewinnung. Auch eine fehlende Speicherung im PET schließt diese Tumore nicht aus, wie folgende Fallpräsentation zeigen soll.

Methoden: Wie präsentieren einen 72 jährigen Patienten der vorstellig wird mit einem größeren zentralen RH sowie mehreren kleinen RH in der linken Lunge unklarere Genese. In der PET zeigt sich keine pathologische Speicherung der Herde. Eine Punktion zur Histologiegewinnung war aufgrund der zentralen Lage des größeren Herdes und der Kleinheit der anderen Herde nicht möglich. Aus diesem Grund entschieden wir und zur operativen Versorgung. Letztendlich wurde von uns eine Segment 2 Resektion im OL li sowie insgesamt 4 Pulmotomie03 im UL li durchgeführt vervollständigt durch eine LA da der Schnellschnitt des größeren Herdes eine Malignität ergab Ergebnisse: Der Eingriff verlief komplikationslos und auch der postoperative Heilungsprozess gestaltet sich problemlos. Die Definitivhistologie ergab schließlich für den größeren Herd ein Atypisches Karzinoid und für die kleineren Herde Typische Karzinoide. Die Lymphknoten waren negativ Schlussfolgerungen: Dieser Fall zeigt auf wie wichtig die Abklärung von unklaren Rundherden der Lunge ist. Das altbewährte Konzept der histologischen Sicherung von unklaren Prozessen in der Lunge hat auch heute trotz Fortschritten in der bildgebenden Diagnostik Priorität. In Verbindung mit den neuen Konzepten der operativen Versorgung können auch sol-phödems. Das Risiko eines sekundären Lymphödems nach VLT stellt eine schwerwiegende Komplikation dar. Ziel dieser Studie war es, eine risikoarme Alternative bei vergleichbarer Wirksamkeit zu untersuchen.

Methoden: Patientinnen, die nach einer Mammakarzinom Erkrankung an Lymphödem der oberen Extremität litten, wurden an unserer Abteilung zur chirurgischen Therapie mittels supermikrochirurgischer Lymphovenöser Anastomosen ( LVA) evaluiert. Postmastektomie Patientinnen, welche zusätzlich den Wunsch nach einer simultanen, Brustrekonstruktion äußerten, bekamen eine kombinierten Behandlung aus entweder Implantatrekonstruktion oder freier Unterbauch-Lappenplastik und ipsilateraler, gestielter A. thoracica lateralis Lymphknoten Lappenplastik. Postoperativ erfolgten regelmäßige Umfangs-Vermessungen sowie Fotodokumentationen der oberen Extremitäten. Charakteristika der freien Unterbauch-Lappenplastik wurden ebenfalls dokumentiert. Die Indikation für Folgeoperationen mittels LVAs wurden im Verlauf regelmäßig kontrolliert.

Ergebnisse: Seit Jänner 2020 wurden insgesamt 3 Patientinnen mit einer kombinierten Therapie des Lymphödems und einer Brustrekonstruktion im Göttlicher Heiland Krankenhaus operiert. Davon erhielt eine Patientin zunächst LVAs, bevor die kombinierte Behandlung des Lymphödems und des Brustaufbaus erfolgte. Die zweite Patientin erhielt bisher ausschließlich die kombinierte Behandlung. Die dritte Patientin erhielt eine kombinierte Behandlung im Rahmen eines beidseitigen Implantatwechsels. Daten der postoperativen Vermessungen werden präsentiert.

Schlussfolgerungen: Unsere Studie zeigt einen risikoarmen Ansatz zur simultanen Behandlung von postmastektomie Patientinnen mit Lymphödem der oberen Extremität. Die Effektivität im Vergleich zur hierorts bereits gut etablierten LVA Operation wird zukünftig weiter untersucht.

Der vaskularisierte Lymphknotentransfer an die distale Empfängerstelle bei Lymphödem der Extremitäten-Ergebnisse und Literaturübersicht 

Splenectomy during esophageal resection and gastric pull-up. Influence on the perioperative course and on long-term survival Roj A 1 , Lindenmann J 1 hoher Clarithromycin-Resistenz in Österreich ist die konkomitierende Vierfachtherapie oder die Bismut-Quadrupeltherapie als Firstline-Therapie anzusehen.

Ergebnisse: Generell ist eine frühe Diagnose, das schnelle Zuführen zur Operation und ein adäquates Sepsismanagement entscheidend für das Outcome. [1, 2] Insbesondere durch die minimalinvasive Operationstechnik können Liegedauern und somit auch Begleitkomplikationen reduziert werden. [3] Schlussfolgerungen: Ein gewissenhafter und strukturierter Therapieansatz ist nötig, um das Outcome zu verbessern. [1, 2] Hausinterne Standards nach aktuellen Leitlinien können dazu beitragen.

Referenzen: [1] 

Super-charged jejunal and colonal interposition -a feasible option for full-length esophageal reconstruction Martin F 1 , Witzel C 1 , Rau B 1 , Raakow J 1 , Feldbrügge L 1 , Biebl M 2 , Pratschke J 1 , Denecke C 1 1 Chirurgische Klinik CCM/ CVK, Charité -Universitätsmedizin Berlin, Berlin, Germany 2 Abteilung für Chirurgie, Ordensklinikum Linz, Linz, Austria Aim: The reconstruction of a missing esophagus as a result of injury, surgical complications, or extensive malignancy without viable stomach conduit presents both a huge burden for the affected patients and a major treatment challenge for surgeons. Super-charged pedicled jejunal or colonal interposition, as has been performed in selected centers in the anglo-american area for many years, represents a valuable surgical treatment option.

Methods: We herein describe the cases of a 56-year old woman, who experienced esophageal injury caused by alkali burn and a 67-year old woman with complicated postoperative course after repeated fundoplication, who underwent supercharged jejunal or colonal interposition in our clinic in 2021. Both patients had multiple previous abdominal operations including esophagectomy and gastrectomy and presented with cervical fistulas.

Results: In the case of the 67-year old patient after fundoplication, a long segment esophageal reconstruction was performed using the right hemicolon as interposition. Right hemicolon and terminal ileum were mobilized and ileocolic vessels were dissected while the Drummond arcade was preserved. The interposition graft was placed in retrosternal position and revascularisation was achieved by microvascular end-to-end anastomosis of the ileocolic vessels with the left internal mammary vessels via an access in the third intercostal space. Gastrointestinal continuity was established by side-to-side esophagoileostomy and ceocojejunostomy. Regarding the 56-year old patient after alkali burn, cervical esophageal reconstruction was performed using a jejunal interposition. After uplifting in a retrosternal position, the pedicle of the first jejunal vessel arcade was anastomosed end-to-end with the left internal mammary ves-diesem Grund gewinnt die chirurgische Rippenosteosynthese bei Rippenfrakturen in letzter Zeit zunehmend an Bedeutung. Im Vergleich zur klassischen konservativen Therapie führt die chirurgische Intervention durch Verbesserung der Atemmechanik auf der einen Seite und durch Reduktion der Schmerzen auf der anderen Seite zu einer raschen Rehabilitation und Reduktion der Begleitmorbidität.

Methoden: Im Vergleichszeitraum Jänner 2019 bis Jänner 2022 haben wir 25 Patienten mit dieser Technik versorgt. Dabei handelt es sich in 8 Fällen um Akuteingriffe bei instabilem Thorax und Serienrippenfrakturen, die innerhalb der ersten 48 h nach Trauma durchgeführt wurden. In 12 Fällen erfolgte die Stabilisierung von dislozierten Rippen im Rahmen einer VATS bei Hämatothorax und in 5 Fällen wurden Pseudoarthrosen mit massiver Schmerzproblematik mit dieser Technik versorgt. Die Stabilisierung erfolgte mit dem MatrixRIBSystem wobei in allen Fällen eine Plattenosteosynthese durchgeführt wurde.

Ergebnisse: Die postoperative Phase war bei allen Patienten durch eine signifikante Reduktion der Schmerzproblematik gekennzeichnet. Weiters konnten wir bei den 8 Patienten mit schwersten Thoraxwandverletzung nach Stabilisierung der Thoraxwand eine auffällig rasche Verbesserung der Atemmechanik und dadurch eine rasche Extubation der Patienten beobachten.

Schlussfolgerungen: Zusammenfassend kommen wir zu dem Schluss dass die operative Stabilisierung des instabilen Thorax in Bezug auf Sekundärkomplikationen und Rückbildung von restriktiven Ventilationsstörrungen von Vorteil ist. Die operierten Patienten erreichen schneller Schmerzfreiheit und werden früher wieder arbeitsfähig. [1, 2] Methoden: Beim klinischen Bild eines akuten Abdomens und dem Verdacht auf ein perforiertes gastroduodenales Ulcus wird die Computertomographie des Abdomens als Diagnostik der Wahl durchgeführt. [1, 2] Bestätigt sich die Diagnose, erfolgt die rasche operative Versorgung durch die Ulcusübernähung, standardisierter Weise in laparoskopischer Technik. [1] [2] [3] Eine adäquate Antibiose, Drainage-Anlage bei ausgeprägter Peritonitis, Kontroll-Gastroskopie, sowie Histologiegewinnung zum Malignitätsausschluss beim Magenulcus, und gegebenenfalls eine perorale Helicobacter-Eradikation vor allem beim Duodenalulcus stellen wesentliche weitere Versorgungsschritte dar. [1, 2] Da Helicobacter pylori, neben NSAR, ursächlich an der Entstehung eines perforierten gastroduodenalen Ulcus beteiligt ist, ist eine Eradikation nach aktuell gültigen Schemata wesentlich, auch im Sinne einer Rezidiv-Prophylaxe. [1, 2] Ziel: Die robotisch-assistierte Chirurgie hat in den letzten Jahren in verschiedenen Subgebieten der Chirurgie aufgrund kürzerer Aufenthaltsdauer und schnellerer Rekonvaleszenz immer mehr an Bedeutung gewonnen. Hierbei ist insbesondere die Nutzung des Roboters zur Versorgung von Leistenhernien stark vom jeweiligen nationalen Umfeld und der Verfügbarkeit eines solchen Systems abhängig. Ziel unserer Untersuchung ist der Vergleich einer Leistenhernienversorgung mittels robotischer Technik im Vergleich zur laparoskopischen Standardtechnik in Hinblick auf klinische Ergebnisse und Wirtschaftlichkeit.

Methoden: Im Zeitraum von März 2021 bis Oktober 2021wurden im Ordensklinikum Linz am Standort Elisabethinen robotische TAPPs (n = 59) (Gruppe I, rob) durchgeführt, sels in the third intercostal space, while lower two thirds were vascularized from below. In both cases, proximal anastomoses healed without ischemic complications and restoration of intestinal continuity could be safely achieved.

Conclusions: Thus, we recommend that in high-volume centers, with the corresponding infrastructure, super charged jejunal or colonic interposition should be considered as a safe therapy option for patients without viable stomach conduit. In particular, microvascular reconstruction offers a well-vascularized cervical anastomosis for these critical patients.

Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery ( SIL+1 additional port). Is an umbilical midline approach really a problem? Tschann P 1 , Lechner D 1 , Girotti P 1 , Adler S 1 , Rauch S 1 , Presl J 2 , Jäger T 2 , Schredl P 2 , Mittermair C 3 , Szeverinski P 1 , Clemens P 1 , Weiss H 3 , Emmanuel K 2 , Königsrainer I 1 1 LKH Feldkirch, Feldkirch, Austria 2 PMU Salzburg, Salzburg, Austria 3 Barmherzige Brüder Salzburg, Salzburg, Austria Aim: Purpose: Umbilical midline incisions for single incision-or reduced port laparoscopic surgery are still discussed controversially because of a higher rate of incisional hernia compared to conventional laparoscopic techniques. The aim of this study was to evaluate incidence and risk factors for incisional hernia after reduced port colorectal surgery.

Methods: Methods: 241 patients underwent elective reduced port colorectal surgery between 2014 and 2020. Follow-up was achieved through telephone interview or clinical examination. The study collective was examined using univariate and multivariate analysis.

Results: A total of 150 patients with complete followup were included into this study. Mean follow-up time was 36 ( IQR: 24-50) months. The study collective consists of 77 (51.3 %) female and 73 (48.7 %) male patients with an average BMI of 26 kg/m 2 ( IQR: 23-28) and an average age of 61 (±14). Indication for surgery was diverticulitis in 55 (36.6 %) cases, colorectal cancer in 65 (43.3 %) patients and other benign reasons in 30 (20.0 %) cases. An incisional hernia was observed 9 times (6.0 %). Obesity ( OR: 5.8, 95 % CI: 1.5-23.1, p = 0.02) and pre-existent umbilical hernia ( OR: 161.0, 95 % CI: 23.1-1124.5, p < 0.01) were significant risk factors for incisional hernia in the univariate analysis. Furthermore, pre-existent hernia is shown to be a risk factor also in multivariate analysis.

Conclusions: We could demonstrate that reduced port colorectal surgery using an umbilical single port access is feasible and safe with a low rate of incisional hernia. Obesity and pre-existing umbilical hernia are significant risk factors for incisional hernia.

63rd Annual Meeting of the Austrian Society of Surgery tränder) werden am Operationspräparat bestimmt. Nach einer neoadjuvanten Therapie ist das Regressionsgrading, z. B. als RCB Score prognostisch wichtig. Genexpressionsprofile (z. B. EndoPredict, Mammaprint, Pam50, Oncotype Dx) und der Ki-67 Färbeindex beeinflussen den Einsatz einer adjuvanten Chemotherapie beim ER positiven, nodal-negativen Karzinom, sind aber auch prognostisch relevant. Der Ki-67 Färbeindex kann einfach und dezentral bestimmt werden, ist aber hinsichtlich der Standardisierung und der Bewertung des Ergebnisses einschliesslich Cut-offs problematisch. Androgenrezeptoren sind hinsichtlich des Gesamtüberlebens in frühen Tumorstadien von Bedeutung. Im Rahmen von Rezidiven bzw. Metastasen werden für neue therapeutische Ansätze PIK3CA Mutationen und Mutationen in den BRCA1 und 2 Genen sowie die Expression des Immuncheckpoint Proteins PDL1 (Immunzellscore) bestimmt. Von zunehmender praktischer Bedeutung sind auch Tumor infiltrierende Lymphozyten ( TiL).

Schlussfolgerungen: Alle wesentlichen Parameter sind integraler Bestandteil des Pathologie-Befundes, der idealerweise standardisiert und synoptisch sein sollte. Die praktische Bedeutung dieser Parameter unterstreicht die zentrale Rolle des Faches Klinische Pathologie und Molekularpathologie für die Therapie des Mammakarzinoms.

Surgical treatment of deep-lying recto-/anovaginal fistulas using deepithelialized "Singapore-Flap" (pudendal tigh flap) − Tried -tested and reinterpreted Sauseng S 1 , Mayerhofer M 1 , Kresic J 1 , Imamovic A 1 , Schemmer P 1 , Mischinger H 1 , Spendel S 2 , Pfeifer J 1 1 Abteilung für Allgemein-, Viszeral-und Transplantationschirurgie Universitätsklinikum Graz, Graz, Austria 2 Abteilung für plastische Chirurgie Universitätsklinikum Graz, Graz, Austria Aim: The treatment of deep-lying recto-/ano-vaginal fistulas presents the treating surgeons with considerable difficulties. The high recurrence rate (36-80 % and the risk of dyspareunia (up to 57 %) or sensory complaints are usually the main problem [1, 2] . Although postoperative incontinence symptoms occur mainly after multiple procedures, they do not appear to affect the quality of life to the same extent as is the case in the rest of the proctological patient population. In principle, the surgical treatment of the deep-lying recto-/ano-vaginal fistulas can nowadays be divided into 5 groups. Fistula cleavage, fistula excision with plastic covering, local therapies (fibrin glue, OTSC clip, plug), LIFT techniques (with or without Bio-MESH) and the interposition of perfused tissue. [3] In particular, the use of the latter is often propagated at an early stage in complicated fistulas. Since interventions due to recurrence in particular show a high rate of long-term complications. [ 4] Here the Singapore Flap offers a sensible alternative to Gracilis and Martius-flap. This is not a new technique, but a procedure for the treatment of vaginal wall defects or congenital malformations, which was used for the first time in 1989. [5] Methods: Over a period of 3 years, 7 patients in our department underwent such an operation. Here, a fascio-cutaneous welche mit einer gematchten Vergleichsgruppe von konventionelle laparoskopischen TAPPs (n = 59) (Gruppe II, lap) verglichen wurde. Es erfolgte eine retrospektive Analyse der im SAP dokumentierten Patientenparameter, welche deskriptiv (Median, range) und mittels parametrischen Tests verglichen wurden. Hierbei wurde ein p-Wert <0.05 als signifikant angesehen.

Ergebnisse: In beiden Gruppen war die überwiegende Anzahl der Patienten männlich (88.1 % (rob) vs. 84,7 % (lap)). Der mediane BMI lag in beiden Gruppen bei 24.5 (18, 4 (rob) vs. 18, 4 (lap) ), das mediane Alter lag bei 52 (18 -82) Jahren (rob) vs. 55 (17-78) Jahren (lap.), wobei bei 40,7 % (rob) vs. 37,3 % (lap) der Patienten eine beidseitige Hernie behandelt wurde. Die mediane Operationsdauer betrug 80,25 (37-160) Minuten (lap) vs 76,35 (40-145) Minuten (rob). Es mussten keine Revisionsoperationen durchgeführt werden. In beiden Gruppen traten weder intraoperative noch postoperative Komplikationen auf. Die durchschnittliche stationäre Aufenthaltsdauer ( LOS) betrug 1,35 Tage (0-3 Tage) vs 1,35 Tage (0-4 Tage) (lap vs. rob). Die Operationskosten lagen durchschnittlich bei 3519,78 Euro vs 5521,23 Euro (lap vs. rob) und median 3390,96 vs 5416,02 (lap vs. rob). Es ergab sich kein Unterschied zwischen den Operationszeiten (76,4 ± 25,0 robotisch vs. 80,1 ± 29,5 laparoskopisch, p = 0,454), jedoch kam es zu signifikant höheren Kosten in der robotischen Gruppe (5.521, 4 ± 687, 4) im Vergleich zur konventionellen Laparoskopie (3.407,9 ± 675,2, p < 0,000) .

Schlussfolgerungen: Sowohl mit der laparoskopischen als auch mit der robotisch assistierten Operationstechnik lassen sich Leistenhernien im Sinne einer TAPP sicher behandeln. Operationsdauer sowie LOS war in beiden Gruppen annähernd gleich, allerdings zeigt sich ein deutlicher Kostenunterschied zu Lasten der robotischen Technik.

Therapeutische Parameter und Prognosefaktoren beim Mammakarzinom: Bewährtes und Neues Lax S 1,2 1 LKH Graz II, Institut für Pathologie, Graz, Österreich 2 Medizinische Fakultät, Johannes-Kepler-Universität, Linz, Österreich Ziel: Das moderne Management des Mammakarzinoms erfordert Interdisziplinarität und wesentliche Informationen aus der Pathologie. Am Anfang des therapeutischen Algorithmus stehen als Entscheidungsgrundlage die histopathologische Tumordiagnose an der Biopsie und die biologische oder molekulare Klassifikation.

Methoden: Diese erfolgt auf Basis von 4 immunhistochemischen Parametern (4IHC), Östrogen-( ER) und Progesteronrezeptoren ( PR), HER2 und Ki-67. 4IHC sollen bei lokalen Tumorrezidiven bzw. Fernmetastasen neu untersucht werden.

Ergebnisse: Die meisten ER positiven Karzinome (auch als luminal bezeichnet) werden primär operiert, HER2 positive und high-grade tripple negative Karzinome hingegen typischerweise neoadjuvant behandelt. Eine kleine Gruppe von low-grade tripple negativen Karzinomen wird ebenfalls primär operativ behandelt. Wesentliche konventionelle Prognosefaktoren aus dem TNM System (Tumorgröße bzw. -kategorie, histopathologisches Grading, Lymphangiose, Nodalstatus, Schnit-63rd Annual Meeting of the Austrian Society of Surgery der Narben zu vermeiden. Der resultierende Defekt konnte spannungsfrei gedeckt werden.

Ergebnisse: Im postoperativen Verlauf wurde ein Serom abpunktiert. Es konnte eine rezidivfreie Sanierung mit einem 33-monatigen Follow-up erreicht werden.

Schlussfolgerungen: Die erfolgreiche Behandlung des Pilonidalsinus stellt für den Chirurgen aufgrund der hohen Rezidivrate von bis zu 35 % und mehr eine Herausforderung dar. Unter den verschiedenen Operationsmethoden scheinen die sogenannten "Off-midline" Verfahren wie Karydakis Plastik und Bascom Cleft Lift die geringste Rezidivrate und Wundheilungsstörungen aufzuweisen [1] [2] [3] .

Referenzen : 

Finanzielle Belastung durch die chirurgische Behandlung von angeborenen Fehlbildungen -die Situation in Österreich Gasparella P 1,2 , Singer G 1,2 , Kienesberger B 1,2 , Arneitz C 1,2 , Fülöp G 3 , Castellani C 1,2 , Till H 1,2 , Schalamon J 1,2 1 Universitätsklinik für Kinder-und Jugendchirurgie, Graz, Österreich 2 Österreichische Gesellschaft für Kinder-und Jugendchirurgie, Graz, Österreich 3 Gesundheit Österreich GmbH, Wien, Österreich Ziel: Angeborene Fehlbildungen sind mit höheren Behandlungskosten verbunden als solche, die nicht chirurgisch behandelt werden müssen. Das Ziel unserer Studie war eine Analyse des finanziellen Aufwandes für das Österreichische Gesundheitssystem von fünf angeborenen Fehlbildungen, die zeitnahe zur Geburt eine Kinder-und Jugendchirurgische Intervention erfordern.

Methoden: Wir durchsuchten die Datenbank der Gesundheit Österreich GmbH ( GÖG; Austrian National Public Health Institute) im Zeitraum 2002-2014 und extrahierten die "Diagnosis-Related Group" ( DRG)-Punkte, die den Krankenhausaufenthalten von fünf angeborenen Fehlbildungen zugeordnet werden konnten. Als Hauptdiagnosen wurden ausgewählt: Ösophagusatresie, Duodenalatresie, Zwerchfellhernie, Gastroschisis und Omphalozele. Die DRGs wurden mit denen aller anderen Krankenhausaufenthalte im gleichen Zeitraum verglichen.

Ergebnisse: Von insgesamt 3,518,625 Krankenhausaufenthalten waren 1664 den oben genannten Fehlbildungen zuzuordnen. Jährlich handelte es sich durchschnittlich um 128 stationäre Aufenthalte an österreichischen Krankenhäusern dieser Diagnosen ( SD 17, range 110-175). Im Vergleich zu allen anderen Krankenhausaufenthalten waren die durchschnittlichen Kosten berechnet nach DRG-Punkten der fünf ange-lobe is created laterally of the labia majora one-sided) and mobilized and stemmed along the pudendal vascular nerve bundle. Subsequently, the lobe is deepithelilized. After that, the lobe can be swayed into the rectovaginal space and fixed there.

Results: A permanent fistula closure was achieved in 6 out of seven patients. (Follow-up ended after 36 months). One patient experienced flap necrosis with reoperation and temporary stoma system. In the successfully operated patients, no dyspareunia, incontinence or hyperesthesia complaints could be raised.

Conclusions: The pudendal tigh flap is a low-complication supplement for the treatment of deep recto-vaginal fistulas by means of tissue interposition. In particular, the lower defect at the sampling site, the smaller thickness of the flap [6] and the nervous care seem to be responsible for the good results and the high patient acceptance.

Modifizierte Karydakis Plastik: Ein Patient mit kompliziertem rezidivierendem Sinus pilonidalis Bubenova M 1 , Schmidt M 1 , Shamiyeh A 1 1 Klinik für Allgemein-und Viszeralchirurgie, Kepleruniversitätsklinik, Linz, Österreich Ziel: Der Pilonidalsinus wird als erworbene Erkrankung angesehen, wobei die Insertion von abgebrochenen Haaren in die Haut der Rima ani und Bildung von Fremdkörpergranulomen eine zentrale Rolle in der Ätiologie spielen. Klinisch werden drei Erscheinungsbilder unterschieden. Die asymptomatische Verlaufsform, die in ein akutes Abszessgeschehen übergehen kann und die chronische Form mit intermittierenden Beschwerden im Sinne einer blutigen, trüb-serösen oder putriden Sekretion und Schmerzen im Bereich der Steißbeinregion.

Methoden: Bei einem 28-jährigen Patienten besteht ein rezidivierender Pilonidalsinus. Die Dauer der Erkrankung beträgt 8 Jahre und der Patient wurde bereits 4 Mal operiert. Zwei Exstirpationen mit Primärverschluss und eine V-Y Plastik mit folgender Revision wegen Hautnekrose wurden durchgeführt. Es zeigen sich mehrere Fistelöffnungen in der Gesäßfalte und tiefe Narben, die die Mittellinie kreuzen. Um eine komplette Lateralisierung der Wunde und Abflachung der Rima ani zu erreichen, wurde die Indikation zur modifizierten Karydakis Plastik gestellt. Die Exzision des Gewebes erfolgte unter Berücksichtigung der Narben asymmetrisch, um die Kreuzung 63rd Annual Meeting of the Austrian Society of Surgery

Extraheptische Gallengangsatresie -15 Jahre Zentrumserfahrung Globke B 1 , Contes V 1 , Moosburner S 1 , Gül-Klein S 1 , Reismann M 2 , Hudert C 3 , Henning S 3 , Bufler P 3 , Pratschke J 1 , Öllinger R 1 1 Chirurgische Klinik, Charité, Berlin, Deutschland 2 Kinderchirurgie Charité, Berlin, Deutschland 3 Klinik für pädiatrische Hepatologie und Gastroenterologie Charité, Berlin, Deutschland Ziel: Die extraheptische Gallengangsatresie ist eine seltene ikterische Erkrankung des Neugeborenen, bei der eine Okklusion der extrahepatischen Gallenwege unbehandelt zur irreversiblen Leberzirrhose führt. Ätiologisch wird eine entzündliche Genese diskutiert. Einziger therapeutischer Ansatz ist die Portoenterostomie nach Kasai. In Ausnahmefällen kann ein Fortschreiten der Parenchymveränderungen erreicht und Lebertransplantation vermieden werden. In den meisten Fällen gelingt es die Leberfunktion zu stabilisieren und den Transplantationszeitpunkt zu verschieben und ein weiteres Gedeihen des Patienten zu ermöglichen. Wir beschreiben hier unsere Zentrumserfahrungen mit der Portoenterostomie nach Kasai und der pädiatrischen Lebertransplantation über 15 Jahre.

Methoden: Es erfolgte eine retrospektive Datenanalyse der Fälle von 50 Kindern, die zwischen 2005 und 2020 in der in unserem Zentrum mit der Diagnose einer Gallengangsatresie chirurgisch behandelt wurden. Die Diagnosesicherung erfolgte bei klinischem und bildgebendem Verdacht mittels Leberbiopsie. Im Falle einer fortgeschrittenen Zirrhose mit entsprechender Klinik erfolgte die primäre Lebertransplantation, andernfalls erfolgte die Portoenterostomie nach Kasai. Die statistische Auswertung erfolgte mittels SPSS.

Ergebnisse: Während in den ersten 9 Jahren des Beobachtungszeitraums noch gut 50 % der Kinder (12/23) in einem späteren Stadium diagnostiziert und primär transplantiert wurden, erfolgt in den letzten 6 Jahren nur bei einem Kind eine primäre Transplantation während die 27 anderen mit einer Kasai OP versorgt wurden. Aus dem Zeitraum von Ende 2014-2020 erfolgten bisher bei 14 Kindern eine Lebertransplantation, 11 Kinder zeigten 100 Tage nach Kasai Operation ein Bilirubin <2 mg/dl und mussten bis dato nicht transplantiert werden. Von den insgesamt 37 Transplantationen erfolgten 13 als Full-size Transplantationen, 3 als Leichenspende-Split Transplantationen und 21 als Lebendspenden. Es erfolgte die statistische Analyse verschiedener perioperativer Parameter, die keine Unterschiede im 1 Jahres-und Langzeitüberleben in Bezug auf Transplantationsmodus und Z. n. vorangegangener Kasai Operation zeigen konnte. Insgesamt zeigt sich mit 95 % 1 Jahres Überleben nach Kasai Operation (35/37) und 88 % 1 Jahres-Überleben der Gesamtkohorte eine gute Prognose, die sich aufgrund früherer Diagnosestellung und Weiterentwicklung chirurgischer Technik im Laufe der Jahre weiter gebessert hat.

Schlussfolgerungen: Die Ergebnisse der chirurgischen Behandlung der extrahepatischen Gallengangsatresie, die alternativlos ist, sind in Bezug auf die Prognose sehr gut. Frühe Erkennung, hohe Interdisziplinarität, strukturiertes Vorgehen und ein gut etabliertes Lebetransplantationsprogramm sind die Voraussetzungen für eine erfolgreiche Therapie dieser untherapiert letalen Erkrankung borenen Fehlbildungen (26, 588; 772, SD 40, 702) signifikant höher, als die durchschnittlichen Kosten der anderen stationären Aufenthalte (n = 3,516,961; mean DRG 2194, range 0-834,997; SD 6161; p < 0.05).

Schlussfolgerungen: Kinder-und Jugendchirurgische Krankheitsbilder, die eine zeitnahe Korrektur nach der Geburt erfordern, sind mit einer deutlich höheren finanziellen Belastung für das Gesundheitswesen verbunden, als andere Erkrankungen. Die Schaffung eines nationalen Registers für derartige Krankheitsbilder könnte die Planung der Ressourcenverteilung, die Optimierung von Kosten und das Outcome der betroffenen Kinder verbessern.

Ergebnisse der Umfrage: "Gefäßanomalien in Österreich" Gasparella P 1 , Banfi C 2 , Flucher C 1 , Singer G 1 , Arneitz C 1 , Till H 1 , Haxhija E 1 Ziel: Vaskuläre Anomalien ( VA) sind seltene, meist angeborene Gefäßerkrankungen des arteriellen, venösen und/ oder lymphatischen Gefäßsystems. Sie können jeden Teil des Körpers betreffen und kommen in vielfältiger Ausprägung mit einem großen klinischen Spektrum vor. Die "Odyssee", die Betroffene erleben, bevor sie eine korrekte Diagnose, fachkompetente Beratung und adäqate individuelle Therapieoptionen erhalten, ist oftmals lang und kompliziert. Genaue Zahlen über VA Patient* innen in Österreich fehlen. Ziel unserer Umfrage war es, erstmals die Kohorte der pädiatrischen Patient* innen mit VA in Österreich zu bestimmen.

Methoden: Nach positivem Votum der Ethikkommission (32-236 ex 19/20) wurden niedergelassenen Kinderärzt* innen in Österreich per E-Mail eingeladen, ein Online-Fragebogen bestehend aus 20 Fragen über den medizinischen Umgang mit vaskulären Anomalien im Kindesalter (<18. LJ) auszufüllen. Die Datenerhebung fand im März und April 2021 statt.

Ergebnisse: Von insgesamt 373 eingeladene Kinderärtz*innen, wurden 93 (25 %) Fragebogen retourniert, 86 davon waren vollständig. Die Mehrheit der Teilnehmer* innen (39/91, 43 %) sahen zwischen 15 und 30 Patient* innen mit infantilen Hämangiomen pro Jahr. Die Hälfte der Teilnehmer* innen (48/91, 53 %) beantworteten, dass sie bei weniger als 5 % der Fälle eine Therapie anfangen, 26/91 (29 %) der Ärzte fangen bei 5 bis 10 % der Fälle eine Therapie und 17/91 (19 %) Ärzte fangen eine Therapie bei mehr als 10 % der Fälle an. Die Gefäßmalformationen werden selten in der Praxis behandelt: die meisten Kinderärzt* innen (58/86, 67 %) gaben an, dass sie weniger als 5 Patienten mit dieser klinischen Diagnose behandeln. Ein auf VA spezialisiertes Zentrum, an welches die Patient* innen überwiesen werden können, ist 78/86 (91 %) der Kollegen* innen bekannt aber nur 14/86 (16 %) kennen die ISSVA Klassifikation und 13/86 (15 %) die AIVA. Eine allgemeine Zustimmung über die Notwendigkeit, ein Netzwerk von Spezialist* innen sowie ein Register aufzubauen, wurde gegeben (> 90 %).

Schlussfolgerungen: Diese Umfrage stellt die erste über Gefäßanomalien unter Kinderärzt* innen in Österreich dar und kann als Grundlage für zukünftige Verbesserungen in der Behandlung dieser Patient* innen dienen. Methoden: Es erfolgte eine retrospektive Auswertung der Daten aller Kinder und Jugendlichen, die im Jahr 2019 mit Frakturen der Hand (Carpus, Metacarpus und Phalangen) an unserer Klinik behandelt wurden. Die Patient* innen wurden in folgende Altersgruppen aufgeteilt: 0-5 Jahre, 6-12 Jahre und 13-17 Jahre.

Ergebnisse: Im Studienzeitraum wurde 704 Patient*innen mit einem Durchschnittalter von 11 Jahren (Spannweite 0-17 Jahre) mit Frakturen der Hand behandelt. 64 % (n = 452) waren männlich und 36 % weiblich (n = 252). 7 % fielen in die Altersgruppe 0-5 Jahre, 55 % in die Gruppe 6-12 Jahre und 38 % in die Gruppe der 13-17-Jährigen. Die Hauptunfallursachen waren Ballsportarten (36 %), Stürze (15 %) und Einklemmungen (15 %). Insgesamt wurden 730 Frakturen diagnostiziert (n = 680 eine Fraktur, n = 22 zwei Frakturen und n = 2 drei Frakturen). 79 % der Frakturen betrafen die Phalangen, 17 % die Metakarpalia und 4 % die Handwurzelknochen. Während in der Altersgruppe der 0-5-jährigen keine Frakturen der Handwurzelknochen diagnostiziert wurden, lag der Anteil dieser Frakturen in der Altersgruppe der 13-17-Jährigen bei 7 % (p < 0,05). Bei 0-5-jährigen Kindern traten signifikant häufiger Frakturen der Phalangen auf (89 %) als bei Patient* innen im Alter zwischen 13 und 17 Jahren (71 %; p < 0,05). Knaben erlitten signifikant häufiger Frakturen der Metakarpalia als Mädchen (22 % versus 8 %, p < 0,05). Insgesamt wurden 638 (13 %) der 730 Frakturen konservativ und 92 (13 %) operativ behandelt. Wir fanden keine signifikanten Unterschiede im Behandlungsmodus bezogen auf die betroffene Region (p = 0,201).

Schlussfolgerungen: Es zeigten sich statistisch signifikante alters-und geschlechtsbedingte Unterschiede von Frakturen des Handskeletts im Kindes-und Jugendalter. Bei Kleinkindern standen Frakturen der Phalangen im Vordergrund. Frakturen der Mittelhandknochen waren typisch männliche Verletzungen. Im Kindes-und Jugendalter überwiegt die konservative Therapie.

Pediatric tibial spine fractures -diagnosis and treatment options Tepeneu NF 1,2 1 University of Medicine and Pharmacy ''V. Babes'' Timisoara, Timisoara, Romania 2 Abteilung für Kinder-und Jugendchirurgie, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria Aim: Pediatric fractures of the tibial spine are relatively rare and controversy remains around how these injuries are best managed. Consequently most non-specialised paediatric units have limited experience of managing these injuries. Injuries that rupture the ACL of an adult typically avulse the anterior tibial spine in a growing child. The conservative treatment of undisplaced fractures (type I) is unambiguous and simple. However, difficulties may arise in relation to the treatment of type II and III fractures, since an anatomical reduction of the fracture and reconstruction of the articular surface are required to preserve the function and the stability of the knee joint. Several methods have been described for the treatment of avulsion of the tibial spine, including operations performed by using either arthrotomy or arthroscopy. The fixation of the fragments can be performed by utilizing Kirschner wires, cerclage wires, intraosseal

Anzahl der Röntgenaufnahmen zur Nachsorge von mit ESIN behandelten pädiatrischen Mittelschaftfrakturen des Unterarms sutures, epiphyseal cannulated screws, screws led through the fragment and screws and bone anchors inserted retrogradely.

Methods: A retrospective study in the period 01.01.2012-31.12.2021 was conducted on cases that were managed by the author of the article. A total of 11 cases were identified. A review of literature was also conducted.

Results: There were 6 male and 5 female patients, mean age of 10,2 years. 3 patients suffered a bicycle fall, 6 patients had skiing accidents, one patient suffered a fall after a slip on wet grass during a football match, one patient suffered a fall from a ladder. The fractures were classified according to Myers and McKeever classification. 6 patients had Type I one fractures and were successfully managed by conservative treatment in a cast. 2 patients had a Type II fracture and closed reduction and casting of the knee in hyperextension was successful at reducing the fracture. The patients were also managed by conservative treatment in a cast, the follow-up radiographs did not show any secondary displacement. The last 3 patients had a Type III fracture and were managed by knee arthrotomy via an open medial para-patellar approach, open reduction and osteosynthesis with 2 cannulated epiphyseal screws and washers. All cases had a favorable outcome with a full recovery of knee range of motion ( ROM), good Tegner Lysholm score and good stability of the knee joint.

Conclusions: Isolated paediatric tibial spine fractures can be successfully managed non-operatively in an extension cast and this should be the normal management of the type I injury. Displaced tibial spine fractures can also be initially managed in this way. Should a displaced fracture not reduce in extension cast then soft-tissue interposition should be suspected. Three dimensional imaging, such as a CT scan, should be used to assess the fracture displacement and anatomy to help guide management. An open knee arthrotomy or arthroscopy should be used to reduce and fix the fracture. This protocol has the potential to reduce the need for unnecessary imaging and surgery. 

Own experience of hypospadias treatment Pereyaslov A 1 , Potsiurko A 2 , Hrymak I 2 , Hyzha B 2 , Ivaskevych D 2 , Potsiurko R 2 1 L'viv National Medical University, L'viv, Ukraine 2 L'viv regional children's clinical hospital " OXMATDYT", L'viv, Ukraine Aim: Surgical repair of hypospadias, especially it's severe forms, remains the actual problem of plastic pediatric urology. The various surgical options available for hypospadias repair are a testament to the fact that no surgical procedure guarantees success by all surgeons. The aim of this study was to summarise own experience of hypospadias treatment with establishment of optimal method for hypospadias repair.

Methods: At the period 2020-2021 years, 46 patients underwent hypospadias repair at our hospital. Patient's age ranged from one year to 5 years. All patients divided on two groups: 31 patients with the conditionally mild form of hypospadias (glanular, sub-coronal, distal penile, and mid shaft without penile deformation) and 15 with conditionally severe form (mid shaft, proximal penile (both with penile deformation), penoscrotal, scrotal, and perineal). One-stage surgery using Snodgraft repair with own modification (wide penile all-perimeter mobilization up till the base with forming of a cylindrical skin sheath that easily displaced along the axis of penile, including the glans' level, without tension and penile deformation) was applied for the treatment of patients with mild hypospadias. Two-stage repair using modifying Duckett method (creation of urethrocutaneostoma) was applied for the treatment in all patients with severe hypospadias.

Results: Among the patients with the mild hypospadias, the excellent cosmetic result was achieved, by that there were no cases of neo-urethra stenosis or urinary fistula. In patients with severe hypospadias, narrowing of neo-meatal opening was in 3 (20 %) of them, which was corrected during second stage, and in 2 (13.3 %) -stenosis on the level of stoma closure that dissected endoscopically. It was no cases of urinary fistula and diverticulitis of neo-urethra.

Schlussfolgerungen: Wir versuchen mit Hilfe von diesen zwei Fallberichte die Meckel Fakten zu reevaluieren und die "state-of-the-art" Empfehlungen zu präsentieren.

Correction of female epispadias Results: The first at the age of 2-months repaired, now 9-years-old patient, is continent. The second patient repaired at 11-months, was seen last in 2019 at the age of 4-years (before she moved away). She was dry at night, but lost occasionally urine during the day (2-3 times a month). The third patient, now 5-years old, is dry at night. She loses urine occasionally during the day in stress envinroment. Bladder volume and the urinary tract ultrasound is normal in all three patients; all have good cosmetic results.

Conclusions: The single-stage correction of female epispadias (urethroplasty, bladder neck-WV-plasty and genital plasty) with the technique presented here leads to continence and good cosmetic outcomes.

Intersex-Gesetz in Österreich 63rd Annual Meeting of the Austrian Society of Surgery developed female structures that was defined by laparoscopy. More "natural", less traumatizing feminizing correction was preformed for each specific case. Mobilization and resection of urogenitale sinus wall, excision of corpora cavernosa with preserving the neuromuscular bundle (in children with mixed gonadal dysgenesis) with the formation and translocation of clitoris, labiaplasty, and vaginoplasty were the main steps of feminizing correction. In all children who underwent surgery, vagina opened into urogenital sinus lower than external urethral sphincter, due to that was no need to form front vagina wall, only back and side walls required formation.

Conclusions: The excision of corpora cavernosa with clitoroplasty and clitoris translocation is the most difficult technical stage, but vaginoplasty is functionally most responsible stage of feminizing surgical correction. All patients with DSD require the careful follow-up by gynecologists, urologists, endocrinologists, and psychologists with the correspondent correction of therapy.

Von Willebrand factor as a central marker for risk stratification before liver resection for hepatocellular carcinoma Pereyra D 1,2 , Mandorfer M 3 , Santol J 1,2 , Köditz C 1 , Ortmayr G 1,4 , Rumpf B 1 , Ammon D 1 , Längle J 1 , Jonas JP 5 , Pinter M 3 , Lindenlaub F 6 , Tamandl D 6 , Grünberger T 5 , Reiberger T 3 , Starlinger P 1,7 Aim: Posthepatectomy liver failure ( PHLF) and disease recurrence determine the outcome of hepatocellular carcinoma ( HCC) patients undergoing liver resection. Von Willebrand factor antigen (vWF-Ag), a non-invasive marker for portal hypertension ( PH), has recently been established as a predictor of PHLF and was linked to tumor biology. This study aimed to evaluate vWF-Ag as a potential biomarker for HCC recurrencefree survival ( RFS), and overall survival ( OS).

Methods: 72 HCC patients with detailed preoperative workup were recruited from a prospective trial (NCT02118545) and followed for complications, RFS, and OS. Additionally, 163 compensated patients with resectable HCC were recruited to evaluate vWF-Ag cut-offs for ruling-out or ruling-in clinically significant PH ( CSPH).

Results: In receiver operating characteristic analyses for prediction of PHLF, vWF-Ag ( AUC = 0.828) performed similar Conclusions: Modified Snodgraft repair in patients with mild hypospadias permit to achieve the excellent curative effect with the minimal cases of complications. Urethroplasty by the Duckett method with the creation of urethrocutaneostoma and its closure during second stage of repair is an effective method and may be become as the "method of choice" for the treatment of patients with severe hypospadias.

Results of feminizing surgical correction of disorders of sexual development in children Potsiurko A 1 , Hrymak I 1 , Helner N 2 , Hyzha B 1 , Ivaskevych D 1 , Chaikivska E 3,1 , Hyzha L 3,1 , Stenyk R 4 , Dvorakevych A 4 , Potsiurko R 1 , Glushko Z 5 , Potsiurko N 6 , Kuksenko O 7 , Pereyaslov A 8 1 L'viv regional children's clinical hospital " OXMATDYT", L'viv, Ukraine 2 Institute of Hereditary Pathology of National Academy of Medical Science of Ukraine, L'viv, Ukraine 3 L'viv national medical university, L'viv, Ukraine 4 L'viv Regional Children's Clinical Hospital " OXMATDYT", L'viv, Ukraine 5 City polyclinic, Drohobych, Ukraine 6 Andrei Krupynskyi L'viv Medical Academy, L'viv, Ukraine 7 City children's hospital, L'viv, Ukraine 8 L'viv National Medical University, L'viv, Ukraine Aim: Disorders of sexual development ( DSD) are defined as congenital conditions in which chromosomal, gonadal, and anatomic sex is atypical. DSD is relatively rare congenital malformations, that requires an individualized and multidisciplinary team approach to provide holistic care throughout the lifespan. The aim of this study was to summarize own experience in the treatment children with DSD.

Methods: During last 5 years 12 children were hospitalized in clinic with the sighs of DSD. Each patient had an individualized plan of investigation, that included hormonal investigation, ultrasonography, laparoscopy, consultation of geneticists, urologists, gynecologists, and endocrinologists. After thorough examination, diagnosis of adrenogenital syndrome was established in 5 girls (referred to another hospital), androgen insensitivity syndrome (Morris syndrome, 46, XY DSD) -in 2 children, syndrome of mixed gonadal dysgenesis (45, X/46, XY DSD) -in 1 child, true hermaphroditism (ovotesticular DSD) -in 1 child, female pseudohermaphroditism (46, XX DSD) -in 1 child, 47 XXY DSD -in 1 child, and Swyer syndrome (46 XY DSD) -in 1 child. Four children were operated, 2 children with Morris syndrome and one child with true hermaphroditism preparing for surgery.

Results: Due to the obvious signs of masculinization, especially of external genitalia, feminizing surgical correction applied in 3 children: in one with mixed gonadal dysgenesis, and in one child with female pseudohermaphroditism. Despite the karyotype 47 XXY, in this child the hypoplastic uterus and Müllerian structures were revealed by USG. The presence of Müllerian structures, hypoplastic uterus with one fallopian tube and ovarian without visible changes were confirmed by laparoscopy. Due to that, feminizing surgical correction was performed in this child. The laparoscopic gonadectomy was performed in child with Swyer syndrome due to the result of histopathological examination (presence of ovarian elements with signs of gonadoblastoma). Children who underwent feminizing surgery did not have male structures and had relatively well-63rd Annual Meeting of the Austrian Society of Surgery cantly lower risk of PHLF. This difference seemed influenced by the striking increase of PHLF in male HCC patients. These hypothesis generating data suggest that sex might play a role in preoperative risk stratification.

Association between age and perioperative outcomes in patients with hepatic resection Hank T 1 , Schwarz C 1 , Stremitzer S 1 , Strobel O 1 , Kaczirek K 1 ( CTX) in resectable colorectal cancer liver metastases ( CRLM) is conflicting and therefore international guidelines differ in recommendations regarding application of a multimodal concept in this specific setting. To date, it does not seem clear whether high-risk and/or low-risk patients benefit from application of systemic therapy when their metastases are upfront resectable. However, it is well known, that previous randomized controlled trials often applied broad exclusion criteria in regards to patient demographics and co-morbidities and also often lack a uniform definition of resectability compared to cohorts treated by many specialized liver surgery units around the globe. We thought to analyze unfiltered real-world data from a large international liver surgery multicenter cohort in regards to the potential benefit and ideal strategy of perioperative CTX to achieve oncological long-term outcome in patients undergoing resection for CRLM. The present report summarizes findings from three of our most recent peer-reviewed publications on this topic.

Methods: A total of 967 patients undergoing hepatectomy for upfront resectable CRLM between 2010 and 2015 with a median followup of 68 months were included in this database of centres from four different European countries. All patients were discussed in multi-disciplinary-tumour-board meetings and resectability was defined as possibility to achieve complete macroscopic resection with an estimated future remnant liver volume of at least 25-30 %. Patients with extrahepatic disease were included only if this was considered resectable. A number of variables on demographics, primary and metastatic tumour characteristics, procedural details, postoperative complications and oncological follow-up data and outcomes were assessed. Three different prognostic risk scores, namely the Clinical Risk Score ( CRS), the Tumour Burden Score ( TBS), and the Genetic And Morphological Evaluation ( GAME) score were calculated. Statistical analysis included propensity score matching, multivariable regression techniques and survival curve analysis.

Results: The first analysis compared perioperative CTX plus resection versus surgery alone in a propensity-score matched cohort of 350 patients. It showed prolonged overall survival ( OS) for the CTX group (82.8 vs. 52.5 months; p = 0.017). In contrary to previous reports by other groups, the benefit of perioperative CTX on survival was also confirmed in the subgroup of patients with a "low" oncological risk ( CRS and TBS <3, GAME <2). Our second study showed, that in a matched comparison of 180 patients, the application of perioperative CTX compared to neoadjuvant CTX only was associated with significantly improved alcoholic fatty liver disease ( NAFLD) and cirrhosis risk, which may also imply a negative influence in postoperative liver regeneration.

Methods: In a retrospective manner, liver biopsies by patients suffering from colorectal liver metastases were screened for SNPs known to be associated with NAFLD. Furthermore, the results were set in context with data available for these patients, with postoperative liver dysfunction ( LD) being selected as primary outcome parameter.

Results: 94 Patients were included in this study. The incidence of LD was 16.3 % in patients with detectable rs738409 variant compared to 14.3 % in those without it (p = 0.799). In patients, who were homozygous for that polymorphism, the incidence was 20 % (p = 0.653). For other analysed polymorphisms the incidences for postoperative LD were 13 % for TM6SF2 rs58542926 (p = 0.652), 15.5 % for MBOAT7 rs641738 (p = 0.541), 12.5 % in GCKR rs780094 (p = 0.410) and 15.8 % in patients who were identified with the TRIB1 rs17321515 (p = 0.432). On another note, patients with detected rs738409 polymorphism displayed a significantly higher incidence of chemotherapy associated steatohepatitis compared its wildtype (43.7 % vs. 10.5 %, p = 0.025).

Conclusions: The selected polymorphisms showed no significant differences regarding postoperative complications in partial hepatectomies. However, further research in this field is highly encouraged. 

Inflammation mit Resiquimod verursacht wurde. Eine modifizierte Vancouver-Scar-Scale, Hyperspektralfotografie und qPCR sowie Histologie aus Biopsien wurden zu definierten Zeitpunkten durchgeführt, um die unterschiedlichen Prozesse in den entstandenen Wunden und Narben zu untersuchen.

Ergebnisse: Die Verbrennungs-und Vollhautwunden, welche durch Resiquimod eine prolongierte Inflammation erfuhren, wiesen bereits nach 77 Tagen einen signifikant höheren Scar Score auf als die unbehandelten Wunden auf. Unterschiede in nativen Verbrennungs-und Vollhautwunden waren erst nach 105 Tagen signifikant. Unterschiede in der Wundoxygenierung und der Genexpression zeigten sich zu ähnlichen Zeitpunkten.

Schlussfolgerungen: Die Verwendung von Resiquimod eignet sich laut unseren Versuchen zur Provokation einer früher auftretenden hypertrophen Narbe. Unterschiede der Wundtypen während der Narbenreifung unterstützen die Rolle der inflammatorischen Prozesse. Weitere Versuche zur Optimierung der Narbenbildung durch Re-Inflammation könnten ein noch verlässlicheres Modell zur Narbenforschung kreieren.

Verbandsapplikation durch Elektrospinning -die Wundbehandlung von morgen? recurrence-free survival ( RFS; HR 0.53; p = 0.007) and OS ( HR 0.58; p = 0.010) in both low and high TBS patients. This highlights the importance of avoiding severe postoperative complications allowing patients to complete the postoperative part of their scheduled chemotherapy concept. The most recent third analysis comprising 386 cases assessed the use of CTX in elderly patients (<75a) with extensive CRLM ( TBS >2) submitted to liver resection. This specific patient group differed significantly in terms of ASA score, median number of hepatic lesions and timing of metastases. Their CTX application rate (66 % vs 88 %) was significantly lower compared to younger individuals. While after PSM (n = 100) the two groups were comparable in terms of disease characteristics, CTX administration rate was still significantly lower in the elderly group.

Conclusions: Results from this large international cohort comprising real-world data from four European countries and a total number of 967 patients suggest, that patients with upfront resectable CRLM benefit from perioperative chemotherapy, regardless of the severity of their clinical risk score. It also underlines the detrimental effect of postoperative complications on oncological long-term survival through limitations in completing systemic therapy. Moreover, elderly patients are at an increased risk of not receiving CTX compared to younger individuals. In conclusion, despite the conflicting evidence from randomized-controlled trials, our data strongly suggest to consider application of perioperative chemotherapy even in resectable CRLM and in cases with a low clinical risk score or in patients aged >75 years.

PorcScar -Ein neues Model der hypertrophen Narbe am Duroc-Schwein Ziel: Entzündungsreaktionen sind ein wesentlicher Bestandteil der Wundheilung und somit eine physiologische Reaktion des Körpers auf Verbrennungen. Ohne Entzündungsreaktionen findet keine Wundheilung statt, da verschiedene Entzündungsfaktoren die regenerativen und proliferativen Prozesse der Wundheilung einleiten. Im Verlauf der Wundheilung von Verbrennungswunden kommt es jedoch häufig zu anhaltenden, sehr starken Entzündungsreaktionen, die den Verlauf der Wundheilung und die Qualität der Wundheilung negativ beeinflussen. Ebenso stellt eine anhaltende Entzündung einen wesentlichen Aspekt bei der Entwicklung chronischer Wunden dar.

Methoden: Es wurden Schweinemodelle zur Analyse der Auswirkungen einer anhaltenden Entzündung auf den Verlauf der Wundheilung von Spalthaut-und Vollhaut-Wunden erstellt. Resiquimod, ein Agonist des TLR7/8-Signaling, wurde als Immunmodulator verwendet, um die Entzündungsphase bis zu 6 Tage nach der Wunde zu verlängern und zu verstärken. Spalthaut-und Vollhaut-Wunden ohne Resiquimod-Applikation dienten als entsprechende Kontrollwunden. Die Genexpression, Produktion und Sekretion verschiedener Zytokine, Wachstumsfaktoren und Lipidmediatoren wurde in Wunden mit unterschiedlichem Heilungszustand, mit oder ohne prolongierter Entzündung, analysiert.

Ergebnisse: Die Anwendung des Immunmodulators Resiquimod auf Spalthaut-und Vollhaut-Wunden induzierte eine starke Entzündung, die zu einer signifikant schlechteren Heilung im Vergleich zu den entsprechenden Kontrollwunden führte. Pro-inflammatorische Biomarker wie IL6, CXCL8 und TNF waren sowohl auf der Ebene der Genexpression, der Proteinproduktion als auch der Sekretion stark erhöht.

Schlussfolgerungen: Die Anwendung des Immunmodulators Resiquimod ermöglichte die Etablierung eines In-vivo-Schweinemodells für die Analyse der Auswirkungen einer prolongierten Entzündung auf den Verlauf der Wundheilung. Dieses Modell, zusammen mit den für das Biomarker-Monitoring entwickelten Methoden, wird maßgeblich zur Erforschung jener Mechanismen beitragen, die zu einer verzögerten Wundheilung führen.

Beeinflussung des Verhältnisses von dermalem und epidermalem Gewebe während der Wundheilung durch Steuerung des Feuchtigkeitsgehalts 

Silk-Silk conduits filled with native spider silk fibers successfully promoted nerve regeneration in a 10 mm sciatic nerve defect in rats Semmler L 1 , Naghilou A 1 , Millesi F 1 , Györi E 1 , Wolf S 1 , Mero S 1 , Stadlmayer S 1 , Vollrath F 2 , Weiss T 1 , Radtke C 1 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Wien, Austria 2 Oxford University, Oxford, United Kingdom Aim: The surgical repair of nerve transection injuries remains a challenging task and often results in unsatisfactory functional recovery. If a direct coaptation is not possible, the current gold-standard is the use of an autograft. However, the availability of autologous nerve tissue is limited and the harvest of a donor nerve entails functional loss and possible donor site morbidity. In the search for alternatives, different synthetic and biological materials are currently tested to bridge nerve gaps. Recent studies supported silk as promising material for tissue engineering and the development of artificial nerve conduits. In addition, nerve conduits that contain an internal framework as guiding structures could enhance a directed axonal re-growth. Spider silk possess excellent mechanical properties such as an adequate tensile strength, long-term degradability and a nonimmunogenic nature, which support their use as promising conduit filling material. In this study, we investigated the performance of a silk fibroin-based conduit filled with spider silk fibers to bridge a 10 mm sciatic nerve defect in rats.

Methods: In 18 male Sprague-Dawley rats, a 10 mm piece of the sciatic nerve was resected and immediately bridged with 1) autografts (control group, n = 6), 2) empty silk conduits (experimental group one, n = 6), and 3) silk conduits filled with spider silk fibers (experimental group two, n = 6). Walking track analysis was performed for each animal prior to surgical intervention and every 14 days over a course of 14 weeks. Functional recovery was evaluated by calculating the sciatic functional index ( SFI) according Bain et al. At the endpoint, animals were sacrificed and the nerves were harvested to assess axon re-growth and myelination by histomorphometric as well as immunofluorescence analyses on paraffin sections.

Results: The walking track results showed that there was no statistical difference in the mean SFI of animals treated with the autograft or the silk fiber containing silk conduits. Moreover, the immunofluoresence stainings of nerve sections illustrated a similar pattern of regenerated nerve tissue in sections of autografts and filled silk conduits, while a less advanced nerve regrowth was seen in the samples containing empty silk conduits. The histomorphometric parameters displayed a similar number of myelinated axons in the autografts and filled silk conduits. Additionally, the mean axon area was comparable between the autograft and the silk conduit filled with spider silk. However, the mean myelin area was the largest in the autograft group.

Conclusions: Taken together, our study demonstrated that the functional recovery of a 10 mm sciatic nerve defect bridged with silk conduits containing spider silk fibers as internal guiding structure was comparable to and autologous nerve grafts.

Die Rolle dermaler Adipozyten in Wundheilungsprozessen Methoden: Im Rahmen der RANGER®-Studie wurden zehn Patienten mit Verletzungen der peripheren Nerven rekrutiert und elf Avance Nerve Grafts® eingesetzt. Die Indikationen waren entweder langzurückliegende Verletzungen (ø = 138 ±154 Monate, min = 13; max = 546) mit Endneuromen (n = 4) oder Neuroma in continuitatem (n = 5) oder Tumoren (n = 2). Die Nachuntersuchungen erfolgten mittels klinischer Untersuchungen der Sensibilität und Motorik und mittels Ultraschallund Nervenleitgeschwindigskeitsmessungen.

Ergebnisse: Bei den Nachuntersuchungen können keine Abstoßungen oder erneuten Auftritte von Neuromen beobachtet werden. Von sieben Patienten konnte bei allen Patienten ein signifkanter Rückgang der Schmerzen beobachtet werden. Alle Patienten konnten eine Sensibilität von S3 oder besser erreichen. 85,7 % erreichten motorische Niveaus von M3 oder besser. Allerdings zeigte ein Patient im Zeitverlauf nach einer initialen Besserung eine Verschlechterung der klinischen Parameter, welche mittels Nervenleitgeschwindigkeitsmessungen verifiziert werden.

Schlussfolgerungen: Bei dem Allograft wurden keine unerwünschten Nebenwirkungen beobachtet. Bei der Sensibilität zeigten sich ähnliche Erfolgsraten, wie bei den, aus der Literatur bekannten, Daten für Autografts. Aufgrund der langen Denervationszeit und vorliegenden Teilatrophien mit teilweisem fettigem Umbau vor der Operation waren die Erfolgsraten bei der funktionellen Regeneration erniedrigt. Ingesamt, stellt die Rekonstruktion von Nerven nach der Neuroma und Tumorresektion mittels Allograft eine Alternative zum Autograft dar.

Lessons learned from implementation of a robotic program at a rural hospital in the United States 

Abdominal negative pressure therapy in extreme situations -Three case reports Sauseng S 1 , Delcev P 1 , Ribeiro Skreinig MA 1 , Mayerhofer M 1 , Schemmer P 1 , Mischinger H 1 , Auer-Schönbach T 1 1 Abteilung für Allgemein-, Viszeral-und Transplantationschirurgie Universitätsklinikum Graz, Graz, Austria Aim: In recent years, intra-abdominal negative pressure therapy ( NPT)has increasingly developed into a successful therapy strategy for the treatment of secondary peritonitis. Of course, there are also certain limitations here. Thus, the remediation of the source of peritonitis, if possible already during the initial intervention, has a very high priority or is even playing the major role, following the current ESTES (European Society of Trauma and Emergency Surgery) recommendations [1] . Likewise, the use of intra-abdominal negative pressure therapy on parenchymatous organs is viewed critically. Even with recommendations for NPT in the context of an abdominal compartment syndrome after HPB surgery, the surgical community is extremely reluctant [2] .

Methods: On the basis of three exemplary cases, we would like to show which decisive role intra-abdominal negative pressure therapy plays in the treatment of complex peritonitis situations, even if the cause of peritonitis cannot be eliminated or parenchymatous organs are affected. The first case concerns a 40-year-old man after Whipple surgery. On the 17th postoperative day, an emergency laparotomy was performed due to an arrosional hemorrhage. Subsequently, the patient developed an anastomosis insufficiency with a consecutive POPF. Due to the massive peritonitis and the problematic abdominal situs, no rescue-pancreatectomy could be performed afterwards. Pancreatitis was treated with negative pressure therapy ( NPT), the drainage of bile was ensured by PTCD. Thus, a healing of the situation could be achieved without further HPB-surgical intervention. The second case is an 84-year-old female patient who underwent a subtotal gastrectomy in a palliative setting due to gastric cancer. In the further course, duodenal fistula and necrotizing pancreatitis occurred. By early application of the negative pressure therapy including deep drainage, a fascia and abdominal wall closure could be achieved within a week. The third case describes the treatment of a huge liver abscess due to amoebiasis, with the patient already showing a septic condition picture. After abscess resection in the sense of a central liver resection, the negative pressure therapy was applied as well onto the liver Results: In all the cases described, both the septic condition and peritonitis could be successfully treated. Furthermore, in all three cases, a closure of the abdominal wall fascia was possible.

Conclusions: The selected cases show very nicely what possibilities intra-abdominal negative pressure therapy can offer even in case of enteric fistulas and on surfaces of parenchymatous organs. Especially if it is not used as the sole form of therapy, but acts as part of a therapy cascade, it represents a safe treatment method which shows a clear benefit for the affected patients.

References: [1] The Bucharest ESTES consensus statement on peritonitis European Journal of Trauma and Emergency Surgery volume 46, pages1005-1023 (2020) [2]Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver Aim: Robotic surgery has evolved in the United States as new standard for many procedures and spread from academic centers to the rural setting in a fast pace during the past 5 years. A major factor in implementation of a robotic program is demand by patients and competition from other health care facilities. Many hospitals have difficulties recruiting urologists and gynecologists if no DaVinci platform is available, however, usually more than 50 % of all robotic procedures are done by general surgeons.

Methods: A DaVinci Xi console was purchased by the hospital in 2019. Despite major shut downs of surgical services during 4 waves of the COVID19 epidemic, almost 1000 robotic cases have been performed by December 2021 and surgical services account for more than 75 % of them. The console is currently used by 16 different surgeons (general, bariatric, thoracic, urology, and gynecology) . The first series of 86 robotic assisted cases performed by one laparoscopic surgeon was analyzed in detail. A prospective database including demographic and clinical data was created, outcome was retrospectively analyzed.

Results: Training on the Xi-console is standardized with tutored mandatory virtual training sessions followed by a theoretical and skill set testing. After training sessions in an animal model and on animal ex-vivo organs, an experienced robotic surgeon supervises four cases in the operating room and the next ten cases are reviewed before the surgeon is licensed to independently perform cases. The analyzed case series included 31 men and 55 women median aged 48.2 (range 19.5-90.4) years. The case series includes 54 bariatric surgeries, 21 abdominal wall hernia surgeries, five paraesophageal/hiatal hernia repairs, one splenectomy, four colectomies and two cholecystectomy including three combined procedures. All patients undergoing gastric bypass, hiatal hernia repair and colectomies required admission. All patients undergoing sleeve gastrectomy (n = 47) were technically admitted as per insurance request but 90 % were discharged within 24 hours. For this procedure, after a short learning curve, a 4 port technique without use of a liver retractor was developed and patients seem to have less pain when compared with laparoscopic approach. Cholecystectomies, gastric band removals and ventral and inguinal hernia repairs are routinely done as same day procedures. No complications directly related to robotic technique were observed, there was one conversion to open surgery and 3 cases were done combined laparoscopic and robotic.

Conclusions: Robotic surgery certainly adds to the armamentarium in surgery, however, increased costs per case and best usage must be considered. The COVID19 epidemic had a significant negative impact on the volume of robotic surgeries. Access to the console remains the biggest hinder to further increase number of cases. Whereas for bariatric surgery a significant advantage of the platform over traditional laparoscopy was found both for ergonomics and patient satisfaction including pain, for small ventral hernias and cholecystectomies, use of the robot has been stopped. For inguinal and hiatal hernia repair the system offers advantages. Currently, only a limited number of colon resections are done on the DaVinci robot due to limited access. Given the overwhelming acceptance by surgeons and the excellent initial experience, the hospital plans to provide a second console in the near future.

63rd Annual Meeting of the Austrian Society of Surgery the anatomy as well as prevents the lower esophageal sphincter to move into the chest, thus improving or optimally stopping reflux altogether.

Results: Methods. The first ten patients that received the implantation of the RefluxStop device in our clinic were included in this follow-up evaluation. All patients were diagnosed with GERD, had persistent symptoms after long proton pump inhibitor intake and proven ineffective esophagus motility ( IEM). Prior surgery, all patients underwent thorough preoperative evaluation through various testing and questioning.

Conclusions: Update. This device has already proven to be more effective concerning dysphagia, a significant symptom when suffering from IEM. All other results will be presented.

Avoiding failure-to-rescue following esophagectomy for esophageal cancer: Preventive EndoVac as successful concept to reduce in hospital mortality Kirchweger P 1,2,3 , Spaun G 1 , Fabbri A 1 , Tschoner A 1 , Wundsam H 1 , Huber J 1 , Biebl M 1,3 1 Ordensklinikum Linz -Department of Surgery, Linz, Austria 2 Ordensklinikum Linz -Gastrointestinal Cancer Center, Linz, Austria 3 JKU Linz -Medical Faculty, Linz, Austria Aim: Esophagectomy is associated with substantial postoperative mortality rates (7.7 % 30d-mortality in 2011), especially when suffering from major complications (incidence up to 40-60 %). Failure-to-rescue ( FTR) is defined as the mortality rate (30d) within patients with complications. Large international database analysis from DUCA revealed FTR rates of 38 % (2011) decreasing to 19 % in 2014. Modern interdisciplinary management, including early endoscopic assessment of anastomoses and early vacuum therapy for anastomoses at risk and centralization have led to a significant improvement in postoperative outcome with a 30d-mortality reduced to <2 % in very high-volume centers.

Methods: To evaluate performance indicators after a change of concept (early/preventive EndoVAC therapy to treat anastomosis leakage since 2019 in contrast to traditional concepts between 2002-2018) at an Austrian Upper GI center, patients undergoing esophagectomy for esophageal cancer between 2002-2021 have been analyzed retrospectively for outcome and failure-to-rescue.

Results: 254 patients undergoing curative intended esophagectomy for esophageal cancer at our tertiary center were included. Centralization led to a decrease of anastomosis leakage and major complication rates from 23.4 % to 18.2 % (p = 0.040) and 45.1 % to 35.7 % (p < 0.000). Interdisciplinary endoscopic interventions and the use of preventive EndoVAC treatment of ‚anastomosis at risk' resulted and a further improvement of failure-to-rescue rates from 19.6 % to 11.1 % (p = 0.011) as well as decreased re-operation rates (34.1 % to 11.1 %, p = 0.003). Thus, mortality rates could be improved from 3.6 %, 7.6 % and 10.1 % (30/60/90-day mortality) to 1.4 %, 3.3 % and 3.3 % respectively leading to a median OS of 35 months (95 % CI 28-42).

Conclusions: Early EndoVAC therapy for anastomosis leakage or anastomosis at risk leads to outstandingly low mortality rates and a significant reduction of failure-to-rescue in esophageal cancer surgery. 

Follow-up of first patients with implanted RefluxStop device Feka J 1 , Paireder M 1 , Kristo I 1 , Asari R 1 , Schoppmann SF 1 surprise diagnosis was made, patients considered at risk were tested for TSH, Vitamin C, Thiamin and Zinc levels. A database was created including demographic, clinical and outcome data.

Results: The index patient was stabilized and intubation for respiratory failure (x-ray showed pneumonia) on the ICU and underwent emergency amputation of the necrotic limb and antibiotics were started. The next day, the large necrotic gluteal area was debrided down to viable tissue. During exploration for laparoscopic assisted colostomy, peritonitis originating from scattered areas of ileum and colon necrosis were identified and resected leaving her in discontinuity. On 2nd look surgery, an ileo-colic anastomosis and end descending colostomy were created. TPN was started. Poor healing at the surgical sites and spread of the skin ulcers was noted. The patient was found to be profoundly hypothyroid and her vitamin C levels were un-measurable and replacement was given. However, the patient did not recover and family opted for hospice care. Following implementation of the testing protocol, an additional six women and two men with elevated TSH and low Vitamin C or Thiamin levels were identified. The median age of study group was 57.5 (range 36.4 to 77.1) years; median BMI was 30.5 (range 20.0 to 49.8) kg/m2 with 55 % being obese or morbidly obese. Two patients had cancer, two a history of bariatric surgery, one of partial gastrectomy. 71 % had low pre-albumin and 75 % low zinc levels. Two patients died from Scurvy (one also had Myxedema). One with a non healing perineal wound after APR for recurrent anal cancer died from tumor progression. All others are alive after a protracted course.

Conclusions: The index patient was hypothyroid, had Scurvy and showed features of thiamin deficiency (symptoms of Korsakov and Beriberi). Despite aggressive medical and surgical treatment and vitamin replacement, this patient succumbed to her critical condition. Poly vitamin deficiency together with endocrinopathy may be under-diagnosed and should be considered in patients presenting with similar unclear symptoms. If appropriately diagnosed and aggressive treatment is initiated, full recovery can be achieved. Aim: Although uncommon in western civilization, poly vitamin deficiency together with protein malnutrition and endocrinopathy may be encountered in individuals presenting with critical illness including sepsis. Homeless status, poverty, drug and alcohol abuse as well as neglect have been identified as risk factors for this condition.

Methods: The case of the 77 year old female, who was brought from home to the emergency room in critical condition with fever, confusion, abdominal pain and distention is described in detail. She had a necrotic left lower leg and a large sacral/ gluteal necrotic area and multiple skin ulcers. Very poor living condition and domestic neglect had been reported. After the 63rd Annual Meeting of the Austrian Society of Surgery 

Die Rolle der Expertin in der Endoskopie 

Implementierung der Pflegefachassistenz am LKH Universitätsklinikum Graz an der CK -AVT Henneth B 1 , Liendl F 2 1 LKH Univ. Klinikum Chirurgie AVT Station 1, Graz, Austria 2 LKH Univ. Klinikum, Chirurgie AVT Station 2, Graz, Austria An den beiden Normalpflegestationen AVT 1 und AVT 2 sind seit 2019 insgesamt 3 Pflegefachassistentinnen beschäftigt. Bereits vor ihrem Dienstantritt wurde von den beiden Stationsleitungen mit ihren Teams, das Tätigkeitsfeld der "neuen Berufsgruppe in der Pflege", intensiv diskutiert, geschult und in mögliche neue Arbeitsabläufe eingebracht.

Als Grundlage dienten das GuKG ( § 92 Abs. 2, § 83 und § 15) und die Funktionsbeschreibung der KAGes (Richtlinie 2002.6531).

Ein Mitarbeitereinschulungsleitfaden für die Pflegefachassistenz wurde erarbeitet und stand den neuen Kolleginnen zur Verfügung.

Alle waren sehr motiviert und mit großer Freude dabei, endlich ihre erlernten Tätigkeitsfelder umsetzen zu können.

Rasch zeigte sich, die große Unterstützung für den gehobenen Dienst, bei den peripheren Blutabnahmen und beim Abund Anhängen von bereits gelaufenen Infusionen am periphervenösen Zugängen. Gerade im Nachtdienst und im Spätdienst ist diese Entlastung am deutlichsten gewesen.

Im Team waren die Pflegefachassistentinnen sehr rasch integriert und von allen sehr geschätzt.

Es ist geplant noch weitere Pflegefachassistent* innen einzustellen. Aber der Gehobene Dienst wird im akutchirurgischen Setting, immer den größeren Anteil im Team darstellen. Ergebnisse: Seit der Implementierung konnten bereits über 200 Patient* innen nach Organtransplantation am Schulungsprogramm teilnehmen. Seit März 2020 wird dieses Patient*innenedukationsprogramm anhand einer prospektiven, randomisiert-kontrollierten Studie ( ISALK-Trial, ClinicalTrials.gov, NCT04207125) evaluiert und befindet sich derzeit in Auswertung.

Schlussfolgerung: Für die erfolgreiche und nachhaltige Implementierung einer multimodalen Patient* innenedukation ist eine Advanced Practice Nurse, das Commitment der Führungskraft sowie eine wertschätzende multiprofessionelle Zusammenarbeit erforderlich. Zusätzlich führt eine Partizipation der Pflegepersonen und der Zielgruppe von Beginn an zu einer schnelleren Akzeptanz der neu umgesetzten Maßnahmen.

Lung decortication in patient with nonspecific chronic pleural empyema Sushchenko E 1,2 , Boyko V 1,2 , Krasnoyaruzhsky A 1,2 , Sochnieva A 1,2 , Korolevska A 1,2 1 State Institution "Zaytcev V. T. Institut of general and urgent surgery NAMN of Ukraine", Kharkiv, Ukraine 2 Kharkiv national medical university, Kharkiv, Ukraine Aim: One of the most serious and life-threatening problems of thoracic surgery is nonspecific chronic pleural empyema ( NCPE). The range of surgical interventions varies from pleural puncture till lung decortication. The aim of the study is to analyze the treatment results of patient with nonspecific chronic pleural empyema after lung decortication.

Methods: The analysis of the treatment results of 37 patients with NCPE after lung decortication during 2015 to 2021 years was performed. So, in TD2 and NASH group, decreased CD105 surface antigens expression to 4 % (n = 36; p < 0.001) comparing to 81 % (n = 25) of control group respectively that affected the properties stem cell. The total mitochondrial pool of NADH in MSCs with patients DT2 complicated course of NASH was also higher (p = 0.001) than in patients DT2 with level (60.3 ± 4.7 %, n = 50) and control group with level (92.0 ± 5.5 %, n = 25, (p < 0.001)), indicating incr Conclusions: The health of patients strongly affects the status of MSCs. Those cells isolated from patients with type 2 diabetes (TD2) or from patientswith TD2 accompanied by the NASH have the increased incidence of apoptosis, autophagy, accumulation of free radical molecules, and mitochondria deterioration. The mitochondrial membrane potential observed in these cells may be a protective mechanism that provides energy and building blocks to restore cellular homeostasis and control oxidative damage. Based on presented data, our conclusion is that crucial metabolic aspects of TD2 are indeed recapitulated at the systemic level and perspective therapeutic application of MSC isolated from TD2 patients may be limited due to their dysfunctionality. Schlussfolgerungen: Immer wiederkehrende Obstipation ist ernst zu nehmen und bei Persistenz weiter abzuklären. Es gilt auch bei schwierigen Gegebenheiten eine ausführliche Anamnese durchzuführen und eine adäquate Dokumentation 63rd Annual Meeting of the Austrian Society of Surgery high as above -10-11 и 13-15 % respectively. There was on difference between these groups (p > 0,05). By day 7, the patients of both groups demonstrated the increase in values of all tests. The statistically reliable difference between G1 and G2 was detected only in cases of MMSE and FAB tests. By the day 30 after surgery the mean values of all tests in both groups of patients closed to initial levels though they stayed at lower levels. The results of Group 2 were lower than in Group 1. The difference was reliable for the MMSE, FAB and Luria tests. The initial and final values in G1 were not statistically different. The corresponding values in the patients of G2 were comparable for MMSE test and statistically different for CD, FAB and Luria tests (the final value was lower than initial).

Conclusions: 1. A significant reduction in the average indicators of the cognitive function in older patients which have undergone prolonged gastrointestinal surgical interventions with general anesthesia is no doubt and remains within the studied period after surgery (30 days). 2. Perioperative use of HA in patients who have undergone operations on the tract with general anesthesia made it possible to reliably improve their cognitive function in the P/O period according to the MMSE, FAB and Luria tests. 3. By 30 day after surgery, the average values of the cognitive function of patients approached the initial in both groups, however, were significantly lower than the initial CD, FAB and Luria in the patients of GR2. 4. The clinical significance of the decline in patients' cognitive function indicators after surgery with general anesthesia needs further study and evaluation, as well as the degree of influence of medications for general anesthesia.

A great match: Combining the transversus abdominis release ( TAR) technique with a biological mesh for frozen open abdomen -a case report Posa K 1 , Kapitanov T 1 , Razek P 1 chial stump leackage after decortication with lung resection was observed in 1 case due to refusal of electrocoagulation during surgery. It was treated with bronchoscopic occlusion. Arrosive lung bleeding from the root was stopped in 1 (2,7 %) by rethoracotomic hemostasis. Sepsis in 1 (2,7 %) case was eliminated using antibiotic therapy and pleural antiseptic sanitation. The mortality rate was 8,1 % (3 patients). One patient (2,7 %) died due to acute cardiovascular failure, One patient (2,7 %) died due to massive pulmonary embolism and one patient (2,7 %) died from septic shock.

Conclusions: Complications of lung decortication require the use of conservative and surgical treatment, as well as the development of preventive methods for their development. 

Lung decortication complications treatment after patients with nonspecific chronic pleural empyema Sushchenko E 1,2 , Boyko V 1,2 , Krasnoyaruzhsky A 1,2 , Korolevska A 1,2 , Sochnieva A 1,2 , Kritsak V 1 1 State Institution "Zaytcev V. T. Institut of general and urgent surgery NAMN of Ukraine", Kharkiv, Ukraine 2 Kharkiv national medical university, Kharkiv, Ukraine Aim: Nonspecific chronic pleural empyema ( NCPE) treatment is accompanied by a large number of postoperative complications and a high mortality rate. Existing treatments are aimed at reducing them. The aim of the study is to reduce postoperative complications and mortality in patients with NCPE by studying their number and structure.

Methods: We analyzed the treatment results of 37 patients with NCPE who underwent lung decortication during the period from 2015 to 2021

Results: Complications were observed in 5 (13,5 %) patients, Acute pneumonia, which was a consequence of the action of electrocoagulation of pleural adhesions, was observed in 2 (5.4 %) patients and was eliminated conservatively. The bron- Aim: Giant inguinoscrotal hernia is a rare disease in industrialized countries that appears due to patients neglect of treatment and still represents a big challenge. Reports on preoperative conditioning with progressive pneumoperitoneum ( PPP) and Botolinum Toxin A treatment ( BTA) are limited, we report a single case of PPP and BTA followed by Hernia Repair in Lichtensteins technique.

Methods: A 69-year old patient was referred to our center with a giant left-sided inguinoscrotal hernia presenting in a reduced nutritional state ( BMI 16,9, serum albumin 2,4 g/dl, anemia) due to a major depressive episode. The CT scan showed loss of domain, with 43 % of the total peritoneal volume in the hernia sac on volumetry according to the Sabbagh method. PPP and BTA were established.

Results: During the clinical course the patient developed aspiration pneumonia. Due to a severe underlying pulmonary impairment caused by both emphysema and bronchial obstruction antibiotic therapy, plural puncture, bronchoscopy and continuous low-flow oxygen therapy were needed to achieve fitness for surgery. Finally a tension-free mesh repair and orchidectomy were performed without any complications. The preoperative extension of the abdominal cavity made it possible to successfully reduce the hernia without any resection of bowel.

Conclusions: Controlling risk factors prior to elective surgery ist key for successful treatment.The decision to establish PPP was based on the volumetric results of the CT scan showing loss of domain. At laparoscopy for secure placement of the intraabdominal catheter an impressive rigidity of the abdominal wall was obvious. It would have been benificial to perform BTA 3 weeks prior to PPP rather than simultaneously. As the CT scan showed nearly total reduction of hernia content on day 6 of PPP, in hindsight we consider our protocol with injections of 500-1000 ml of ambient air twice daily as too agressive.

References: Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau JM. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia. 2012 Feb;16 (1) 

Kasuistik eines lokal fortgeschrittenen Kolonkarzinoms ( CRC) ration. Open repair was performed by using the hernia sac as an extension of the posterior and anterior rectus sheet, a nonabsorbable sublay-mesh was placed into retro-rectus-space and a release of the anterior oblique aponeurosis was additionally performed to provide a sufficient anterior midline closure with restoring a physiological position of the rectus muscle. Drains were positioned in subfascial and subcutaneous position. A closed incision negative pressure therapy (ciNPT) device was used as a dressing. Perioperative antibiotics had been applied for 7 days. The postoperative stay was uneventful. The patient was discharged from hospital on the 12th postoperative day.

Results: If primary fascia midline closure with retromuscular mesh enforcement is not appropriate for large hernia repair owing to extensive tension, different lateral tissue releasing techniques will exist to address this problem. These "component separation" techniques commonly allow a tension free or reduced tension midline closure. Different "sandwich techniques" could be used for reconstruction of large incisional hernias if classic "sublay-" and "component separation" techniques have been proved to be limited. The peritoneal flap procedure is using the divided hernia sac to bridge the gap and isolate the implanted mesh from both (the intraperitoneal and subcutaneous space), which allows a retro-rectus mesh position. In fact, this technique is associated with low recurrence rate and low complication rate. Component separation following peritoneal flap repair is feasible but should be reserved for very large defects regarding an increasing wound complication rate linked to the creation of wide skin flaps.

Conclusions: In case of large ventral hernias, the knowledge of several different repair techniques is required to ensure a tension free closure of the midline performed by an experienced surgeon.

Das Spektrum der interventionellen Radiologie und Gastroenterologie umfasste 243 Leberbiopsien, 188 kurative Behandlung von Leberherden mittels TACE (n = 99), SIRT (n = 29), Mikrowellenablation (n = 48) und sRFA (n = 12). An der interdisziplinären Endoskopie wurden 2254 ERCPs und 153 therapeutische Endosonografien mit HotAxios-Drainagen durchgeführt.

Schlussfolgerungen: In einer modernen HPB-Einheit wird durch das breite interdisziplinäre Angebot an Spezialisten und deren 24/7/365-Verfügbarkeit eine patientenzentrierte Betreuung von der Abklärung über die Behandlung bis zum Komplikationsmanagement bei Erkrankungen des hepatopankreatobiliären Systems gewährleistet. Dies führt einerseits zu niedrigen Morbiditäts-und Mortalitätsraten und ermöglicht andererseits ein maßgeschneidertes Therapieangebot für jeden Patienten.

Präoperative Abklärung bei Pankreasresektionen -Leitlinien und Alltag Ergebnisse: Ausgelöst durch erhöhte, nicht situationsadäquate Stressreaktion und die damit verbundene Überforderung der Stresssysteme selber mit massiver Katecholaminausschüttung bis hin zur Depletion Noradrenalin-produzierender Zellen, kommt es zum damit fehlenden Schutz des Gehirns vor der gleichzeitigen Cortisolausschüttung. Die Folge ist eine Zellzerstörung in erheblichem Ausmaß vor allem im limbischen System. Diese Ausfälle führen letztlich zur depressiven Sympto-blieben negativ und die Patientin wurde wieder einer onkologischen Nachsorge zugeführt.

Schlussfolgerungen: Dieser Fall zeigt wie in der Literatur beschrieben, dass bei gut differenzierten Tumoren Spätrezidive auftreten können und die Nachsorge über mindestens 10 Jahre, wenn nicht sogar lebenslang erfolgen sollte.

Pancreatic adenocarcinoma mimics gastric tumor Van de Haar R 1 , Spuller E 1 , Trampitsch E 1 , Jenic G 1 1 

Aim: This case report shows that despite clear diagnostic signs directing to a diagnosis, considerations regarding differential diagnosis always should be made. Furthermore, a multimodal therapy of advanced pancreatic carcinoma including surgery can be considered.

Methods: . Results: In August 2020 a 56 year old female patient was presented in our department with shortly occurred melena, inappetence and fatigue. A performed gastroscopy showed a macroscopically urgent suspicion of a gastric carcinoma. Histologically a Laurén intestinal-type Adenocarcinoma was confirmed. Staging-CT showed a 5 cm Tumor in the left upper abdominal quadrant with gastric, splenic, pancreatic and left adrenal gland involvement, cTNM: cT4cNcM0. Under the suspicion of a gastric adenocarcinoma, a neoadjuvant FLOT scheme was applied. Restaging showed a clear decrease in tumor mass and a downgrading could be achieved. Afterwards, an en-bloc gastrectomy, splenectomy, left pancreatectomy, as well as resection of the left colonic flexure, left adrenal gland, cholecystectomy and lymphadenectomy was performed. Interestingly, histology showed a nodal positive ductal pancreatic adenocarcinoma, ypT3pN1,L1,V1,Pn1,M1 -the neodjuvant FLOT scheme led to a significant regression. The postoperative recovery of the patient went very well and she could be discharged after fifteen days with Karnosfsky Index score of 100 %. An adjuvant chemotherapy with m-Folfirinox was applied. Until now, recurrent or metastatic disease could not be detected.

Conclusions: Despite the initial suspicion of a gastric adenocarcinoma, histology showed a ductal adenocarcinoma of the pancreas. Nevertheless, the neodjuvant chemotherapy using a FLOT scheme led to a significant regression and feasible resection. In our opinion, a standardized regressions grading for pancreatic adenocarcinoma should be defined and histological facts should be reviewed carefully in diagnostic point of view.

Zufallsbefund nach Port-Explantation Ziel: Der Volvulus ist eine seltene Differenzialdiagnose des akuten (oder unklaren) Abdomens. Die akute Mesenterialischämie, Aortendissektion und das perforierte Aortenaneurysma müssen bei akuten Abdominalbeschwerden grundsätzlich abgegrenzt werden und sind wie der Volvulus mögliche Ursachen der Beschwerden. Die Bildgebung grenzt diese formal automatisch ab. Das Ziel dieser repräsentativen Kasuistik ist es, basierend auf selektiven Referenzen der medizinisch-wissenschaftlichen Literatur und gewonnenen klinischen Erfahrungen aus dem Diagnose-bezogenen Fallmanagement den seltenen Volvulus im Erwachsenenalter mit instruktivem "whirl sign" im CT zu illustrieren.

Methoden: Wissenschaftlicher Fallbericht -76-jähriger männlicher Patient: -Anamnese (jetzig): mit diffusen Bauchschmerzen (Eigen: arterieller Hypertonus, Hyperlipoproteinämie, Glaukom; zahlreiche Vor-Op's). -Klinischer Befund: Akutes Abdomen mit diffusem Druckschmerz (p. m.: Oberbauch), Peritonismus und Abwehrspannung bei reizlosen Narben (Flanken-und Suprainguinalschnitt rechts, Wechselschnitt).

Ergebnisse: KASUISTIK: -Diagnostik: * Triage: RR 80/40 mmHg, HF: 44/min, O2-Sättigung: 94 %. * Aufnahmelabor: Normwertige Leukos, Elektrolyte und CrP (Hb/Hk dezent erniedrigt; CKD-EPI: 61,8 ml/min/1,73 m 2 [2.-gradige Niereninsuffizienz]). * Computertomographie ( CT) des Abdomens: Dilatierte Jejunalschlingen und freie Flüssigkeit. Die Mesenterialgefäße imponierten typisch wie ein "whirl sign"/daneben: zystische Läsionen im Lebersegment V/IVb [10/6 mm]) sowie im Pankreasschwanz/-kopf (13/11 mm) mit V. a. auf Seitengang-IPMN). -Diagnose: Dünndarmvolvulus mit hämorrhagischer Infarzierung und CT-basiertem "whirl sign". -Differenzialdiagnosen: Grunderkrankungen des akuten Abdomens (freie Magen-/Darmperforation, Appendizitis, Cholezystitis, Ileus, insbesondere akute Mesenterialischämie, Aorten-Dissektion, perforiertes Aortenaneurysma, innere Herniation nach Magenbypass-Anlage mit Roux-Y-Rekonstruktion.

-Therapie: Explorative Laparotomie mit Volvulus des Jejunums und segmentaler Dünndarminfarzierung bei 10 cm aboral des Treitzschen Bandes (Briden: ursächlich) -Detorquierung und 130-cm-Jejunumsegmentresektion (verbliebene Dünndarmlänge: ca. 300 cm) mit End-zu-End-Anastomose (2-reihige matik, die damit die Endstrecke der Überforderung der Stresssysteme bildet. Flankiert wird die Zerstörung der Stresssysteme von der Ausschüttung proinflammatorischer Substanzen wie IL-2 und IL-6. Der Weg zur Überforderung wird hier gebildet durch die beiden betrachteten Krankheitsfelder (Herzinfarkt, ausgewählte Tumorerkrankungen).

Schlussfolgerungen Ergebnisse: Der postoperative Verlauf gestaltet sich unauffällig, histopathologisch findet sich ein 50 mm im Maximaldurchmesser großes, kaum verhornendes, in sano reseziertes 63rd Annual Meeting of the Austrian Society of Surgery phragm after prolonged ventilation. We present a patient who suffered from diaphragmatic rupture 2 months after recovering from a severe Covid 19 pneumonia Methods: A 71 years old male patient presented with massive thoraco-abdominal pain and severe dyspnea. At the time of admission, the patient was diagnosed with rupture of the diaphragm and developed cardiogenic shock. Intraoperatively there was a 4 cm diameter large rupture of the diaphragm with enterothorax (transverse colon, stomach, spleen, parts of the jejunum). Avulsion of the mesenteric arteries made a segmental resection of the jejunum together with the spleen necessary. A jejuno-jejunostomy was performed and organs were replaced into the abdomen. The rupture of the diaphragm underwent primary closure with non-resorbable suture material.

Results: The patient has shown an uneventful post-operative course, fully recovered and was discharged on day 11 after surgery.

Conclusions: Covid 19 is a disease that is known to have various effects on different organs. The diaphragm is only paid heed in case of dysfunction. Also in the setting of Covid 19 it is not known as prominent effector organ. Nevertheless its affection by coughing caused by Covid 19 can lead to life threatening complications.

Über Umwege zur Diagnose: Akuter Thoraxschmerz aufgrund einer Pankreatikopleuralen Fistel Aigner C 1 , Kurz F 1 , Shamiyeh A 1 1 Kepler Universitätsklinikum, Klinik für Allgemein-und Viszeralchirurgie, Linz, Österreich Ziel: Ein 62-jähriger Patient wurde aufgrund von akutem Thoraxschmerz eingeliefert. Nach Ausschluss eines akuten Kornarsyndroms zeigte sich im Thoraxröntgen zunächst ein ausgedehntes pneumonisches Infiltrat mit Begleiterguss. Es wurde eine Antibiose eingeleitet -bei ausbleibendem therapeutischem Ansprechen erfolgte eine CT des Thorax die eine zystoide Formation mit 7 × 10 cm zeigte -entlang des linken Zwerchfellschenkels von thorakal nach intraabdominell reichend. Es wurde zu diesem Zeitpunkt ein thorakaler Ursprung im Sinne eines Senkungsabszesses angenommen.

Methoden: Der Patient wurde zur Evaluierung einer interventionellen Therapie ins Kepleruniklinikum verlegt. Es erfolgte eine Endosonographie. Die im CT beschriebene Retention zeigte einen schmalen Übergang zur Pankreaskauda, sodass sich der Verdacht auf eine Pankreaspseudozyste ergab. Es erfolgte eine diagnostische Punktion der Retention -Amylase und Lipase waren positiv im gewonnenen Material. Nach weiterführender Abklärung mittels MRCP und interdisziplinärer Besprechung des Falles folgte der Entschluss zur chirurgischen Sanierung. Es wurde eine thorakoskopische Dekortikation links nen Auftretens existieren auch keine Guidelines zum Umgang mit dieser Erkrankung.

Schlussfolgerungen: Die radikale Exzision des Tumors soll bei bestätigtem Verrukösem Karzinom, wenn immer möglich, die Therapie der Wahl sein. Die Rezidivrate ist hoch, aus diesem Grund sind engmaschige Kontrollen in 3-6-monatigen Abständen empfohlen. Bei synchronem Vorliegen einer HPV Infektion und Condylomata Accuminata kann eine Lokaltherapie mit Imiquimod in Erwägung gezogen werden.

"Ein spezieller Ileus" Stübler M 1 , Hauser H 1 , Schmölzer H 1 , Orgler S 1 1 LKH Graz II, Standort West, Graz, Österreich Ziel: Ziel des Posters, ist die Präsentation eines Patienten mit Ileussymptomatik, ausgelöst durch eine Hernia Obturatoria, eine wahre Rarität unter den Hernien, sowie deren Diagnostik und weiterfolgende Therapie.

Methoden: Vorgestellt wurde uns eine 91 -jährigen Patientin mit reduziertem Allgemeinzustand, deutlich geblähtem Abdomen, Stuhlverhalt seit 5 Tagen und protrahiertem Erbrechen. Es erfolgte umgehend eine klinische Untersuchung, Laborabnahme und Bildgebung. Im CT -Abdomen zeigte sich eine inkarzerierte Hernia obturatoria als Ursache für einen mechanischem Dünndarmileus, welcher umgehend komplikationslos operativ versorgt werden konnte.

Ergebnisse: Die Hernia obtoratoria, auch bezeichnet als Beckenhernie/Obturatorhernie, stellt mit einer Inzidenz von 4 % eine der seltensten Formen einer Hernie dar und ist vorwiegend bei kachektischen Frauen zu finden. Die Obturatorhernie ist eine seltene Form des Eingeweidebruchs, bei der Eingeweide und Organteile durch das Foramen obturatorium austreten, das normalerweise durch Bindegewebe verschlossen ist.

Schlussfolgerungen: Die Diagnose der Hernie gestaltet sich oft schwierig und gelingt prä¬operativ nur in maximal einem Drittel der Fälle, wobei sich Sonographie und CT als hilfreich erwiesen haben. Bei untergewichtigen Frauen jedweden Alters sollte man verdächtige Schmerzen immer abklären. Denn die Mortalität kann auf bis auf 25 % ansteigen, wenn die Diagnose nicht rechtzeitig gestellt wird.

Life threatening rupture of the diaphragm after Covid 19 pneumonia Imamovic A 1 , Wagner D 1 , Sauseng S 1 , Lindenmann J 2 , Fink-Neuböck N 2 , Waha J 1 , Kresic J 1 , Auer-Schönbach T 1 , Schemmer P 1 , Mischinger H 1 1 General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria 2 Division for Thoracic Surgery, Dept. of Surgery, Medical University of Graz, Graz, Austria Aim: The incidence of diaphragmatic rupture is low; however, it maybe life threatening. Normally caused by blunt trauma, some cases are reported after pulmonary infections with extensive coughing. Covid 19 causes pulmonary infections and pneumonia and has been associated with weakening of the dia- 

Crosstalk between hyperglycemia, inflammation and coagulation in severe acute pancreatitis Chuklin S 1 , Chooklin S 2 1 Saint Paraskeva Medical Center, Lviv, Ukraine 2 Lviv Regional Clinical Hospital, Lviv, Ukraine Aim: Acute pancreatitis ( AP) is a complex disease that if accompanied by organ failure can cause serious complications and death. Pancreatic inflammation results in destruction of pancreatic islet with loss of β-cells. However, the pathogenesis of hyperglycemia in acute pancreatitis ( AP) is not completely clear; the activation of inflammatory cytokines and coagulation may be keys in the initiation of this process.

Methods: We examined 155 patients with acute necrotizing pancreatitis. According to the international classification in 98 patients we diagnosed the moderately severe AP, and in 57 patients the severe AP. Hyperglycemia were in 79 patients. We determined the glucose level, indicators of hemostasis and inflammation.

Results: In acute pancreatitis patients was shown a direct correlation between hyperglycemic state in the blood serum with concentration of interleukin 2 (F = 8.5386, p = 0.00480), interleukin 6 (F = 7.2821, p = 0.00890), tumor necrosis factor α (F = 6.8345, p = 0.01114), C-reactive protein (F = 5.5902, p = 0.02111), Analysis of the relationship of hemostasis in patients with acute pancreatitis and hyperglycemia is accompanied by decreased of activated partial thromboplastin time (F = 5.883, р = 0.01812), increased of thrombin time (F = 8.9490, р = 0.00394), D-dimers level (F = 6.0297, р = 0.01679), and level of soluble fibrin-monomer complexes (F = 8,438, р = 0.00504), lack of activity of antithrombin III (F = 8,2847, р = 0.00543). The level of glucose in the blood serum significantly increased with increasing concentrations of interleukin 2 (R = 00.247179, p = 00.045405).

Conclusions: The mechanism of the hyperglycemia in acute necrotizing pancreatitis is complicated. Acute pancreatitis is characterized by local and systemic inflammation, which leads to metabolic dysfunction. In the pathogenesis of hyperglycemia plays an important role increased synthesis of proinflammatory cytokines and C-reactive protein, as well hypercoagulative state. sowie eine laparoskopische Pankreaslinkresektion mit Splenektomie durchgeführt.

Ergebnisse: Histologisch bestätigte sich die Verdachtsdiagnose -es zeigte sich eine Fistel ausgehend vom Ductus pankreaticus. Das übrige Pankreas zeigte eine chronische Pankreatitis.

Schlussfolgerungen: Pankreasfisteln können sich klinisch sehr unterschiedlich darstellen und mitunter lange symptomarm verlaufen. Auch bei akuten thorakalen Ereignissen sollte bei unklarer Genese ein abdomineller Ursprung ausgeschlossen werden.

Small bowel obstruction due to phytobezoar originating in a duodenal diverticulum Aim: Formation of a phytobezoar within a duodenal diverticulum is rare. Few cases of small bowel obstruction ( SBO) caused by such enteroliths developing within a SB diverticulum have been previously reported (1) .

Methods: A 76 year old male came to the emergency room with acute onset abdominal pain and nausea. CT-scan showed multiple SB diverticula including a large diverticulum in the 3rd portion of the duodenum filled with debris.

Results: During the next three months he returned three times to the ER with signs of partial SBO and a foreign body with calcifications and air inclusion could be seen slowly traveling through the small bowel. He had multiple comorbid conditions and a non-operative approach was attempted hoping the phytobezoar would pass. However, after three months he had to be hospitalized with complete SBO and the foreign body was seen in the RLQ in the distal ileum. He underwent exploratory laparoscopy during which the object was identified lodged 10 cm proximal to colon in the terminal ileum. The right colon was mobilized and through a 4 cm periumbilical incision the SB segment containing the enterolith was resected and an extracorporeal anastomosis was created. The patient had an uneventful intra-and postoperative course.

Conclusions: SBO caused by a dislodged phytobezoar originating in a duodenal diverticulum is a rare condition and is best treated by laparoscopy and either removal through an enterotomy or limited SB resection. Similar to Gallstone ileus, the object usually cannot pass the terminal ileum.

References : Aim: Introduction: We report the case of a congenital buttock sinus tract in a nine-year old female patient who was referred with acute inflammation and purulent secretion of a left sided gluteal sinus tract that had been present since birth. Various physicians have taken note over it but no further diagnostics or surgical presentation was initiated before.

Methods: We started intravenous antibiotics and performed an MRI of the gluteal region and pelvis. Despite a minor intraabdominal extent of the abscess there was no need for drainage and the inflammation responded well to the antibiotic treatment. Two months after the initial presentation a surgical excision of the fistula-tract was performed. The excision was extended to the level of the foramen ischiadicus taking care of the nerval structures and as the preoperative MRI showed a complete resolution of the intrapelvinic parailical inflammation no intraabdominal resection was enclosed. The histology showed a nonspecific chronic inflamed fistula tract filled with celldetritus and neutrophile granulocytes. Short-and long-term follow-up showed excellent wound healing and an uneventful postoperative course without recurrence.

Results: Results/Discussion: A skin opening that does not correspond to the usual presentation of cutaneus sinus tract diseases with untypical location is often difficult to diagnose due to the rarity of the disease. In many cases the unusual skin openings are not given much attention until presented with inflammation. Some patients present in the first months of life, often due to acute inflammation of the sinus tract. In the majority of cases with the exception of even rarer concomitant anorectal malformation, there is no involvement of the anal canal. Patients profit from timely depiction and diagnostic classification of the sinus. This is best done by ultrasound following MRI to accurately portray the whole extent and course of the sinus tract before inflammation occurs. In our patient antibiotic treatment alone was sufficient to treat the inflammation. In the literature some cases of initial incision and drainage after surgical resection was necessary. If the patients receive adequate diagnostics, the clinical course is straightforward and elective surgery for resection of the sinus tract is recommended to avoid a prolonged morbidity due to infection.

Conclusions: With timely implementation of diagnostics, the adequate imaging tool of MRI and apt referral to a pediatric surgeon, congenital fistulas, although a rare disease, can be treated successfully and without short-or long-term effects for the patient. 

Cushing's syndrome and virilization in an infant due to adrenocortical carcinoma ( ACC) Turial S 1 , Krause H 1 , Meyer F 2 , Zenker M 3 , Redlich A 4 1 Ki67-index: 1 %, no MDM2 expression was described. 4) MRI revealed partially liquid, partially fat-equivalent tumor-like lesion of 44 × 34 × 48 mm in size within the adductor group of thigh muscles occupying the medial myofascial compartment of the right leg including i) a finger-shaped tail up to the left hip (no intraarticular tumor extension) and like a tumor cone to the right obturator internus muscle, ii) displacement of the nerve and vessels to the lateral site with no hint for osseus infiltration, and iii) blood supply from the right common femoral artery (additionally, cystiforme ovarian lesion of 9 × 7 mm in size at the left side). -Therapy (surgical intervention, 92 min): Complete resection (R0) by an interdisciplinary team of surgeons (comprising pediatric and vascular surgeons) of the mass with a gentle capsule (orienting tumor margin) including surrounding muscle fibers (for tumor-free resection margin), lymphadenectomy as part of the resected tumor conglomerate and additional excision of the dermal puncture site at the right groin as well as preserving all vessels was performed. An 1-mm lesion of the articular capsule of the right hip was sutured and a drainage was placed prior to the closure of the 10-cm dermal longitudinal cut.

-Histopathological investigation (surgical specimen): Confirmation of lipoblastoma Conclusions: -Clinical course: Postop. time period during hospital stay showed development of a wound seroma with fever and inflammatory response prompting to surgical wound revision and initiation of antibiotic treatment (Piperacillin, Tazobactam, Gentamycin). After an episode of an infection of the upper respiratory tract, a wound abscess needed to be surgically opened, at the initial phase with exposed vascular segment of the right groin prompting for antiseptic wound dressing, later on treated with vacuum-assisted closure ( VAC) wound dressing with no further problems. The further follow-up of 2 months after discharge did not show any further irregularities.

-Further therapeutic consequences/outlook: Regular clinical and ultrasound-based control investigations in an outpatient clinic setting and clinical data documentation in the "Soft Tissue Sarcoma Registry" ( CWS-SoTiSar). Discussion: R0 resection was achieved, short-term outcome was favorable. In conclusion, careful and complete surgical resection is valued to be the only potentially curative treatment (including interdisciplinary cooperation with other surgical disciplines such as vascular or plastic surgery if required) for such type of soft tissue tumor lesion, which occurs rarely in childhood. Continuous follow-up investigations including clinical finding and imaging controls are indicated to reliably exclude recurrent tumor growth and -if necessary -to respond early and appropriately in case of possible recurrency.

Präklinische Daten und Outcome-Analyse zur zentralisierten Versorgung von traumatischen Extremitätenarterienverletzungen Klocker J 1 , Heuberger S 1 , Wipper S 1 1 Medizinische Universität Innsbruck, Innsbruck, Österreich Ziel: Unsere Institution ist ein Traumazentrum mit großem Einzugsgebiet. Traumatische arterielle Gefäßverletzungen, die in diesem Einzugsgebiet auftreten, werden vornehmlich an unserer Gefäßchirurgischen Abteilung rekonstruiert. Wir analysierten Aspekte der präklinischen Versorgung (Entfernung des Unfallorts, Transportmodalität) und deren Einfluss auf die Versorgungsqualität (Outcomeparameter: Letalität, Extremitätenerhalt, Folgeoperationen und Länge des KH-Aufenthaltes). and patients who suffered from postoperative morbidity ( APRI+ALBI, p = 0.007; vWf-Ag, p < 0.000). To analyze the predictive potential for PHLF we used receiver operating characteristic curve analysis and both APRI+ALBI and vWf showed comparably high predictive potential ( APRI+ALBI, area under the curve ( AUC) = 0.739, p = 0.001; vWf-Ag, AUC = 731, p = 0.001). In a sub-group analysis of different tumor types, while both parameters showed high predictive potential APRI+ALBI performed better in patients with metastasized colorectal cancer (mCRC) ( APRI+ALBI mCRC, AUC = 0.905, p = 0.007; vWf-Ag mCRC, AUC = 0.848, p = 0.021) and respectively vWf-Ag outperformed APRI+ALBI in patients with hepatocellular carcinoma ( HCC) ( APRI+ALBI HCC, AUC = 733, p = 0.038; vWf HCC, AUC = 0.805, p = 0.007). We then defined two cut-offs. A cut-off of vWf ≥ 174 % for HCC patients undergoing major resection, with a high negative predictive value ( NPV), to identify patients who could safely be resected in this high-risk group (vWf ≥ 174 %, Sensitivity = 1.00, Specificity = 0.63, NPV = 1.00, positive predictive value ( PPV) = 0.63). And a high NPV cut-off for APRI+ALBI of ≥ -1.923 for mCRC patients ( APRI+ALBI ≥ -1.923, Sensitivity = 0.75, Specificity = 0.96, NPV = 0.98, PPV = 0.60, p < 0.00

Conclusions: With this study were able to demonstrate that both APRI+ALBI and vWf-Ag show a comparable overall potential as preoperative predictors for patient outcome after hepatic resection. In closer inspection however, chemotherapy induced liver injury in mCRC appears to be captured more sensitively via the APRI/ ALBI score while portal hypertension and chronic liver disease as in HCC patients is more adequately reflected via vWf-Ag. Therefore, both APRI+ALBI and vWf-Ag show promise as predictors for postoperative outcome in specific indications and further characterization of specific strengths and weaknesses of these tests will improve personalized patient evaluation in the ever-developing field of liver surgery.

Keimspektrum und Resistenzen bei schwerer sekundärer Peritonitis Justin V 1,2 , Glaser B 2 , Kriwanek S 2 1 Section for Surgical Research, Medical University of Graz, Graz, Österreich 2 Klinik Donaustadt, Wien, Österreich Ziel: Sekundäre Peritonitis führt zu hohen Morbiditäts-und Mortalitätsraten. Dabei lassen sich community ( CAP) und Hospital acquired peritonits ( HAP) unterscheiden, wobei letztere weiter in postoperative ( POP) und nicht-postoperative Peritonitis ( HAP-non-POP) eingeteilt werden kann. Neben rascher Source Control, stellt die adäquate antimikrobielle Therapie einen wesentlichen Faktor für den Behandlungserfolg dar. Für die initiale empirische Therapie ist daher Wissen um typische Keimspektren und Resistenzen hochrelevant.

Methoden: Abdominelle Abstriche von 195 konsekutiven Patienten (75 CAP, 90 POP, 28 HAP-non-POP) von 2010 bis 2018 mit intensiv-pflichtiger sekundärer Peritonitis wurden retrospektiv ausgewertet. Krankheitsverlauf sowie Keimspektrum und allfällige Resistenzen wurden erhoben und die Veränderung des Keimspektrums sowie mögliche Resistenzentwiklungen über die Zeit analysiert und zwischen CAP, POP und HAP-non-POP verglichen.

Ergebnisse: Patientencharakteristika und Outcomes unterschieden sich zwischen CAP und POP nicht. Signifikant höhere Sterblichkeitsraten zeigten sich bei HAP-non-POP. Bei der Indexoperation identifizierten 77,7 % der positiven Abstriche und dadurch die Konversionsrate zu reduzieren bzw. komplexere Eingriffe zu ermöglichen.

Gruppen (lowest 50 %, highest 50 %) aufgeteilt. Die Gruppe mit den niedrigsten Werten zeigte signifikant höhere Transaminasen im postoperativen Verlauf ( ASAT Tag 1: p = 0.01; ASAT Tag 5: p = 0.009; ASAT Tag 10: p = 0.035; ALAT Tag 5: p = 0.029).

Schlussfolgerungen: Mit dieser Studie wird erstmals der perioperative Verlauf von 5-HT bis zum zehnten Tag beschrieben. Die Tendenz des IP 5-HT PP ist ein Hinweis auf einen möglichen Einfluss von 5-HT auf die Leberregeneration nach Lebertransplantation. Tatsächlich weisen Lebern von Spendern mit niedrigem IP 5-HT PP postoperativ signifikant höhere Transaminasen im Verlauf auf, was klinisch für einen höheren Zellzerfall und somit eine größere Leberschädigung spricht. Eine größere Kohorte ist nötig, um diesen Verdacht zu verifizieren.

Chirurgische Ausbildung während der SARS Covid 19 Pandemie Glaser B 1 , Justin V 1 , Kriwanek S 1 1 Klinik Donaustadt, Wien, Österreich Ziel: Die Corona Pandemie hat die chirurgische Ausbildung durch die wiederholten Reduktionen elektiver operativer Eingriffe von Ausbildungsoperationen in den letzten 2 Jahren stark beeinflusst. Die Auswirkungen wurden bereits international untersucht und beschrieben. Da es kaum möglich ist, die notwendigen Reduktionen zu vermeiden, ist es notwendig, alternative Ausbildungsmöglichkeiten einzusetzen, um diesen Mangel zu verringern.

Methoden: Die folgenden alternativen Möglichkeiten der Ausbildung wurden an den operativen Abteilungen der Klinik Donaustadt eingesetzt: 1. Training an Übungsgeräten im Bereich der laparoskopischen Chirurgie mit der Möglichkeit, Naht -und Knüpftechniken zu üben. 2. Beurteilung der operativen Performance durch gemeinsame Analyse von Operationsvideos durch Assistent und Supervisor. Operationsvideos von laparoskopischen Eingriffen wurden mit Hilfe eines Video-Capture Systems aufgenommen; bei offenen Operationen erfolgten die Aufnahmen mittels Kopfkameras (GoPro). 3. Gemeinsame Besprechungen von Lehrvideos, in denen die einzelnen Schritte abgefragt wurden, bevor sie im Video zu sehen waren. Darstellung von möglichen Risiken und Techniken zu deren Vermeidung bzw. Behandlung.

Ergebnisse: Die Wirkung dieses Trainingsprogramms wurde mittels Fragebogen, den Assistenten und Supervisoren ausfüllten, evaluiert.

Schlussfolgerungen: Die Folgen der Corona Pandemie erfordern eine Änderung und Erweiterung der Ausbildungskonzepte um die Verringerung der operativen Erfahrung so weit wie möglich zu kompensieren.

Chihungi PM 1 , Gebauer D 1 , Fink M 1 , Reichhold D 1 , Klaus A 1 30-Tage-Überlebenswahrscheinlichkeit nach der Index-Operation war 71 % vs. 72,7 % vs. 50,5 % für CAP, POP und nsHAP. Die analysierten prognostischen Scoringsysteme ( APACHE II, SAPS II, MPI) die routinemäßig bei der Aufnahme auf die Intensivstation erhoben wurden, zeigten jedoch keine signifikanten Unterschiede.

Schlussfolgerungen: nsHAP werden meistens nicht als eigene Entität betrachtet, sondern mit den anderen Peritonitisformen zusammengefasst, obwohl diese aufgrund zugrunde liegender Faktoren eine deutlich erhöhte Mortalitätrate aufweisen. Die derzeit am häufigsten verwendeten Scoringsysteme konnten diesen prognostischen Effekt in diesem Kollektiv nicht messen. Eine bessere Unterscheidung, Klassifikation und spezielle prognostische Systeme für die sekundäre Peritonitis könnten helfen in Zukunft die Therapie und das Outcome zu verbessern.

Banfi, C S87 Bareck, E S32 Barth, U S7 Bartik, C S88 Bartsch, C S56 Ba-Ssalamah, A S13 Bastati, N S13 Bauer, D S39 Baumgartner, R S127 Beckerhinn, P S22, S37 Becker, P S71 Beganovic, M S4, S31, S81, S82, S107, S111, S123, S124 Bekö, E S4 Belarmino, A S26, S71 Beldi, G S125 Bellotti, R S43 Benabchiasli, M S4 Benej, M S68, S82 Benkö, E S31, S111 Benkoe, E S81, S82, S107, S123, S124 Dittrich, L S56 Dobretzberger, C S100 Doleschal, S S46 Dombrowsky, S S112 Domenig, C S8, S9 Dorcaratto, D S93 Dornauer, I S20, S53 Dr. Hammer, R S46 Driedger, M S92 Dr. rer. nat. Reissig, K S54 Dr. Schmölzer, H S118 Dr.Stübler, M S46, S118 Drummer, B S51 Dubivska, S S105 Duraes, L S51, S55 Dvorakevych, A S79, S91 Dzafic, A S100 Dziodzio, T S3, S74 E Eberl, A S95 Ebner, P S46 Eichelter, J S23, S24, S46, S128 Eichwalder, A S8 Eilenberg, W S8 Eilenberg, WH S9 Einsiedler, J S95, S96 El-Heliebi, A S30 Emmanuel, K S6, S10, S16, S18, S20, S22, S23, S33, S44, S49, S53, S84, S108, S124 Entschev, A S71 EOA Dr. Orgler, S S118 Erdogmus, C S68 F Fabbri, A S5, S49, S99 Falch, C S38 Fasching, G S61 Fediuk, M S50, S67, S123, S124 Fehrer, H S58, S108 Feka, J S4, S18, S19, S99, S130 Feldbrügge, L S83 Fellner, S S84 Felsenreich, DM S24 Felsenreich, M S23, S39 Fenz, W S80 Fickert, P S48 Fink, J S94, S95, S96 Fink, M S46, S93, S99, S126 Fink, N S102 Fink-Neuböck, N S50, S67, S118, S123, S124 Finsterbusch, M S42 Fischer, I S15, S48, S110 Fleischhacker, M S26 Flörcken, A S3 Flucher, C S44, S60, S74, S87 Foditsch, R S108 Fodor, M S42 Fößleitner, P S36 Frank-Moldzio, L S13, S26 Franz, M S113 Friedl, H S65 Friesenbichler, J S65 Fuchs, A S102 Fuchs, L S8 Fuchs, P S77 Függer, R S15, S48, S58, S84, S110, S116 Fülöp, G S86 Funk, M S95

Matzi, V S123 Mayer, A S37 Mayer, F S6, S10, S20 Mayerhofer, M S33, S70, S71, S85, S98 Mayer, P S26 Mayrhofer, S S76 McCabe, C S28 Mehrabi, A S26 Meng, S S80 Mengwasser, J S29 Mero, S S96 Mertlitsch, S S17 Messner, A S13 Messner, B S25, S27 Messner, F S42 Meszaros, A S42 Metz, A S80 Metzelder, M S63 Metzelder, ML S77, S78 Metzger, R S90 Meyer, F S7, S9, S12, S106, S110, S112, S113, S114, S115, S116, S117, S120, S121, S122, S131 Michaelis, E S29 Michelitsch, B S65 Michellitsch, B S80 Michlmayr, L S35 Miekisch, W S77 Millesi, F S43, S45, S96, S97 Minukhin, D S106 Mischinger, H S33, S70, S71, S73, S85, S98, S118 Mitteregger, M S30, S54 Mittermair, C S20, S35, S59, S71, S84 Monschein, M S69 Moosburner, S S74, S87 Mosshammer, V S20, S59 Mousavi, M S75 Muehlbacher, J S13 Mühlbacher, I S10, S49 Müller, BP S38 Müller, C S73 Müller, H S26, S48 Müller, M S82 Müller, MR S68 Müller, W S38 Mussbacher, M S27 Mykoliuk, I S50, S67, S124 N Naghilou, A S96 Nagorney, DM S92 Neubauer, S S102 Neumann, M S7 Neumayer, B S18 Neumayer, C S8, S9 Neureiter, D S18 Neuschitzer, A S113 Ng, C S68 Nichita, M S32 Niernberger, T S4, S31, S81, S82, S107, S111, S123, S124 Nikolic, M S4 Nischwitz, SP S94 Nixdorf, L S24, S39, S128 Nodale, M S9 Novak, I S22, S23 Kulmer, AK S101 Kupferthaler, A S110 Kurtaran, A S17 Kurz, F S118 Kusar, M S48 L Lackner, K S48 Laengle, F S127 Lalagas, K S117 Langer, F S23, S24, S39, S46 Langer, O S83 Langer, S S121 Längle, F S29 Längle, J S91 Lax, S S30, S56, S85 Lebo, P S65 Lechner, D S84 Lechner, M S6, S20, S44, S53 Lehmann, M S7 Leitner, S S45 Lemarchand, T S95 Lenz, F S9 Leonhardt, C S13 Levytskyi, M S108 Liang, YY S27 Liendl, F S101 Lindenlaub, F S91 Lindenmann, J S50, S67, S82, S118, S123, S124 Lindner, M S44 Lin, MC S81 Lisman, T S129 Lopez-Garcia, P S77 Lucciarini, P S68 Lumenta, DB S65, S80 Lurje, G S74 Luyendyk, JP S129 Luze, H S94 Lyons, PA S25 M Maglione, M S43 Magnes, C S77 Maier, A S50, S67, S123, S124 Maier, E S61 Maier, H S68 Mailänder, L S74 Mairinger, M S23, S24 Mallinger, C S23 Malovanyy, B S79 Mandl-Pohl, A S26 Mandorfer, M S91, S125 Manhartsgruber, Y S17 Mann, A S43, S97 March, C S113, S115, S117 Marcher, M S68 Märdian, S S3 Marolt, C S48 Martin, F S3, S29, S83 Martini, J S42 Marzluf, BA S68 Mathis, S S42 63rd Annual Meeting of the Austrian Society of Surgery O Oberhuber, R S42 Obermayer, B S39, S40 Obermüller, B S76, S77 O´Brien, D S28 Obrist, C S20, S35, S57, S59 Oehler, R S25, S27 Öfner, D S21, S32, S34, S43, S68 Okresa, L S50, S67, S123, S124 Oliver, K S44 Öllinger, R S3, S87 Onafowokan, O S119 Opelt, H S37 Ortmayr, G S27, S91, S92 Ortner, M S126 P Paasch, C S12, S113, S116 Paireder, M S99, S130 Panhofer, P S39, S40 Pankratz, K S30 Partl, R S49 Pasha, A S66 Passler, C S18 Patrick, K S15 PD Dr. Schildberg, C S54 Pech, M S9 Penicka, D S61 Perathoner, A S32, S34 Pereyaslov, A S79, S90, S91 Pereyra, D S27, S28, S29, S42, S91, S92, S125, S126, S127, S128, S129, S130 Perneder, A S107 Pery, R S92 Singer, G S44, S60, S74, S76, S77, S86, S87, S88 Singer, H S102 Singhartinger, F S10, S33, S124 Singh, J S32 Sitzwohl, C S48 Skalicky, S S128 Smajic, E S71 Smolle, J S50, S67, S123, S124 Smolle-Jüttner, FM S50, S67, S123, S124 Smoot, R S28, S42, S92 Sochnieva, A S102, S106, S107 Soliman, B S18, S19 Sorantin, E S88 Sorre, C S108 Spaun, G S10, S49, S99, S110 Spendel, S S85, S94 Speth, C S43 Spils, M S82 Spittler, A S27 Springer, A S63, S90 Spuller, E S108, S112 Stadlbauer, V S76, S77 Stadlmayer, S S96 Staettner, S S125 Stanek, R S75 Starlinger, P S27, S28, S29, S42, S91, S92, S125, S126, S127, S128, S129, S130 Stättner, S S56 Staudinger-Kohl, W S107 Stavrou, GA S19 Steele, S S51, S55 Steflitsch, KM S107 Steinbacher, J S80 Steindl, F S68 Steindl, J S4, S31, S81, S82, S107, S111, S123, S124 Stenyk, R S79, S91 Stephan-Falkenau, S S7 Steyrer, GE S70 Stift, A S25, S52, S53, S69, S71 Stifter, A S22 Stift, J S42 Stillger, R S54 Stockinger, MS S64 Stoyanova, R S93 Stremitzer, S S92 Stricker, M S108, S109 Strobel, O S13, S15, S26, S92 Strohmeyer, K S3 Strunk, S S15 Strutzmann, J S37, S104 Summerer, B S83 Summer, P S130 Suppan, G S3 Supper, P S43, S45, S97 Surci, N S15 Surov, A S122 Sushchenko, E S102, S103, S105, S106, S107 Syn, N S93 Szabo, K S70 Szeverinski, P S84 T Tamandl, D S91 Tamussino, K S56 Taumberger, N S36 S Sachet, M S27 Sadoghi, B S25 Sahora, K S13, S43 Saini, T S84 Sallinger, K S30 Sanal, M S59, S79 Sandurkov, C S107 Santol, J S27, S28, S29, S42, S91, S92, S125, S127, S128, S129 Sauer, I S29 Sauseng, S S33, S70, S71, S73, S85, S98, S118 Savvi, S S105 Schaaf, S S34, S72 Schäfer, A S21, S51, S54 Schäfer, G S43 Schagerl, J S7 Schalamon, J S86, S88 Schardey, H S35 Schauer, W S23 Schellnegger, M S94, S95 Schemmer, P S26, S33, S48, S70, S71, S73, S85, S98, S118 Schenkenfelder, B S80 Scherbauer, F S42 Schernthaner, R S8 Scheuba, C S17, S18, S19, S35 Schiffner, C S106 Schildberg, C S116 Schima, W S93 Schimek, V S25, S27 Schimke, C S90 Schindl, M S13, S43 Schirnhofer, J S20, S59 Schlader, F S64 Schlager, L S52, S69 Schmelzle, M S74 Schmidt, M S86 Schmölzer, H S30, S31, S103, S104, S109, S117 Schneeberger, S S42 Schneider, M S18 Schöfl, R S110 Schöllnast, H S31, S103, S117 Scholtz, V S9 Schöning, W S56, S74 Schopf, S S35 Schöppl, S S22, S37 Schoppmann, SF S4, S99 Schredl, P S20, S84 Schrittwieser, R S3, S5, S7, S12, S104 Schröpel, A S104 Schrottmaier, WC S27, S28 Schuld, G S25 Schüller, J S69 Schulte, L S82 Schulte, LT S68 Schumi, K S108 Schuster, S S70, S71 Schwarz, A S95, S96 Schwarz, C S92 Schweiger, S S16, S107 Seitinger, G S19, S54 Semmler, L S43, S45, S96, S97 Senekowitsch, G S5 Shamiyeh, A S11, S17, S47, S70, S71, S86, S112, S118, S119 Shevchenko, O S106 Shiyamsundar, L S45 Silberhumer, G S126 63rd Annual Meeting of the Austrian Society of Surgery Watkin, R S42 Watzka, S S82 Watzka, SB S68 Weber, F S115 Weidinger, G S22, S37 Weiner, B S39, S40 Weinhandl, AC S77, S78 Weissenbacher, A S42 Weiss, H S20, S35, S59, S71, S84 Weiss, T S27, S96 Weitzendorfer, M S22, S23 Weitzer, C S88 Weninger, WJ S73 Wewalka, F S110 Wicher, AS S17, S18 Widmann, KM S53 Wiederstein-Grasser, I S73 Wiener, C S77, S78 Wiering, L S74 Wiesner, P S45 Wilfing, L S43 Willms, AG S34, S72 Wimmer, A S10 Wimmer, K S4 Windhaber, J S44, S60 Windsperger, K S36 Winkler, D S4, S43 Winter, R S65, S95 Wintersteller, L S24 Wipper, S S122 Witzel, C S3, S29, S74, S83 Wolf, B S92 Wolf, S S96 Wundsam, H S5, S14, S15, S48, S49, S84, S99, S110 Wurzer, P S65 Wykypiel, H S21, S51, S54 Y Yevtushenko, D S106 Yuksel, M S77, S78 Z Zacherl, J S48 Zach, P S110 Zaglmair, W S49, S84 Zaránd, A S55 Zauner, G S130 Zechmeister, M S130 Zeilinger, M S45 Zenker, M S121 Ziegler, T S66 Zmugg, J S100 Zott, T S126 Zrim, R S65 Zügner, E S77 Tentschert, G S22, S38, S41 Tepeneu, NF S60, S62, S63, S64, S88 Terbuch, A S50, S67, S124 Texler, B S43 Thumfart, S S80 Till, H S44, S60, S74, S76, S77, S86, S87, S88 Tinhofer, I S80, S81 Toller, W S48 Tonnhofer, U S63 Toth, AJ S31, S103, S104, S109 Trajanoski, S S77 Trampitsch, E S112 Trattner, M S56 Trautwein, I S117 Trieb, K S108 Tripolt-Droschl, K S25 Tschann, P S84, S104 Tschauner, S S65, S75 Tschoner, A S10, S49, S99 Tuca, A S65, S95 Tullius, S S29 Turial, S S121, S122 Tzou, C S81 Tzou, CH S80 Tzou, CJ S66, S80 U Ubl, DS S92 Udelnow, A S9 Ugrekhelidze, K S38, S41, S46 Uhl, I S101 Unger, LW S25, S52, S69 Univ. Doz. Dr. Wurzer, H S46 Univ. Prof. Dr. Hauser, H S46, S118 Univ. -Prof. Dr. Lax, S S46 Uranitsch, S S30, S54 Urban, I S56 V Valeskini, K S5, S104 Van de Haar, R S112 Varga, M S16, S124 Vinzenz, K S47 Viragos-Toth, I S29 Vlasak, T S39, S40 Vollrath, F S96 Von Boetticher, P S15 von Rahden, B S10 Vouk, M S83 Vraka, C S45

Ultrasound in pediatrics, clinics in diagnostic ultrasound

Ovary-containing hernia in a premature infant: sonographic diagnosis

The inguinal herniation of the ovary in the newborn: ultrasound and color Doppler ultrasound findings

Retroperitoneal abscess and septicarthritis of the hip in children: a problem in differential diagnosis

Obturator internus pyomyositis in a young adult: a case report and review ofthe literature

Acuterespiratory distress syndrome in a young soccer player: search obturatorinternus primary pyomyositis. A reverse Lemierre syndrome

Rektovaginale Fisteln (ohne M. Crohn) AWMF-Registriernummer: 088/004 S3 Guidelines: rectovaginal fistulas (without Crohn's disease

fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent: a case report and review of the literature

Fractures of the tibial spine in children: an evaluation of knee stability

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures

Bale RS, Banks AJ. Arthroscopically guided Kirschner wire fixation for fractures of the intercondylar eminence of the tibia

McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia

Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation

Results of displaced pediatric tibial spine fractures: a comparison between open, arthroscopic, and closed management

Tension band wire fixation for anterior cruciate ligament avulsion fracture: biomechanical comparison of four fixation techniques

Avulsion len Bruchsack u. a.) oder Assoziation mit Nebenbefunden (z. B. Nabelhernie und Rektusdiastase etc.). Die Herniation wurde im Rahmen der Leberteilresektion nicht adäquat mit teils resorbierbarem Netz in "Sublay"-Position versorgt in Prävention eines möglichen Komplikationsmanagements bei komplikationsreicher Vorgeschichte. Referenzen: -AMBOSS Miamed

Gerd Herold 2021 -Jensen KK. Incidence of Incisional Hernia Repair After Laparoscopic Compared to Open Resection of Colonic Cancer: A Nationwide Analysis of 17,717 Patients

The Incidence of Mental Disorders Increases over Time in Patients with Cancer Pain: Data from a Retrospective Cohort Study

Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial

S2-Leitlinie Divertikelkrankheit/Divertikulitis. Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten ( DGSV)

Evaluation and management of traumatic diaphragmatic injuries: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma

Germany genital dermal sinus in the lateral buttock

Late-onset congenital lateral dermal sinus tract

Congenital fistula between the lateral buttock and postanal dermal sinus tracts with a low-type anorectal malformation

Germany 2 Klinik für Radiologie und Nuklearmedizin

Considering 93 % malignant underlying disease most of which had already spread distantly postinterventional survival was limited. It ranged between one to 1289 days (mean: 209,8 days, median: 110 days). Conclusions: Percutaneous interventional stenting of the superior vena cava is feasible even in high-grade stenoses. In contrast to therapeutic alternatives such as chemo-or radiation therapy it provides instant relief which is crucial for this severely ill collective of patients. The complication rate is acceptable

Aim: During esophageal resection and subsequent reconstruction by gastric pull-up splenectomy is sometimes unavoidable due to anatomical or oncological reasons. The condition has been reported to be linked to an increased risk for postoperative complications. We retrospectively analyzed the impact of splenectomy on the perioperative course (complications according to the Clavien scale) and on long-term survival in patients who underwent esophagectomy for benign or malignant indications.Methods: Between January 2000 and December 2021, 636 patients (114 females, 522 males; mean age 62,2; range 21,2 -90,7) underwent esophageal resection/reconstruction for benign (N = 137) or malignant disease (N = 499), 49 thereof had splenectomy. While the patients with benign disease were significantly younger than the ones with malignancies, splenectomy was equally distributed between the two groups.Results: In the total collective and both subgroups splenectomy had no statistically significant influence on overall postoperative complications (Clavien 1-5; p = 0,06). There was, however, significant increase of SIRS/sepsis (p = 0,02) and of pleural empyema (p = 0.019). When analyzing the two groups separately, patients with benign conditions still showed the highly significant effect of splenectomy on SIRS, sepsis or pleural empyema, whereas it was not any longer present in the group with malignancies. In neither uni-nor in multivariable analysis did splenectomy show a significant influence on survival in the total collective or the two subgroups.Conclusions: Whereas neither the overall rate of complications following esophagectomy and reconstruction by gastric pull-up nor long-term survival were influenced by splenectomy, there was an increased rate of SIRS/sepsis and pleural empyema in patients with benign disease.

Operative Stabilisierung von Serienrippenfrakturen. Ein eingeschlagener Weg erfolgreich fortgesetzt Gabor S 1 , Niernberger T 1 , Steindl J 1 , Beganovic M 1 , Kramos A 1 , Benkoe E 1 , Klug E 1 1 Chirurgie Allgemeines KH Oberwart, Oberwart, Österreich Ziel: Abhängig vom Unfallmechanismus können beim stumpfen Thoraxtrauma Rippenserien und Sternumfrakturen bis hin zum instabilen Thorax auftreten. Die dadurch auftretende Störung der Atemmechanik in Verbindung mit der Schmerzproblematik stellen die Ursache für die mit diesem Verletzungsmuster bedingte Morbidität und Mortalität dar. Aus che Patienten kurativ versorgt werden im Sinne einer personalisierten Tumortherapie.

Prognostische Faktoren für Rezidivrate und krankheitsfreies Überleben bei radikal resezierten pulmonalen Karzinoiden Spils M 1,2 , Krenbek D 3 , Jankovic I 1,2 , Schulte L 1,2 , Krajc T 1,2 , Benej M 1,2 , Getman V 1,2 , Ruiz Navarrete J 1,2 , Akan A 1,2 , Müller M 1,2,4 , Watzka S 1,2,5 Methoden: Hierzu wurde eine retrospektive Analyse von 82 Patienten durchgeführt, die sich zwischen 2010 und 2019 einer Lungenresektion zur Behandlung eines primären pulmonalen Karzinoids unterzogen. Zur statistischen Analyse des Überlebens wurde die Kaplan-Meier-Methode einschließlich des Log-Rank-Tests verwendet. Des Weiteren wurden unabhängige prognostische Faktoren für das krankheitsfreie Überleben sowie die Rezidivrate mit Hilfe der multivariablen blockweisen Cox-Regression bzw. der Rückwärtselimination in der multivariablen logistischen Regression ermittelt.Ergebnisse: In diese Studie wurden 82 Patienten inkludiert, 48 Frauen (58,5 %) und 34 Männer (41,5 %) mit einem Durchschnittsalter von 58,9 ± 14,2 Jahren, welche 84 Fälle von pulmonalen Karzinoiden repräsentierten, davon 56 typische (66,7 %) und 28 atypische (33,3 %) Karzinoide. Die mediane Follow-up Zeit erstreckte sich über 22 Monate. Das 5-Jahres-Gesamtüberleben betrug 87,5 % und 84,7 %, das 5-Jahres-krankheitsfreie Überleben 97,5 % und 74,9 % (p = .012) für typische bzw. atypische Karzinoide. Rezidive traten bei 1 Patienten (1,8 %) mit typischem und 5 Patienten (17,9 %) mit atypischem Karzinoid auf (p = .014). Die Tumorgröße (cm) wurde als unabhängiger prognostischer Faktor für ein verkürztes krankheitsfreies Überleben ermittelt (p = .018; HR: 1,77; 95 % CI: 1,10 -2,83). Darüber hinaus erwiesen sich der Lymphknotenbefall (p = .043; OR: 2696; 95 % CI: 1,30 -5606388) und die Tumorgröße (p = .023; OR: 11, 88; 95 % CI: 1, 92 ) als statistisch signifikante, unabhängige prognostische Prädiktoren, die auf ein erhöhtes Rezidivrisiko hinweisen. Das Alter, Geschlecht, Rauchverhalten, Lage (zentral/peripher) sowie Ki-67-Index zeigten keinen unabhängigen, statistisch signifikanten prognostischen Wert für die Rezidivrate oder das krankheitsfreie Überleben.Schlussfolgerungen: Nach vollständiger Primärresektion eines pulmonalen Karzinoids treten Rezidive relative selten auf. Nichtsdestotrotz ist das krankheitsfreie Überleben bei atypischen Karzinoiden im Vergleich zu typischen Karzinoiden signifikant verkürzt. Außerdem scheinen die Tumorgröße und der Lymphknotenbefall die wichtigsten prognostischen Faktoren zu 63rd Annual Meeting of the Austrian Society of Surgery 56.7

Bogovic M 1 , Krafka K 1 Aim: Over the past decades an increasing number of elderly patients receive hepatic surgery for primary and metastatic lesions. However, the influence of patient age on perioperative outcomes remains poorly understood. Aim of this study was to investigate perioperative outcomes in association with age in a contemporaneous cohort of patients with hepatic resection.Methods: Patients undergoing hepatic resection were identified from a prospectively maintained database between 2006 to 2017. Data on demographics, co-morbidities, pathology and complications according to Clavien-Dindo Classification ( CDC) were analyzed between patients older or younger than 70 years.Results: 997 patients underwent hepatic resection, of whom 242 (24.3 %) were ≥70 years. Elderly patients were more likely to be male (64.9 % vs 52.1 %; p < 0.001) while the rate of major hepatectomies (≥70: 43.8 % vs <70: 43.9 %) were comparable between both groups. Elderly patients experienced significantly higher rates of overall (53.7 % vs 43.8 %; p = 0.005) and major ( CDC≥3) complications (23.9 % vs 18.0 %; p = 0.04) as well as higher in-hospital mortality (4.5 % vs 2.6 %). There was no difference on co-morbidities regarding overall complications between both groups, however, individuals ≥70 years with CDC≥3 had significantly higher rates of co-diagnoses compared to younger patients (56.8 % vs 38.9 %; p = 0.039).Conclusions: Elderly patients frequently receive hepatic resections which are associated with increased morbidity and mortality compared to younger individuals. Especially older patients with co-morbidities are at higher risk for major complications and the decision for hepatic resection in these individuals should be made with caution.

Single nucleotide polymorphisms and risk for postoperative liver dysfunction in patients with colorectal liver metastases Rumpf B 1 , Pereyra D 1 , Santol J 1 , Ortmayr G 1 , Kim S 1 , Kern AE 1 , Huber FX 1 , Wolf B 1 , Starlinger P 2 1 Medizinische Universität Wien, Vienna, Austria 2 Allgemeines Krankenhaus Wien, Vienna, Austria Aim: Since elective surgery remains the most promising approach in the treatment of colorectal liver metastases, evaluating its risk-reward ratio beforehand still poses as a challenging task. Especially genetic dispositions may be neglected in this process. Single nucleotide polymorphisms (SNPs), such as the rs738409 variant of the patatin-like phospholipase domaincontaining 3 (PNPLA3) gene are strongly associated with non-as indocyanine green clearance (plasma disappearance rate: AUC = 0.880, retention rate at 15 minutes: AUC = 0.894). Computation of future liver remnant ( AUC = 0.756) was less accurate. Cox-regression revealed an association of vWF-Ag with RFS (per 10 %-HR = 1.056; 95 % CI: 1.017-1.097) and OS (per 10 %-HR = 1.067, 95 % CI: 1.022-1.113). Moreover, vWF-Ag yielded an AUC = 0.824 for diagnosing CSPH with vWF-Ag ≤182 % ruling out and >291 % ruling in CSPH. Thereby, a highest-risk group (>291 %, 9.7 % of patients) with a 57.1 % incidence of PHLF was identified, while no patient with vWF-Ag ≤182 % (52.7 %) developed PHLF.Conclusions: VWF-Ag allows for simplified preoperative risk stratification in patients with resectable HCC, as it predicts PHLF, RFS and OS. Patients with vWF-Ag levels >291 % might be considered for alternative non-surgical treatments, while vWF-Ag levels ≤182 % identify HCC patients best suited for liver resection.

Hepatocellular carcinoma as predominant cancer subgroup accounting for sex differences in posthepatectomy liver failure, morbidity and mortality De la Cruz Ku G 1,2 , Aizpuru M 1 , Hackl H 3 , Ubl DS 4 , Habermann EB 4 , Pery R 1 , Driedger M 1 , Assinger A 5 , Aim: Background. As the most common gastrointestinal disease, gastroesophageal reflux disease ( GERD) presents a general health problem with a variety of symptoms and an impairment of life quality. Conservative therapies do not offer any symptom relief in up to 40 % of patients, hence surgical repair is often inevitable. The implantation of the RefluxStop device is a new way to revolutionize anti-reflux surgery.Methods: Surgical technique. The RefluxStop is a 21.5 × 21.5 mm sized implantable silicone, non-active, single use device consisting of 5 parts. This device is fixed laparoscopically at the ventral stomach wall with purse string sutures. Additionally, the repair of the His angle by fixation of the fundus to the abdominal part of the esophagus is conducted. This repairs 63rd Annual Meeting of the Austrian Society of Surgery Aim: Metabolic syndrome and finally diabetes 2 type (DT2) as a result of progressive obesity, insulin resistance, abnormal cholesterol or triglyceride levels are newfound problems in the current endocrinology. As reported by the International Diabetes Federation, in the entire world 382 million of adults (8.3 %) are living with diabetes; the number is estimated to increase to 592 million in the next 20 years. More than 260 million people will be afflicted globally by 2022. The study focused on mitochondrial dysfunction was performed to unveil novel metabolism-related clues that may she light on pathophysiology of T2D.Methods: The study population (n = 96) was represented by diabetic patients and healthy volunteers. The mean age of patients in the study was 61 ± 6,3 years. Gender data: 56 (58,3 %)male, 40 (41,7 %) -female. MSCs were isolated from peripheral blood ( PB) from method magnetic-separated in used automatic system AutoMACS, seeding 50,000 mononucleotide cells/ cm 2 in RPMI (1x)+GlutaMAX medium supplemented with 10 % fetal bovine serum, in CELLdisc™ a range of cell culture surfaces from 1000 cm 2 up to 1 square meter. Passage 6 MSCs were used for all experiments. The characterization and standardization of MSCs are as plastic-adherent and spindle-shape, expression of antigen markers (CD73+, CD90+, CD105+, and CD45-, CD34-, CD14-, CD79-) on their surface and differentiation potential. For identification of mitochondrial localization, cells were loaded with 200nM Mitotracker Green FM in RPMI medium in HBSS. NADH auto-fluorescence was measured using an epifluorescence inverted microscope with a 20X fluorite objective. Excitation light at a wavelength of 350 nm was provided by a Xenon arc lamp, the beam passing through a monochromator. FAD and NADH redox indexes and mitochondrialpools were estimated according to the method described in Bartolome et al. ATP was measured by luciferin-luciferase technique in which the amount of light generated by the reaction of ATP with recombinant luciferase is dependent on the ATP concentration.Results: In addition, MSCs of 25 healthy human volunteers with equal sex for all was sampled. Average ages for normal control individuals without medication and history of diabetes disease was 37.7 ± 4.9. Changes in TMRM fluorescence showed a significant decrease in basal ∆Ψm in patients with complicated TD2 MSC NASH, so the patients with TD2 MSC showed a significant decrease in mitochondrial membrane potential (p < 0.001). Thus, in the TD2+ NASH MSC group ∆Ψm was reduced to 61.2 ± 3.2 % (n = 36; p < 0.001), while in the group of patients with diabetes mellitus this indicator was a bit higher -75.4 ± 3.7 % respectively (n = 50; p < 0.001). Control group had ∆Ψm MSC 85.2 ± 3.1 % (n = 25).This data indicates possible mitochondrial impairment in mesenchymal stem cells in patients with TD2+ NASH. The results of study showed the expression of MSCs surface antigens CD with patients TD2 higher with accompanying NASH. So, we found that MSCs showed significantly decreased expression of CD90 by 96 % that was also observed in patients TD2 higher with accompanying NASH.Results: All patients underwent decortication of the lung. In 20 (54 %) cases, drainage of the pleural cavity was performed as a preparation for radical surgery. There were 22 (59,4 %) men and 15 (40,6 %) women. The age of patients ranged from 18 to 71 years. Left-sided NCPE was performed in 11 (29,7 %) and right-sided -in 26 (70,3 %) cases In 6 (22,2 %) cases, decortication was supplemented with lobar resection, in 2 (5,4 %) cases with pulmonectomy. Complications of surgical treatment were observed in 5 (13.5 %) patients: acute pneumonia in 2 (5,4 %), the bronchial stump leackage in 1 (2,7 %) case, lung arrosive bleeding in 1 (2,7 %) case, sepsis in 1 (2,7 %) case. The mortality rate was 8,1 % (3 patients).Conclusions: The presence of postoperative complications and mortality leaves open the question for improving the results of NCPE treatment.

Obturator hernia − A rare cause of intestinal obstruction Toth AJ 1 , Schmölzer H 1 , Hammer R 1 , Kofler L 1 , Schöllnast H 2 , Hauser H 1 Aim: Obturator hernia is a very rare type of abdominal wall hernia. It is characterized as the protrusion of abdominal content through the obturator foramen. It typically occurs in elderly, thin, multiparous women. Signs and symptoms are often unspecific, so diagnosis is usually made in patients with manifest mechanical bowel obstruction.Methods: A 89-year-old female patient presented with abdominal pain, nausea and vomiting. Computed tomography ( CT) scan revealed acute mechanic small bowel obstruction due to incarcerated left sided obturator hernia. Immediate laparoscopy was performed. The incarcerated bowel segment was reduced, the sac inverted, ligated, dissected and additional direct herniorrhaphy-suture as second layer closure performed. No bowel resection was necessary. Our patient had a fast postoperative recovery with early discharge from hospital. Up to now no recurrence is noticed.Results: Regarding its rare condition and the fact that obturator hernia commonly is diagnosed in elderly patients with manifest bowel obstruction the surgical management is often performed under acute conditions and depends on individual patient factors. Due to that several operative approaches are suggested in the literature. In general, the management of obturator hernia defects depends on its size. Small defects can be repaired by various, simple direct closure techniques, larger defects need hernioplasty either with adjacent tissue or synthetic mesh.Conclusions: CT scan describes sufficient an obturator hernia as cause of intestinal obstruction. Delays in surgical treatment when associated with intestinal strangulation increase morbidity and mortality. If feasible laparoscopic approach should be performed providing additional benefits for high-risk patients. Obturator hernia can be repaired sufficient by simple direct suture techniques. The recurrence rate after surgery reported in the literature is generally very low.

Aim: Complex abdominal wall reconstruction after ventral hernia formation can be a challenging task. The goal is to reestablish the abdominal domain and ensure durable results. This can be achieved by providing optimal mesh reinforcement while avoiding foreign body reaction or infection. Posterior component separation by conducting a transversus abdominis release offers a reliable surgical technique to repair complex ventral hernias, as the 2-year recurrence rate is 5 %.Methods: This study presents a case report for an abdominal wall reconstruction in a 34-year old male, following open abdominal surgery due to an incarcerated incisional hernia and two parastomal hernias. The initial surgery left a defect of 30 × 40 cm in size to approximate, which was additionally classified as a "frozen abdomen". Therefore, TAR was chosen as a surgical approach, combined with the implantation of three biological meshes (Biosis Healing™) to serve as a newly created posterior sheath to enable abdominal wall reconstruction. The biomesh derived from porcine small intestinal submucosa, offering an extracellular matrix on which autologous cells can migrate to promote tissue regeneration and local immune modulation. Further steps to promote wound healing included immediate application of abdominal negative-pressure wound therapy and split-skin graft autotransplantation four weeks later.

Cognitive postsurgical dysfunction in patients with esophageal diseases Sushchenko E 1,2 , Dubivska S 2 , Hryhorov Y 2 , Savvi S 1,2 , Korolevska A 1,2 , Goloborodko M 2 1 State Institution "Zaytcev V. T. Institut of general and urgent surgery NAMN of Ukraine", Kharkiv, Ukraine 2 Kharkiv national medical university, Kharkiv, Ukraine Aim: Annually thousands of patients of different age all over the world undergo surgery with general anesthesia. Cognitive dysfunction after surgery is one of types of human response for general anesthesia and surgical intervention. General anesthesia is considered a risk factor regarding the emergence or exacerbation of cognitive disorders. Thus, the degree of its influence on the central nervous system depends on the depth and duration of anesthesia in each case. The first available report concerning the cognitive dysfunction after general anesthesia dates from 1955. The feasibility and efficacy of early neuroprotective therapy in prophylaxis and correction of postoperative cognitive dysfunction still remains unclear. Mild manifestations of POCD are found in 10-30 % and advanced -in 1-10 % of postop patients. The persistent manifestations of POCD are marked in about 6 % of middle-aged patients and in 14-30 % -in patients of advanced age. The recorded duration of POCD symptoms may vary from weeks to more than 7 years. Aim: to analyse the influence of CA on the CF of patients after surgery with GA and study the changes of cognitive function in patients after operative intervention with the use of general anaesthesiaAim: to analyse the influence of CA on the CF of patients after surgery with GA and study the changes of cognitive function in patients after operative intervention with the use of general anaesthesia Methods: Research was conducted at the Department of diseases of esophagus and gastrointestinal tract during the period 2009-2021. The criteria of inclusion were following: age 55-70 years regardless of gender, absence of serious concomitant diseases and complications, surgery with the use of general anaesthesia during one hour or longer, unaffected mental status before surgery, the informed consent of the patient, no alcoholism and mental disorders in personal and familial history, un 264 patients of 58-67 years were included in the study (171 male and 93 female). The patients had surgical diseases of esophagus and undervent surgery with general anesthesia. Patients were divided in two groups. The patients of the main group (G1) consisted of 115 patients (68 male and 47 female) and G2 -of 149 patients (103 male and 46 female). The median age was 64,6 ± 8,1 years in G1 and 66,8 ± 7,2 years. Patients of G1 received the CA since the day of surgery and within 30 days post-op. Choline alfoscerate was administered intravenously 1000 mg a day during 15 days, and later -orally in capsules 400 twice a day up to day 30. The patients of Group 2 were managed as regular surgical patients. The mental status of patients was tested one day before surgery and 1, 7 and 30 days after surgery and presented as median value in each group.Results: In the perioperative period the cognitive function of patients was assessed using the following neuropsychological tests: MMSE, FAB, CD and Luria test. The results are presented in the Table 1 . The difference in the content and mental status between both groups by one day before the operation was not significant. The most significant and reliable decrease in was values detected by FAB and Lur tests (up to 25 % less) may point to the dysfunction of frontal lobes of brain. The difference between Groups 1 and 2 was not significant. MMSE and CD tests also demonstrated a reliable decrease in values, though not as Results: Ultrasound revealed various signs of biliary tract diseases: high obstruction of the bile ducts -in 50 (67.6 %) patients; low obturation -in 24 (32.4 %); dilatation of the biliary tract -in 60 (81.1 %), dilation of intrahepatic segmental and lobular hepatic ducts -in 68 (91.9 %); dilatation of the walls of the biliary tract -in 28 (37.8 %), acoustic shadows in the bile ducts -in 32 (43.2 %), organic changes in the liver -in 38 (51.3 %). Signs of biliary tract damage were not detected in 10 (13.5 %) cases. The accuracy of ultrasound in the detection of tumors of the biliary tract was 79.7 %.Conclusions: The use of ultrasound in the diagnosis of MF is a mandatory non-invasive, widely available, inexpensive method of examination in the differential diagnosis of biliary hypertension. The sensitivity of the use of ultrasound in the detection of MF was 74.3 %, in the detection of tumors of the biliary tract -79.7 %. Ultrasound cannot be used in isolation as the only diagnostic method (3B level of evidence). Ultrasound is the method of choice in the diagnosis of MF of benign etiology, which also allows to establish or exclude the mechanical genesis of jaundice -no dilatation of the biliary tract at any level, regardless of liver function.Results: Throughout follow-up procedures partial lateral tearing of the biomesh was observed. However, mesh integration was noticed within days to weeks. Currently ongoing outpatient visits did not reveal herniation of intestines.Conclusions: Comparison with literature indicates advantages to the strategy applied in this case report, although with ambiguous results and recommendations regarding the use of biological meshes. However, their use to recreate a posterior sheath and combine it with a TAR procedure to approximate the abdominal wall may offer a safe approach, while avoiding surgical site infection and managing open abdomen.

Ungewöhnliche epigastrische Narbenhernie hinsichtlich linkem Leberlappen als Bruchsackinhalt 

Peritoneal flap hernioplasty combined with anterior external oblique release for reconstruction of a giant ventral hernia. A case report Kofler L 1 , Schmölzer H 1 , Hammer R 1 , Toth AJ 1 , Hauser H 1 Aim: In general, the repair of large incisional hernias is challenging. Even more, if primary closure of the fascia seems not to be possible. Different surgical techniques exist to address this problem and sometimes a combination of different repair techniques is required to assure a midline closure.Methods: A 61-year old, obese ( BMI 33), male patient presented with large incisional midline hernia. CT-scan revealed a transverse defect size of 16 cm. There were no signs of incarce- 

Wundsam H 1 , Kirchweger P 1 , Fischer I 1 , Punkenhofer P 1 , Spaun G 1 , Kupferthaler A 2 , Jakob A 2 , Böhm G 2 , Wewalka F 3 , Schöfl R 3 , Függer R 1 , Biebl M 1 1 Abteilung für Chirurgie OKL, Linz, Österreich 2 Abteilung für diagnostische und interventionelle Radiologie OKL, Linz, Österreich 3 Abteilung für Gastroenterologie und Hepatologie, OKL, Linz, Österreich Ziel: Hepato-biliär-pankreatische ( HBP) Operationen werden zukünftig durch Mindestfallzahlen geregelt. Gerade in der HBP Chirurgie ist jedoch exakte Indikation sowie Komplikationsmanagement durch eine multidisziplinäre Zusammenarbeit von Gastroenterologie, Chirurgie, Endoskopie sowie Radiologie gekennzeichnet. Somit ist Patienten-Outcome und die Vermeidung von failure-to-rescue Szenarien nicht alleine an das operative Volumen einer chirurgischen Einheit, sondern mehr als in anderen Bereichen an die 24/7/365 Verfügbarkeit eines spezialisierten Behandlungsteams gekoppelt. Jedoch ist ein solches interdisziplinäres Umfeld strukturell bisher nur wenig definiert Methoden: Deskriptive Darstellung der interdisziplinären Leistungszahlen einer modernen HBP-Einheit am Beispiel des hepatobiliopankreatischen Zentrums am Ordensklinikum Linz.Ergebnisse: In drei Jahren (2019-2021) wurden am Ordensklinikum Linz 5052 therapeutische Eingriffe am hepatobiliopankreatischen System durchgeführt (operativ 48 % (n = 2214), endoskopisch 47,6 % (n = 2407), interventionell radiologisch 8,5 % (n = 431). Operativ wurden 1647 Eingriffe an der Gallenblase und den Gallenwegen mit einer 90- Tage Methoden: Überblick über den Erkenntnisstand der bisherigen Studienaktivität zum Forschungsgegenstand, der Korrelation von Depression und benignen bzw. malignen Erkrankungen, im Fallaufkommen am Universitätsklinikum Magdeburg A. ö. R. (tertiäres Zentrum mit hochspezialisierter Betreuung) -zum einen im Rahmen einer klinisch-systematischen prospektiven unizentrischen Beobachtungsstudie (Design) eines interdisziplinär-klinischen Forschungsteams (Schmerztherapie und Bereich Allgemein-/Viszeralchirurgie der berichtenden Kliniken) an einer konsekutiven Patientenkohorte mit repräsentativer Fallzahl über einen definierten Untersuchungszeitraum zur Reflexion der klinischen Alltagsrealität ("real-world data") und darüber hinaus weitere themenbezogene Untersuchungen. Die Patienten-, Symptom-, (Depressions-/Tu-)Befund/-Diagnose-und Outcome-assoziierten Daten wurden in Excel-basierten Computerdateien erfasst und einer deskriptiv-sowie testend-statistischen Auswertung unterzogen.Ergebnisse: (selektive Eckpunkte) -Der Schweregrad der F3-Depressionen nahm im Laufe der Zeit ab. In den letzten Jahren stieg der Anteil psychisch unauffälliger Nicht-Tu-Patienten von 33, 3 Schlussfolgerungen: Basierend auf dem Paradoxon einer pathogenetisch akut-entzündlichen Erkrankung (Appendicitis) bei gleichzeitiger immunsuppressiver/antiinflammatorischer Therapie ( JAK-Inhibitor) aufgrund einer Colitis ulcerosa, wird ein außergewöhnlich erscheinender Kasus berichtet, trotzdem die Nebenwirkung formal bekannt ist. Es könnte die Manifestation i) einer immunmodulatorisch herabgesetzten mukosalen Abwehr mit erhöhtem Risiko opportunistischer Infektionen als spezifisch viszeraler "side effect" des JAK-Inhibitors und/oder als Folge ii) eines/r induzierten alternativen Entzündungsmechanismus/proinflammatorischen Signaltransduktion bzw. einer intestinalen Abflussstörung im Gebiet der A. colica dextra mit konsekutiver Ansammlung nekrotischer Zellen und Aktivierung von Entzündungsmediatoren sein. (6) Aim: With the 2017 legislation, a different approach to cannabis prescribing became possible. At the same time, however, the question arised as to where the benefits and dangers of cannabis medication exist now, in particular, in that the public is being given the option to legally use cannabis.Methods: Data provided by and obtained from: -health insurance companies, the medical association, the "Medical Service of the Health Insurance Companies" (German abbreviation, " MdK") on previously approved uses (e. g., in case of tumor cachexia and spasticity in MS). -Chamber of Pharmacists, professional organization and umbrella group. in particular, on self-purchased cannabis preparations were used. With regard to possible and identifiable consequences, wich can lead to derive reasonable new regulations, the use of cannabis was compared with that of opioids.Results: Three various types of administration behaviors exist: -Physicians using cannabis for "confirmed" indications such as tumor cachexia, nausea, and spastic pain in MS; -Physicians who also "try cannabis!" for up to 50 other indications; -Physicians who use cannabis as a bridging measure because they do not have an idea for a particular pain situation (even though there would be other options). In contrast, there are three types of cannabis preparation: -As tablet, as flower, as a tetrahydrocannabinol( THC)-free preparation on a green prescription. A comparison in tabular form shows that a danger of addiction in cannabis medication, which also exists with opioids, originates in the uncritical expansion of indications as well as in the use of flowers against "everything".Conclusions: Addiction to opioid intake has been already known for a long time. Therefore, countermeasures such as stricter indications and quantity limits in non-cancer patients were taken. Against a possibly threatening wave of addiction to cannabis, a further development as well as careful and approved extension of indications, as well as adequate control over flower users, appear indicated.

Was wirkt besser bei neuropathischen Schmerzen -Antikonvulsiva oder Antidepressiva? Conclusions: Preoperative biopsy, incomplete resection and intraoperative tumor spillage are associated with poor prognosis. Therefore, careful and complete surgical resection is valued to be the only potentially curative treatment for ACC. Preoperative metastatic spread of ACC is universally considered a highly unfavorable prognostic factor. In adrenal masses with signs of steroid hormone excess, attempts for taking a biopsy or puncture of the tumor mass are strictly to be avoided. Steroid profiling before surgery and preservation of tumor samples for the GPOH-"tumorbox" should be considered at the time of surgery to provide a "Liquid-biopsy" (ctDNA) for follow-up purposes. In terms of surgical approaches, the role of laparoscopic resection for ACCs remains controversial. In case of necessity for the postoperative chemotherapy, in Germany, the NN1/ NN2 protocol (according to the GPOH-MET) is recommended. The adjuvant mitotane (pesticide, adrenocorticolytic agent) used for patients with COG stage III and IV disease seems to be the most beneficial medication.

Aim: Soft tissue tumor lesion in an infant is rare and challenging with regard to its appropriate diagnostic and therapeutic management. Aim: To illustrate a rare case of a soft tissue tumor mass of the right groin diagnosed as lipoblastoma based on specific references of the scientific medical literature and the experiences obtained in the case-specific care Methods: Scientific case report (22-months old girl): -Medical history (hx): Swelling of the right groin increasing after physical activities (hopping, jumping). Familiary medical hx, breast cancer of the grandmother. -Clinical findings: Elastic swelling of 2 × 3 cm in size at the right groin. -Diagnostics: 1) Laboratory parameter profile was characterized by a white blood cell count of 11.1 Gpt/L (normal range, 3.7 -9.8 Gpt/L). 2) Ultrasound-guided biopsy: Appropriate puncture specimen was obtained with no puncture-associated complications such as postinterventional bleeding.Results: … cont.: 3) Histopathological investigation: A lipomatous lesion with lipoblast-like cells and muscle tissue; 

Aim: The superior vena cava syndrome ( SVCS) is sequelae of caval obstruction or compression by usually malignant mediastinal or intrathoracic pathologies. In addition to the problems caused by their underlying disease, the patients are compromised by SVCS, which may even be gatal in rare cases. Moreover, untreated SVCS may be a hindrance for surgically invasive diagnostic procedures in the thorax. Interventional stenting is a valid therapeutic option for SVCS. Though widely used, longterm results are sparse.Methods: 100 patients with SVCS, treated between 03.2004 and 08.2019, were included. A total of 114 radiologically interventional stenting procedures were performed.Results: In 96,5 % of cases superior caval flow improved while symptoms lessened. The peri-and postinterventional rate of complications was 12,4 %, compromising preminantly thromboses within the stent or hematoma due to the required anticoagulation. In two cases the complication was potenti-63rd Annual Meeting of the Austrian Society of Surgery

Methods: Between January 2000 and December 2021, 636 patients (115 females, 522 males) underwent esophageal resection/reconstruction. 43 (6,7 %) patients (16 males, 27 females) were aged between 80, 3 and 90,7 (mean: 82,6) . 26 of them had elective resection for esophageal carcinoma, 17 an emergancy, one for esophageal perforation not amenable to conservative treatment. Transhiatal approach was chosen in 28, combined mini-thoracotomy and -laparotomy in 12 and minimally invasve technique in three patients.Results: If compared to the younger patients the total collective of octogenarians showed neither significant for the incidence of complications (Clavien 1-5) with 5 perioperative deaths, nor for duration of stay at the intensive care unit ( ICU), total hospital stay or overall survival in uni-or multivariable analysis. The approach had no impact. The same was true for the patients with esophageal carcinoma. Patients with esophageal perforation as well showed no difference concerning duration of ICU-or hospital stay, yet complications (Clavien 1-5) were significantly more frequent (p = 0,046). Survival time was reduced in univariable analysis only, whereas multivatiable analysis showed no statistically significant difference.Conclusions: Whether done electively or as an emergancy procedure, esophagectomy and reconstruction by cervical esophago-gastrostomy in octogenarians is connected with duration of ICU-and in-hospital stay and survival rates comparable to younger patients. Only in esophageal perforations complications were more frequent in the older group, though perioperative deaths showed no difference.

Varga M 1 , Gruber R 1 , Singhartinger F 1 , Presl J 1 , Emmanuel K 1 , Koch O 1 1 Universitätsklinik für Chirurgie, SALK, Salzburg, Österreich Ziel: Die steigende Inzidenz von Pankreastumoren führt auch zu einer steigenden Anzahl an den Pankreasresektionen. Bei linksseitigen Tumoren des Pankreases ist die laparoskopischen Resektion eine etablierte Methode. Ziel dieser Arbeit ist es die Implementierung der roboterassistierten Pankreaslinkresektion an unsere Abteilung zu analysieren.Methoden: Es wurde eine retrospektive Analyse der Ergebnisse der ersten 10 Patienten, die am Uniklinikum Salzburg eine roboterassistierte Pankreaslinksresektion erhielten durchgeführt. Prä-, intra-und postoperative Daten wurden untersucht und verglichen mit den letzten 10 laparoskopisch operierten Patienten.Ergebnisse: Intraoperativ zeigte sich kein Unterschied beim Blutverlust (< 50 ml vs < 50 ml) allerdings zeigte sich bei den laparoskopischen Operationen eine höhere Konversionsrate (4/10 versus 2/10) und dadurch auch eine längere Operationsdauer in der laparoskopischen Gruppe (Mittelwert 3:30 Stunden vs 2:42 Stunden). Bei der postoperativen Morbidität (20 % vs 30 %), insbesondere bei Inzidenz von Pankreas Fistel (10 % vs 20 %) sowie Aufenthaltsdauer (14 vs 17 Tage) haben sich auch keinen signifikanten Unterschied zwischen laparoskopische und roboterassistierte Operation gezeigt.Schlussfolgerungen: Die Einführung der roboterassistierten Pankreaslinksresektion ist in unserem Zentrum problemlos gelungen. Die perioperativen Ergebnisse der roboterassistierten Pankreaslinksresektion sind gleichwertig mit der laparoskopischen Technik. Allerdings scheint die robotische Technik eine Erweiterung der intraoperativen Möglichkeiten dazustellen P48 Der Sternoklaviculargelenksabszeß -Einfach spalten und das war es oder doch nicht? Niernberger T 1 , Gabor S 1 , Kramos A 1 , Beganovic M 1 , Steindl J 1 , Benkoe E 1 , Wagner S 1 , Grohmann M 1 , Klug E 1 1 Chirurgie, Oberwart, Österreich Ziel: Sternoclaviculargelenksinfektionen sind selten und werden in Bezug auf alle Gelenksinfektionen mit einer Häufigkeit von 0.5 bis 1 % angegeben. 20 % dieser Affektionen zeigen ein Gelenksempyem. Infektionen des Sternoclaviculargelenkes sind in Zusammenhang mit Drogenabusus, HIV, Diabetes mellitus, onkologischen Operationen an Hals und Nacken, lokale Bestrahlungstherapie sowie die Verwendung von Zentralvenenkatheder und intraarticulären Infiltrationstherapien zu setzen.Methoden: Von 5/2020 bis 12/2020 wurden 4 Patienten '2 weibliche und 2 männliche Patienten, mit einem Sternocalviculargelenksabszeß operativ therapiert. Das mittlere Alter lag bei 66,5 Jahre (40-81 a). Die operative Strategie bestand in allen Fällen in einer kompletten Resektion des Sternoclaviculargelenkes mir anschließender VAC Therapie und Rekonstruktion mit Musculus pectoralis Schwenklappen.Ergebnisse: Alle Fälle zeigten bis zur Entlassung einen unkomplizierten postoperative Verlauf mit einer mittleren Aufenthaltsdauer von 20 Tagen. Eine Rekonstruktion konnte in 75 % der Fälle nach zweimaligem VAC-Wechsel durchgeführt werden. In einem Fall konnte bereits nach initaler VAC-Therapie eine Rekonstruktion angestrebt werden. In einem Fall zeigte sich im Rahmen der ambulanten Nachsorge eine Wundheilungsstörung welche eine operative Revision notwendig machte. Funktionell waren alle Patienten nach der Entlassung beschwerdefrei mit einem ansprechendem kosmetischem Ergebnis.Schlussfolgerungen: Trotz oftmals diskreter klinischer Symptome ist der Sternoclavicularagelenksbszeß auf Grund seiner topographisch anatomischen Lage zur Pleurakuppel und Mediastinum als auch um Rezidive zu vermeiden und ein ansprechendes kosmetisches Ergebnis zu erzielen einerseits einer aggressiven chirurgischen Therapie als auch einer plastisch rekonstruktiven Chirurgie zuzuführen.

Esophagectomy in octogenarians -a worthwhile indication? Aim: Due to the change in life expectancy in recent decades, esophageal surgery in the elderly has become an issue in the public health system. We analyzed the short-and long-term results of esophageal resection and reconstruction by gastric pull-up and cervical esophago-gastrostomy in our collective.

Aim: Preoperative liver function assessment remains vital to miminize the risk for postoperative complications like posthepatectomy liver failure ( PHLF) after hepatic resection. Scores derived from routine laboratory parameters like aspartate aminotransferase to platelet ratio index ( APRI) or albuminbilirubin grade ( ALBI) and their summative score APRI+ALBI have been evaluated in recent studies for their predictive potential for postoperative patient outcome. vWf-antigen (vWf-Ag) is a non-invasive marker for portal hypertension and preoperatively shows high predictive potential for development of PHLF. With this study we aimed to compare both APRI+ALBI and vWf-Ag and characterize their predictive potential for patient outcome in patients undergoing liver resection.Methods: For this study 228 patients undergoing liver resection were included. Using a commercially available enzyme-linked immunosorbent assay ( ELISA) vWf-Ag was retrospectively measured from plasma samples, which were prospectively collected from blood taken prior to the operation at multiple European institutions. APRI, ALBI and APRI+ALBI were calculated using routine laboratory parameters.. Postoperative outcome was assessed.Results: We assessed differences in APRI+ALBI and vWf in patients in the context of postoperative outcome. Both APRI+ALBI and vWf-Ag were significantly higher in patients who developed PHLF ( APRI+ALBI, p = 0.001; vWf-Ag, p = 0.001)

Ziel: Die TAPP eignet sich als Ausbildungsoperation im Hinblick auf die Minimal-Invasive Chirurgie durch ihre häufige eine polymikrobielle Flora, wobei E. coli (26 %), Bacteroides spp. (18 %) und Enterococcus spp. (15 %) die häufigsten Bakterien waren. Bei der Indexoperation wiesen 35,4 % der getesteten Bakterien Resistenzen gegen Ampicillin/Sulbactam ( POP 44,2 %; CAP 22,3 %; HAP-non-POP 39,5 %), und 29,0 % gegen Cephalosporine der zweiten Generation ( POP 29,5 %; CAP 31,2 %; HAP-non-POP 21,4 %) auf. Erwartungsgemäß verschob sich das mikrobielle Spektrum bei Patienten mit offenem Abdomen im Laufe der Zeit: Nach 7 bis 30 Tagen offener Bauchbehandlung waren Enterococcus spp. (37 %) und Candida spp. (33 %) die am häufigsten identifizierten Keime.Schlussfolgerungen: Diese Studie beschreibt die mikrobielle Flora schwerer intraabdominaler Infektionen an einem mittelgroßen Akutkrankenhaus. Hohe Resistenzraten gegen bestimmte Antibiotika sollten für die empirische Therapieführung bei Peritonitis berücksichtigt werden.

Zott T 1 , Pereyra D 1 , Kersten I 2 , Hüpper N 2 , Ortner M 2 , Starlinger P 1 , Berlakovich G 1 , Silberhumer G 1 1 Medizinische Universität Wien, Universitätsklinik für Allgemeinchirurgie, Wien, Österreich 2 Medizinische Universität Wien, Wien, Österreich Ziel: Verschiedene klinische Studien haben gezeigt, dass Serotonin (5-HT), besonders jenes in Thrombozyten, wichtig für eine erfolgreiche Leberregeneration nach Leberresektion ist. 5-HT und andere thrombozytäre Faktoren scheinen eine adäquate Leberregeneration über eine komplexe Signalkaskade zu beeinflussen. Über die Rolle von 5-HT auf die Leberregeneration nach Lebertransplantation liegen jedoch kaum Daten vor. Das Ziel dieser Studie ist es, mehr Einsicht in den postoperativen Verlauf von 5-HT nach Lebertransplantation, die Korrelation mit der Spender-Organqualität sowie das klinische Ergebnis zu gewinnen.Methoden: Plasma-und Serum-5-HT wurden mittels ELISA (enzyme-linked immunosorbent assay) gemessen. Dies erfolgte präoperativ, intraoperativ und an Tag eins, fünf und zehn postoperativ. Das intra-thrombozytäre ( IP) 5-HT wurde durch Subtraktion des Plasma-vom Serum-5-HT berechnet und relativ zur Thrombozytenzahl betrachtet ( IP 5-HT PP). Die Entwicklung einer early allograft dysfunction ( EAD) wurde mittels Olthoff-Kriterien ermittelt.Ergebnisse: Vierundvierzig Leberempfänger zwischen 2018 und 2021 und eine Kontrollkohorte, bestehend aus 30 wegen mangelnder Organqualität nicht realisierten Spendern, wurden in diese Studie eingeschlossen. Wir konnten keinen signifikanten Unterschied in den Spender-5-HT-Werten von realisierten und abgelehnten Organspendern feststellen (Plasma 5-HT: p = 0.269; Serum 5-HT: p = 0.269; IP 5-HT PP: p = 0.430). Es konnte keine Signifikanz zwischen den postoperativen 5-HT-Werten und der Entwicklung von EAD nach Olthoff festgestellt werden. Patienten, welche eine EAD aufwiesen, hatten jedoch signifikant niedrigere Thrombozytenzahlen am postoperativen Tag zehn (p = 0.026). Präoperative Spenderparameter, wie Plasma-5-HT, Serum-5-HT und die Thrombozytenzahl, hatten keinen Einfluss auf die Entwicklung von EAD (Plasma 5-HT: p = 0.766; Serum 5-HT: p = 0.170; Thrombozytenzahl: p = 0.135). Allerdings war eine Tendenz von niedrigerem Spender-IP 5-HT PP in Patienten, welche postoperativ eine EAD entwickelten, zu erkennen ( IP 5-HT PP: p = 0.077). Zur weiteren Analyse wurde die Kohorte nach den Spenderwerten von IP 5-HT PP in zwei 63rd Annual Meeting of the Austrian Society of Surgery Aim: Underlying liver disease in patients eligible for liver surgery varies greatly. Risk for posthepatectomy liver failure ( PHLF) has been shown to range from 5-30 % depending on chronic or malign liver disease and chemotherapy induced liver injury. As liver function assessment tests like indocyanine green (icg) clearance assessment are time consuming, costly and invasive, more easily accessible alternatives are being evaluated. Recently the summative combination of the aspartate transaminase to platelet ratio index ( APRI) and the albumin-bilirubin grade ( ALBI) APRI+ALBI has been associated with postoperative patient outcome and has shown potential as a predictor for PHLF. With this study we aim to examine possible associations of APRI+ALBI and icg-clearance with postoperative patient outcome and compare the predictive potential of APRI+ALBI and icg-clearance for PHLF. We then aim to validate APRI+ALBI in an international multicenter validation cohort.Applikationsmöglichkeit bei bestehender hoher Inzidenz an Leistenhernien. Eine strukturiere Durchführung der Operation soll zu einer rasch ansteigenden Lernkurve und guter Reproduzierbarkeit bei gleichzeitiger maximaler Patientensicherheit führen.Methoden: Alle durchgeführten TAPP-Eingriffe wurden retrospektiv identifiziert. Dafür wurde unser Operationsplanungstool ( MMC) herangezogen. OP-Dauer, intra-und postoperative Komplikationen, Assistenzen und Teilschritte wurden über einen Zeitraum von 2 Jahren analysiert.Ergebnisse: Insgesamt 52 Patienten wurden operiert. Das Teilnahmeausmaß beläuft sich über die 1. Assistenz zu Beginn der Ausbildung, über das Durchführen von Teilschritten der OP, bis zur selbstständigen Operation mit FachärztInnen (12) und schließlich mit StudentInnen (2). Als Operateur wurden 20 einseitige Leistenhernien, davon 10 mediale und 10 laterale, sowie 5 beidseitige Leistenhernien operiert. Es zeigte sich eine deutliche Reduktion der OP-Dauer von 118min auf 56min über die Zeit und eine aufgebaute Kompetenz über alle Aspekte der chirurgischen Behandlung der Leistenhernie. Mit einer Rezidiv-Nabelhernie waren die postoperativen Komplikationen minimal.Schlussfolgerungen: Eine strukturiere Ausbildung erwies sich als zielführend. Verbesserungsmöglichkeiten bestehen in der Form einer Zuständigkeit eines ausgewählten Mentors zur detailierten und spezifischen Beurteilung und Verbesserung der Fähigkeiten des Auszubildenden. Dies haben wir mit 2022 bei uns etabliert.

Mortalität bei schwerer sekundärer Peritonitis -nicht-chirurgische spitalserworbene Formen zeigen das schlechteste Outcome 

Ziel: Im Rahmen des regulären Humanmedizincurriculums an österreichischen Universitäten rückt die chirurgische Lehre in den Hintergrund. Verglichen mit anderen Disziplinen werden Studierende spät und auf zunehmend freiwilliger Basis mit Chirurgie konfrontiert. In klinischen Praktika zeigt sich bei vielen Studierenden in fortgeschrittenem Studienabschnitt aber der Wunsch, schon früher mit chirurgischen Themen in Kontakt gekommen zu sein, gerade in Anbetracht der späteren Berufswahl. Daher soll an der Medizinischen Universität die chirurgische Lehre systematisch ausgebaut werden, um interessierte Studierende schon frühzeitig abholen und über ein niederschwelliges Lehrangebot ein breites Publikum erreichen zu können. So sollen einerseits die Ärztinnen und Ärzte der nächsten Generation die beste chirurgische Grundlagenausbildung erhalten und anderseits chirurgische Nachwuchstalente frühzeitig erkannt und gefördert werden.Methoden: Ein Lehrkonzept zum stufenweisen Ausbau des extracurricularen klinischen Lehrangebots wurde erarbeitet. Neben theoretischen Grundlagen werden Fertigkeiten trainiert und so frühzeitig der Kontakt mit chirurgischen Instrumenten und das Üben an Simulationsmodellen ermöglicht. Ein Leuchtturmprojekt ist das Wahlfach Basics of Laparoscopic Surgery, bei dem Studierende ohne Vorerfahrung die theoretischen und praktischen Grundlagen der laparoskopischen Chirurgie erlernen.Ergebnisse: Bereits mehr als 100 Studierende nahmen in den letzten 4 Semestern am Wahlfach "Basics of Laparoscopic Surgery" teil. Damit wurden kumulativ rund 150-200 Stunden theoretisches Selbststudium mithilfe der eigens erstellten Lehrvideos und Lehrmaterialien über die Online-Plattform Moodle und über 800 Stunden aktive Praxisübungen absolviert werden. Die Studierenden wurden jeweils durch ein 1:4 bis 1:5 Mentoringverhältnis von Ärztinnen und Ärzten der Universitätsklinik für Allgemeinchirurgie betreut. Zusätzlich waren weitere 246 Studierende auf der Warteliste, was das große Interesse und den enormen Bedarf für den Ausbau der Lehrkapazitäten (die nicht zuletzt Corona-bedingt eingeschränkt waren) aufzeigt.Schlussfolgerungen: Das Interesse an theoretischer wie praktischer chirurgischer Lehre und Ausbildung ist seitens der Humanmedizinstudierenden ungebrochen groß. Ein Ausbau der Lehrkapazitäten wird zu einem wichtigen Ziel für die Vermittlung der chirurgischen Denkweise und die Weitergabe chirurgischer Fähigkeiten an die nächste Ärztinnen-und Ärztegeneration erklärt.

Circulating microRNAs show predictive potential for outcome and long term overall survival Methods: For this study 457 patients were retrospectively included. All patients underwent liver surgery either at the general hospital Vienna (Vienna, Austria) or the clinic Landstrasse (Vienna, Austria). As a validation cohort 609 patients, who all underwent liver surgery, were retrospectively included from the Karolinska University Hospital, (Stockholm, Sweden), the clinic Favoriten (Vienna, Austria) and the state hospital Wiener Neustadt (Wiener Neustadt, Austria). APRI+ALBI was calculated using preoperative routine laboratory parameters. ICG clearance was routinely measured prior to the operation in the initial cohort and retrospectively documented, parameters recorded were plasma disappearance rate ( PDR) and retention after 15 minutes (R15). Postoperative patient outcome was retrospectively assessed.Results: Initially we analyzed differences in APRI+ALBI and icg-clearance depending on the development of PHLF. APRI+ALBI was significantly increased in patients who suffered from PHLF (p < 0.001) and R15 was higher in this group (R15 = 0.028), while PDR did not show any difference (p = 0.063). Interestingly APRI+ALBI was higher in patients who suffered from 90 days mortality (p < 0.001), icg-clearance showed no significant difference in this group (R15, p = 0.406; PDR, p = 0.616) We then analyzed the predictive potential of APRI+ALBI and icg-clearance using receiver operating characteristic ( ROC) curve analysis. APRI+ALBI outperformed both PDR and R15 when comparing their respective areas under the curve ( AUC) ( APRI+ALBI, AUC = 0.635, p < 0.001; R15, AUC = 0.576, p = 0.028; PDR, AUC = 0.565, p = 0.064). Using Youden's J statistic we then defined a cut-off of ≥-2.50 for APRI+ALBI (sensitivity = 0.61, specificity = 0.60, positive predictive value [ PPV] = 0.21, negative predictive value [ NPV] = 0.90, p = 0.001). With a high NPV our cutoff could identify in this heterogenous group patients who could safely be resected. We then tried to validate our findings in our validation cohort. APRI+ALBI was significantly higher in patients who developed PHLF (p < 0.001) and predicitve potential of APRI+ALBI improved in this cohort ( AUC = 0.675, p < 0.001). Our cut-off repeatedly showed high NPV (Sensitivity = 0.084, specificity = 0.35, PPV = 0.27, NPV = 0.88, p < 0.001).Conclusions: With this study we present data showing an association of APRI+ALBI with both PHLF and 90 days mortality in patients undergoing liver resection. It seems that the components of a compound score like APRI+ALBI reliably reflect the current state of liver disease in a heterogenous patient group. The predictive potential of APRI+ALBI even outperformed an established liver function test in icg-clearance and could identify patients at low risk for adverse outcome after surgery. We could replicate our findings in our validation cohort and hope that in the future APRI+ALBI may find routine clinical implementation. This of course should only happen after further multicentric prospective testing. APRI+ALBI remains an extremely easily accessible score for clinicians worldwide, components are routinely assessed in clinics and scores can be calculated using only a smartphone.

Basics of Laparoscopic Surgery -Ein multimodales Trainingkonzept zur Ausbildung der nächsten Generation von Ärztinnen und Ärzten Eichelter J 1 , Jedamzik J 1 , Gensthaler L 1 , Nixdorf L 1 , Bichler C 1 , Prager G 1 Aim: Even with surgical technique improving, many patients undergoing liver resection still develop posthepatectomy liver failure ( PHLF). In this context, understanding the mechanisms behind liver regeneration are of critical clinical importance. Recently, Fibrinogen and other parameters involved in the coagulation cascade have been shown to play an important role in rodent but as well as human liver regeneration. Intrahepatic platelet accumulation is mediated via intrahepatic fibrinogen deposition and indispensable for sufficient posthepatectomy liver regeneration. Further, Antithrombin III ( ATIII) has also been implicated to be involved in the process of hepatic regeneration. In this study we aimed to explore perioperative dynamics of fibrinogen and selected coagulation parameters and also explore if these factors show an association with postoperative patient outcome.Methods: 55 patients undergoing hepatic resection were included. Fibrinogen levels, ATIII activity as a surrogate parameter for absolute ATIII levels, thrombin time ( TT) and prothrombin time ( PT) were assessed out of routine laboratory blood tests from prior to the operation (preOP) and from the first and fifth postoperative day ( POD). Postoperative patient outcome was retrospectively evaluated.Results: Patients who developed PHLF had prolonged PT on POD1 (p = 0.012). We saw a tendency for patients with PHLF to exhibit higher levels of Fibrinogen preOP (p = 0.098) and lower levels on POD1 (p = 0.074). When evaluating postoperative morbidity in our patient cohort, prolonged PT was associated with development of postoperative morbidity (p = 0.021). In patients who developed severe morbidity (Dindo Morbidity grade ≥ 3) preOP fibrinogen levels were higher (p = 0.002). Regarding perioperative dynamics, Fibrinogen levels significantly declined from preOP to POD1 in patients who did and didn't develop PHLF (no PHLF, p = 0.002; PHLF, p = 0.008). Fibrinogen then Aim: Preoperative risk assessment in patients evaluated for hepatic resection remains a challenging task for clinicians as up to 30 % of patients can develop posthepatectomy liver failure ( PHLF). In this context the potential of microRNAs (miRNA) as multifunctional biomarkers has become a topic of great scientific interest. MiRNAs are involved in a plethora of different cellular processes including regeneration but also neoplastic growth. In this study we aimed to validate the association of miRNAs with postoperative patient outcome and examine a possible association of miRNAs with overall patient survival.Methods: For this study 175 patients undergoing liver resection were included. Using a commercially available quantitative polymerase chain reaction (qPCR) array, miRNAs were measured in patient plasma prepared from blood samples. Blood was drawn prior to the operation and on the first and fifth postoperative day and plasma was prepared in a timespan of 30 minutes after sample acquisition. miRNAs assessed were miRNA 151a-5p, 192-5p and 122-5p. Relative logarithmic differences were calculated between miRNAs to form self-normalizing pairs. Both miRNA pairs 122-5p_151a-5p and 151a-5p_192-5p were combined and the logarithmic differences of the miRNA combination for each patient was calculated. Logarithmic difference is stated as P* value.Results: Initially, we performed a subgroup analysis of underlying tumor types in the context of PHLF. High P* values correlated with PHLF in patients with colorectal cancer liver metastases ( CRCLM) and hepatocellular carcinoma ( HCC) (both p < 0.005). P* values showed high predictive potential with an area under the curve ( AUC) of 0.794 (p < 0.001). We divided our cohorts using a previously published low-stringency cutoff of P*>0.59 (P*>0.59) and a stringent cutoff of P > 0.68 (P*>0.68) and analyzed Overall Survival ( OS) using Kaplan-Meier-Curve survival analysis. Both cutoffs showed a significant difference in OS in the low-and high-risk groups (P*>0.59 Median OS: 53.5 months low-risk group, 12.0 months high-risk group; p = 0.021) (P*>0.68 Median OS: 51.4 months low-risk group, 11.2 months high-risk group; p = 0.001). Cut-offs were further assessed for PHLF, 90-day mortality and OS categorized in OS < 1 year, OS < 3 years and OS < 5 years. P*>0.59 showed a significant difference for PHLF, 90-day mortality and OS < 1 year (p < 0.005). P*>0.68 however, showed a statistical difference in all analyzed parameters between the low-and high-risk groups (p < 0.005 for PHLF, 90-day mortality, OS < 1 year, OS < 3 years; p < 0.05 for OS < 5 years).Conclusions: In this study, we were able to validate earlier findings showing a high predictive potential of miRNAs for the development of PHLF in our 2 largest patient subgroups ( CRCLM and HCC). However, we now also document that miR-NAs are also predictive for OS, also when excluding immediate postoperative mortality. While the pathophysiology behind the role of miRNAs in liver regeneration needs to be further examined, the predictive potential of miRNAs for patient outcome could aid clinical decision making for patients undergoing hepatic resection. Given the association with OS, miRNAs might ultimately also help to stratify treatment strategies, tailoring oncological therapy to each individual patient. Ultimately, risk assessment in patients undergoing liver resection remains an invasive, costly and time-consuming process for clinicians and patients alike. An easily implementable qPCR array for the evaluation of the presented miRNA combination could significantly improve preoperative patient evaluation. rose from POD1 to POD5, only in patients who didn't develop PHLF (p < 0.001). ATIII activity was also inhibited in patients who did and didn't develop PHLF when comparing preOP to POD1 (no PHLF, p < 0.001; PHLF, p = 0.028). But only in patients who developed PHLF ATIII activity then decreased even further from POD1 to POD5 (p = 0.002).Conclusions: With this study, we document that coagulation parameters are not only significantly affected by liver resection but also associated with postoperative outcome in human patients undergoing liver resection. Given the accumulating experimental evidence that fibrinogen and other coagulation parameters affect hepatic regeneration, these data indicate that a significant lack of postoperative fibrinogen might result in an abolished hepatic regeneration. Given multiple possibilities to interact with fibrinogen levels as well as its endogenous release, future research will need to assess if pharmacological intervention, particularly in patients with low fibrinogen levels, might ultimately translate into improved outcomes in patients undergoing hepatic resection (HeLiX Trail ongoing). Ergebnisse: Postoperativ konnte in beiden Fällen eine Verbesserung der Lebensqualität erzielt werden.

Schlussfolgerungen: Magenentleerungsstörungen zählen zu den häufigen postoperativen Komplikationen nach Ösophagusresektion mit Magenhochzug nach Ivor-Lewis. Trotzdem gibt es bis dato keine standardisierten Empfehlungen hinsichtlich optimaler chirurgischer Therapie bei Versagen konservativer Therapiemaßnahmen. Aus diesem Grund gelten solche Beschwerden nach wie vor als Herausforderung für den erfahrenen Ösophaguschirurgen.

Aim: The options of pain therapy are manifold, ranging from infiltrations and blockades to stimulation, surgical procedures as well as physical and psychosocial measures. The guarantee and optimization of a low-pain to pain-free perioperative care management and reliable or sustainable efficacy and course are considered high demands in this context. This is especially true with regard to the invasiveness of surgical interventions, partially implemented multimodality as well as age, secondary disease and risk profile and, last but not least, the medication spectrum of patients. Objective: To summarize the results of an interdisciplinary clinical work & research group of a pain outpatient clinic & general/abdominal surgery department at a tertiary institution in a representative overview to reflect on upcoming research topics & current trends in the field.Methods: Synopsis of written publications & lectures on the topic given by the two disciplines in recent years.Results: Corner points (I): -The creation & implementation of an institutional pain management SOP represents a worthwhile & promising endeavor. -For the ubiquitously possible application of the SOP, it is provided in the form of a pocketsized manual for the medical staff. -For quality assurance, the consults for pain patients are supervised by the senior physicians of the outpatient pain division. -Abdominal surgery poses an increased risk for the occurrence of back pain in later years.-Own studies provide also reliable data showing effective pain therapy w/Novaminsulfon/NSAIDs & Dipidolor up to a postop. duration of 8 d; especially for cancer pats., sustained-release opioids + psychotropic drugs should be considered thereafter.-Medications are then selected based on the pat.'s classification of pain quality, which is complained about. -In clinical practice, the level of pain is not a basis for assessing the medication required; pain level of the individual pat. is used solely to assess the course of therapy. -The consults are not solely for the purpose of administering opioids to every pat. requested; the aim is rather the dissemination of the SOP, its internalization by the ward staff &, based on this, the implementation of a therapy adapted to the individual case -therefore, it seems necessary to increase the No. of consults in the long run to get more & appropriate information.Conclusions: Corner points ( II): -The goal is to provide consultation beyond the normal consultative case, not to the individual physician but to the ward team. In this context, the pain service is more involved in the inpatient case &, in return, the team is more actively involved in pain management. -In the best case management scenario, the on-demand medications to be given in addition to the sustained-release opioids are a matter between the consultation service, the nursing staff & the patient. -Even the student body can be involved in this setting. -This flattening of structures also increases the personal responsibility of the nursing staff as well as the trainees. In conclusion, our own experience with a postop. algorithm shows that a continuation of the administration or combination of NSAIDs/ Dipidolor not only for 3 (according to the previous recommen- Aim: Due to the high incidence of posthepatectomy liver failure ( PHLF) risk assessment prior to hepatic resection remains a challenging for surgeons. We have recently discovered a blood-based biomarker consisting of three microRNAs (HepatomiR) that showed promising performance for the prediction of PHLF. The aim of this study was to assess the impact of including the evaluation of HepatomiR in preoperative risk assessments in Austria on budget and health outcomes of the target population.Methods: A cost-utility-model was developed to simulate the health and budget impact of taking up microRNA screening prior to performing hepatic resections in HCC, CCC, and CRCLM patients over a short-term period of 90-days in comparison to the standard-of-care. Incidence of HCC, CCC, and CRCLM as well as PHFL were derived from literature and Austrian registries. MicroRNA screening was assumed to have a positive-predictive value of 83 % and a negative-predictive value of 85 % based on previously published results. Hepato-miR stratified patients into three risk groups: low-risk, indicating immediate resection; medium-risk, indicating portal vein embolization to enhance liver regeneration prior to resection; high-risk, indicating alternative cancer treatment according to the standard-of-care. Results evaluate the total number of PHLF for HepatomiR against the comparator actual standard of care, and direct costs for treatment including resection, drugs and treatment of PHFL.Results: Assuming 50 % uptake rate for risk assessments across the three different cancer types (462 patients per year), HepatomiR reduces PHLF incidence by 34 cases per year compared to the standard-of-care. With 80 % uptake (594 patients) this number increases to 48 PHLF cases that can be avoided per year. Under these assumptions, the cost per avoided PHLF were 1.309 € ( HCC), 3.731 € ( CCC), and € 3.275 € ( CRCLM). To further evaluate the cost-effectiveness of HepatomiR screening, 1000 scenarios with varying assumptions for uptake rate, cost (material and personal), and incidence were calculated. It was found that 900 scenarios (90 %) were within the limit of 10.000 € per avoided PHLF.Conclusions: Preoperative risk assessment using the Hepa-tomiR test constitutes a cost-effective approach to lower the incidence of PHLF in HCC, CCC and CRCLM patients evaluated for hepatic resection.

Interdisciplinary pain management in various surgical disciplines at a tertiary center -clinical research results of an interdisciplinary working group representing modern aspects and trends Hackert, T S15 Hackl, D S100 Hackl, H S28, S92 Hackl, M S28, S128, S130 Hagenauer, L S74 Hagleitner, G S11 Halloul, Z S9, S122 Hammer, R S31, S103, S104, S109, S117 Hammond, T S27 Hank, T S13, S92 Hargitai, L S17, S18, S19 Harpain, F S53, S71 Härter, B S59 Härtinger, M S43, S97 Hartmann, R S80 Hauer, A S110 Haunold, I S71 Hauser, H S30, S31, S103, S104, S109, S117 Hautz, T S42 Havranek, L S15, S58, S108 Haxhija, E S74, S87 Haxhija, EQ S75 Hechenleitner, P S59, S79 Hecker, A S95 Hegazy, J S17 Heinl, S S76 Heitzer, E S30 Helbich, T S45 Helner, N S91 Henneth, B S101 Henning, S S74, S87 Herbst, F S71 Hermann, M S3, S17, S18, S35 Herrmann, L S28 Heuberger, S S122 Himmelbauer, E S16 Hinz, U S15 Hirsova, P S28 Hoelzenbein, T S75 Hoffer, F S22, S37 Hofmann, E S95, S96 Hofmann, J S42 Hoi, H S20, S59 Holzer-Geißler, J S95 Holzer-Geissler, JCJ S96 Holzinger, J S10, S20 Horvath, A S76, S77 Horvath, Z S107 Hryhorov, Y S105 Hrymak, I S90, S91

Gabersek, A S6, S10, S18 Gabler, C S52 Gabor, S S4, S31, S81, S82, S111, S123, S124 Gabor, SE S107 Gangl, O S58, S84, S108 Gantschnigg, A S10, S16, S49 Gasparella, P S44, S60, S74, S86, S87, S88 Gasser, E S34 Gasteiger, S S32 Gebauer, D S126 Gehwolf, P S21, S49, S51, S54 Geiger, E S128 Gensthaler, L S23, S24, S39, S128 George, A S100 Gesslbauer, B S97 Getman, V S82 Gilg, S S127 Giretzlehner, M S80 Girotti, P S84 Girsch, W S65 Glaser, B S125, S126, S127 Glaser, K S50, S58 Globke, B S3, S74, S87 Glushko, Z S91 Goeber, V S27 Gollackner, B S8, S9 Goloborodko, M S105 Gombos, P S90 Gores, GJ S28 Gorjanc, J S6 Grabherr, R S76 Grabner, T S35 Gramatiuk, S S103 Granowski, D S7 Grechenig, M S22, S23 Groeber-Becker, F S95 Groemer, G S68 Groeneveld, D S129 Grohmann, M S124 Gruber-Blum, S S58 Gruber, ES S43 63rd Annual Meeting of the Austrian Society of SurgeryHuber, E S21 Huber, FX S92, S129 Huber, J S5, S31, S48, S49, S99, S130 Huber-Zeyringer, A S60 Hubmann, M S30 Hudert, C S87 Hummel, B S36 Hüpper, N S126 Hutter, J S16, S44 Hüttinger, N S80 Hyzha, B S90, S91 Hyzha, L S91 I Ilhan-Mutlu, A S4 63rd Annual Meeting of the Austrian Society of Surgery