Is laparoscopic ileocecal resection a safe option for Crohn's disease? Best evidence topic

AbstractA best evidence topic was constructed according to a structured protocol. The question addressed was whether laparoscopic ileocecal resection for Crohn's disease is associated with higher morbidity rates in comparison to open surgery. From a total of 123 articles, 11 studies provided the best available evidence on this topic. Five observational studies, two randomized trials, three follow up studies and a meta-analysis were identified. The primary author, date and country of publication, study type, patient group characteristics, relevant outcome parameters and results of these papers were tabulated. Perioperative morbidity was either similar between the laparoscopic and the open group, or favored the laparoscopic approach. Convalescence was consistently reported to be shorter in the laparoscopic treatment arm, at cost of longer duration of surgery. Limited evidence suggests lower incidence of small bowel obstruction and disease recurrence for laparoscopy, although follow up data are of poor quality. It may be concluded that laparoscopic ileocecal resection is a safe alternative approach to open surgery for uncomplicated Crohn's disease, provided laparoscopic expertise is available

The use of biological meshes in diaphragmatic defects – An evidence-based review of the literature

The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation

Evaluation von chirurgischem Koordinationstraining [Evaluation of surgical coordination]

[english] The eye-hand coordination is important in the use of monitors performing successfully diagnostic and therapeutic procedures. It is necessary to interpret the screen on the monitor anatomical correctly in order to coordinate instruments without the intention of depth. The Tübinger Skills Trainer (TST) was manufactured not only for great cohorts of students but also to evaluate manual skills without great numbers of controllers. Younger and senor students and younger surgeons were studied. Mistakes and time duration were registered by the PC. In the group of the students mistakes and time durations were decreased in the second trial. Therefore the measuring of the training effect is objective. In the third group the training with both hands showed a diminished time space but an increase of the mistakes. The Tübinger Sills Trainer was fully accepted by students and is reliable to use it for medical education. [german] Die Augen-Hand Koordination ist beim Einsatz von Monitoren in Diagnostik und Therapie von entscheidender Bedeutung für den angestrebten Erfolg. Dabei muss das zweidimensionale Monitorbild anatomisch korrekt interpretiert und der Einsatz von Instrumenten bei fehlender Tiefenwahrnehmung koordiniert werden. Der Tübinger Geschicklichkeitstrainer wurde für große Studentenkohorten nicht nur für ein Basistraining zur Erlangung von manuellen Fertigkeiten entwickelt, sondern auch um diese mit geringem Dozentenaufwand evaluieren zu können. Bei insgesamt 125 Studienteilnehmern wurde ein einhändiges und beidhändiges chirurgisches Basistraining für Medizinstudenten in verschiedenen Ausbildungsstadien und Ärzten in der chirurgischen Weiterbildung durchgeführt. Als Variablen wurden Fehlerquote und Zeitbedarf computergestützt aufgezeichnet. Bei Studenten und PJ Studenten sanken Fehlerzahl und Zeitbedarf beim einhändigen und beidhändigen Training im zweiten Durchgang. Damit konnte ein Trainingserfolg objektiviert werden. In der Gruppe der Ärzte zeigte sich beim beidhändigen Training im zweiten Durchgang eine Minderung der Zeit, die mit einer erhöhten Fehlerrate einherging. Der Tübinger Geschicklichkeitstrainer fand im Zuge der Skills Lab Ausbildung bei Studenten und Ärzten hohe Akzeptanz und hat sich beim Training und für die Evaluation manueller Basisfertigkeiten in der studentischen Medizinausbildung bewährt

EAES recommendations for the management of gastroesophageal reflux disease

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most frequent benign disorders of the upper gastrointestinal tract. Management of GERD has always been controversial since modern medical therapy is very effective, but laparoscopic fundoplication is one of the few procedures that were quickly adapted to the minimal access technique. The purpose of this project was to analyze the current knowledge on GERD in regard to its pathophysiology, diagnostic assessment, medical therapy, and surgical therapy, and special circumstances such as GERD in children, Barrett's esophagus, and enteroesophageal and duodenogastroesophageal reflux. METHODS: The European Association of Endoscopic Surgery (EAES) has tasked a group of experts, based on their clinical and scientific expertise in the field of GERD, to establish current guidelines in a consensus development conference. The expert panel was constituted in May 2012 and met in September 2012 and January 2013, followed by a Delphi process. Critical appraisal of the literature was accomplished. All articles were reviewed and classified according to the hierarchy of level of evidence and summarized in statements and recommendations, which were presented to the scientific community during the EAES yearly conference in a plenary session in Vienna 2013. A second Delphi process followed discussion in the plenary session. RESULTS: Recommendations for pathophysiologic and epidemiologic considerations, symptom evaluation, diagnostic workup, medical therapy, and surgical therapy are presented. Diagnostic evaluation and adequate selection of patients are the most important features for success of the current management of GERD. Laparoscopic fundoplication is the most important therapeutic technique for the success of surgical therapy of GERD. CONCLUSIONS: Since the background of GERD is multifactorial, the management of this disease requires a complex approach in diagnostic workup as well as for medical and surgical treatment. Laparoscopic fundoplication in well-selected patients is a successful therapeutic option