Population-based trend analysis of laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease

Background: The Nissen and Toupet fundoplications are the most commonly used techniques for surgical treatment of gastroesophageal reflux disease. To date, no population-based trend analysis has been reported examining the choice of procedure and short-term outcomes. This study was designed to analyze trends in the use of Nissen versus Toupet fundoplications, and corresponding short-term outcomes during a 10-year period between 1995 and 2004. Methods: A trend analysis was performed of 873 patients (Toupet: 254 patients, Nissen: 619 patients) prospectively enrolled in the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery. Results: The frequency of the performed techniques remained stable during the observation period (p value for trend 0.206). The average postoperative and total length of hospital stay both significantly decreased during the 10-year period from 5.6 to 4.0days and 6.8 to 4.8days, respectively (both p values for trend <0.001). The average duration of surgery decreased significantly from 141 minutes to 121 minutes (p value for trend <0.001). There was a trend towards less complications in later years (2000-2004) compared to early years (1995-1999, p=0.058). Conversion rates were significantly lower in later years compared with early years (p=0.004). Conclusions: This is the first trend analysis in the literature reporting clinical outcomes of 873 prospectively enrolled patients undergoing Nissen and Toupet fundoplications during a 10-year period. The proportion of laparoscopic Nissen versus Toupet fundoplications remained stable over time, indicating that literature reports of the advantages of one procedure over the other had minimal influence on surgeons' choice of technique. Length of hospital stay, duration of surgery, morbidity, and conversion rate decreased over time, reflecting the learning curve. Clearly, patient outcomes have much improved during the 10-year observation perio

Osteosynthese distaler Radiusfrakturen mit der AO/ASIF Titan-Pi-Platte

Zusammenfassung: Die AO/ASIF Titan-Pi-Platte wurde entwickelt, um eine optimale Versorgung distaler, intraartikulärer und instabiler Radiusfrakturen zu gewährleisten. Dies soll durch eine optimale Anpassung an die Anatomie sowie durch Winkelstabilität und flachem Design erfolgen. Ziel der vorliegenden retrospektiven Fallkontrollstudie war es, die objektiven und subjektiven Resultate anhand einer konsekutiven Reihe von 61Patienten mindestens 12Monate (12-29Monate) postoperativ mittels Befragung, klinischer Untersuchung und konventioneller radiologischer Bildgebung zu erheben. Nach Klassifikation der AO handelte es sich um 3A2-, 23A3-, 1B1-, 12C1- und 22C2-Frakturen. Die Resultate zeigen insgesamt ein gutes bis sehr gutes Resultat bezüglich des subjektiven Befindens. Die Messungen des Bewegungsumfangs ergaben durchschnittlich über 80% im Vergleich zur Gegenseite. Die klinische Prüfung der Extensorensehnen ergab keine Rupturen und 18% Irritationen. Das Kollektiv mit Osteosynthesematerialentfernung zeigte einen signifikant größeren Bewegungsumfang der Extension und Ulnarabduktion, eine höhere Kraft sowie nur 3,8% Sehnenirritationen. Mit der Pi-Platte lassen sich gute subjektive und objektive Resultate erreichen. Aufgrund der signifikant besseren Beweglichkeit und höheren Kraft sowie der geringeren Rate an Sehnenirritationen nach Entfernung der Platte sollte die Indikation zur Osteosynthesematerialentfernung großzügig gestellt werde

Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate

Background: Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established. Methods: All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up. Results: Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1-10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (P<0.001), respiratory failure (P=0.01), and pneumonia (P=0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population. Conclusions: Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical techniqu

Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial

Background: Postoperative ileus is a common condition after abdominal surgery. Many prokinetic drugs have been evaluated including osmotic laxatives. The data on colon-stimulating laxatives are scarce. This prospective, randomized, double-blind trial investigates the effect of the colon-stimulating laxative bisacodyl on postoperative ileus in elective colorectal resections. Materials and methods: Between November 2004 and February 2007, 200 consecutive patients were randomly assigned to receive either bisacodyl or placebo. Primary endpoint was time to gastrointestinal recovery (mean time to first flatus passed, first defecation, and first solid food tolerated; GI-3). Secondary endpoints were incidence and duration of nasogastric tube reinsertion, incidence of vomiting, length of hospital stay, and visual analogue scores for pain, cramps, and nausea. Results: One hundred sixty-nine patients were analyzed, and 31 patients discontinued the study. Groups were comparable in baseline demographics. Time to GI-3 was significantly shorter in the bisacodyl group (3.0 versus 3.7days, P = 0.007). Of the single parameters defining GI-3, there was a 1-day difference in time to defecation in favor to the bisacodyl group (3.0 versus 4.0days, P = 0.001), whereas no significant difference in time to first flatus or tolerance of solid food was seen. No significant difference in the secondary endpoints was seen. Morbidity and mortality did not differ between groups. Conclusion: Bisacodyl accelerated gastrointestinal recovery and might be considered as part of multimodal recovery programs after colorectal surger

Randomized controlled trial investigating the effect of music on the virtual reality laparoscopic learning performance of novice surgeons

Background: Findings have shown that music affects cognitive performance, but little is known about its influence on surgical performance. The hypothesis of this randomized controlled trial was that arousing (activating) music has a beneficial effect on the surgical performance of novice surgeons in the setting of a laparoscopic virtual reality task. Methods: For this study, 45 junior surgeons with no previous laparoscopic experience were randomly assigned to three equal groups. Group 1 listened to activating music; group 2 listened to deactivating music; and group 3 had no music (control) while each participant solved a surgical task five times on a virtual laparoscopic simulator. The assessed global task score, the total task time, the instrument travel distances, and the surgeons' heart rate were assessed. Results: All surgical performance parameters improved significantly with experience (task repetition). The global score showed a trend for a between-groups difference, suggesting that the group listening to activating music had the worst performance. This observation was supported by a significant between-groups difference for the first trial but not subsequent trials (activating music, 35 points; deactivating music, 66 points; no music, 91 points; p=0.002). The global score (p=0.056) and total task time (p=0.065) showed a trend toward improvement when participants considered the music pleasant rather than unpleasant. Conclusions: Music in the operating theater may have a distracting effect on novice surgeons performing new tasks. Surgical trainers should consider categorically switching off music during teaching procedure

Holographic Superconductors with Lifshitz Scaling

Black holes in asymptotically Lifshitz spacetime provide a window onto finite temperature effects in strongly coupled Lifshitz models. We add a Maxwell gauge field and charged matter to a recently proposed gravity dual of 2+1 dimensional Lifshitz theory. This gives rise to charged black holes with scalar hair, which correspond to the superconducting phase of holographic superconductors with z > 1 Lifshitz scaling. Along the way we analyze the global geometry of static, asymptotically Lifshitz black holes at arbitrary critical exponent z > 1. In all known exact solutions there is a null curvature singularity in the black hole region, and, by a general argument, the same applies to generic Lifshitz black holes.Comment: 23 pages, 4 figures; v2: added references; v3: matches published versio

Komplexe proximale Humerusfraktur beim alten Menschen: Winkelstabile Plattenosteosynthese vs. Hemiarthroplastik

Zusammenfassung: Hintergrund: Ziel der vorliegenden Untersuchung ist ein direkter Vergleich der Schulterhemiarthroplastik (SHA) mit der winkelstabilen Plattenosteosynthese (WSPOS) beim alten Patienten mit komplexer proximaler Humerusfraktur. Patienten und Methoden: Zwischen 2003 und 2005 wurden alle Patienten (n=52, Alter ≥70Jahre) mit 3- und 4-Segment-Frakturen des proximalen Humerus, welche mit einer WSPOS (PHILOS®) versorgt wurden, prospektiv erfasst und nach einem Jahr mittels Constant-Score (CS), Oxford Shoulder Score (OSS) und radiologisch nachkontrolliert. Verglichen wurde die WSPOS mit einem historischen Kollektiv mit identischen Einschlusskriterien, welches zwischen 1995 und 1997 an der gleichen Institution mittels SHA versorgt wurde (n=59). Ergebnisse: Beide Patientenkollektive zeigten keine Unterschiede bezüglich Alter, Geschlechterverteilung und Frakturtypen. Der CS war signifikant besser für die WSPOS (median 71 vs. 41). Bezüglich Schmerzen zeigte sich im OSS kein Unterschied zwischen den Gruppen. In der WSPOS-Gruppe mussten signifikant mehr Revisionseingriffe durchgeführt werden (25% vs. 2%). Schlussfolgerung: Die WSPOS liefert beim alten Patienten, bei komplexen proximalen Humerusfrakturen deutlich bessere funktionelle Resultate, ist jedoch mit mehr Rezidiveingriffen behaftet. Die Selbständigkeit der Patienten kann bei beiden Operationsmethoden bei guter Schmerzfreiheit meist erhalten werde

A promising new device for the prevention of parastomal hernia.

Parastomal hernia (PSH) is the most frequent long-term stoma complication with serious negative effects on quality of life. Surgical revision is often required and has a substantial morbidity and recurrence rate. The development of PSH requires revisional surgery with a substantial perioperative morbidity and high failure rate in the long-term follow-up. Prophylactic parastomal mesh insertion during stoma creation has the potential to reduce the rate of PSH, but carries the risk of early and late mesh-related complications such as infection, fibrosis, mesh shrinkage, and/or bowel erosion. We developed a new stomaplasty ring (KORING), which is easy to implant, avoids potential mesh-related complications, and has a high potential of long-term prevention of PSH. Here we describe the technique and the first use