Perioperative Enhanced Recovery Concepts Significantly Improve Postoperative Outcome in Patients with Crohn`s Disease.

Background And Aims: Despite recent advancements in medical and surgical techniques in patients suffering from Crohn`s disease [CD], postoperative morbidity remains relevant due to a long-standing, non-curable disease burden. As demonstrated for oncological patients, perioperative enhanced recovery concepts provide great potential to improve postoperative outcome. However, robust evidence about the effect of perioperative enhanced recovery concepts in the specific cohort of CD patients is lacking.

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery.

Aim: This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM).

Methods: With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given.

[Elective colorectal fast-track resections-Treatment adherence due to coordination by specialized nursing personnel].

Fast-track treatment pathways reduce the frequency of postoperative complications in elective colorectal resections by approximately 40% and due to the rapid recovery reduce the postoperative duration of hospitalization by approximately 50%. Specialized nursing personnel (enhanced recovery after surgery, ERAS, nurses) have already been appointed internationally to accompany and monitor the execution of multimodal perioperative treatment. In November 2018 a fast-track assistant was appointed in the Clinic for General and Visceral Surgery of the Municipal Clinic in Solingen for coordination of the fast-track treatment pathway.

[Background, Necessity and Methodology of the S3 Guideline "Perioperative Management of Gastrointestinal Tumours (POMGAT)"].

Malignancies are among the most common diseases, especially in old age, and are responsible for 25% of all deaths in Germany. Especially carcinomas of the gastrointestinal tract can be cured in most cases only through extensive surgery with significant morbidity. About 25 years ago, the multimodal, perioperative Fast Track (FT) concept for reducing postoperative complications was introduced and additional elements were added in the following years.

[Structured Implementation of a Fast-Track Program - How Does it Work?].

Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany.

[Enhanced recovery after surgery-Does the ERAS concept keep its promises].

Introduction: Perioperative enhanced recovery after surgery (ERAS) concepts or fast-track are supposed to accelerate recovery after surgery, reduce postoperative complications and shorten the hospital stay when compared to traditional perioperative treatment.

Methods: Electronic search of the PubMed database to identify systematic reviews with meta-analysis (SR) comparing ERAS and traditional treatment.

Results: The presented SR investigated 70 randomized controlled studies (RCT) with 12,986 patients and 93 non-RCT (24,335 patients) concerning abdominal, thoracic and vascular as well as orthopedic surgery.

The Perioperative Care of Older Patients.

Background: Elderly patients are a growing and vulnerable group with an elevated perioperative risk. Perioperative treatment pathways that take these patients' special risks and requirements into account are often not implemented in routine clinical practice.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, the AWMF guideline database, and the Cochrane database for guidelines from Germany and abroad, meta-analyses, and Cochrane reviews.

Complications After Ostomy Surgery: Emergencies and Obese Patients are at Risk-Data from the Berlin OStomy Study (BOSS).

Background: Complications are common after ostomy surgery. Data from the Berlin OStomy Study were evaluated to determine risk factors for complications.

Patients And Methods: Patients with a bowel ostomy were questioned using a questionnaire concerning patients' characteristics and history as well as the ostomy and its complications.

Quality of life and need for care in patients with an ostomy: a survey of 2647 patients of the Berlin OStomy-Study (BOSS).

Background: Although ostomies are sometimes necessary, it is unclear which type of ostomy is advantageous for quality of life (QoL). In an observational study of 2647 patients, QoL after colostomy (CS) and small bowel stoma (SBS) formation was evaluated.

Methods: The European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30 and CR-38 questionnaires were used.

Effects of psychological interventions and patients' affect on short-term quality of life in patients undergoing colorectal surgery.

Psychological interventions can improve Quality of Life (QoL). Object of interest was if different psychological interventions influence short-term QoL after colonic resection for carcinoma. Furthermore, we wanted to see if there is a correlation between patients` preoperative affect and postoperative QoL.

Vagus-preserving technique during minimally invasive esophagectomy: the effects on cardiac parameters in a swine model.

Background: Cardiac complications are an important cause of morbidity and mortality observed after esophageal resections. We examined whether an high intrathoracic vagotomy during abdominothoracic esophagectomy would have an effect on intraoperative and early postoperative cardiac function in the setting of a minimally invasive resection. Two hypotheses were generated for this study: (1) Vagotomy would cause cardiac changes, and (2) vagus-preserving esophagectomy would prevent cardiac problems during resection and in the early postoperative phase.

Symptoms and clinical course of EHEC O104 infection in hospitalized patients: a prospective single center study.

Objectives: Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain.

Impact of prolapse mass on Contour Transtar technique for third-degree rectal prolapse.

Purpose: Contour Transtar procedure for rectal prolapse is a promising technique according to safety and efficacy. One potential surgical problem is failure of the stapler due to the thick rectal wall. In order to evaluate the practicability and the impending limitations of the Contour Transtar technique, we reviewed our data with special respect to the necessity of additional anastomosis suturing.

Laparoscopic assisted sigmoid resection for diverticular disease.

Purpose: Laparoscopic assisted sigmoid resection (LASR) has become a widely accepted procedure in colorectal surgery. In the last decade, numerous variations of surgical details have been established. In order to demonstrate a feasible technique, this video is provided.

Thoracoscopic resection of a combined esophageal leiomyoma and diverticulum: a case report.

We report the case of a 66-year-old male patient with a combined esophageal leiomyoma and diverticulum. On account of the low incidence, there is little literature available with regard to the management of those conditions. Our patient underwent a simultaneous thoracoscopic enucleation of the leiomyoma and resection of the diverticulum.

[Mesenterial lymphangiolipoma - a rare finding in an asymptomatic patient].

Background: Lymphangioma is an uncommon tumor, an intraperitoneal lymphangiolipoma is exceedingly rare. These tumors are principally benign, but lead to complications due to their size and localization.

Case Report: A 46 year old male patient presented for a regular medical check up.

Problems of randomization to open or laparoscopic sigmoidectomy for diverticular disease.

Purpose: Although complicated sigmoid diverticulitis is the most common reason for laparoscopic sigmoidectomy, the level of evidence for preference of the laparoscopic approach is low.

Methods: A multicenter, randomized clinical trial comparing laparoscopic and open sigmoidectomy for diverticulitis was conducted to evaluate the short- and mid-term outcome after both techniques. Data were assessed from randomized patients and from patients who refused randomization.

Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders?

The Health of the Nation Outcome Scales (HoNOS) is an internationally established clinician-rated instrument. The aim of the study was to assess the psychometric properties in inpatients with substance-related disorders. The HoNOS was applied in a multicenter, consecutive sample of 417 inpatients.

Current perioperative practice in rectal surgery in Austria and Germany.

Objective: 'Fast-track' rehabilitation is able to accelerate recovery, reduce general morbidity, and decrease hospital stay. This is widely accepted for colonic resections. Despite recent evidence that fast track concepts are safe and feasible in rectal resection, there is no information on the acceptance and utilization of these concepts among Austrian and German surgeons.

Multimodal approach for treatment of peritoneal surface malignancies in a tumour-bearing rat model.

Purpose: Surgical cytoreduction of peritoneal surface malignancy of colorectal origin in combination with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) has become an established treatment approach. Only a few of animal models for scientific research on various therapeutic strategies have been described yet. The feasibility of an established rat model with a peritoneal surface malignancy from colorectal origin for treatment investigation should be examined in this study.