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F Marusch

Publications and source records attributed to F Marusch.

35 records · Page 2Linked to original sources
PubMed2001

Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study.

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

Adenocarcinoma↗
PubMed2001

Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results.

BACKGROUND: The influence of experience on the results of treatment with laparoscopic surgery is indisputable. The establishment of indications and contraindications is relative, and varies depending on the experience of the surgeon. Learning curves have been described for a number of laparoscopic interventions, in particular laparoscopic cholecystectomy. The current prospective multicenter study investigates, among other things, the interrelation between experience and the results of treatment using laparoscopic colorectal surgery. The study makes no pronouncements on the long-term results achieved in patients with colorectal carcinoma who underwent an operation with curative intent, although relevant data were indeed collected. RESULTS: Between August 1, 1995 and February 1, 1999, a total of 1,658 patients were recruited to the prospective multicenter study initiated by the Laparoscopic Colorectal Surgery Study Group. To investigate the influence of surgical experience, two groups were formed. Group A comprised all the institutions and surgeons with experience of more than 100 laparoscopic colorectal operations. Group B contained institutions and surgeons with experience of fewer than 100 such interventions. The results of this study clearly show that in Group A, significantly more procedures involving the rectum were performed (26.7% vs 9.5%), and significantly more carcinomas were surgically managed (37.3% vs 17.3%). Despite this significantly higher level of technically difficult procedures in the patient population of group A, which was comparable in terms of age, gender, height, and weight with the patient in group B, the postoperative mortality and morbidity was, with the exception of urinary tract infections, identical between the two groups. Conversion to open surgery was significantly less frequent in group A (4.3% vs 6.9%), and, finally, the duration of the procedures performed by the more experienced surgeons of group A was appreciably shorter than in institutions with a smaller frequency of such operations. CONCLUSIONS: Laparoscopic colorectal surgery is very demanding, and can be performed with low morbidity and mortality rates only by a surgeon with above-average experience with this type of surgery and a large caseload of laparoscopic colorectal procedures. The learning curve for such procedures is appreciably longer than for other laparoscopic operations. With increasing experience, technically more demanding operations, including radical oncologic rectal laparoscopic procedures, can be performed with appreciably reduced operating times and conversion rates, but with no increase in morbidity or mortality.

Adult↗
PubMed2001

Hospital caseload and the results achieved in patients with rectal cancer.

BACKGROUND: The aim of the study was to investigate the impact of hospital caseload on the short-term postoperative outcome of patients with rectal carcinoma. METHODS: A multicentre study involving 75 German hospitals was carried out between January and December 1999. Some 1463 patients with rectal carcinoma were studied. RESULTS: The hospitals were divided into three groups by annual caseload as follows: less than 20 (group 1), 20-40 (group 2) and more than 40 (group 3). The groups were identical in terms of age, gender, height, weight, tumour stage, risk factors and American Society of Anesthesiologists classification. Postoperative morbidity was less in hospitals with a case volume of more than 20 patients per year (41.7 per cent in group 2 versus 49.9 per cent in group 1). The proportion of patients undergoing abdominoperineal resection with a permanent stoma was less in hospitals with a case volume of more than 40 patients per year (26.4 per cent in group 3 versus 34.0 per cent in group 2). CONCLUSION: A large caseload in rectal surgery results in a significant reduction in permanent stoma formation and postoperative morbidity.

Anastomosis, Surgical↗
PubMed2001

Antigenicity of polyester (Dacron) vascular prostheses in an animal model.

Objectives to investigate the specific humoral immune response to three different polyester (Dacron) prostheses in pigs. Design, materials and methods twenty-four growing pigs were randomly divided into three groups. The infrarenal aorta was replaced by a segment of collagen-impregnated woven polyester prosthesis (low, medium and high porosity). Serum antibodies were detected by modified enzyme immunoassay using non-impregnated prosthesis as the target for the blood samples taken on experimental days 1, 10, 17, 24, 62 and 116 of the 22 pigs followed over the whole observation period. Results significantly enhanced (p <0.05) mean IgG antibody binding against polyester was detected on experimental days 10, 17, 24 and 62 with antibody prevalences of 41%, 41%, 32% and 37%, respectively. Antibody positive pigs were divided into early responders (n =9) and late responders ( n =5) with antibody detection on day 10 and/or 17 vs day 62 and/or 116. No significant differences between the three different prostheses were found. The formation of specific IgG antibodies against polyester in the animals investigated demonstrates a broad individual variability. Conclusions polyester is an antigenic polymer. Specific antibodies, reflecting the inflammatory response, might be not only a parameter for testing biomaterials but also for determining individual bio(in)compatibility for long-term biomaterial function.

Animals↗
PubMed2001

[Singular late metastasis of renal cell carcinoma in the pancreas. An unusual pancreatic tumor].

We present the rare case of a solitary pancreatic metastasis of renal cell cancer being the only manifestation of tumordissemination. In 1993 the patient underwent a transperitoneal nephrectomy for removal of a clear cell renal cancer. In 1998 during follow up we detected a pancreatic tumor which was treated by pancreas resection, splenectomy and resection of the colon transversum. The histology revealed a metastasis of the previously resected renal cancer. The postoperative recovery was impaired by the development of an abcess in the former pancreatic region. During the first year of follow up we did not find any signs for local or distant tumor recurrence. Pancreas resection adapted to the location of the tumor is the treatment of choice for isolated solitary late metastases of renal cell cancer.

Carcinoma, Renal Cell↗
PubMed2001

[Evidence-based surgery in colon carcinoma].

Only a few therapeutic approaches in colon cancer therapy are based on controlled study results. Via an internet search using different search strategies 965 abstracts written about colon cancer therapy between 1980-2000 were analysed. Studies focussing on adjuvant therapy were not included. We found 446 retrospective, 150 prospective randomized, 151 prospective non-randomized studies and 218 review articles. Controlled study results as a scientific base are available for perioperative antibiotic prophylaxis (127 prospective randomized studies), mechanical intestinal cleansing (n = 5), a similar efficacy of stapler and hand-made anastomosis (n = 15), and the early onset of a stage-adjusted nutrition (n = 3). Our internet search shows that only a minor fraction (approximately 10%) of colon surgery is evidence based. The most important prerequisites for an appropriate surgical resection are the pathology results reflecting the degree of tumor spreading. Besides the data from controlled studies we have to take the results from prospective multi-center studies in consideration.

Anastomosis, Surgical↗
PubMed2000

Prospective multicenter study of antibiotic prophylaxis in operative treatment of appendicitis.

BACKGROUND/AIMS: A prospective, multicenter observation study was conducted to investigate the effectiveness of antibiotic prophylaxis in the operative treatment of appendicitis. METHODS: Between June 1996 and May 1997, a total of 4,968 patients underwent an operation for appendicitis at 34 East German hospitals. 41.4% (n = 2,424) received perioperative antibiotic prophylaxis whereas in 58.9% of the cases this was not given. The patients who received antibiotic prophylaxis constituted a negative selection, both with regard to risk factors and to the stage of inflammation. RESULTS: In the total test group, the rate for septic disorders of wound healing amounted to 2.5% (n = 120). The use of antibiotic prophylaxis makes it possible to significant lower the incidence of postoperative septic disorders of wound healing (p < 0.001). In both conventional (0.7% with prophylaxis vs. 3.8% without) and in laparoscopic appendectomy (0 vs. 1.0%) the rate for septic disorders of wound healing can be reduced (p < 0.001). The global comparison irrespective of possible antibiotic prophylaxis shows a significant advantage for appendectomies which started with laparoscopy (p = 0.008), but in the subgroups with prophylaxis this advantage is completely neutralized (p = 0.78). CONCLUSION: From this one can deduce that conventional appendectomy with antibiotic prophylaxis comprises no higher risk of wound infection than laparoscopy, since the risk of conversion exists for every operation begun by laparoscopy. These results would lead to the conclusion that antibiotic prophylaxis should be given before every appendectomy, whether by laparoscopy or conventional methods.

Adolescent↗
PubMed2000

[Animal experiment study on pros and cons of laparoscopic interventions on the liver].

The safety of laparoscopic liver resections compared to open procedure was to be evaluated in an animal study. Besides it had to be examined, whether onco-surgical principles could be kept sufficiently. Therefore 8 one-year-old pigs underwent laparoscopic liver resections; in 2 pigs left-lateral segmental resections were performed, in 5 left-sided hemi-hepatectomies and in one right-sided hemihepatectomy. It became obvious that a control of the vessels around the v. cava inf., of the left branch of the portal vein and of the suprahepatic veins was not possible with sufficient safety. Extraction of the preparations was a further problem. According to these results laparoscopic hemihepatectomy cannot be recommended for clinical routine. Further indications for a laparoscopic operation like deroofing of liver cysts, wedge-resections or treatment of superficial liver injuries are to be accepted.

Animals↗
PubMed2000

[Surgical quality assurance exemplified by operative therapy of colorectal carcinoma].

Quality management of physicians' performance is supposed to guarantee optimal diagnostic and therapeutic procedures for patients. Quality control in the scope of prospective multicenter quality securing programs are based on the overall analysis of cases with selected tracer diagnoses. It serves as voluntary self-regulation for surgeons who perform an evaluation of their results in a team-based setting. Using colorectal cancer as an example, the quality management of diagnostic issues and surgical treatment are used to outline a treatment protocol for a surgical condition under quality securing aspects. We present the treatment protocol of colorectal cancer on the basis of three studies from 1985/1986, 1991/1993 and 1999. We emphasize our opinion that quality management should be addressed as an concern of the surgical profession, and not as an administrative problem.

Colectomy↗
PubMed1999

[Laparoscopic creation of stomas--an ideal single indication in minimally invasive surgery].

The laparoscopic creation of ileostomas and colostomas can be performed in a quick, safe and technically effective manner. The advantages of the minimally invasive approach are low morbidity and mortality, minimal blood loss and fast recovery in these mostly multimorbid patients as well as shorter time of hospitalization. We report on a total of 20 patients who underwent laparoscopic creation of colostoma in 19 cases and creation of ileostoma in one case in a period of 2 years. There were no intraabdominal complications and no lethal outcome. All patients reached their preoperative level of mobilization at the 2nd postoperative day. The indications for the laparoscopic enterostomy are described.

Aged↗
PubMed1999

[Minimally invasive concepts in esophageal surgery--thoracoscopic anastomosis. An animal experiment study].

Based on animal trials the presented study describes two versions of thoracoscopic oesophageal anastomosis within the scope of abdomino-thoracoscopic oesophagectomy. This experimental approach is considered to provide a solution for the oncological problem to salvage the tumor bearing oesophagus. We describe the procedure of intrathoracic stapler anastomosis under thoracoscopic vision. By using a laparoscopic purse string suture clamp we were enabled to prepare the proximal oesophageal stump for anastomosis. A circular stapling instrument turned out to be very suitable for the thoracoscopic use. The final evaluation of the importance of minimally invasive surgery for the resection of oesophageal carcinomas should not be given until multicenter studies are performed.

Anastomosis, Surgical↗
PubMed1999

[Identifying the recurrent laryngeal nerve by intraoperative neuromonitoring].

301 patients underwent thyroid surgery in 1998 by using the intraoperative neuromonitoring. The documentation was done prospectively. The system of intraoperative neuromonitoring consists of a stimulation circuit and an electromyographic record. We placed the deriving electrode transligamentally through the cricothyroid membrane. By relaxometry we investigated the influence of the relaxation level on the electromyographic record of the vocal muscle. Using a standardized operative technique we found a side-related rate of primary palsy of 2.3% (n = 13), from which 61.5% (n = 8) showed to be only temporary during a postoperative follow-up period. The intraoperative neuromonitoring with the purpose of identification of the recurrent laryngeal nerve is a safe and reliable method.

Adolescent↗
PubMed1998

[Postoperative recurrent nerve paralysis after initial interventions for benign goiter].

Between January 1st, 1979 and December 31st 1993, 2501 operations for benign diseases of the thyroid gland were performed. The documentation was done prospectively. The operation technique remained the same during these years. The recurrent laryngeal nerve wasn't routinely identified. All together we saw 0.6% permanent vocal cord palsies. The incidence of nerve paralysis was correlated to the size (weight), to the expansion of the goiter, to the performed operative procedure and to patients' age and gender.

Adult↗
PubMed1998

[Abdomino-thoracoscopic esophagus resection--an animal experiment study].

Based on animal trials the presented study results describe a method of abdomino-thoracoscopic oesophagectomy for the treatment of oesophageal carcinoma of the middle and lower third. Technical details and the advantages of the surgical procedure, including the avoidance of thoracotomy and the practicability of the thoracoscopic dissection of the oesophagus are shown. Problems exist in the salvage of the specimen, especially in the transcervical passage of the tumorbearing oesophageal part. A final evaluation of the importance of the minimally invasive techniques in oesophageal surgery should not be given until the results of clinical studies are available.

Anastomosis, Surgical↗
PubMed1998

[Laparoscopy-assisted harvesting of free small intestine transplants for reconstruction of voice and deglutition after total laryngopharyngectomy--an animal experiment study].

Based on animal trials the presented study results describe a laparoscopic assisted removal of an extra-long free jejunal graft to reconstruct voice and swallowing after a total laryngo-pharyngectomy in cases with advanced malignancies of the larynx including invasion in the upper oesophagus. With a microvascular anastomosed small bowel segment, we have been able to reconstruct parts of the pharynx and to create a speaking syphon as devised by Ehrenberger in an one-stage procedure. The concept of avoidance of an extensive laparotomy may result in an decreased morbidity of this surgical procedure. Therefore it represents a challenging single indication of minimally invasive surgery of the oesophagus. A well established interdisciplinary teamwork is the key for success in this extensive procedure.

Animals↗
PubMed1998

[Value of ultrasound in diagnosis of appendicitis. Results of the East German Multicenter Study. East German Working Group "Outcome Assessment and Quality Assurance in Surgery" of the CAQ of the German Society of Surgery].

Based on the East German quality assessment study our investigation was aimed to evaluate if sonography has a diagnostic value for the indication to appendectomy or if it is only relevant for the differential diagnosis of acute abdominal pain. In a prospective trial we recorded and analysed all sonograms which were obtained in a period of one year at 34 East German hospitals. 3924 patients were examined by ultrasonography. The sex distributions was 1:1.8 on behalf of the female patients. The correlation of sonogram and intraoperative macroscopic findings showed a high rate (68.2%) of acute inflamed appendices in cases with negative ultrasound results. A positive sonogram with an inflamed appendix was confirmed in 90% of the cases intraoperatively. In our study the routine use of ultrasonography for the diagnosis of acute appendicitis shows a sensitivity of 21.5% an a specificity of 80.1%. The positive predictive value is 95.6% and the predictive value for negative results is 9.8%. In conclusion, if clinical examination shows the presumptive diagnosis of acute appendicitis, a negative sonogram should not withhold the surgeon to perform an operative intervention.

Appendectomy↗