M. Kaminski

Complicated umbilical hernia in patients with decompensated liver cirrhosis. Concept for risk reduction of repair

Umbilical hernia repair is often accompanied by complications in patients with liver cirrhosis and ascites. In recent years we have been using the following concept for treating umbilical hernias in such patients: repair of the hernia by direct sutures and concomitant implantation of two large bore Robinson drainage tubes until the wound healing was completed within the next postoperative 10-14 days. During this time the reconstruction of the abdominal wall is in our opinion as robust that the ascites no longer represents a risk. Preconditions to perform this procedure were the best medicamentous treatment of ascites as ever possible and the perioperative administration of prophylactic antibiotics like gyrase inhibitors to avoid spontaneous bacterial peritonitis. Over a period of 10 years (01.01.1997-31.12.2006) we operated on 22 patients suffering from liver cirrhosis and ascites because of a complicated umbilical hernia (incarceration, irreponibility, skin ulceration, leackage of ascites). One group of patients (n=10) was treated by umbilical hernia repair with the concomitant implantation of two drainage tubes and the other group (n=12) by umbilical hernia repair without draining off the ascites. Morbidity and mortality were compared in both groups in a retrospective analysis. The postoperative morbidity could be reduced from 25% to 10% by using the drainage tubes as well as the rate of recurrent hernias in the drainage group. Due to these experiences we use the concept as standard in such patients and would like to recommend it further. However, we would like to initiate a prospective, randomized, at best multicenter trial for further validation.

[Persistent perineal sinus closure after rectal extirpation-an alternative using bulbocavernosus fat flaps].

We present a 78-year-old female who had undergone rectal excision due to Crohns disease of the rectum with loss of fecal continence. This led to a chronic perineal sinus and vaginal fistula which was closed with a Martius procedure using a bulbocavernosus fat flap. The sinus healed uneventfully after 4 weeks. In our opinion, the gracilis muscle was too large for this defect. We suggest use of this flap in female patients with small persistent perineal sinuses.

[Interdisciplinary management of thoracic wall tumors: indication, technique, and results of interscapulothoracic amputation].

ZusammenfassungDie interskapulothorakale Armamputation, erstmals 1887 von Berger beschrieben, erfuhr einen Indikationswandel von traumatischen Verletzungen hin zur radikalen Resektion von malignen Tumoren der oberen Extremität, der Axilla oder der angrenzenden Thoraxwand, insbesondere, wenn die Tumoren keiner neoadjuvanten Therapie bzw. lokalen Kontrolle durch Radiatio zugänglich sind. Es werden die Indikationen, die operative Technik und Ergebnisse dieser Amputationsform am eigenen Krankengut (5 operierte Patienten) vorgestellt. Obgleich diese Amputationsform eine kosmetische und funktionelle Einschränkung für den Patienten bedeutet, kann diese durch moderne prothetische Versorgung befriedigend ausgeglichen werden.AbstractInterscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.Interscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.

Nabelhernien bei Patienten mit dekompensierter Leberzirrhose

Umbilical hernia repair is often accompanied by complications in patients with liver cirrhosis and ascites. In recent years we have been using the following concept for treating umbilical hernias in such patients: repair of the hernia by direct sutures and concomitant implantation of two large bore Robinson drainage tubes until the wound healing was completed within the next postoperative 10-14 days. During this time the reconstruction of the abdominal wall is in our opinion as robust that the ascites no longer represents a risk. Preconditions to perform this procedure were the best medicamentous treatment of ascites as ever possible and the perioperative administration of prophylactic antibiotics like gyrase inhibitors to avoid spontaneous bacterial peritonitis. Over a period of 10 years (01.01.1997-31.12.2006) we operated on 22 patients suffering from liver cirrhosis and ascites because of a complicated umbilical hernia (incarceration, irreponibility, skin ulceration, leackage of ascites). One group of patients (n=10) was treated by umbilical hernia repair with the concomitant implantation of two drainage tubes and the other group (n=12) by umbilical hernia repair without draining off the ascites. Morbidity and mortality were compared in both groups in a retrospective analysis. The postoperative morbidity could be reduced from 25% to 10% by using the drainage tubes as well as the rate of recurrent hernias in the drainage group. Due to these experiences we use the concept as standard in such patients and would like to recommend it further. However, we would like to initiate a prospective, randomized, at best multicenter trial for further validation.

Interskapulothorakale Amputation nach Berger

ZusammenfassungDie interskapulothorakale Armamputation, erstmals 1887 von Berger beschrieben, erfuhr einen Indikationswandel von traumatischen Verletzungen hin zur radikalen Resektion von malignen Tumoren der oberen Extremität, der Axilla oder der angrenzenden Thoraxwand, insbesondere, wenn die Tumoren keiner neoadjuvanten Therapie bzw. lokalen Kontrolle durch Radiatio zugänglich sind. Es werden die Indikationen, die operative Technik und Ergebnisse dieser Amputationsform am eigenen Krankengut (5 operierte Patienten) vorgestellt. Obgleich diese Amputationsform eine kosmetische und funktionelle Einschränkung für den Patienten bedeutet, kann diese durch moderne prothetische Versorgung befriedigend ausgeglichen werden.AbstractInterscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.Interscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.

Nabelhernien bei Patienten mit dekompensierter Leberzirrhose@@@Complicated umbilical hernia in patients with decompensated liver cirrhosis: Konzept zur Risikominderung der Reparation@@@Concept for risk reduction of repair

Umbilical hernia repair is often accompanied by complications in patients with liver cirrhosis and ascites. In recent years we have been using the following concept for treating umbilical hernias in such patients: repair of the hernia by direct sutures and concomitant implantation of two large bore Robinson drainage tubes until the wound healing was completed within the next postoperative 10-14 days. During this time the reconstruction of the abdominal wall is in our opinion as robust that the ascites no longer represents a risk. Preconditions to perform this procedure were the best medicamentous treatment of ascites as ever possible and the perioperative administration of prophylactic antibiotics like gyrase inhibitors to avoid spontaneous bacterial peritonitis. Over a period of 10 years (01.01.1997-31.12.2006) we operated on 22 patients suffering from liver cirrhosis and ascites because of a complicated umbilical hernia (incarceration, irreponibility, skin ulceration, leackage of ascites). One group of patients (n=10) was treated by umbilical hernia repair with the concomitant implantation of two drainage tubes and the other group (n=12) by umbilical hernia repair without draining off the ascites. Morbidity and mortality were compared in both groups in a retrospective analysis. The postoperative morbidity could be reduced from 25% to 10% by using the drainage tubes as well as the rate of recurrent hernias in the drainage group. Due to these experiences we use the concept as standard in such patients and would like to recommend it further. However, we would like to initiate a prospective, randomized, at best multicenter trial for further validation.

Interskapulothorakale Amputation nach Berger@@@Interdisciplinary management of thoracic wall tumors: Indikationen, Techniken und Ergebnisse bei Thoraxwandtumoren@@@Indication, technique, and results of interscapulothoracic amputation

ZusammenfassungDie interskapulothorakale Armamputation, erstmals 1887 von Berger beschrieben, erfuhr einen Indikationswandel von traumatischen Verletzungen hin zur radikalen Resektion von malignen Tumoren der oberen Extremität, der Axilla oder der angrenzenden Thoraxwand, insbesondere, wenn die Tumoren keiner neoadjuvanten Therapie bzw. lokalen Kontrolle durch Radiatio zugänglich sind. Es werden die Indikationen, die operative Technik und Ergebnisse dieser Amputationsform am eigenen Krankengut (5 operierte Patienten) vorgestellt. Obgleich diese Amputationsform eine kosmetische und funktionelle Einschränkung für den Patienten bedeutet, kann diese durch moderne prothetische Versorgung befriedigend ausgeglichen werden.AbstractInterscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.Interscapulothoracic amputation of the upper extremity, described for the first time by Berger in 1887, has undergone a change of indication. Originally performed in traumatic injuries of the shoulder or arm, it has been done in radical resection of malignancies of the upper extremity, axilla, or the surrounding thoracic wall. Particularly it is performed in tumors which cannot be controlled by neoadjuvant therapies or locally by radiation. The indication, technique, and results of such amputation are discussed by presenting our patients operated on with the procedure. Although this treatment is combined with a loss of function and body integrity, it is safe and sufficiently radical. The loss of function and integrity may be compensated by prosthetic reconstitution.

Verschluss eines persistierenden perinealen Sinus nach Rektumexstirpation

We present a 78-year-old female who had undergone rectal excision due to Crohns disease of the rectum with loss of fecal continence. This led to a chronic perineal sinus and vaginal fistula which was closed with a Martius procedure using a bulbocavernosus fat flap. The sinus healed uneventfully after 4 weeks. In our opinion, the gracilis muscle was too large for this defect. We suggest use of this flap in female patients with small persistent perineal sinuses.

Verschluss eines persistierenden perinealen Sinus nach Rektumexstirpation@@@Persistent perineal sinus closure after rectal extirpation?an alternative using bulbocavernosus fat flaps: Eine weitere Anwendungsmglichkeit des Bulbokavernosusfettlappens

We present a 78-year-old female who had undergone rectal excision due to Crohns disease of the rectum with loss of fecal continence. This led to a chronic perineal sinus and vaginal fistula which was closed with a Martius procedure using a bulbocavernosus fat flap. The sinus healed uneventfully after 4 weeks. In our opinion, the gracilis muscle was too large for this defect. We suggest use of this flap in female patients with small persistent perineal sinuses.