Abstracts DGAV

D. Prassas 1 , D. Stunneck 1 , T. M. Rolfs 1 , F.-J. Schumacher 1 1 Katholisches Klinikum Oberhausen, Oberhausen Background: Transanal intestinal evisceration is a very rare pathologic entity with dramatic presentation, where the small bowel eviscerates through a rectal wall defect intraluminally and exits transanally. Materials and methods: The present case reported refers to a 91 year old lady with a history of rectal bleeding by local ischemia of the anterior rectal wall, who presented to us with intestinal loops extruding through the anus. Results: The patient underwent prompt surgical intervention with segmental small bowel resection, resection of the rectum and construction of an end colostomy, with her postoperative recovery being uneventful. Conclusion: Our report demonstrates local ischemia of the anterior rectal wall as an etiopathogenic factor and stresses its role as an alarm sign for a subsequent rectal perforation with evisceration of the small intestine. M. Brunner 1 , I. Schneider 1 , K. Günther 2 , R. Grützmann 1 , K. Matzel 1 1 Universitätsklinikum Erlangen, Erlangen 2 Klinik Hallerwiese, Nürnberg Background: For treatment of anal fistula a variety of surgical methods are available. While the less invasive sphincter-preserving methods have a lower risk of postoperative fecal incontinence, the recurrence rate appears to be higher. The fistula treatment with PermacolTM collagen paste, an acellular crosslinked porcine dermal collagen matrix suspension, represents a new method for the treatment of anal fistula. We present our first experience. Materials and methods: From October 2015 to September 2016 a total of 20 patients with anal fistula (16 (80%) with transsphincteric fistula and 4 (20%) with anovaginal fistula) were treated with Permacol paste. Patients were regularly followed up, starting with the first postoperative examination after one week and subsequently on demand, but always 6 and 12 months postoperatively. Special focus was on the healing rate of the fistula and on postoperative incontinence. Fistula healing was defined as the absence of signs of recurrence in clinical examination and proctoscopy/rigid rectoscopy. Fecal incontinence was assessed before surgery and at each follow-up. Results: The total group included 20 patients (mean age 53 [range 27-78], gender: 12x female, 8x male) with an average number of previous fistula operations of six. Seven patients (35%) suffered from Crohn's disease. 36% of patients had at least one failed attempt of fistula elimination (fistula plug, fistula excision) in the past. The mean follow-up time after Permacol fistula closure was 8 months [range 2-12]. The healing rate was 80%, in patients with at least a follow-up of 6 months (13 patients) 69%. None of the operated patients developed postoperative fecal incontinence. Two patients (10%) had an adverse event (1x perianal pain, 1x fluid accumulation) and needed a deposit of fistula drainage. Neither the presence of Crohn's disease (p=1,000), nor the age (p=1,000) or gender (p=0,603), nor active smoking (p=0,351), nor a number (> 4) of previous operations (p=1,000) had a significant impact on healing rate. Conclusion: Our preliminary data indicate that the use of Permacol paste appears to be a safe and effective method for patients with transsphincteric and anovaginal fistula. Long-term results are needed to confirm these promising results. A. Brandl 1 , S. Katou 1 , A. Pallauf 1 , B. Rau 1 , J. Pratschke 1 , U. Goerling 1 1 Charité - Universitätsmedizin Berlin, Berlin Background: Psycho-oncologic screening is known to be a useful tool to identify oncologic patients who benefit from early postoperative psycho-oncological therapy. Materials and methods: This retrospective analysis included all patients who were treated for peritoneal surface malignancies with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) at our department between 01/2013 and 02/2016. A psycho-oncologic screening form was preoperatively handed to the patient at the outpatient clinic and was filled out by the patient himself. The aim of this study was to raise demographic data and to examine correlations between high risk of psychological distress and clinical outcome of the patients. Results: A total of 150 patients were included in this analysis, while 76 (50.7%) patients participated in the psycho-oncologic screening reaching a score of 5.5 (±2.7) on average. 49 patients were identified at high risk for anxiety and depression (Score >=5). Patients with Cancer of unknown Primary (7.7±0.6; n=5) and low-grade appendiceal mucinous neoplasm (6.8±1.6; n=22) scored higher compared to patients with colorectal cancer (5.5±2.5; n=33), mesothelioma (4.8±2.9; n=18) or gastric cancer (4.4±3.4; n=35). Female patients had a higher score (6.0±2.6) compared to male patients (4.8±2.8; p=0.09). Patients age (p=0.78), comorbidities (p=0.30) and Peritoneal Cancer Index (p=0.25) had no significant influence on psycho-oncologic score. The postoperative rate for surgical 15/49 (30.6%) or non-surgical complications 16/49 (32.7%) in patients at high risk was comparable with patients with low risk (4/16 (25.0%), 5/16 (31.3%); p=0.46, p=0.59). Linear regression analysis revealed psychological problems in Sadness (HR 2.15; p=0.04) and Sleep (HR 2.94; p=0.06) with the strongest impact on psycho-oncologic screening score. Conclusion: The average psycho-oncologic screening score is not related to the medical prognosis of the patients due to their underlying disease and showed no correlation to the complication rate. Sadness and problems with sleep are of major influence in this score. Further studies including larger numbers of patients are necessary to establish more information about the psycho-oncologic screening and its clinical impact. M. Gruendl 1 1 Harvard University/ Universitaet Freiburg, Poesing Background: 5 Billion people around the world to not currently have access to safe, affordable, surgical and anesthesia care when needed. Surgically treatable conditions now result in more deaths than HIV/AIDS, tuberculosis and malaria combined. However, Global Surgery is still the “neglected stepchild” of Public Health. $12.3 Trillion projected GDP losses in low-income countries associated with not investing in essential surgical & anesthesia care. These are just a few numbers that show that universal access to quality surgical, obstetric, trauma and anesthesia care is a human right. Every human being is entitled to ready access to high quality, lifesaving, safe surgical, obstetric, trauma and anesthesia care performed in their communities. Significant improvements in surgical and anesthesia care, which save lives and prevent life-long disability or life-threatening complications, can be sustainably and affordably integrated within existing health systems. Surgery is an essential component of health systems but has generally been neglected within global public health. This is despite growing evidence documenting the cost-effectiveness of essential surgical care in low- and middle-income countries (LMICs) At the 68th WHO Assembly in Geneva in May 2015 resolution A68/15 was passed on “on Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage”. This was a majore milestone. My presentation will focus on the burden of surgical disease in low-income countries, the formation of the Lancet Commission on Global Surgery, collection of specific indicators for research studies to better understand the current surgical situation, health systems strengthening and the implementation of National Surgical Plans in several countries. I am intending to give a brief overview about Global Surgery. Global Surgery Research is almost exclusively conducted in the United States and this would be the first Global Surgery presentation at a German conference. S. Sauseng 1 , T. Niernberger 1 , S. E. Gabor 1 , M. Themel 1 , C. Mörth 1 , M. Uggowitzer 1 , H. Rabl 1 1 LKH Hochsteiermark / Leoben, Leoben Background: A portal vein thrombosis after extended upper GI surgery can lead to severe or even life threatening complications such as complete liver failure, bleeding complications or ischaemic bowel necrosis. Depending on the size of the thrombosis extension a mortality of nearly 100 % is shown (especially in case of an acute thrombosis) The primary goal of treatment should be an immediate recanalization of the thrombotic vessel. Normally under local or systemically lysis - therapy a high recanalization rate is shown (40% total and 45% sufficient recanalization rate). After preceded extended surgery this therapy option is not usable due to bleeding complications. In those situations the interventional placement of a portal vein stent is an alternative treatment option. Materials and methods: In cooperation of the department of surgery and the department of radiology at the LKH Hochsteiermark/Leoben three patients with a clinical life threatening portal vein thrombosis underwent an interventional stent placement to achieve a recanalisation. All three patients where treated between 1/2015 and 12/2015 The stent placement was performed through a locking-system which had been surgical placed (via minimal - laparotomy) into a mesenteric vein. Results: In all three cases a recanalisation of the portal vein after a successful stent placement could be achieved. Two times a total collapse of the liver function could be prevented. (The portal vein thrombosis occurred after a split - liver procedure respectively after extended Whipple resection with a venous graft implantation) Within the third case a not stoppable, transfusion requiring, recurrent upper GI bleeding after Kausch -Whipple resection could be successfully treated. Conclusion: This interdisciplinary and interventional recanalization of the portal vein is a quick and safe procedure and the therapy success is immediately verifiable C. Pape-Köhler 1 1 Evangelisches Krankenhaus, Köln Background: Presently, there exist a great number of possibilities to access surgical content throughout the internet. The advantages of surgical educational web-based platforms have recently been outlined. We aimed to determine how many surgical education platforms exist today. Additionally, we compared the quality and breadth of knowledge as well as educational tools offered to medical students and surgeons in training by these websites. Materials and methods: Based on pre-existing website evaluation tools in the literature, a catalogue of acknowledged evaluation items was created as our evaluation tool to rate surgical educational websites. The evaluation tool assessed three major website characteristics: the website itself, video features and multimedia features offered. A systematic search process using www.google.de and www.yahoo.de was used to retrieve available websites. These websites were screened using previously defined inclusion criteria to produce the list of websites for our study analysis. Results: More than 80 websites were retrieved and screened. Of these, 30 platforms were found to meet the inclusion criteria. The study assessment showed great heterogeneity between websites as there was a wide range across our website, video and multimedia evaluation tools. Conclusion: Surgical platforms may provide additional learning benefits beyond conventional training in the operating room, sparing precious time and financial resources. The number of platforms is steadily increasing and they are characterized by considerable differences in their quality both in terms of content as well as available teaching tools.