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Article ; Online: Response: don't give up on wound protectors yet.

Lauscher, J C / Kreis, M E

2013 Volume 398, Issue 4, Page(s) 619–620

MeSH term(s)	Colorectal Surgery ; Female ; Humans ; Laparoscopy ; Male ; Surgical Equipment ; Surgical Wound Infection/prevention & control
Language	English
Publishing date	2013-03-08
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-013-1067-4
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Article: Selektive Indikation zur neoadjuvanten Radiochemotherapie beim Rektumkarzinom. Selective indication for neoadjuvant chemoradiation therapy for rectal cancer

Lauscher, J. C. / Rayya, W. / Kreis, M. E. / Schineis, C.

Chirurgische Praxis

2020 Volume 87, Issue 3, Page(s) 406

Language	German
Document type	Article
ZDB-ID	500633-8
ISSN	0009-4846
Database	Current Contents Medicine

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Article: Stapled intestinal anastomoses are more cost effective than hand-sewn anastomoses in a diagnosis related group system.

Schineis, C / Fenzl, T / Aschenbrenner, K / Lobbes, L / Stroux, A / Weixler, B / Beyer, K / Kamphues, C / Kreis, M E / Lauscher, J C

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2020 Volume 19, Issue 6, Page(s) 321–328

Abstract: Purpose: Creation of an optimal bowel anastomosis with low postoperative leakage rate is an immanent part of colorectal surgery contributing to recovery, length of hospital stay and overall hospital costs. We aimed to investigate costs of small and ... ...

Abstract	Purpose: Creation of an optimal bowel anastomosis with low postoperative leakage rate is an immanent part of colorectal surgery contributing to recovery, length of hospital stay and overall hospital costs. We aimed to investigate costs of small and large bowel resection, length of hospital stay, anastomotic leakage rate and its risk factors depending on the anastomotic technique. Methods: Retrospective analysis of 198 patients (67 stapled and 131 hand-sewn anastomoses) undergoing elective bowel resection with a single anastomosis without protective ileostomy either stapled or in double-rowed running suture technique between 1st October 2012 and 30th September 2018 at Charité University Hospital Berlin, Campus Benjamin Franklin. We analyzed costs of treatment, total length of hospital stay, rate of anastomotic leakage and possible risk factors for anastomotic leak. Results: No significant difference between both anastomotic techniques could be detected for hospital stay (p = 0.754), 30-day-readmission rate (p = 0.827), or anastomotic leakage (p = 606). Neither comorbidities (p = 0.449), underlying disease (p = 0.132), experience of the surgical team (p = 0.828) nor scheduling of the operation (p = 0.531) were associated with anastomotic leakage. Stapled anastomoses took 22 min less operation time than sutured anastomoses (130 vs. 152 min. Median) (p = 0.001). Operations with stapled anastomoses saved 183 € in operation costs and 496 € in overall hospital costs. Conclusion: Stapled and hand-sewn bowel anastomoses can be performed equally safe without differences in postoperative outcome. No patient, procedure or surgeon related risk factors for anastomotic leakage could be detected. Bowel resections with stapled anastomoses take less time and save operation and overall hospital costs.
MeSH term(s)	Anastomosis, Surgical ; Cost-Benefit Analysis ; Diagnosis-Related Groups ; Humans ; Retrospective Studies ; Surgical Stapling
Language	English
Publishing date	2020-10-23
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2020.09.002
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Article ; Online: Colectomy with ileostomy for severe ulcerative colitis-postoperative complications and risk factors.

Schineis, C / Lehmann, K S / Lauscher, J C / Beyer, K / Hartmann, L / Margonis, G A / Michel, J / Degro, C E / Loch, F N / Speichinger, F / Kreis, M E / Kamphues, C

International journal of colorectal disease

2019 Volume 35, Issue 3, Page(s) 387–394

Abstract: Purpose: In the era of biological therapy of ulcerative colitis (UC), surgical treatment frequently consists of colectomy, end ileostomy, and rectal stump closure before patients go on towards restorative proctocolectomy. We aimed to evaluate possible ... ...

Abstract	Purpose: In the era of biological therapy of ulcerative colitis (UC), surgical treatment frequently consists of colectomy, end ileostomy, and rectal stump closure before patients go on towards restorative proctocolectomy. We aimed to evaluate possible risk factors for the occurrence of postoperative complications and investigate those after initial colectomy in these patients. Methods: Retrospective analysis of 180 patients (76 female, 104 male) undergoing colectomy for UC with formation of a rectal stump and terminal ileostomy between March 2008 and March 2018 at Charité University Hospital Berlin, Campus Benjamin Franklin. A panel of possible postoperative complications was established, patient history was screened, and postoperative complications were analyzed using the Clavien Dindo Classification. Results: Postoperative complication rate was 27.7%. Mortality was 0.5%. Postoperative ileus occurred in 15.3% and rectal stump leakage in 14.8%. Complications were categorized as Clavien Dindo 3 in 80%. Risk factors for surgical complications after multivariate analysis were ASA classification (p = 0.004), preoperative anemia (Hemoglobin < 8 mg/dl) (p = 0.025), use of immunosuppressants (p = 0.003), more than two cardiovascular diseases (p = 0.016), and peritonitis (p = 0.000). Reoperation rate of patients with surgical complications was 27.7%. Conclusion: Colectomy in high-risk UC patients is associated with significant morbidity. However, most of the surgical complications can be treated conservatively. Overall mortality is low. Patient-related risk factors are associated with postoperative complications. Optimizing these risk factors or earlier indication for surgery in the course of UC may help to reduce morbidity of this procedure.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects ; Colitis, Ulcerative/surgery ; Female ; Humans ; Ileostomy/adverse effects ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors ; Young Adult
Language	English
Publishing date	2019-12-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-019-03494-w
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Article ; Online: Risk factors for reoperation after ileostomy reversal - Results from a prospective cohort study.

Schneider, V / Lee, L D / Stroux, A / Buhr, H J / Ritz, J P / Kreis, M E / Lauscher, J C

International journal of surgery (London, England)

2016 Volume 36, Issue Pt A, Page(s) 233–239

Abstract: Background: Ileostomy reversal is frequently performed in abdominal surgery. Postoperative complications after ileostomy reversal are encountered in around 20% of patients. Data regarding risk factors for reoperation after ileostomy closure are scarce. ... ...

Abstract	Background: Ileostomy reversal is frequently performed in abdominal surgery. Postoperative complications after ileostomy reversal are encountered in around 20% of patients. Data regarding risk factors for reoperation after ileostomy closure are scarce. The purpose of this prospective trial was to determine risk factors for operative revision after ileostomy closure. Materials and methods: This is an additional post hoc analysis of a two center prospective trial. After enrollment, patient characteristics and intraoperative details were analyzed. Patients were followed up at one postoperative visit before discharge and at a three months postoperative visit by standardized questionnaire. All reoperations occurring in the three months period after surgery were analyzed, and immediate reoperations which were directly related to the ileostomy reversal were analyzed separately. Results: 118 patients with elective ileostomy reversal were included in the trial. 12 out of 106 patients (11.3%) underwent any reoperation within three months after surgery (Clavien-Dindo grade IIIb). On multivariate analysis, anemia was associated with any reoperation p = 0.004; OR 6.93 (95% CI 1.37-30.07). Six out of 114 patients (5.3%) required an immediate reoperation (small bowel perforation, anastomotic leakage, postoperative ileus, deep wound infection) due to surgical complications directly related to the ileostomy reversal. Higher body mass index and anemia were associated with immediate reoperations (BMI: p = 0.038; OR 0.73 (95% CI 0.55-0.98); anemia: p = 0.001; OR 25.50 (95% CI 3.87-168.21). Conclusion: Surgical complications after ileostomy reversal occurred to a substantial extent. Rate of reoperations was associated with anemia and high body mass index. Optimizing patients in terms of preoperative hemoglobin and BMI may reduce surgical complications after ileostomy closure.
MeSH term(s)	Adult ; Aged ; Anastomotic Leak/epidemiology ; Anastomotic Leak/surgery ; Anemia/epidemiology ; Cohort Studies ; Colorectal Neoplasms/surgery ; Female ; Humans ; Ileostomy/methods ; Ileus/epidemiology ; Ileus/surgery ; Intestinal Perforation/epidemiology ; Intestinal Perforation/surgery ; Intestine, Small/surgery ; Male ; Middle Aged ; Multivariate Analysis ; Overweight/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery ; Prospective Studies ; Reoperation/statistics & numerical data ; Risk Factors ; Suction/methods ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/surgery
Language	English
Publishing date	2016-12
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2016.10.043
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Article ; Online: Necessity of subcutaneous suction drains in ileostomy reversal (DRASTAR)-a randomized, controlled bi-centered trial.

Lauscher, J C / Schneider, V / Lee, L D / Stroux, A / Buhr, H J / Kreis, M E / Ritz, J P

Langenbeck's archives of surgery

2016 Volume 401, Issue 4, Page(s) 409–418

Abstract: Purpose: Data regarding length of hospital stay of patients undergoing ileostomy reversal are very heterogeneous. There are many factors that may have an influence on the length of postoperative hospital stay, such as postoperative wound infections. One ...

Abstract	Purpose: Data regarding length of hospital stay of patients undergoing ileostomy reversal are very heterogeneous. There are many factors that may have an influence on the length of postoperative hospital stay, such as postoperative wound infections. One potential strategy to reduce their incidence and to decrease hospital stay is to insert subcutaneous suction drains. The purpose of this study was to examine the influence of the insertion of subcutaneous suction drains on hospital stay and postoperative wound infections in ileostomy reversal. Risk factors for postoperative wound infection were determined. Methods: This is a randomized controlled two-center non-inferiority trial with two parallel groups. The total length of hospital stay as primary endpoint and the occurrence of a surgical site infection, the colonization of the abdominal wall with bacteria, and the occurrence of hematomas/seromas as secondary endpoints were monitored. Results: One hundred eighteen patients with elective ileostomy reversal were included. Fifty-nine patients were randomly assigned to insertion of a subcutaneous suction drain, and 59 patients were randomly assigned to receive no drain. After 3 months of follow-up, 50 patients in the group with drain and 53 patients in the group without drain could be analyzed. Median total length of hospital stay was 8 days in the SD group and 9 days in the group without SD (p = 0.17). Fourteen percent of patients with SD and 17 % without SD developed SSI, p = 0.68. Multivariate analysis revealed anemia (p < 0.01), intraoperative bowel perforation (p = 0.02) and resident (p = 0.04) or fellow (p = 0.048) performing the operation as risk factors for SSI. Conclusions: This trial shows that the omission of subcutaneous suction drains is not inferior to the use of subcutaneous suction drains after ileostomy reversal in terms of length of hospital stay, surgical site infections, and hematomas/seromas.
MeSH term(s)	Adult ; Aged ; Drainage/instrumentation ; Female ; Humans ; Ileostomy ; Intestinal Diseases/surgery ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Reoperation ; Risk Factors ; Suction/instrumentation ; Surgical Wound Infection/etiology ; Surgical Wound Infection/prevention & control
Language	English
Publishing date	2016-06
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-016-1436-x
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Article ; Online: Erfahrungen aus über 2100 Hernienreparationen. Wie hat sich die Therapie in den letzten 15 Jahren verändert?

Lauscher, J C / Buhr, H J / Gröne, J / Ritz, J P

Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen

2010 Volume 82, Issue 3, Page(s) 255–262

Abstract: Introduction: Inguinal hernia (IH) surgery has changed fundamentally during the last 25 years due to tension-free repair, minimally-invasive approaches and growing influence of economy in medical decision making. Aim of the study was the documentation ... ...

Title translation	Experiences from more than 2,100 hernia repair operations. How has the therapy changed in the last 15 years?.
Abstract	Introduction: Inguinal hernia (IH) surgery has changed fundamentally during the last 25 years due to tension-free repair, minimally-invasive approaches and growing influence of economy in medical decision making. Aim of the study was the documentation and analysis of changes in IH surgery during the last 15 years in our patient cohort. Material and methods: Patients undergoing elective or emergency inguinal/femoral hernia repair from January 1995 to December 2009 were included in the study. Analysis of patient data was carried out by prospective online recording. Results: A total of 1,908 patients with 2,124 IHs were treated in the study period and the number of IH repairs decreased continuously. The number of recurrent hernias peaked in 2005-2009 with 16.4%. The average preoperative hospital stay decreased from 2.4 to 0.4 days and the postoperative hospital stay from 7.0 to 3.3 days. The percentage of suture repairs declined from 54.9% in 1995 to 4.1% in 2009 and the percentage of open tension-free repairs rose to 52.9% in 1998. In the following years the majority of repairs were performed by minimally invasive procedures but in 2009 the percentage of conventional hernia repairs exceeded the rate of minimally invasive repairs. Conclusion: The main reason for these changes is the implementation of diagnosis-related groups which hampers inpatient repair of "simple" inguinal hernias, favors short hospital stay and does not adequately reimburse minimally invasive repairs.
MeSH term(s)	Antibiotic Prophylaxis/trends ; Biocompatible Materials ; Cross-Sectional Studies ; Diagnosis-Related Groups/trends ; Forecasting ; Germany ; Hernia, Femoral/epidemiology ; Hernia, Femoral/surgery ; Hernia, Inguinal/epidemiology ; Hernia, Inguinal/surgery ; Humans ; Length of Stay/trends ; Minimally Invasive Surgical Procedures/statistics & numerical data ; Minimally Invasive Surgical Procedures/trends ; National Health Programs/trends ; Prospective Studies ; Recurrence ; Reimbursement Mechanisms/trends ; Reoperation/trends ; Surgical Mesh/statistics & numerical data ; Surgical Mesh/trends ; Suture Techniques/trends ; Utilization Review
Chemical Substances	Biocompatible Materials
Language	German
Publishing date	2010-08-10
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1521-0
ISSN	1433-0385 ; 0009-4722
ISSN (online)	1433-0385
ISSN	0009-4722
DOI	10.1007/s00104-010-1969-4
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Article ; Online: Long-term follow-up after incisional hernia repair: are there only benefits for symptomatic patients?

Lauscher, J C / Loh, J C / Rieck, S / Buhr, H J / Ritz, J P

Hernia : the journal of hernias and abdominal wall surgery

2012 Volume 17, Issue 2, Page(s) 203–209

Abstract: Introduction: Incisional hernias are among the most frequent complications in visceral surgery and are currently considered to be an indication for surgery in all cases, regardless of the patient's symptoms. However, it still remains unclear to what ... ...

Abstract	Introduction: Incisional hernias are among the most frequent complications in visceral surgery and are currently considered to be an indication for surgery in all cases, regardless of the patient's symptoms. However, it still remains unclear to what extent surgery actually results in improvement according to objective (e.g., less pain or dysesthesia) or subjective criteria (e.g., less discomfort or better cosmetic result). The purpose of this prospective study was to identify patients who derive objective and subjective benefit from surgical repair. Materials and methods: This prospective study included patients who underwent open incisional hernia repair with mesh implantation from December 2006 to April 2009. Data were collected before and 18 months after surgery. Pain intensity was rated on the numerical analog scale (NAS) pre- and postoperatively. Patients were divided into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups based on their preoperative pain level, and the postoperative outcome of the two groups was compared by standardized questionnaire. Results: Ninety patients were prospectively enrolled, 45 (50 %) of each gender. Prior to surgery, 43 patients (47.8 %) were oligosymptomatic, and 47 (52.2 %) reported clinically relevant pain. Eighteen months after surgery, 7.5 % of the oligosymptomatic patients complained of clinically relevant pain; its rate remained unchanged. The symptomatic group showed a significant reduction in clinically relevant pain from 100 % to 14.0 %, (p < 0.001). The percentage of patients with clinically relevant dysesthesia was 12.5 % in the oligosymptomatic and 20.9 % in the symptomatic group 18 months postoperatively. The overall recurrence rate was 13.3 % after 18 months without difference in both groups. A reduction in discomfort in the surgical area was reported by 77.5 % of the oligosymptomatic and 79.1 % of the symptomatic patients. Conclusions: Symptomatic patients definitely profit from surgical repair in the long-term course. However, the notable postoperative rate of clinically relevant pain and dysesthesia in oligosymptomatic patients and their high recurrence rate cast doubt on whether they really benefit from surgical repair. The remarkable degree of subjective satisfaction in oligosymptomatic patients should not be underestimated.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Asymptomatic Diseases ; Continuity of Patient Care ; Female ; Hernia, Ventral/complications ; Hernia, Ventral/surgery ; Herniorrhaphy ; Humans ; Male ; Middle Aged ; Pain, Postoperative/epidemiology ; Prospective Studies ; Therapeutics
Language	English
Publishing date	2012-07-11
Publishing country	France
Document type	Journal Article
ZDB-ID	1388125-5
ISSN	1248-9204 ; 1265-4906
ISSN (online)	1248-9204
ISSN	1265-4906
DOI	10.1007/s10029-012-0955-9
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Article ; Online: Totale extraperitoneale Hernioplastik: Schmerzen und Dysästhesien im Langzeitverlauf.

Lauscher, J C / Yafaei, K / Buhr, H J / Ritz, J-P

Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen

2009 Volume 80, Issue 10, Page(s) 956–965

Abstract: Introduction: Minimally invasive repair with alloplastic material for inguinal hernia has become a method with few complications and a low recurrence rate. Persistent pain and dysesthesia years after the procedure are however of growing clinical ... ...

Title translation	Pain and dysesthesia following total extraperitoneal hernia repair.
Abstract	Introduction: Minimally invasive repair with alloplastic material for inguinal hernia has become a method with few complications and a low recurrence rate. Persistent pain and dysesthesia years after the procedure are however of growing clinical interest. It is still unknown to what degree initial pain or dysesthesia change in the long term. Therefore this study was done to evaluate patient complaints following total extraperitoneal repair (TER) over a long observation period. Materials and methods: Included in the study were patients from January 2000 to December 2006 who were treated electively for uni- or bilateral inguinal hernia using TER. Exclusion criteria were emergency procedures, incarcerated hernia, and scrotal hernia. The patient data were collected using a prospective online data system and evaluation of long-term results via standardized questionnaires determining persisting pain, dysesthesia, physical limitations from the surgery, satisfaction with the operation, and recurrences. The patients were grouped according to length of follow-up after surgery: 12-36 months (group 1), 37-60 months (group 2), and 61-96 months (group 3). Results: Since January 2000, 484 patients 18 to 97 years old with 620 inguinal hernias were operated. Of those, 349 were evaluated for this study (proportion of returned questionnaires: 72.1%). No significant differences were noted in patient characteristics or early postoperative complications. The percentage of patients suffering from relevant pain (moderate to severe) dropped significantly: 10.3% (group 1) vs 1.0% (group 2) (P<0.05) and 3.4% (group 3) (P<0.05). No significant differences were found concerning dysesthesia (19.6% in group 1 vs 19.2% in group 3). There were no significant differences in satisfaction with the operation, as 73.8% in group 1, 67.7% in group 2, and 73.3% in group 3 were very satisfied with the results. The number of recurrences increased during the observation period: 1.9% in group 1, 3.1% in group 2, and 5.5% in group 3 (P>0.05). Conclusions: Total extraperitoneal repair is a reliable method with low recurrence rate and high patient satisfaction. A relevant proportion of patients complain however of pain and dysesthesia persisting over years. The data from this study show that in the long term, pain incidence drops significantly while the rate of dysesthesia remains constant. Long follow-up is needed to evaluate the long-term course of persistent pain. For more precise understanding of the long-term results of herniotomy, prospective randomized studies are needed with accordingly long follow-up.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Hernia, Inguinal/surgery ; Humans ; Length of Stay ; Middle Aged ; Pain/etiology ; Pain Measurement ; Paresthesia/etiology ; Patient Selection ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Treatment Outcome ; Young Adult
Language	German
Publishing date	2009-04-23
Publishing country	Germany
Document type	English Abstract ; Journal Article
ZDB-ID	1521-0
ISSN	1433-0385 ; 0009-4722
ISSN (online)	1433-0385
ISSN	0009-4722
DOI	10.1007/s00104-009-1705-0
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Conference proceedings: Wie hat sich die Therapie von Leistenhernien in den letzten 15 Jahren verändert? Erfahrungen aus über 2.100 Hernienreparationen

Ritz, J.P. / Lauscher, J.C. / Buhr, H.J.

2009 , Page(s) 09dgch11124

Event/congress	126. Kongress der Deutschen Gesellschaft für Chirurgie; München; Deutsche Gesellschaft für Chirurgie; 2009
Keywords	Medizin, Gesundheit
Publishing date	2009-04-23
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/09dgch238
Database	German Medical Science

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