U T Hopt

Publications (206)309.94 Total impact

• Article: Prognosefaktoren geriatrischer chirurgischer Intensivpatienten

  P.K. Baier, P. Ober, M. Kaffanik, M. Hüll, U.T. Hopt, S. Utzolino
  [show abstract] [hide abstract]
  ABSTRACT: Um die Ergebnisse der Intensivtherapie geriatrischer Patienten (≥75Jahre) einer chirurgischen Intensivstation zu analysieren, wurden 314Krankenakten retrospektiv ausgewertet und das Überleben der Patienten durch Nachsuche ermittelt. Es ergab sich ein 5-Jahres-Überleben von über 20%. Einfluss auf die Mortalität hatten insbesondere die Nebendiagnosen KHK, Pneumonie und Niereninsuffizienz sowie die notwendigen intensivmedizinischen Maßnahmen Beatmung, Katecholamintherapie und Dialyse. Keinen Einfluss hatten das Alter oder stattgehabte Operationen. Erkrankungsschwere und Intensität der Therapie gemessen im APACHE-Score bzw. Core-10-TISS, korrelierten gut mit der Letalität, sind aber zu ungenau, um im Einzellfall eine Prognose zu rechtfertigen. To investigate the outcome of geriatric surgical intensive care patients (age ≥75 years), we analyzed 314 patient files and determined patient survival. The 5-year survival exceeded 20%. Mortality was influenced by concomitant diseases (CHD, pneumonia, renal insufficiency) and intensive care procedures (mechanical ventilation, catecholamine therapy and dialysis). Neither patient age nor the operative procedure influenced survival. However, severity of illness and invasiveness of intensive care, measured by APACHE and Core-10 TISS, correlated well with mortality but were not able to predict mortality for a specific patient.
  Intensivmedizin + Notfallmedizin 05/2012; 46(5):355-360.
• Article: Pankreasleckage nach Pankreasresektion Eine Analyse von 345 operierten Patienten

  U. Adam, F. Makowiec, H. Riediger, S. Benz, S. Liebe, U. T. Hopt
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  ABSTRACT: Einleitung. Trotz einer zunehmend sinkenden Letalität bleiben Komplikationen nach Pankreasresektion häufig. Pankreasleckagen stellen einen relevanten Anteil an den postoperativen Komplikationen dar, aber Daten zu Risikofaktoren sind rar. Anhand eines umfangreichen Patientenkollektives analysierten wir in vorliegender Arbeit Inzidenz, Verlauf und Risikofaktoren der postoperativen Pankreasleckage. Methoden. Die prospektiv erhobenen perioperativen Daten von 345 zwischen 1994 und 2001 durchgeführten Pankreasresektionen wurden ausgewertet. Indikationen zur Operation waren hauptsächlich eine chronische Pankreatitis (57%) und maligne Tumoren (36%). Folgende Operationsverfahren wurden durchgeführt: klassische Whipple-Operation (15%), pyloruserhaltende Pankreaskopfresektion (53%), duodenumerhaltende Kopfresektion (19%) und distale Resektion (13%). Die Analyse von Risikofaktoren wurde univariat und multivariat durchgeführt. Ergebnisse. Die Letalität betrug 2,9%, die Morbidität 41%. Eine Pankreasleckage trat bei 9,9% der Patienten auf, war aber in der Mehrzahl asymptomatisch und konnte durch Drainagenbelassung beherrscht werden. Ein Viertel der Patienten mit einer Pankreasleckage musste reoperiert werden. Die Letalität der Komplikation betrug 12%, aber kein Patient mit chronischer Pankreatitis verstarb wegen einer Pankreasleckage. Einzig signifikanter Risikofaktor für eine Pankreasleckage war ein präoperativ erhöhter Kreatininwert. Schlussfolgerungen. Obwohl in der Mehrzahl problemlos, stellen Pankreasleckagen nach Pankreasresektion vor allem bei Tumorpatienten weiterhin klinisch relevante Komplikationen dar. Da Patienten mit präoperativ eingeschränkter Nierenfunktion ein erhöhtes Risiko dieser Komplikation aufwiesen, sollte dieser Tatsache perioperativ besonderes Augenmerk geschenkt werden. Introduction. Complications after pancreatic resections remain frequent despite a decreasing mortality. Pancreatic leakages represent a relevant part of those complications but data on risk factors for their occurrence are rare. We analyzed our experience with incidence, clinical course, and risk factors of pancreatic leakage in a large patient group. Methods. We analyzed the prospectively documented perioperative data of 345 patients with pancreatic resections carried out between 1994 and 2001. Main indications for surgery were chronic pancreatitis (57%) and malignant tumors (37%). The following operations were performed: Whipple's operation 15%, pylorus-preserving pancreaticoduodenectomy 53%, duodenum-preserving pancreatic head resection 19%, and distal pancreatic resection 13%. Risk factors were analyzed using uni- and multivariate methods. Results. Postoperative mortality and complication rate were 2.9% and 41%, respectively. A pancreatic leakage occurred in 9.9%. In the majority of patients, pancreatic leakage was asymptomatic and controlled by prolonged drainage. However, one fourth of the patients with pancreatic leakage required reoperation. The mortality of pancreatic leakage was 12%. No patient with chronic pancreatitis died as a consequence of pancreatic leakage. Impaired preoperative renal function was the only risk factor for the occurrence of postoperative pancreatic leakage. Conclusions. Although easily managed in the majority of cases, pancreatic leakage still represents a relevant postoperative complication after pancreatic resection, especially in patients with malignant disease. Because of an increased risk of developing pancreatic leakage, an impaired renal function should be considered specifically in the perioperative management of the patients.
  Der Chirurg 05/2012; 73(5):466-473. · 0.70 Impact Factor
• Article: Physiologie der Anastomosenheilung

  G. Marjanovic, U.T. Hopt
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  ABSTRACT: In der gastrointestinalen Chirurgie ist die Anastomoseninsuffizienz immer noch eine der am meisten gefürchteten und bedeutendsten Komplikationen. Für den Chirurg ist das exakte Verständnis der Abläufe der Anastomosenheilung und möglicher Schwachstellen genauso wichtig wie die richtige Anastomosentechnik. Die Heilung intestinaler Anastomosen ist ein komplexer, zellulär vermittelter Prozess mit dem Ziel der primären Wiederherstellung der Darmkontinuität. Die frühen Phasen der Anastomosenheilung sind für viele Störfaktoren am anfälligsten, was sich letztlich klinisch in der Auftretenswahrscheinlichkeit der Anastomoseninsuffizienz widerspiegelt. Die chirurgische Forschung im Bereich der Anastomosenheilung sollte sich in Zukunft von den rein störfaktororientierten Ansätzen mehr auf die zelluläre und molekulare Ebene verlagern. Hierdurch kann ein besseres Verständnis der genauen Heilungsprozesse erlangt und die Entwicklung neuer diagnostisch-prädiktiver und therapeutischer Methoden vorangetrieben werden. Anastomotic insufficiency still remains the most dreaded complication following digestive surgery. The surgeon’s understanding of the mechanisms underlying anastomotic healing and the possible weak points are just as important as a correct anastomotic technique. Intestinal anastomotic healing is a complex, cell-mediated process which aims at restoring bowel wall continuity. The early stages of anastomotic healing are most susceptible to various sources of irritation, which is reflected by the likelihood of early anastomotic insufficiency. In our opinion, the focus of future research should shift from primarily examining pathogenetic factors to a more cellular and molecular level. A better comprehension of the anastomotic healing process might thus promote the development of new diagnostic predictive and therapeutic methods. SchlüsselwörterGastrointestinaltrakt–Anastomose–Wundheilung–Physiologie–Anastomoseninsuffizienz KeywordsGastro-intestinal tract–Anastomosis–Wound healing–Physiology–Anastomic insufficiency
  Der Chirurg 04/2012; 82(1):41-47. · 0.70 Impact Factor
• Article: Erfolgreiche lokale Katheterfragmentation und Thrombolyse bei akuter Lungenembolie in der frühen postoperativen Phase nach Pankreaskopfresektion

  R. Obermaier, J. C. Kröger, S. Benz, F. Makowiec, W. Schareck, U. Adam, U. T. Hopt
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  ABSTRACT: Lungenembolien in der frühen postoperativen Phase sind immer noch mit hoher Morbidität und Letalität verbunden. Eine systemische Lyse ist in dieser Phase aufgrund der zu befürchtenden Blutungskomplikationen kontraindiziert, die operative Thromembolektomie ist mit einer hohen Letalität verbunden. Wir berichten über den Fall einer erfolgreichen lokalen Thrombolyse in Kombination mit Katheterfragmentation einer am 4. postoperativen Tag diagnostizierten massiven beidseitigen Lungenembolie nach pyloruserhaltender partieller Duodenopankreatektomie mit Lymphadenektomie bei distalem Choledochuskarzinom. Die Thrombolyse erfolgte in 3 Sitzungen durch Kombination der kathetergestützten interventionellen Thrombusfragmentation mit lokaler rt-PA-Lysetherapie. Im Verlauf zeigten sich keine Blutungskomplikationen, ebenfalls kam es zu keiner Störung der Anastomosenheilung. Der Patient konnte am 23. postoperativen Tag nach Umstellung auf einen Vitamin-K-Antagonisten aus der stationären Behandlung entlassen werden. Der vorliegende Fall zeigt die Möglichkeit der lokalen Lyse in Kombination mit interventionellen Methoden zur Therapie der massiven Lungenembolie in der frühen postoperativen Phase als Alternative zu operativen Strategien auf. Pulmonary embolism in the early postoperative period is characterized by high morbidity and mortality. Systemic application of thrombolytic agents during this time is contraindicated; operative thrombectomy also has a high mortality rate. We report a case of successful local lysis in combination with catheter fragmentation of a massive two-sided pulmonary embolism diagnosed on the 4th postoperative day after pylorus-preserving duodenopancreatectomy for distal carcinoma of the common bile duct. Thrombolysis was performed in three sessions by a combination of catheter-supported interventional fragmentation of the thrombus with local rt-PA lysis. There were no bleeding complications or disturbances of anastomotic healing. The patient was discharged from the hospital on the 23rd postoperative day after changing anticoagulation to a vitamin K antagonist. The case presented demonstrates the possibility of local lysis in combination with interventional methods as a therapeutic option for pulmonary embolism in the early postoperative period as an alternative to surgical strategies.
  Der Chirurg 04/2012; 73(9):945-949. · 0.70 Impact Factor
• Article: Kostenträgerrechnung in der Pankreaschirurgie

  D. Tittelbach-Helmrich, L. Abegg, U. Wellner, F. Makowiec, U.T. Hopt, T. Keck
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  ABSTRACT: HintergrundPankreaskopfresektionen sind heute in Zentren mit einer niedrigen Mortalität, jedoch weiterhin hohen Morbidität assoziiert. Die Komplikationsrate kann durch langjährige Erfahrung sowie Behandlung in sogenannten High-volume-Zentren signifikant reduziert werden. In der vorliegenden Studie soll auf dem Boden einer Kostenträgerrechnung der Einfluss postoperativer Komplikationen auf die Gesamtkosten und -erlöse analysiert werden. Patienten und MethodenAus den Jahren 2005 und 2006 wurden insgesamt 36 Patienten in die Analyse eingeschlossen. Daten zu Operationszeit, Aufenthaltsdauer, Komplikationsrate und Kosten wurde retrospektiv erhoben und ausgewertet. Gruppenvergleiche erfolgten mittels Mann-Whitney-U-Test: Ein p-Wert <0,05 wurde als signifikant angesehen. ErgebnisseBei Auftreten von Komplikationen verlängerte sich die Dauer des stationären Aufenthaltes von im Median 16 (11–38) auf 33 (10–69) Tage. Die durchschnittlichen Gesamtkosten, insbesondere für die Intensivtherapie und bildgebende diagnostische Verfahren, erhöhten sich signifikant. Insgesamt entstanden Kosten von 10.015EUR (8099–14.785EUR) bei Patienten ohne Komplikationen (n=21) und 15.339,5EUR (9368–31.418EUR) bei Patienten mit Komplikationen (n=15). Demgegenüber stehen durchschnittliche Erlöse von 13.835EUR (10.441–15.062EUR) bzw. 15.062EUR (10.441–33.217EUR) nach dem DRG-System. SchlussfolgerungDie Kostenträgerrechnung zeigt, dass Pankreaschirurgie nur in Zentren mit niedrigen Komplikationsraten kostenneutral durchgeführt werden kann. Die Konzentrierung der Pankreaschirurgie auf Zentren mit geringen Komplikationsraten, möglichst High-volume-Zentren, muss daher auch aus ökonomischer Sicht befürwortet werden. BackgroundPancreatic resections in specialized centers are associated with low mortality, however, still with high morbidity. The complication rate can be reduced by long-term experience in high volume centers. In this study the influence of complications on costs in the German DRG system were analyzed. Patients and methodsData regarding operation time, hospital stay, complications and costs of 36 patients undergoing pancreatic head resection in the years 2005 and 2006 were collected and analyzed retrospectively. Statistical analysis was performed using the Mann-Whitney U-test. A p-value of p<0.05 was considered statistically significant. ResultsPostoperative complications caused an increase in the duration of hospital stay from a median of 16 (range 11–38) to 33 (10–69) days. Costs, especially for ICU treatment and radiographic diagnostics, rose significantly. The average overall costs were 10,015EUR (range 8,099–14,785EUR) in patients without complications (n=21) and 15,340EUR (9,368–31,418EUR) in patients with complications (n=15). In contrast, according to the German DRG system 13,835EUR (10,441–15,062EUR) and 15,062EUR (10,441–33,217EUR) were refunded on average, respectively. ConclusionsThis case-cost calculation proves that pancreatic surgery in the context of the German DRG system can only be performed economically neutral in centers with low complications rates. The concentration of pancreatic surgery to centers with low complications rates, namely high volume centers, must be recommended from an economic point of view. SchlüsselwörterPankreaschirurgie–Mindestmengen–Kostenträgerrechnung–High-volume-Zentren–Postoperative Komplikationen KeywordsPancreatic surgery–Minimum amount–Insurance costs–High volume centers–Postoperative complications
  Der Chirurg 04/2012; 82(2):154-159. · 0.70 Impact Factor
• Article: Pankreastransplantation

  O. Drognitz, H. Neeff, U.T. Hopt, P. Pisarski
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  ABSTRACT: Die klinische Pankreastransplantation ist ein hoch effektives Verfahren zur Wiederherstellung der physiologischen Blutzuckerkontrolle bei Diabetikern. Im Gegensatz zur Inselzelltransplantation können für die Mehrzahl der Patienten Langzeitinsulinfreiheiten von deutlich mehr als 5Jahren erreicht werden. Die simultane Pankreas-Nieren-Transplantation ist die Therapie der Wahl in der Behandlung von Typ-I-Diabetikern mit terminaler Niereninsuffizienz. Sie führt zu einer Verdreifachung der Lebenserwartung verglichen mit Patienten auf der Warteliste. Dies wird im Wesentlichen auf eine Reduktion der kardiovaskulären Mortalität zurückgeführt. Der vorliegende Artikel beschreibt die Pankreastransplantation im Hinblick auf Indikationen, Timing, chirurgische Technik, Komplikationen und Ergebnisse. Pancreas transplantation is an effective and highly successful procedure for restoring physiological glucose control in diabetics. In contrast to islet transplantation, long-term results beyond 5years can be achieved for the majority of patients. Simultaneous pancreas and kidney transplantation is the therapy of choice for type1 diabetics with end-stage renal failure. This procedure leads to a threefold longer life expectancy compared with patients on the waiting list. These results are mainly due to a decreased mortality rate from cardiovascular events. This article reviews the indications, timing, surgical technique, complications, and results of pancreas transplantation.
  Der Gastroenterologe 04/2012; 4(6):540-547.
• Article: Perkutane endoskopische Gastrostomie

  O. Ruthmann, A. Seitz, S. Richter, G. Marjanovic, M. Olschewski, U.T. Hopt, A. Fischer, H.-J. Schrag
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  ABSTRACT: HintergrundDie perkutane endoskopische Gastrostomie (PEG) wird bislang als Hochrisikoeingriff klassifiziert (ASGE-Leitlinien). Koagulopathien, Thrombozytenaggregationshemmer (Aspirin, Clopidogrel u.a.) und Phenprocoumon bzw. Wafarine gelten als Kontraindikationen. Die Studie untersucht erstmals Komplikationen und Risikofaktoren bei Patienten mit und ohne Antikoagulation. Material und MethodenAn der Klinik für Allgemein- und Viszeralchirurgie der Universität Freiburg wurden zwischen 2001 and 2007 insgesamt 450Patienten mit neurologischer Dysphagie mit einer PEG versorgt und prospektiv während des stationären Aufenthalts untersucht. Die Patienten wurden drei Gruppen zugewiesen: Gruppe1: keine Antikoagulation (n=50), Gruppe2: Prophylaxe mit niedermolekularem Heparin (NMH, n=152), Gruppe3: therapeutische Antikoagulation und Thrombozytenaggregationshemmer (UFH, NMH, Phenprocoumon, Acetysalicylsäure, Clopidogrel und Kombinationen, n=248). 11 Risikofaktoren und die Komplikationen Infektion, Blutung und Peritonitis wurden univariat analysiert (p-Wert, Odds Ratio [OR], 95%-Konfidenzintervall [KI]). ErgebnisseDer mittlere stationäre Aufenthalt betrug 27,4 Tage (1–268). Die Krankenhausmortalität betrug 6%. Ein PEG-abhängiger Todesfall trat nicht auf. Es zeigten sich 6,6% peristomale Infekte (n=30) und 1,3% Peritonitiden (n=6). Eine Post-PEG-Blutung wurde weder mit noch ohne Antikoagulation beobachtet. Die untersuchten Risikofaktoren zeigten sich in der Vorhersage auf o.g. Komplikationen statistisch nicht signifikant und konnten aufgrund der geringen Anzahl nicht multivariat getestet werden. SchlussfolgerungKomplikationen der PEG mit der Fadendurchzugsmethode sind per se selten. Ein erhöhtes PEG-assoziiertes Blutungsrisiko unter therapeutischer Antikoagulation wurde nicht beobachtet. Unseres Erachtens kann nach den vorliegenden Daten bei ausgewählten Patienten mit hohen Thromboembolierisiken eine PEG-Anlage auch ohne Absetzen der Antikoagulation erfolgen. BackgroundPercutaneous endoscopic gastrostomy (PEG) has been classified to date as a high-risk procedure (ASGE guidelines). Coagulopathies, thrombocyte aggregation inhibitors (Aspirin, clopidogrel etc.) and phenprocoumone or warfarin are considered to be contraindications. The study examined for the first time the risk factors in patients with and without concurrent anticoagulation. MethodsBetween 2001 and 2007 PEGs were placed in 450 patients with neurological diseases at the University Hospital for General and Visceral Surgery in Freiburg and studied prospectively during hospitalization. The patients were divided into 3 groups: group 1 controls (n=50, no anticoagulation), group 2 low-molecular-weight heparin (LMWH) prophylaxis (n=152) and group 3 therapeutic anticoagulation (unfractionated heparin, phenprocoumone, therapeutic LMWH, aspirin, clopidorel and combinations, n=248). Univariate analyses were performed to determine risk factors for the occurrence of infection, bleeding and peritonitis. The p-values (p), odds ratios (OR) and 95% confidence intervals (CI) are given. ResultsThe average hospitalization time was 27.4 days (range 1–268 days) and hospital mortality was 6%. There were no cases of death due to the PEG. Complications included peristomal infections (n=30, 6.6%) and peritonitis (n=6, 1.3%). Post-PEG bleeding did not occur either with or without anticoagulation. The investigated risk factors showed no statistically significant values with respect to prognosis for these complications. Multivariate testing could not be carried out due to the low number of complications. ConclusionComplications of PEG placement with the method used here are rare. An increased risk of bleeding during therapeutic anticoagulation was not observed. In our opinion the present data indicate that PEG placement can be carried out in selected patients with increased risk of thromboembolism without discontinuation of anticoagulation. SchlüsselwörterPerkutane Endoskopische Gastrostomie-Komplikationen-Risikofaktoren-Antikoagulation KeywordsPercutaneous endoscopic gastrostomy-Complication-Risk factors-Anticoagulation
  Der Chirurg 04/2012; 81(3):247-254. · 0.70 Impact Factor
• Article: Totale Pankreatektomie

  T. Keck, U.T. Hopt
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  ABSTRACT: Die stetige Reduktion von Morbidität und Mortalität an Zentren für Pankreaschirurgie hat zu einer wesentlichen Änderung der Indikation für die totale Pankreatektomie geführt. Früher wurde die totale Pankreatektomie vor allem als Restpankreatektomie bei Komplikationen durchgeführt. Aktuell dagegen ist die totale Pankreatektomie in der elektiven Chirurgie zur Therapie ausgedehnter intraduktal papillär muzinöser Neoplasien vom „main duct type“ indiziert. Wir diskutieren die Indikationen für die totale onkologische Pankreatektomie, die Restpankreatektomie bei Komplikationen und die Indikationen für eine Entfernung des Organs bei der chronischen Pankreatitis, sowie des Weiteren technische und metabolische Aspekte der totalen Pankreatektomie. Permanent reduction of morbidity and death in centers for pancreatic surgery has led to a change in the indication for total pancreatectomy from rescue pancreatectomy for complications of pancreatic surgery increasingly to elective surgery, especially in the management of advanced intraductal papillary mucinous neoplasms. We discuss the indication for oncologic total pancreatectomy, rescue pancreatectomy, and removal of the whole pancreas for chronic pancreatitis. Furthermore we describe technical and metabolic aspects following total pancreatectomy.
  Der Chirurg 04/2012; 79(12):1134-1140. · 0.70 Impact Factor
• Article: Immunsuppression bei Pankreasorgan-, Insel(zell)- und Nierentransplantation

  B.M. Jaenigen, S. Meyer, P. Pisarski, O. Drognitz, U.T. Hopt
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  ABSTRACT: Nach Organtransplantation sind die Empfänger ein Leben lang auf die Einnahme von immunsuppressiven Medikamenten angewiesen, um eine Abstoßungsreaktion und somit einen Verlust des Transplantates zu verhindern. Der vorliegende Beitrag zeigt aktuelle Standards auf und diskutiert neue Erkenntnisse der letzten Jahre. Gerade der Bereich der Immunsuppression steht im ständigen Wandel. Ziele der intensiven klinischen Forschungsbemühungen sind nicht nur die Wahl der richtigen Kombination verschiedener Wirkstoffe, sondern ebenso die Findung eines adäquaten therapeutischen Wirkspiegels, um eine Überimmunsuppression, welche mit einer erheblichen Steigerung des Auftretens von Nebenwirkungen einhergeht, zu vermeiden. Organ recipients rely on life-long immunosuppressive therapy in order to avoid organ rejection and graft loss. This report focuses on the current standards in immunosuppression and discusses new findings made in recent years. The field of immunosuppression is constantly changing. The main objective of intensive clinical research is not only choosing the correct immunosuppressive drug combination, but also establishing an appropriate level of effectiveness in order to avoid over-immunosuppression, which is associated with a significant increase in adverse reactions. SchlüsselwörterImmunsuppression-Pankreastransplantation-Insel(zell)-Transplantation-Nierentransplantation-Organtransplantation KeywordsImmunosuppression-Pancreas transplantation-Islets of Langerhans transplantation-Kidney transplantation-Organ transplantation
  Der Diabetologe 04/2012; 6(6):442-450. · 0.25 Impact Factor
• Article: Laparoendoscopic mediastinal vacuum therapy of a gastric perforation through the diaphragm.

  A Fischer, P K Baier, U T Hopt, H J Richter-Schrag
  Endoscopy 12/2011; 43 Suppl 2 UCTN:E393-4. · 5.21 Impact Factor
• Article: [Laparoscopic resection of the pancreatic head. Feasibility and perioperative results].

  T Keck, U Wellner, S Küsters, F Makowiec, O Sick, U T Hopt, K Karcz
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  ABSTRACT: Whereas pancreatic tail resection is routinely and safely performed in several institutions, laparoscopic resection of the pancreatic head is only performed by a handful of surgeons worldwide, none of them in Germany. We review our experience with 9 laparoscopic pancreatic head resections (lap-PPPD) performed between March and September 2010. The operations were performed using a hybrid approach with complete laparoscopic pylorus-preserving pancreatic head resection and successive reconstruction via a small retrieval incision. Perioperative outcome was compared to 605 open pancreatic head resections (1997-2010). In the group lap-PPPD 3 out of 9 conversions had to be performed due to oncologic reasons. There were no significant differences in perioperative outcome when comparing open-PPPD to lap-PPPD. Laparoscopic pancreatic head resection with hybrid open reconstruction combines the potential advantages of laparoscopic resection with the safety of an open pancreatic anastomosis. Even at the beginning of the learning curve the procedure can be performed with no concessions to safety or duration of the operation.
  Der Chirurg 02/2011; 82(8):691-7. · 0.70 Impact Factor
• Article: [Insurance costs in pancreatic surgery : does the pecuniary aspect indicate formation of centers?].

  D Tittelbach-Helmrich, L Abegg, U Wellner, F Makowiec, U T Hopt, T Keck
  [show abstract] [hide abstract]
  ABSTRACT: Pancreatic resections in specialized centers are associated with low mortality, however, still with high morbidity. The complication rate can be reduced by long-term experience in high volume centers. In this study the influence of complications on costs in the German DRG system were analyzed. Data regarding operation time, hospital stay, complications and costs of 36 patients undergoing pancreatic head resection in the years 2005 and 2006 were collected and analyzed retrospectively. Statistical analysis was performed using the Mann-Whitney U-test. A p-value of p<0.05 was considered statistically significant. Postoperative complications caused an increase in the duration of hospital stay from a median of 16 (range 11-38) to 33 (10-69) days. Costs, especially for ICU treatment and radiographic diagnostics, rose significantly. The average overall costs were 10,015 EUR (range 8,099-14,785 EUR) in patients without complications (n = 21) and 15,340 EUR (9,368-31,418 EUR) in patients with complications (n = 15). In contrast, according to the German DRG system 13,835 EUR (10,441-15,062 EUR) and 15,062 EUR (10,441-33,217 EUR) were refunded on average, respectively. This case-cost calculation proves that pancreatic surgery in the context of the German DRG system can only be performed economically neutral in centers with low complications rates. The concentration of pancreatic surgery to centers with low complications rates, namely high volume centers, must be recommended from an economic point of view.
  Der Chirurg 02/2011; 82(2):154-9. · 0.70 Impact Factor
• Article: [The abdominal compartment syndrome - relevance and therapeutic consequences].

  S Utzolino, C Kayser, U T Hopt
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  ABSTRACT: Intra-abdominal hypertension (IAH) has a high prevalence among critically ill patients. It is increasingly recognised as a risk factor for poor outcome. PATIENTS / MATERIAL AND METHODS: A review of the literature including explicit management instructions was performed. We report the standardised techniques for intra-abdominal pressure (IAP) measurement as well as consensus definitions and treatment recommendations ranging from conservative measures to decompression laparotomy. The abdominal compartment syndrome (ACS) is defined as a sustained IAH > 20 mmHg accompanied by new organ dysfunctions. It occurs predominantly in surgical patients and is associated with a poor outcome. Organ dysfunctions related to IAH mainly concern the kidneys and -respiratory system. The mechanism of action essentially is a perfusion deficit. Clinical judgement alone does not allow a valid estimate of intra-abdominal pressure. In patients at risk the IAP should be measured. In case of IAH conservative options for lowering the pressure are mandatory. Decompression laparotomy should be considered if conservative measures fail.
  Zentralblatt für Chirurgie 02/2011; 136(2):129-34. · 1.02 Impact Factor
• Source

  Available from: Simon Kuesters

  Article: Influence of Sleeve Gastrectomy on NASH and Type 2 Diabetes Mellitus.

  W K Karcz, D Krawczykowski, S Kuesters, G Marjanovic, B Kulemann, H Grobe, I Karcz-Socha, U T Hopt, W Bukhari, J M Grueneberger
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  ABSTRACT: Background. Nonalcoholic fatty liver disease is present in up to 85% of adipose patients and may proceed to nonalcoholic steatohepatitis (NASH). With insulin resistance and obesity being the main risk factors for NASH, the effect of isolated sleeve gastrectomy (ISG) on these parameters was examined. Methods. 236 patients underwent ISG with intraoperative liver biopsy from December 2002 to September 2009. Besides demographic data, pre-operative weight/BMI, HbA1c, AST, ALT, triglycerides, HDL and LDL levels were determined. Results. A significant correlation of NASH with higher HbA1c, AST and ALT and lower levels for HDL was observed (P < .05, <.0001, <.0001, <.01, resp.). Overall BMI decreased from 45.0 ± 6.8 to 29.7 ± 6.5 and 31.6 ± 4.4 kg/m(2) at 1 and 3 years. An impaired weight loss was demonstrated for patients with NASH and patients with elevated HbA1c (plateau 28.08 kg/m(2) versus 29.79 kg/m(2) and 32.30 kg/m(2) versus 28.79 kg/m(2), resp.). Regarding NASH, a significant improvement of AST, ALT, triglyceride and HDL levels was shown (P < .0001 for all). A resolution of elevated HbA1c was observed in 21 of 23 patients. Summary. NASH patients showed a significant loss of body weight and amelioration of NASH status. ISG can be successfully performed in these patients and should be recommended for this subgroup.
  Journal of obesity 01/2011; 2011:765473.
• Article: [Physiology of anastomotic healing].

  G Marjanovic, U T Hopt
  [show abstract] [hide abstract]
  ABSTRACT: Anastomotic insufficiency still remains the most dreaded complication following digestive surgery. The surgeon's understanding of the mechanisms underlying anastomotic healing and the possible weak points are just as important as a correct anastomotic technique. Intestinal anastomotic healing is a complex, cell-mediated process which aims at restoring bowel wall continuity. The early stages of anastomotic healing are most susceptible to various sources of irritation, which is reflected by the likelihood of early anastomotic insufficiency. In our opinion, the focus of future research should shift from primarily examining pathogenetic factors to a more cellular and molecular level. A better comprehension of the anastomotic healing process might thus promote the development of new diagnostic predictive and therapeutic methods.
  Der Chirurg 11/2010; 82(1):41-7. · 0.70 Impact Factor
• Article: Pitfalls and technical aspects during the research of intestinal anastomotic healing in rats.

  G Marjanovic, P Holzner, B Kulemann, S Kuesters, W K Karcz, S Timme, A Zur Hausen, T Baumann, U T Hopt, R Obermaier, J Hoeppner
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  ABSTRACT: Fundamental experimental research into intestinal anastomotic healing in rodent models will gain increasing interest in the future. The aim of this study was to describe our 5-year experience with a standardized experimental setup of small and large bowel anastomoses in a rodent model and present a basic set of assessment tools investigating anastomotic healing. Anastomotic technique, perioperative complications such as anastomotic insufficiency (AI) and obstructive ileus were in the focus. During different studies with varying study patterns, 167 rat small bowel anastomoses and 120 colonic anastomoses were performed. Overall mortality was 3.6% in small bowel and 2.5% in colonic anastomoses, AI occurred in 2.9 and 4%, respectively. A postoperative obstructive ileus was seen in 3/167 small bowel anastomoses and none in the colonic group. When performing experimental intestinal anastomoses in a standardized operative setting and critically considering special perioperative issues, the incidence of relevant complications can be maintained at an adequately low level.
  European Surgical Research 10/2010; 45(3-4):314-20. · 0.93 Impact Factor
• Article: [Postoperative sepsis: diagnosis, special features, management].

  S Utzolino, U T Hopt, M Kaffarnik
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  ABSTRACT: A high level of suspicion is necessary to detect postoperative sepsis in good time. It may be difficult to differentiate sepsis from normal SIRS in the postoperative setting. Early signs and symptoms include delirium and respiratory compromise. These should trigger the search for a septic focus aggressively with special attention to the original site of surgery. Key recommendations include early goal-directed resuscitation of the septic patient, administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis, and source control with attention to the balance of risks and benefits of the chosen method. In cases of severe abdominal sepsis the concept of relaparotomy on-demand has become most popular.
  Zentralblatt für Chirurgie 06/2010; 135(3):240-8. · 1.02 Impact Factor
• Article: [Metabolic surgery and remission of type 2 diabetes].

  Goran Marjanovic, K Winkler, T Schewe, S Küsters, U T Hopt, B Kulemann, W K Karcz
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  ABSTRACT: A new therapeutic field is developing from bariatric surgery. Gastrointestinal surgery does not only seem to be a very efficacious method for weight reduction but may also have the potential to reduce obesity-related metabolic disorders. Even if there is still a lack of prospective randomized trials evaluating the correct indications for metabolic surgery in patients with type 2 diabetes mellitus, there is the legitimate expectation that the surgical approach can be successful. This article provides an overview of the current state of bariatric surgery and gives a surgical perspective on the treatment of type 2 diabetes mellitus.
  DMW - Deutsche Medizinische Wochenschrift 05/2010; 135(20):1020-4. · 0.53 Impact Factor
• Article: [Patient assignment to a surgical intensive care unit - plea for a preoperative risk stratification].

  S Utzolino, L Lämmermann, M Kaffarnik, F Makowiec, U-T Hopt
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  ABSTRACT: Surgical intensive care units (ICUs) have to meet the demands of caring for elective surgical patients, for surgical emergencies, and for trauma patients. To achieve this a high flexibility and a high rate of admissions and discharges are needed. ICU beds are scant and expensive, so who is to be admitted? All admissions and dis-charges of a 20-bed surgical ICU in a university hospital within one year have been analysed. During the analysed year 2524 patients were admitted to the surgical ICU (6.9 + or - 3.1 per day). Of 1886 planned admissions (elective surgery) only 1234 were eventually admitted, but there were 1290 additional patients admitted as emergencies. Of all realised admissions only 49 % were planned. In 653 requested but refused elective admissions, the surgery was performed with-out intensive care admission in 432 patients (64.9 %). Half of the patients of the surgical ICU are electively surgical, half of them are emergencies. The limited number of ICU beds requires strict indications for admission. It turns out to be useful to create a category of patients in whom postoperative intensive care is desirable but not mandatory.
  Zentralblatt für Chirurgie 02/2010; 135(1):49-53. · 1.02 Impact Factor
• Article: Reinforcement of colonic anastomoses with a collagenous double-layer matrix extracted from porcine dermis.

  J Hoeppner, K Willa, S Timme, D Tittelbach-Helmrich, U T Hopt, T Keck, G Marjanovic
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  ABSTRACT: Anastomotic leakage is a major factor for morbidity in colorectal surgery. Anastomotic reinforcement with biological or synthetic materials has been claimed to be useful in preventing anastomotic leakage. We evaluated a non-cross-linked collagenous matrix Bio-Gide (BG) for sealing colonic anastomoses in a rodent model. The animals were investigated for 4, 30 and 90 days. Macroscopic examination, histological examination and measurement of bursting pressure were performed. The anastomotic stricture rate was evaluated by radiographic contrast enema. Microscopically anastomoses sealed by BG showed impaired anastomotic healing. Blood vessel ingrowth and collagen deposition were decreased without reaching significance after 4 days. The anastomotic bursting pressure was significantly decreased (p = 0.0454) in the early phase of healing. Anastomotic neovascularization was significantly decreased compared to the control group after 30 (p = 0.0058) and 90 days (p = 0.0275). Although no difference in anastomotic stricture rate was evident, the rate of intra-abdominal adhesions was significantly increased after 30 (p = 0.0124) and 90 days (p = 0.0281). BG failed to improve colonic anastomotic healing. Early anastomotic healing was impaired if anastomoses were reinforced with BG. BG did not affect the anastomotic stricture rate for up to 3 months; nevertheless, intra-abdominal adhesions were increased.
  European Surgical Research 01/2010; 45(2):68-76. · 0.93 Impact Factor