R Albrecht

HELIOS Klinikum Aue, Stadt Aue, Saxony, Germany

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Publications (11)12.46 Total impact

  • C Bochmann · O Reichelt · R Albrecht ·

    Zeitschrift für Gastroenterologie 08/2015; 53(08). DOI:10.1055/s-0035-1559464 · 1.05 Impact Factor
  • R Albrecht · H Hönicke · C Bochmann · U Settmacher · T Wirth ·
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    ABSTRACT: Frequently, the first clinical sign of colorectal cancer is complete obstruction, which has to be considered an emergency situation. The treatment goal is to overcome ileus including reduction of the associated high morbidity and mortality. Therefore, alternative therapeutic options to emergency surgery have been sought in order to allow adequate preparation for elective surgery or stabilization of palliative patients and avoid colostoma. Therapeutic results of the placement of self-expanding metal stents (SEMS) are discussed in terms of a single-center, retrospective observational study. In 35 patients with a clinically manifest stenosis of colonic cancer, it was attempted to insert SEMS to treat ileus as the first therapeutic step. Therapeutic results were investigated with regard to technical and clinical success, spectrum and rate of complications, and survival time, differentiating between a palliative and curative group of patients. Primary placement of a stent was achieved in 29 of 35 patients (82.9 %); 14 underwent the procedure with palliative and 15 with curative intention. Stent location was mainly the left hemicolon. In 2 of 15 patients (13.3 %), emergency surgery within 48 h was required because of complications, whereby in 13 patients (86.7 %), 6 patients (46.2 %) underwent elective open surgery and 7 patients (53.8 %) underwent a laparoscopic procedure. In all patients treated with curative intent, primary anastomosis was achieved, thus, avoiding a colostoma. Survival times of the palliative and curative patient groups were on average 7 and 28 months, respectively. In carefully selected cases, placement of SEMS in malignant stenosis of the left hemicolon with ileus can be considered a reasonable therapeutic alternative to emergency surgery since it allows surgical intervention with curative intention under more favorable conditions and also avoids a colostoma.
    Der Chirurg 06/2015; DOI:10.1007/s00104-015-0022-z · 0.57 Impact Factor
  • R Albrecht · L Meyer ·

    Zentralblatt für Chirurgie 10/2013; 138(5):e24-6. DOI:10.1055/s-0033-1350821 · 1.05 Impact Factor

  • Zentralblatt für Chirurgie 10/2013; 138(5):e27-34. DOI:10.1055/s-0033-1350859 · 1.05 Impact Factor
  • R Albrecht · K Franke ·

    Zeitschrift für Gastroenterologie 08/2013; 51(08). DOI:10.1055/s-0033-1353068 · 1.05 Impact Factor
  • R Albrecht · K Franke · H Koch · H-D Saeger ·
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    ABSTRACT: Background: The surgical approach of choice in the treatment of symptomatic cholecystolithiasis is considered to be elective laparoscopic cholecystectomy (CCE) as the established gold standard. Today, approximately 80-90 % of CCE are performed using a laparoscopic approach whereas the remaining portion undergoes primary conventional CCE, however, in 6 % conversion is necessary.Aim: Since pathological aspects found intraoperatively and finally requiring conversion are correlated to an increased risk for complications, it appears reasonable to assess the risk factors prior to operation. Patients and Methods: Through a well defined study period of 9 years, all consecutive patients who underwent CCE for cholecystolithiasis at the Municipal Hospital "HELIOS Klinikum Aue" were enrolled in a registry comparing laparoscopic and conversion CCE. Diverse parameters were tested as to whether they increase significantly the risk for conversion. The intensity of each factor-associated impact on a possible conversion was determined. Results: From 2001 to 2009 1477 patients underwent CCE at the Municipal Hospital "Helios Klinikum Aue", out of them 131 (8.9 %) cases were primarily treated by conventional CCE whereas in the vast majority (1346 subjects [91.1 %]), laparoscopic CCE was the initial approach. However, conversion became necessary in 106 individuals resulting in a conversion rate of 7.9 %. Comparing data obtained from laparoscopic CCE with those from open procedure after conversion, there were significant differences in operating time, complication rate and postoperative hospital stay (p = 0.01). Over the study period, there were 5 cases (0.37 %) with iatrogenic injuries of the biliary system. Hospital mortality was 0.08 % in the laparoscopic and 2.8 % in the conversion group. The following parameters were found to have a significant impact on the risk for conversion (univariate analysis): elevation of CRP, preoperative ERCP, renal insufficiency, previous laparotomy, histological grade M3 (ulcerous, haemorrhagic necrotising cholecystitis, perforation of the gall bladder) and M4 (carcinoma of the gall bladder). While in the spectrum of preoperative factors former ERCP, elevation of CRP and terminal renal insufficiency were most relevant (2- to 3-fold each), histological grade M3 and M4, 7- and 14-fold, respectively, showed the greatest impact on conversion rate highlighting the profile of postoperative parameters. Conclusion: The main focus is directed to keep the conversion rate low. In case of diagnosing a severely inflamed gall bladder, a primarily open procedure or an early decision for conversion should be considered.
    Zentralblatt für Chirurgie 07/2013; DOI:10.1055/s-0032-1328348 · 1.05 Impact Factor
  • R Albrecht · L Meyer ·

    Zentralblatt für Chirurgie 04/2013; 138(2):e5-7. DOI:10.1055/s-0032-1328217 · 1.05 Impact Factor
  • R Albrecht · C Bochmann · A Süße · L Jablonski · U Settmacher ·
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    ABSTRACT: Unlabelled: INTRODUCTION, AIM AND METHOD: Consecutive female patients undergoing hybrid NOS appendectomy (NA - with prospectively collected data) and laparoscopic appendectomy (LA - with retrospectively registered data) were compared by means of a matched-pair analysis according to selected criteria such as patient age, BMI, ASA and previous operations showing a near-perfect congruence with the following aims to: 1) demonstrate the feasibility of NA and to estimate its general costs, and 2) elucidate the outcome of the two techniques using available perioperative parameters from daily clinical practice. In particular, operating time, complications, histopathological findings, postoperative hospital stay and analgesic scores were used for comparison. A gynaecological follow-up investigation was carried out on the day of discharge and after a medium-term time period of 4 weeks in the NA group, and 6 months postoperatively, patients of both groups were interviewed using a standardised questionnaire. Results: From 05/01/2008 to 02/28/2010, transvaginal NA (n = 30) was compared with the results of the conventional LA (n = 30) in 60 female patients with regard to the operative outcome. Overall, matched-pair analysis of LA with NA, the novel technique resulted in the assessment of basically comparable surgical procedures with regard to perioperative routine parameters and outcome. There were no intraoperative complications in either of the two approaches; conversion was not required in both techniques. In addition, there were no significant differences in operating time (p = 0.099), postoperative complications (p = 0.72) and analgesic scores (p = 0.33/0.46). Postoperative hospital stay was even slightly shorter in the NA group (p = 0.02). The costs of the two methods are almost identical if the same instruments are used. Patient interviews suggested a slightly faster recovery, greater satisfaction with the better cosmetic outcome as well as a reduced pain intensity in favour of transvaginal NA. Conclusion: Provided that a well developed laparoscopic expertise exists, it turned out i) that there are no serious reasons to resist a quick inauguration and establishment of NA for selected cases as well as ii) even to facilitate further clinical distribution of NA. Further systematic data collection appears to be indicated to analyse long-term outcome as parameters of an appropriate quality assurance.
    Zentralblatt für Chirurgie 12/2012; 138(4). DOI:10.1055/s-0032-1327892 · 1.05 Impact Factor
  • R Albrecht · H Koch · C Bochmann ·
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    ABSTRACT: Introduction: By minimising the invasiveness of a surgical intervention, a reduction of operative trauma can be achieved. Aim and methods: The aim of this study was based on a theoretical approach to investigate (i) the feasibility of the SP approach and its overall costs, and, furthermore, (ii) the patients' outcome based on simple perioperative parameters available in daily clinical practice. Therefore, single-port (SP) and laparoscopic appendectomies (LA) were compared using a matched-pair analysis. As a prediction, an absolute match between the criteria histology, sex and ASA stage was required. Results: From 01/01/2009 to 12/31/2010, 196 (60 % were females) consecutive patients underwent appendectomy. Out of them, in 23 patients with either SP or LA appendectomy the predictions for matched-pair analysis (congruence in histopathological finding, sex and ASA criteria) were fulfilled. The operating time was the target criterion for the feasibility of the new surgical method (SP), which could be shortened as seen by comparing SP No. 1-10 with 11-23 (54.6 ± 19.8 min vs. 28.5 ± 18.9 min) expressing the typical effect of a learning curve. The times were similar to those for LA. The postoperative hospital stay and complication rate used to appropriately assess patient outcome did not show a significant difference if comparing SP and LA. Based on the use of single ports, which can be re-used (which has been also a further target) in SP (34.8 %) at the end of the investigation period, SP and LA can be considered comparable surgical techniques with regard to operating times, middle-term outcome and general costs. Conclusion: SP is (in case of well-developed laparoscopic expertise) a surgical method that can be easily inaugurated and considered as a feasible approach in daily surgical practice; it is comparable to LA with regard to outcome and general costs. Based on this, SP can be gradually added to the spectrum of surgical procedures in clinical practice and can be performed in suitable cases. A further systematic institutional or even country-wide case register appears to be recommendable to recruit a larger case number and, thus, to achieve a better knowledge on the perioperative management as well as the especially interesting long-term outcome for an appropriate assessment of treatment quality.
    Zentralblatt für Chirurgie 12/2012; 138(3). DOI:10.1055/s-0032-1315174 · 1.05 Impact Factor
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    ABSTRACT: Background: Resection of colorectal liver or lung metastases is an established therapeutical concept at present. However, an affection of both these organs is frequently still regarded as incurable. Methods: All cancer patients are documented in our prospective cancer registry since 1995. Data of patients who underwent liver and lung resection for colorectal metastases were extracted and analysed. Results: Sixty-five patients underwent surgery for liver and lung metastases. In 33 cases, the first distant metastasis was diagnosed synchronously to the primary tumour. For the remaining patients, median time interval between primary tumour and first distant metastasis was 18 months (5-69 months). Complete resection was achieved in 51 patients (79 %) and was less likely in patients with synchronous disease (p = 0.017). Negative margins (p = 0.002), the absence of pulmonary involvement in synchronous metastases (p = 0.0003) and single metastases in both organs (p = 0.036) were associated with a better prognosis. Five- and 10-year survival rates for all patients are 57 and 15 % from diagnosis of the primary tumour, 37 and 14 % from resection of the first metastasis and 20 and 15 % from resection of the second metastasis. After complete resection, 5- and 10-year survival rates increased to 61 and 18 %, 43 and 17 % as well as 25 and 19 %, respectively. Long-term survivors (≥10 years) were seen only after complete resection of both metastases. Conclusions: Patients with resectable liver and lung metastases of the colorectal primary should be considered for surgery after multidisciplinary evaluation regardless of the number or size of the metastases or the disease-free intervals. Clear resection margins are the strongest prognostic parameter.
    International Journal of Colorectal Disease 08/2012; 28(4). DOI:10.1007/s00384-012-1553-0 · 2.45 Impact Factor
  • R Albrecht · C Bochmann ·
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    ABSTRACT: Surgery of complicated sigmoid diverticulitis should be as gentle as possible. Serious time pressure, unpredictable operation fields and unprepared bowel determine the surgical strategy. Hence, we examine whether minimal invasive surgery (MIS) (i. e., Hartmann procedure) is suited for emergency conditions in selected patients. Furthermore, the objective of the study was to -assess the feasibility of the reversal of Hartmann procedure in appropriate patients after a preceding classical or laparoscopic intervention. -Between 2005 and 2009 128 patients with sigma diverticulitis were operated, 72 patients of them with complicated sigmoid diverticulitis (peritonitis, haemorrhage, ileus, perforation), The classical Hartmann procedure was performed in 45 (35 %) patients, 39 of them being treated within 24 hours. The laparoscopically assisted Hartmann procedure was realised in 15 patients and could be successfully completed in 13 cases. The cor-responding mortality rate was 0 %. A Hartmann reversal could be performed in 26 patients (58 %). A laparoscopic approach was chosen in 16 patients and could be successfully completed in 14 cases. 12 patients were operated with classical Hartmann reversal. The respective mortality rates in both groups were 0 %. We therefore conclude that in cases of peritonitis due to sigmoid diverticulitis laparoscopic surgery, like laparoscopically assisted Hartmann procedure and a subsequent laparoscopically assisted reversal could be recommended in selected patients.
    Zentralblatt für Chirurgie 02/2011; 136(1):61-5. DOI:10.1055/s-0030-1262683 · 1.05 Impact Factor