G. Köhler

• MD, senior physician
• Head of Department at Klinikum Rohrbach/OÖ

With increasing economic pressure on health care, modern hospital management is focusing at industrial optimization techniques to improve efficiency while maintaining quality. Shop floor management, a technique of code-based, process-oriented guidance directly on site is a method of lean management intended to increase efficiency in the operating r...

Background AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgica...

Purpose Retromuscular mesh augmentation is generally considered to be the ideal technique for repairing ventral hernias and can be performed laparoscopically by ‘enhanced view totally extraperitoneal plasty’ (eTEP)—a technically complex procedure that requires a high level of surgical expertise. We aimed to develop a simplified technical modificati...

Die hohe Inzidenz parastomaler Hernien (PSH) von bis zu 80 % bei endständigen Stomaträgern und die breite Palette an Beschwerden und Komplikationen mit hohen Raten an Notoperationen aufgrund von Inkarzerationen (ca. 15 %) beweisen die klinische Relevanz der PSH-Prävention bereits bei Stomaanlage bzw. die großzügigere Indikationsstellung zur elektiv...

Die erfolgreiche Therapie komplexer Bauchwandhernien erfordert ein integratives, individualisiertes und ggf. interdisziplinäres Behandlungskonzept. Aufgrund des hohen abdominellen sowie kardiopulmonalen Komplikationspotenzials sollte die Betreuung an spezialisierten Zentren mit entsprechender Erfahrung und Expertise erfolgen. Neben der Prähabilitat...

Zusammenfassung Einleitung Das Prinzip der präperitonealen umbilikalen Mesh-Plastik (PUMP) besteht in der extraperitonealen Netzplatzierung hinter der Rektusmuskulatur mit nachfolgendem anterioren Fasziendefektverschluss. Schwierigkeiten können im Rahmen der Dissektion ebenso auftreten wie bei der Netzeinbringung, Entfaltung und Positionierung. Met...

Die Ventralhernienchirurgie hat in den letzten Jahren eine dynamische Wandlung durchlaufen, indem neue, minimal-invasive bzw. endoskopisch-laparoskopische Techniken entwickelt wurden. Trotz der Methodenvielfalt haben sich fünf Hauptkriterien der Zielsetzung herauskristallisiert: 1) die morphologisch-funktionelle Rekonstruktion der Bauchwand, 2) die...

Background and Objectives The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach, surgical treatment, and outcome. The analysis is based on a comprehensively documented case and a complete systematic review of published literature. Potentia...

PurposeTransabdominal preperitoneal hernia mesh plasty (TAPP) offers significant benefits to patients undergoing bilateral inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for bilateral placement as an alternative to two separate meshes. Methods Thirty-six patients underwent elect...

Introduction: Patients with umbilical or epigastric hernias benefit from mesh- based repairs, and even more so if a concomitant rectus diastasis (RD) is present. The ideal technique is, however, still under debate. In this study we introduce the minimal invasive linea alba reconstruction (MILAR) with the supraaponeurotic placement of a fully absor...

Introduction: Endoscopic anterior component separation (ECS) techniques facilitate tension-free midline closure of wide ventral hernia defects. We describe a novel approach with a precostal incision and a new cylindrical ballon trocar. Materials and methods: A single-center analysis of 19 patients undergoing ECS between January 1, 2014 and Augus...

Purpose: Open anterior release of the external oblique fascia to enable midline closure of large abdominal wall defects is associated with relevant morbidity due to extensive subcutaneous dissection. Using endoscopic techniques, wound complications can be minimized. However, identification of the correct entry point (e.g. for balloon trocar insert...

PURPOSE: Open anterior release of the external oblique fascia to enable midline closure of large abdominal wall defects is associated with relevant morbidity due to extensive subcutaneous dissection. Using endoscopic techniques, wound complications can be minimized. However, identification of the correct entry point (e.g. for balloon trocar inser...

Background The assessment of hiatal hernias (HH) is typically done with barium swallow X‑ray, upper endoscopy, and by high-resolution esophageal manometry (HRM). The aim of this study was to assess the clinical utility of these methods in terms of HH detection and their correlation to gastroesophageal reflux disease (GERD). Methods A retrospective...

Background: Parastomal hernias (PSHs) are a common and challenging issue. In previous studies, three-dimensional (3D) funnel mesh devices have been used successfully for the repair of PSHs. Methods: We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmenta...

INTRODUCTION: The aim of this study was to evaluate a new method of parastomal hernia (PSH) repair by using a hybrid approach with a cylindrical-shaped mesh of 4 cm funnel length. MATERIALS AND METHODS: In a pilot prospective case series, 12 patients underwent surgical repair of PSHs with a combined laparoscopic and ostomy-opening approach. Af...

Introduction: The aim of this study was to evaluate a new method of parastomal hernia (PSH) repair by using a hybrid approach with a cylindrical-shaped mesh of 4 cm funnel length. Materials and methods: In a pilot prospective case series, 12 patients underwent surgical repair of PSHs with a combined laparoscopic and ostomy-opening approach. Afte...

Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Her...

Background: The Lichtenstein repair is a frequently used treatment of inguinal hernias. In recent years, there has been an increasing tendency to apply self-gripping meshes (s.g). In many cases, additional suture of the mesh is carried out; however, it is uncertain what the benefits or potential risks of this actually are. Methods: The evaluatio...

Methods: After the preperitoneal space is dissected and all the myo­ pectineal orifices are identified, mesh must cover not only the exist­ ing but also potential defects, with sufficient overlap. Potential hernia defects need to be covered to prevent the development of new hernias in those spaces. The hernia defect tends to enlarge and the mesh te...

Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures. From January 1999 to January 2014, we assessed all cases of PSH repair perfor...

Measures have been taken to improve methodological quality of randomized controlled trials (RCTs). This review systematically assessed the trends in volume and methodological quality of RCTs on minimally invasive surgery within a 10-year period. RCTs on minimally invasive surgery were searched in the 10 most cited general surgical journals and the...

Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR). In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped m...

Laparoscopic repair of large hiatal hernias is associated with high recurrence rates. Erosion and mesh migration are rare but devastating complications of synthetic mesh repair, whereas reoperation is accompanied by significant operative morbidity. The aim of this study was to estimate the comparative risk of hernia recurrence following primary sut...

Background Funnel mesh implants can be used for both prevention and repair of parastomal hernia (PSH). We aimed to prove the practice of such implants as well as the magnetic resonance (MR) presentability in humans. Methods Five patients were surgically treated for laparoscopic PSH prevention, and five patients underwent laparoscopic repair of mani...

PURPOSE: In open inguinal hernia repair self-gripping meshes are currently commonly employed. Assumed benefits are saving of time, ease of handling and omission of fixation. Self-gripping meshes are, however, not as easy to handle and position as commonly stated. We describe a newly developed way of intra-operative mesh preparation and implantati...

Introduction: Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carr...

In patients with terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. They are commonly associated with various degrees of complaints and occasionally lead to life-threatening complications. Various strategies and measures have been tested and evaluated, but to date there is a lack of published evidence with regard to the best su...

Several methods for assessment of methodological quality in randomized controlled trials (RCTs) have been developed during the past few years. Factors associated with quality in laparoscopic surgery have not been defined till date. The aim of this study was to investigate the relationship between bibliometric and the methodological quality of lapar...

Background We aimed to evaluate the first human use of magnetic resonance (MR) visible implants for intraperitoneal onlay repair (IPOM) of incisional hernias with regard to MR presentability. Methods Ten patients were surgically treated with intraperitoneally positioned superparamagnetic flat meshes. An MR investigation with a qualified protocol wa...

Patients with incisional hernias (IH) and risk factors for surgical site occurrences (SSOs) such as defined comorbidities and/or potential contaminations are considered to be treated with bioprosthetics. A retrospective analysis of consecutive patients who had undergone elective IH repair with synthetic mesh materials between 2009 and 2013 was cond...

The clinical effects of laparoscopy in the pulmonary function of obese patients have been poorly investigated in the past. A systematic review was undertaken, with the objective to identify published evidence on pulmonary complications in laparoscopic surgery in the obese. Outcome measures included pulmonary morbidity, pulmonary infection and morta...

For patients with gastroesophageal reflux disease (GERD) who suffer from severe symptoms despite adequate medical therapy, interventional procedures are the only option for improving symptoms and thus the quality of life. In the clinical practice it is decisive if a hiatal hernia (HH) is present or not and whether it is larger or smaller than 2-3 c...

Background: Parastomal hernias (PSHs) are a frequent complication and remain a surgical challenge. We present a new option for single-port PSH repair with equilateral stoma relocation using preshaped, prosthetic 3-dimensional implants and flat mesh insertion in intraperitoneal onlay placement for additional augmentation of the abdominal wall. Meth...

Background: Obesity has been reported to adversely affect the outcome of laparoscopic antireflux surgery (LARS). This study examined pre- and postoperative clinical and objective outcomes and quality of life in obese and normal-weight patients following LARS at a specialized centre. Methods: Prospective data from patients subjected to LARS (Niss...

BACKGROUND AND AIMS: Self-expanding metallic stents are increasingly used in the management of malignant and benign colorectal obstructions. We aimed to identify relevant predictive factors for stent failure and stent-related complications. MATERIAL AND METHODS: We conducted a retrospective single-center analysis of 204 consecutive patients who u...

Background: Umbilical and epigastric hernias are common in the adult population and prompt repair is advised. We aimed to evaluate the impact of concomitant rectus diastasis on the outcome of patients who underwent primary sutured fascia closure of a hernia without mesh. Methods: We performed a retrospective analysis of 231 consecutive adult pat...

Introduction Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal de...

Purpose: Parastomal hernias (PSHs) have been a major clinical problem. The aim of this study was to evaluate a new method of PSH repair in combination with an additional flat mesh reinforcement of the abdominal wall. Methods: In a pilot case series, seven patients suffering from complex PSHs (≥5 cm diameter and/or recurrence) underwent surgery a...

Purpose: Management of emergently admitted patients due to a complicated large paraesophageal hernia with acute symptoms of an "intrathoracic stomach" is controversial. The aim of this study was to clarify whether emergency surgery in such cases should be the procedure of choice. Methods: The retrospective analysis of patients who were hospitali...

Background A percutaneous endoscopic gastrostomy (PEG) can be performed as a direct stomach puncture, known as Seldinger technique (“push”) or a thread pulling method (“pull”). The aim of this study was to compare the final results deriving from both application methods. Methods Data of all pull-through-PEG and push-PEG applications, which had b...

Background Seroma formation is a frequent postoperative complication following open ventral hernia repair (OVHR), especially in cases requiring wide subcutaneous dissection (WSD). The aim of this study was to evaluate the effectiveness of a new low-thrombin fibrin sealant for seroma prevention. Methods A total of 60 consecutive patients with med...

Background AirSeal™ is a novel class of valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide (CO2) recirculation during laparoscopic surgery. Comparison data to standard CO2 pressure pneumoperitoneum insufflators is scarce. The aim of this study is to evaluate the potential advant...

Background: Usually a temporary and diverting ileostomy is reversed not earlier than 8 weeks because of adhesions and edema with vulnerability of the intestinal wall. We aimed to evaluate if early closure of loop ileostomy during index admission by using an anti-adhesive bioabsorbable membrane is feasible and safe. Methods: We included all patients...

Routine drainage of the subhepatic space has been a surgical trend of open cholecystectomy, carried on to the era of laparoscopic surgery without substantial evidence. Avoiding the potentially devastating sequelae of an undetected bile leakage is the main rationale behind this practice. Aim of this meta-analysis was to compare evidence on routine d...

The co-occurrence of incisional and parastomal hernias (PSH) remains a surgical challenge. Standardized treatment guidelines are missing, and the patients concerned require an individualized surgical approach. The laparoscopic techniques can be performed with incised and/or stoma-lateralizing flat meshes with intraperitoneal onlay placement. The pu...

Background: The separation of autologous and functional active components of the lateral abdominal wall for closing large midline defects was introduced in 1990. The original components separation technique (CS) has undergone numerous modifications. The aim of this work is to summarise the essential steps of the development. Methods: Based on a...

Gastrointestinal and abdominal bleeding can lead to life-threatening situations. Embolization is considered a feasible and safe treatment option. The relevance of surgery has thus diminished in the past. The aim of the present study was to evaluate the role of surgery in the management of patients after embolization. We performed a retrospective si...

Using the usual diagnostic tools like barium swallow examination, endoscopy, and manometry, we are able to diagnose a hiatal hernia, but it is not possible to predict the size of the hernia opening or, respectively, the size of the hiatal defect. At least a correlation can be expected if the gastroesophageal junction is endoscopically assessed in a...

Endoscopic grading of the gastroesophageal flap valve (GEFV) is simple, reproducible, and suggested to be a good predictor of reflux activity. This study aimed to investigate the potential correlation between grading of the GEFV and quality of life (QoL), gastroesophageal reflux disease (GERD) symptoms, esophageal manometry, multichannel intralumin...

Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. This study reports a total number of 104...

Studies on Plasma and Tissue Concentrations of Etofenamate following Intramuscular Application/Pharmacokinetics of etofenamate and flutenamic acid in plasma, synovia and tissues of patients with chronic polyarthritis after application of oily etofenamat solution Pharmacokinetics of etofenamate (ETO, CAS 30544-47-9; Rheumon i.m.) and flufenamic acid...

Die Sonographie stellt eine neue Methode zur Beurteilung der Synovialisdicke am Kniegelenk dar. Als therapeutische Maßnahmen kommen bei Patienten mit rheumatoider Arthritis in Abhängigkeit von der Synovialishypertrophie sowohl die (Radio-)Synoviorthese als auch die operative Synovialektomie in Betracht. Um die Aussagekraft der sonographischen Dicke...

Surgery has been a mainstay in the treatment of rheumatic conditions. Basically, its effect is limited to the site involved. Reconstruction of a damaged component of the locomotor system, however, may also relieve other components, and thus improve their function. Usually the prescribed drug treatment and physiotherapy must be continued, although t...

Opiumderivate werden routinemäßig in der postoperativen Schmerzbehandlung nach orthopädischen Eingriffen angewandt. Nebenwirkungen wie Blutdruckabfall, Atemdepression und Übelkeit nimmt man dabei in Kauf. Unabhängig von bestehenden Therapieregimen gewinnen nichtsteroidale Entzündungshemmer (NSAID) in den letzten Jahren zunehmend als Analgetika an B...

An 81 Patienten mit chronischer Polyarthritis und ihren Sonderformen sowie Arthrosis deformans wurden die Wirkstoffe nach Acemetacin-Applikation und Indometacin- Applikation in Blut und Synovialflüssigkeit bestimmt. Die Untersuchungen erfolgten 2, 4 und 6 Stunden nach einmaliger bzw. 2, 4 und 6 Stunden nach der letzten von 19 Applikationen (3 Appl....

Non-steroidal antiinflammatory drugs (NSAID) are indispensable for modern treatment of rheumatoid arthritis. Reports on drug concentration in rheumatoid human tissues are still lacking. We now report about steady-state concentrations of Indomethacin and Acemetacin in blood, synovial fluid, synovial membrane, muscle, bone and fat 6h after the last a...

Metabolism and pharmacokinetics of [1-(p-chlorobenzoyl)-5-methoxy-2-methylindole-3-acetoxy]-acetic acid (acemetacin, TV 1322, Rantudil) in comparison to equimolar doses of indometacin was investigated in human volunteers after a single oral application and in rheumatic patients after multiple application. After multiple application (t.i.d. for 10 d...