W Padberg

Vitos Gießen-Marburg, Giessen, Hesse, Germany

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Publications (123)186.11 Total impact

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    ABSTRACT: Purposes: An abdominal inflammatory focus is the second most often source of sepsis with a high risk of death in surgical intensive care units. By establishing evidence-based bundled strategies the surviving sepsis campaign provided an optimized rapid and continuous treatment of these emergency patients. Hereby the hospital mortality decreased from 35 to 30 %. Sepsis treatment is based on three major therapeutic elements: surgical treatment (source control), antiinfective treatment, and supportive care. The international guidelines of the surviving sepsis campaign were updated recently and recommend rapid diagnosis of the infection and source control within the first 12 h after the diagnosis (grade 1c). Interestingly this recommendation is mainly based on studies on soft tissue infections. Methods: In this retrospective analysis 76 septic patients with an intraabdominal inflammatory focus were included. All patients underwent surgery at different time-points after diagnosis. Results: With 80 % patients of the early intervention group had an improved overall survival (vs. 73 % in the late intervention group). Conclusions: Literature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients. Further multi-center approaches will be necessary to evaluate, whether the TTI has any impact on the outcome of septic patients with intestinal perforation.
    Full-text · Article · Nov 2015 · World Journal of Emergency Surgery
  • A Hecker · B Hecker · M Hecker · J G Riedel · M A Weigand · W Padberg
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    ABSTRACT: Background: If untreated, the abdominal compartment syndrome (ACS) has a mortality of nearly 100 %. Thus, its early recognition is of major importance for daily rounds on surgical intensive care units. Intraabdominal hypertension (IAH) is a poorly recognized entity, which occurs if intraabdominal pressure arises >12 mmHg. Measurement of the intravesical pressure is the gold standard to diagnose IAH, which can be detected in about one fourth of surgical intensive care patients. Purpose: The aim of this manuscript is to outline the current diagnostic and therapeutic options for IAH and ACS. While diagnosis of IAH and ACS strongly depends on clinical experience, new diagnostic markers could play an important role in the future. Therapy of IAH/ACS consists of five treatment "columns": intraluminal evacuation, intraabdominal evacuation, improvement of abdominal wall compliance, fluid management, and improved organ perfusion. If conservative therapy fails, emergency laparotomy is the most effective therapeutic approach to achieve abdominal decompression. Thereafter, patients with an open abdomen require intensive care and are permanently threatened by the quadrangle of fluid loss, muscle proteolysis, heat loss, and an impaired immune function. As a consequence, complication rate dramatically increases after 8 days of open abdomen therapy. Conclusion: Despite many efforts, the mortality of patients with ACS remains unacceptably high. Permanent clinical education and surgical trials will be necessary to improve the outcome of our critically ill surgical patients.
    No preview · Article · Oct 2015 · Langenbeck s Archives of Surgery

  • No preview · Article · Oct 2015 · Transplant International
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    C Koch · A Hecker · V Grau · W Padberg · M Wolff · M Henrich
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    ABSTRACT: Necrotizing fasciitis (NF) is an inflammatory disease of the soft tissue, which causes local tissue destruction and can lead to lethal septic shock. The therapy consists of early surgical treatment of the septic focus and an accompanying broad spectrum antibiotic therapy. Recent literature considers the additional use of immunoglobulin therapy in severe soft skin and tissue infections. In this report, we describe the case of a 33-year-old male patient treated at a university hospital intensive care unit because of an NF of his left leg. The patient rapidly developed a complicated septic disease after a minor superficial trauma. Despite intense microbiological diagnosis, no causative pathogens were identified. After non-responding to established broad anti-infective treatment, the patient received intravenous immunoglobulin, that rapidly improved his clinical condition. NF represents a disease processes, which is characterized by fulminant, widespread necrosis of soft tissue, systemic toxicity, and high mortality (>30%). Beside the surgical debridement and broad spectrum antibiotic therapy IVIg therapy might be an additional option in the treatment of NF. But the current literature supporting the use of IVIG in NF is largely based on retrospective or case-controlled studies, and only small randomized trials. The demonstrated case suggests that IVIg treatment of patients with NF can be considered in case of hemodynamic unstable, critically ill patients. Although randomized controlled trials are missing, some patients might benefit from diminishing hyperinflammation by immunoglobins.
    Full-text · Article · Sep 2015 · Annals of Medicine and Surgery
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    ABSTRACT: Purpose: Resection rectopexy (RR) provides good functional results and low recurrence rates for the treatment of obstructed defecation syndrome based on rectal prolapse and cul-de-sac syndrome, whereas little is known about changes in pelvic floor dynamics and patient satisfaction after surgery. Materials and Methods: Within three years 26 consecutive female patients were prospectively included. Indications for RR (22 laparoscopic, 3 primary open and 1 converted-to-open) were rectal prolapse III degrees in 11 patients and cul-de-sac syndrome in 15 patients. Patients' quality of life (QOL), fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery. Results: RR improved the rate of fecal incontinence (p < 0.01) and CCIS (p = 0.01). The use of laxatives (p = 0.01), the need for self-digitation (p = 0.02) and VAS (p < 0.01) were decreased, leading to improvements in QOL (overall p < 0.01). RR led to shortening of the H-line but not of the M-line under rest (p < 0.01) and during defecation (p = 0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (p < 0.01) and declined protrusion (p = 0.03) of the rectocele. This results in a decreased rate of cul-de-sac (p < 0.01) and increased rate of complete defecation (p < 0.01) after surgery. At the 36-month follow-up no recurrence was observed. Conclusion: RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients.
    No preview · Article · Sep 2015 · RöFo - Fortschritte auf dem Gebiet der R
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    Full-text · Article · Aug 2015 · Zeitschrift für Gastroenterologie
  • A Busse · E Schneck · C Koch · R Röhrig · G Krombach · M Weigand · F Roller · W Padberg

    No preview · Article · Aug 2015 · Zeitschrift für Gastroenterologie

  • No preview · Article · Jul 2015 · Pneumologie

  • No preview · Article · Jul 2015 · Pneumologie

  • No preview · Article · Jul 2015 · Pneumologie

  • No preview · Article · Jul 2015 · Pneumologie
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    ABSTRACT: Hintergrund In mehreren klinischen Studien zeigt sich eine Verbesserung der Langzeitprognose für Patienten, die unter perioperativer periduraler Schmerztherapie zusätzlich zur Allgemeinnarkose an einem kolorektalen Karzinom operiert wurden. Fragestellung Hat eine zusätzlich verwendete perioperative peridurale Analgesie (PDA) einen Effekt auf das Langzeitüberleben von Patienten nach chirurgischer Resektion eines kolorektalen Karzinoms? Material und Methoden Es erfolgten eine systematische Literaturrecherche (bis 5/2014) in Medline sowie eine Metaanalyse des Einflusses einer PDA auf das Langzeitüberleben von Patienten nach Resektion eines kolorektalen Karzinoms in den UICC-Stadien I bis IV. Die korrigierten Hazard Ratios (HR) mit einem 95 %-Konfidenzintervall (KI) wurden als Maß für den statistischen Effekt auf das Langzeitüberleben zugrunde gelegt. Für die Analyse wurde ein Modell mit zufälligen Effekten verwendet und auf einen potenziell publikationsbezogenen Fehler überprüft (Forest-/Funnel-Plot). Ergebnisse Von 608 identifizierten Publikationen wurden 5 Studien eingeschlossen. Im Modell mit zufälligen Effekten zeigte sich ein verbessertes Langzeitüberleben für Patienten, die perioperativ zusätzlich zur Allgemeinnarkose eine PDA erhielten (HR = 0,81, 95 %-KI 0,68–0,97, p = 0,055). Die Analyse der Einflussfaktoren zeigte einen statistisch robusten Effekt. Damit verminderte sich das Sterblichkeitsrisiko in den analysierten Studien durch die Verwendung einer PDA im Mittel um 19 % gegenüber einer alleinigen Allgemeinanästhesie. Diskussion Diese Metaanalyse zeigt trotz eines Publikationsbias, dass eine zusätzliche perioperative peridurale Analgesie das Langzeitüberleben von Patienten mit einem nicht fernmetastisierten kolorektalen Karzinom nach chirurgischer Resektion verbessern kann.
    No preview · Article · Jul 2015 · Der Chirurg
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    ABSTRACT: To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial. PJ and PG are established methods for reconstruction in pancreatoduodenectomy. Recent prospective trials suggest superiority of the PG regarding perioperative complications. A multicenter prospective randomized controlled trial comparing PG with PJ was conducted involving 14 German high-volume academic centers for pancreatic surgery. The primary endpoint was clinically relevant postoperative pancreatic fistula. Secondary endpoints comprised perioperative outcome and pancreatic function and quality of life measured at 6 and 12 months of follow-up. From May 2011 to December 2012, 440 patients were randomized, and 320 were included in the intention-to-treat analysis. There was no significant difference in the rate of grade B/C fistula after PG versus PJ (20% vs 22%, P = 0.617). The overall incidence of grade B/C fistula was 21%, and the in-hospital mortality was 6%. Multivariate analysis of the primary endpoint disclosed soft pancreatic texture (odds ratio: 2.1, P = 0.016) as the only independent risk factor. Compared with PJ, PG was associated with an increased rate of grade A/B bleeding events, perioperative stroke, less enzyme supplementation at 6 months, and improved results in some quality of life parameters. The rate of grade B/C fistula after PG versus PJ was not different. There were more postoperative bleeding events with PG. Perioperative morbidity and mortality of pancreatoduodenectomy seem to be underestimated, even in the high-volume center setting.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Full-text · Article · Jul 2015 · Annals of surgery
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    ABSTRACT: Patients with signs of an acute abdomen continue to be a challenge for both the emergency physician and the intensivist. Clinical symptoms usually result from secondary peritonitis possibly progressing to intraabdominal sepsis. Critically ill patients need rapid diagnostic work-up and an interdisciplinary therapeutic approach. Among patients with secondary peritonitis, those with postoperative peritonitis (e.g., after anastomotic leakage) show a particularly high mortality because of unspecific symptoms. Beyond routine diagnostic procedures, patients with an acute abdomen often require a CT scan which helps to detect the septic focus, thereby often allowing an interventional source control. Therapy consists of three main elements: source control, broad-spectrum antimicrobial therapy, and supportive intensive care medicine.
    No preview · Article · Mar 2015 · Notfall
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    Full-text · Article · Jan 2015 · Der Chirurg
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    ABSTRACT: Die akute Mesenterialischämie stellt auch heutzutage aufgrund ihrer hohen Letalität den behandelnden Mediziner vor eine große Herausforderung. Unspezifische Symptome in der frühen Phase der Erkrankung erschweren eine rasche Diagnose der Mesenterialischämie und nur eine frühzeitige Diagnose und Therapie kann den Patienten vor irreversibler Darmischämie, ausgedehnten Darmresektionen, Sepsis und Tod bewahren. Im Gegensatz zu beispielsweise Troponin als frühem Marker für die kardiale Ischämie ist ein zuverlässiger Marker für die Mesenterialischämie bisher nicht im klinischen Alltag etabliert. Dieser würde eine Früherkennung der Patienten in der frühen, reversiblen Phase ermöglichen. Diese Übersichtsarbeit fasst die Pathophysiologie, Epidemiologie und klinische Symptomatik der akuten Mesenterialischämie zusammen und soll einen Überblick über mögliche Biomarker, allen voran das Serumlaktat, geben. Nur Serumlaktat wird bisher als Routineparameter zur Diagnostik der mesenterialen Ischämie verwendet.
    No preview · Article · Oct 2014 · Der Chirurg
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    Preview · Article · Oct 2014 · Medizinische Klinik - Intensivmedizin und Notfallmedizin
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    ABSTRACT: Rectovaginal fistulas (RVF) are rare but represent a challenge for both patients and surgeons. The most common cause of RVF is obstetric trauma, and treatment is based on fistula classification and localization of the fistula in relation to the vagina and rectum. Conventional therapy frequently fails, making surgery the most viable approach for fistula repair. One surgical procedure which offers adequate repair of lower and middle rectovaginal fistulas consists of interposition of a bulbocavernosus fat flap also called modified Martius flap. First described by Heinrich Martius in 1928, this approach has been continuously modified and adjusted over time and is used in the repair of various pelvic floor disorders. Overall success rates reported in the literature of the interposition of a Martius flap as an adjunct procedure in the surgical management of RVF are 65-100 %. We present a detailed description of the operation technique together with a discussion of the use of a dorsal-flapped modified Martius flap in the treatment of RVF.
    No preview · Article · Oct 2014 · Geburtshilfe und Frauenheilkunde
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    ABSTRACT: Sowohl für den Notaufnahmearzt als auch den Intensivmediziner stellt der Patient mit einem „akuten Abdomen“ eine besondere Herausforderung dar. Dabei ist der sog. brettharte Bauch Resultat einer sekundären Peritonitis, die zwangsläufig in einer intraabdominellen Sepsis gipfelt. Diese kritisch kranken Patienten profitieren von einer möglichst raschen Diagnostik und interdisziplinären Therapie. Die Gruppe der Patienten mit einer postoperativen Peritonitis (z. B. nach Anastomoseninsuffizienz) weist oftmals ein maskiertes klinisches Bild auf, das ein Grund für die inakzeptabel hohe Letalität ist. Nach Durchlaufen einer Standarddiagnostik wird die Indikation zur Computertomographie früh gestellt, da sie zusätzlich zur Fokussuche bereits eine Operationsplanung und ggf. eine radiologisch-interventionelle Drainageeinlage erlaubt. Die Therapie fußt auf 3 elementaren Säulen: der raschen Fokussanierung, einer breiten Antibiotikatherapie und den supportiven intensivmedizinischen Maßnahmen.
    No preview · Article · Sep 2014 · Medizinische Klinik - Intensivmedizin und Notfallmedizin
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    ABSTRACT: Due to possible harmful side effects and difficult practical calculations the dosimetry during hyperthermic isolated limb perfusion (HILP) is a challenging task: during perfusion up to 10-fold higher doses of chemotherapeutics are applied. In conjunction with hyperthermia, local side effects may therefore increase dramatically. Unfortunately normal dosage schemes which are based on body surface area or body weight are not applicable in these circumstances. Neither surface area nor body weight show an acceptable correlation with plasma levels of chemotherapeutic agents in the isolated limb. Only the limb volume allows reproducible dosage schemes. The spatial complexity of the limb requires mathematical models similar to calculations of solids. Beside the water displacement method which has been used in the past, more recent methods use mathemat ical approximations. The limb can be seen as a simplified truncated cone or as a series of small cylindrical sections. The cylindrical section model is of greater value than the truncated cone model. An adequate approximation of foot or hand volumes is not possible using normal bodyvolume models. Imaging techniques like computer tomography may simplify calculations, the using cross-sections to convert complex areas into volumes. This enables a clear improvement in the therapeutic window of chemotherapeutic drugs.
    No preview · Article · Sep 2014

Publication Stats

581 Citations
186.11 Total Impact Points

Institutions

  • 2009-2015
    • Vitos Gießen-Marburg
      Giessen, Hesse, Germany
  • 1991-2015
    • Justus-Liebig-Universität Gießen
      • • Department of Internal Medicine
      • • Department of Anaesthesiology and Intensive Care Medicine
      • • Department of Pediatric Hematology and Oncology
      Giessen, Hesse, Germany
  • 2006-2014
    • Universitätsklinikum Gießen und Marburg
      • Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie
      Marburg, Hesse, Germany
  • 1999
    • Universität Heidelberg
      • Department of Transplantation Immunology
      Heidelburg, Baden-Württemberg, Germany
  • 1986-1987
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States