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Background: There are various procedures to be considered in the surgical treatment of complicated diverticulitis, which must be selected depending on the classification of diverticular disease (CDD) type and the condition of the patient. Objective: Comparison of surgical procedures with respect to aspects such as morbidity, mortality, reconstructive surgery and postoperative quality of life. Material and methods: Evaluation, analysis and assessment of the current literature on surgical treatment of diverticular disease. Results: Laparoscopic sigmoid resection with primary anastomosis is now considered the standard procedure for complicated sigmoid diverticulitis. It is preferable to open resection because of the better results of the minimally invasive approach with respect to the incidence of wound infections, abdominal abscesses and the occurrence of fascial dehiscence. In an emergency situation with perforation and peritonitis (CDD type 2c1/2), primary anastomosis with protective ileostomy should be favored over discontinuity resection (Hartmann's procedure). In particular, it must be taken into account that in a large proportion of patients there is no restoration of continuity after Hartmann's operation. The damage control strategy can be used in perforated sigmoid diverticulitis with generalized peritonitis (CDD type 2c1/2). In individual cases, laparoscopic lavage with insertion of a drainage may be considered as a therapeutic treatment strategy for perforated sigmoid diverticulitis with purulent peritonitis (CDD type 2c1). Conclusion: Selection of the surgical procedure for complicated sigmoid diverticulitis remains challenging. Randomized controlled trials of new treatment strategies as well as robotic-assisted surgery should be considered in the choice of surgical procedure in the future. [ABSTRACT FROM AUTHOR]

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Penetrating traumatic injuries or laceration wounds in horses often affect joints and tendon sheaths. The open wound allows bacteria and foreign material to enter the joint or tendon sheath. A thorough lavage of the affected synovial space is required to remove bacteria, foreign material and inflammatory mediators. In cases with traumatic injuries, lavage is performed along with the surgical reconstruction of the injured tissue. In literature two methods for joint/tendon sheath lavage are generally acknowledged: the arthroscopic/tenoscopic guided lavage and a through-and-through needle lavage. The efficiency of both previously mentioned methods is discussed controversially, as arthroscopic/tenoscopic lavage provides higher flow rates and volumes of sterile irrigation fluid. Further, the synovial space can be visualized and debris can be removed under visual control. The advantages of the through-and-through needle lavage are the reduced costs and expense and the facilitated performance by less-experienced surgeons. In a case series of 60 foals treated with septic arthritis, both methods did not show any significant difference in outcome (Wright et al. 2017). This is consistent to a study describing an age-mixed population suffering septic arthritis from different etiologies (Schneider et al. 1992). However, other authors favor arthroscopic lavage to treat septic joints (ter Braake 2002). In cases of septic tenosynovitis, the surgical technique for lavage was not found to be associated with outcome (Wereska et al. 2007). A recent study from Duggan and Mair (2019) focusing on the outcome of horses suffering septic calcanean bursitis also concluded no dependence of lavage method and outcome. There is lack of information about the outcome of horses presented with septic arthritis due to a penetrating or lacerating wound treated with either arthroscopic or needle-lavage. Therefore, the aim of our study is to proof the efficiency of a through-and-through needle lavage in horses with penetrating traumatic joint and tendon sheath injuries. We hypothesized no significant difference regarding complications and outcome in comparison to horses treated with arthroscopic/ tenoscopic guided lavage. We assumed other factors to be associated with outcome. Data from clinical records from the Department for Horses at the University of Leipzig from the years November 2008 to August 2019 were analyzed. Horses were included if they were presented with a joint or tendon sheath penetrating injury treated surgically with either arthroscopic/tenoscopic lavage or needle lavage and primary wound closure. Horses with accompanying bone injuries were excluded from the study. The age of the horse, localization of the synovial injury, duration of injury, results of synovial analysis, antimicrobial therapy and hospitalization time were documented. Outcome was defined in terms of being discharged from the clinic without lameness when walked. Results were evaluated descriptively and tested for normal distribution using the Shapiro-Wilk test. Groups were compared using the Mann-Whitney-test. Data were further analyzed with Fisher's exact test to test statistical correlation. Significance was set at p < 0.05. Within that time 42 horses met the inclusion criteria, 31 were lavaged arthroscopically/tenoscopically, 10 via needle lavage and one horse with two injured synovial structures was treated with both methods. There was no significant difference for horses to be discharged non-lame when walked among those groups. Also, the necessity to repeat lavage treatments did not depend on the initial lavage method. The age of the wound (≤6 hours versus > 6 hours) as well as synovial parameters like white cell count, percentage of polymorphonuclear leucocytes, total protein and proof of bacteria did not influence the outcome. Horses with shorter systemic antibiotic therapy and shorter hospitalization time were significant more likely to be discharged non-lame at walk. This study suggests that in cases with penetrating or lacerating joint and tendon sheath injuries the method for joint/tendon sheath lavage is not associated with the outcome. Through-and-through needle lavage is a considered equivalent to arthroscopic/tenoscopic joint/tendon sheath lavage in such cases. [ABSTRACT FROM AUTHOR]

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Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Secondary diffuse peritonitis still has a high morbidity and mortality even now; therefore, the various strategies and options for the different surgical therapies are undergoing an evidence-based review. Laparoscopic lavage without resection of the focus of sepsis for example is a profoundly different approach in the treatment of diffuse peritonitis from the damage control-based strategy of surgery with initial laparostomy and deferred anastomosis. The evidential data for minimally invasive therapy are comparatively well-reviewed for appendicitis, cholecystitis and ulcerated perforation of the stomach and duodenum. In contrast, the evidence for laparoscopy and minimally invasive surgery with lavage and deferred anastomosis or damage control in secondary peritonitis has improved but is still low and cannot yet be clearly recommended. This article presents an overview of the currently available therapeutic methods for diffuse peritonitis and a critical consideration of the evidence-based data. The key recommendation is that the decision to use a surgical procedure based on the currently available data depends more on the severity of the abdominal sepsis, the duration, the age of the patient and comorbidities than on the individual technique. [ABSTRACT FROM AUTHOR]

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Despite modern therapeutical options, perforated sigmadiverticulitis still represents a life-threatening disease. In terms of diagnostic and therapeutic proceeding, the covered perforation has to be distinguished from free perforation. Primary therapeutic objective is the excision of the inflamed bowel segment to avoid abdominal sepsis. Therapeutic options for covered perforation include conservative treatment with or without placement of interventional drains. A free perforated diverticulitis implies the resection of the perforated bowel segment. Primary anastomosis should be aspired. In advanced cases, Hartmann procedure may be required. Individual decision making should be based on individual risk profile, on peritonitis severity score and on surgeon experience. In a two stage procedure, relevant morbidity of the second operation has to be considered. Recently suggested approaches, laparoscopic lavage or interventional drainage without resection, remain a matter of debate. [ABSTRACT FROM AUTHOR]

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Despite significant progress the therapy of peritonitis remains challenging. With a mortality of up to 20% peritonitis is a predominant cause of death due to surgical infections. An early and efficient source control combined with effective antibiotic therapy and modern intensive care and sepsis therapy are definitive for the outcome and prognosis of secondary peritonitis. In approximately 90% of patients an effective source control can be achieved by one single operation with extensive peritoneal lavage. A reoperation is necessary in only about 10% of patients. The aggressive concepts of planned relaparotomy or open packing are associated with increased morbidity and are indicated only in rare cases. The gold standard is to attempt a definitive source control by one single operation. An operative revision should be performed only on demand. The antibiotic therapy should begin with a broadly calculated empirical therapy and should later be adapted to microbiological findings. The therapy of sepsis requires standardized and state of the art intensive care. [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: There are various procedures to be considered in the surgical treatment of complicated diverticulitis, which must be selected depending on the classification of diverticular disease (CDD) type and the condition of the patient., Objective: Comparison of surgical procedures with respect to aspects such as morbidity, mortality, reconstructive surgery and postoperative quality of life., Material and Methods: Evaluation, analysis and assessment of the current literature on surgical treatment of diverticular disease., Results: Laparoscopic sigmoid resection with primary anastomosis is now considered the standard procedure for complicated sigmoid diverticulitis. It is preferable to open resection because of the better results of the minimally invasive approach with respect to the incidence of wound infections, abdominal abscesses and the occurrence of fascial dehiscence. In an emergency situation with perforation and peritonitis (CDD type 2c1/2), primary anastomosis with protective ileostomy should be favored over discontinuity resection (Hartmann's procedure). In particular, it must be taken into account that in a large proportion of patients there is no restoration of continuity after Hartmann's operation. The damage control strategy can be used in perforated sigmoid diverticulitis with generalized peritonitis (CDD type 2c1/2). In individual cases, laparoscopic lavage with insertion of a drainage may be considered as a therapeutic treatment strategy for perforated sigmoid diverticulitis with purulent peritonitis (CDD type 2c1)., Conclusion: Selection of the surgical procedure for complicated sigmoid diverticulitis remains challenging. Randomized controlled trials of new treatment strategies as well as robotic-assisted surgery should be considered in the choice of surgical procedure in the future., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft tissue coverage., Indications: Indications are Gustilo-Anderson grade I-III A-C open fractures., Contraindications: Contraindications are injuries requiring amputation, burns, and life-threatening injuries which make appropriate treatment temporarily impossible., Surgical Technique: Removal of gross contamination and macroscopic contaminants; debridement of the wound; complete resection of contaminated and dirty tissue; sparse step-by-step resection of contaminated or non-vital wound and bone margins until vital, bleeding tissue begins; low-pressure irrigation with isotonic irrigation fluid; diagnostic biopsies for microbiological testing; reduction of dead space by interpositioning of muscle or cement spacers loaded with local antibiotics; primary wound closure if tension-free closure possible; otherwise, if resources and knowhow permit and satisfactory clean debridement was achieved, local flap; if flap impossible, debridement not satisfactory, secondary tissue necrosis likely, potential remaining contamination or contamination with fecal matter, then vacuum-assisted closure therapy., Postoperative Management: Wound inspection on the second postoperative day, generous indication for second-look surgery after 36-48 h, wound inspection on the second postoperative day, wound inspection every other day, primary antibiotic prophylaxis with a first- or second-generation cephalosporin (e. g., cefuroxime), and adaptation of antibiotic therapy according to susceptibility screening., Results: Infection rates of 2-4.7% are reported for immediate primary wound closure in Gustilo-Anderson grade I, II, and III A open fractures. For Gustilo-Anderson grade III B, good wound healing, bony consolidation, and no need for secondary surgery was reported in 86.7% when primary wound closure was achieved.

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Joint infections of the hand may lead to irreversible lesions and impairment of hand function due to early cartilage damage. Furthermore, persistent infections which are not treated immediately can cause osteitis and/or spread systemically. Finger joints are prone to infection due to bite wounds or crush and sharp injuries. Whereas the wrist is often affected in patients with immunosuppression or chronic diseases, such as diabetes mellitus. If diagnosis and therapy are delayed, joint damage may be inevitable. Therefore, urgent treatment of the infected joint is imperative to preserve the function of the hand. This article reviews the current diagnostics and treatment of joint infections of the hand.

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Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)