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Bei Lagerung, Zugang und Instrumentation unterscheidet sich die minimal-invasive Chirurgie (MIC) fundamental von der konventionell-offenen Chirurgie. Jeder dieser Aspekte ist mit einer eigenen, spezifischen Morbiditat assoziiert, wie z. B. Lagerungsschaden, Trokarverletzungen, Hyperkapnie und thermische Lasionen. Technologische Entwicklungen und zunehmende Erfahrung erklaren die Reduktion von MIC-assoziierten Komplikationen und das Meistern von besonderen Herausforderungen. Diese Fortschritte sind Voraussetzung fur die beeindruckende Ausbreitung dieser neuen Operationsform in der Chirurgie des Haufigen wie Cholezystektomie oder Hernienreparatur und in der Chirurgie des Speziellen wie bariatrische, onkologische oder Thoraxchirurgie. Die vorliegende Ubersichtsarbeit befasst sich mit den MIC-spezifischen und MIC-typischen Komplikationen.

In unserer Gesellschaft steigt die Zahl der adiposen Patienten an, die wegen schwerwiegender Folgeerkrankungen einen adipositaschirurgischen Eingriff benotigen. Trotz Standardisierung dieser Operationen konnen Komplikationen wie Stenosen und Ulzerationen nach Magenbypass (RYGB) und Schlauchmagen (SG) auftreten. Unter Einbeziehung der aktuellen Literatur mit randomisierten klinischen Studien, Reviews, Einzelfallberichten und Expertenmeinungen wird ein Komplikationsmanagement entwickelt und vorgestellt. Stenosen treten mit einer Haufigkeit von 0,1–3,9 % bei der SG und 3–27 % beim RYGB auf. Sie sind meist Folge einer fehlerhaften Operationstechnik oder Mikroinsuffizienz. Ulzerationen finden sich vor allem nach RYGB in 2–12 % der Falle. Ursachlich kommen Fremdkorperreaktionen, lokale Ischamien, peptische Lasionen und Mikroinsuffizienzen infrage. Das therapeutische Vorgehen hangt von der Lokalisation und Genese der Striktur ab. Endoskopische Interventionen fuhren bei Stenosen meist zum Erfolg. Selten ergibt sich hier eine Indikation zur operativen Revision. Auch Ulzerationen konnen in der Regel konservativ behandelt werden. Eine operative Intervention ergibt sich bei akuten Notfallen wie Perforation oder Blutung.

Hintergrund Die totale mesorektale Exzision (TME) entlang der viszeralen Faszie („holy plane“) ist die chirurgische Standardoperation fur das mittlere und tiefe Rektumkarzinom. Diese schichtorientierte Dissektion hat ein erhebliches Potenzial fur die Verletzung der viszeralen Faszie, nachweislich durch inadaquate Praparatequalitat, und der parietalen Faszie, nachweislich durch Storung der autonomen Nervenfunktion. Wir haben eine Operationstechnik entwickelt, bei der die autonomen Nerven als zusatzliche anatomische Leitstrukturen im kleinen Becken verwendet werden.

Background Peristomal skin lesions are frequent complications of ostomy; however, there is no generally accepted nomenclature and classification system. Objective An interdisciplinary German expert panel (GESS) composed of ten members, developed an innovative semiquantitative classification system for peristomal skin lesions for further stratification of ostomy therapy. This score is based on criteria which can be assessed by stomal therapists and treating physicians. Results The new peristomal skin lesion score grades three categories: lesion (L), status of ostomy (S) and disease (D). The L category describes the integrity of the skin as normal (L0), lesion with sustained integrity of skin (L1), integrity destroyed (L2) and local infection (L3). The S category rates the complexity of ostomy therapy as normal (S0), increased (S1) and high but not sufficiently effective (S2). The additional letters for categorization O. R. P. H. E. US describe anatomical pathologies of the stoma itself: ostomy stenosis (O), retraction (R), prolapse (P), hernia (H), edema (E) and unfavorable site (US). A systemic disorder is either absent (D0), irrelevant (D1) or relevant (D2). The LSD score is the basis for a management algorithm. Conclusion The LSD score is comprehensive, standardized and holistic. Its straightforward use by health professionals can improve the consistency of the description of skin lesions and enhance the quality of ostomy therapy.

Introduction: Negative Pressure Wound Therapy (NPWT) is widely used in the management of the open abdomen despite uncertainty regarding several aspects of usage. An expert panel was convened to develop evidence-based recommendations describing the use of NPWT in the open abdomen. Methods: A systematic review was carried out to investigate the efficacy of a range of Temporary Abdominal Closure methods including variants of NPWT. Evidence-based recommendations were developed by an International Expert Panel and graded according to the quality of supporting evidence. Results: Pooled results, in non-septic patients showed a 72% fascial closure rate following use of commercial NPWT kits in the open abdomen. This increased to 82% by the addition of a ‘dynamic’ closure method. Slightly lower rates were showed with use of Wittmann Patch (68%) and home-made NPWT (vac-pack) (58%). Patients with septic complications achieved a lower rate of fascial closure than non-septic patients but NPWT with dynamic closure remained the best option to achieve fascial closure. Mortality rates were consistent and seemed to be related to the underlying medical condition rather than being influenced by the choice of dressing, Treatment goals for open abdomen were defined prior to developing eleven specific evidence-based recommendations suitable for different stages and grades of open abdomen. Discussion and conclusion: The most efficient temporary abdominal closure techniques are NPWT kits with or without a dynamic closure procedure. Evidence-based recommendations will help to tailor its use in a complex treatment pathway for the individual patient.

Das klinische und wissenschaftliche Interesse an der minimalinvasiven Osophagusresektion („minimally invasive esophagectomy“, MIE) nimmt zu. Allerdings ist die Technik – insbesondere die der intrathorakalen Anastomose – nicht standardisiert. Haufig wird sie mithilfe der Minithorakotomie per Zirkularstapler hergestellt. Im vorliegenden Beitrag wird eine Methode prasentiert, die ganzlich auf die Thorakotomie verzichtet, indem der Stapler transhiatal in den Thorax gefuhrt wird. Die Operationsergebnisse werden an einem nichtselektionierten Krankengut untersucht. Der abdominelle Akt erfolgt laparoskopisch und der thorakale minimalinvasiv in Linksseitenlage des Patienten unter Einlungenbeatmung. Ausmas von Resektion und Zweifeldlymphadenektomie entsprechend der konventionellen Operation. Die kippbare Andruckplatte wird transoral in den Osophagusstumpf platziert. Das Praparat wird uber einen transrektalen Wechselschnitt im rechten Oberbauch geborgen. Der Zirkularstapler wird extravulnar in den Magenschlauch positioniert und handgefuhrt transabdominell transhiatal in den Thorax vorgeschoben; hier erfolgt die Anastomosierung videoendoskopisch. Die Krankenakten der konsekutiven Patientenserie wurden retrospektiv ausgewertet. Von Juni 2010 bis Juni 2013 wurden 23 Patienten (medianes Alter 69 Jahre; Range 46 bis 80 Jahre) mit Adeno- (n = 19) oder Plattenepithelkarzinomen (n = 4) total-minimalinvasiv operiert. Davon waren 15 Patienten neoadjuvant vorbehandelt (10 Teil- und 4 Vollremissionen). Alle Resektionen und intrathorakalen Anastomosen wurden ohne technische Schwierigkeiten/Konversion in 305 min (Range 220–441 min) durchgefuhrt. Die mediane Lymphknotenzahl betrug 16 (Range 4–42), die R0-Rate 91 %. Zwei Anastomoseninsuffizienzen konnten mit endoskopischen Techniken beherrscht werden. Kein Patient verstarb. Die intrathorakale Anastomose kann mit der vorgestellten Technik in standardisierter Weise total-minimalinvasiv auch ohne Thorakotomie hergestellt werden. Oberstes Ziel bleibt die Reduktion der Morbiditat.

Nach operativer Harnableitung uber ein Ileumconduit stellen parastomale Hernien mit einer Inzidenz von 4–16% eine relativ haufige Komplikation dar. Eine operative Korrektur wird nach allgemeinen Angaben in etwa 30–35% der Falle notwendig. Fur die operative Korrektur einer parastomalen Hernie sind verschiedenste Verfahren beschrieben worden. Die primare Fasziennaht hat eine hohe Rezidivrate von 46–100%, wohingegen die Stomaneuplatzierung mit Komplikationsraten von bis zu 88% assoziiert ist. Mit der Verwendung von alloplastischem Material (meist Polypropylennetze) kann die Rezidivrate deutlich von bis zu 100% fur die primare Fasziennaht und 71% fur die Stomatranslokation auf 33% gesenkt werden. Netze mit einer Doppelbeschichtung aus Polypropylen und ePTFE („expanded polytetrafluorethylene“), kombinieren die Vorteile der ausgepragten Bauchwandverstarkung durch einsprossendes Bindegewebe mit der einfachen, schonenden und gut kontrollierbaren intraperitonealen Platzierungsmoglichkeit. In der Arbeit werden unsere Erfahrungen mit doppelt beschichteten Zwei-Komponenten-Netzen zur Hernienversorgung nach Anlage eines Ileumconduits vorgestellt.

Summary Background: Anal cancer is an evolving problem in HIV-infected patients. In fear of excessive toxicity in patients with HIV infection, aggress

Metastatic calcinosis is a common feature of chronic renal failure. Its first manifestations are bone demineralization and non-visceral and/or visceral calcification with mostly mural deposits in arteries and arterioles. It is initially characterized by hyperphosphataemia followed by secondary or tertiary hyperparathyroidism. Cutaneous involvement is a rare complication. Histologically, the lesions show vascular calcification with ischaemic skin necrosis. Extreme cases may produce calcinosis cutis (calciphylaxis), i.e. disseminated calcification of the subcutaneous tissue and dermis in the form of hard painful cutaneous nodules and plaques with subsequent ulceration. Metastatic calcinosis is a disease affecting adults, while the dystrophic or idiopathic type can develop in children. We present the case of a 6-year-old boy with end-stage renal disease, attributed to congenital renal hypoplasia, and accompanied by secondary hyperparathyroidism. He developed fulminant tertiary hyperparathyroidism and metastatic calcinosis of the lungs, as well as cutaneous necrosis of the buttocks and legs, subsequent to calcification of arteries and arterioles. A maternal renal transplant failed to function. The serum parathormone, calcium and phosphate levels could not be controlled by maintenance dialysis, phosphate binders and calcitriol. Total parathyroidectomy without autotransplantation of parathyroid tissue rapidly returned the serum parathormone, calcium and phosphate levels to normal. In addition, topical treatment using merbromine solution and hydrocolloid dressings, healed the ulcers with significant scar formation, within 2.5 months after parathyroidectomy. A renewed increase of the calcium x phosphate product, 2 months after parathyroidectomy, was attributed to mobilization of calcium compounds from the viscera, as confirmed by a chest X-ray.

Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.

The hydrogen clearance technique (HCT) was employed for measurements of local pancreatic blood flow (PBF) in dogs, opossums, and rats under normal conditions and in opossums during biliary pancreatitis. Local PBF (ml/min/100 g) in dogs was 57.6 +/- 10.4, in opossums 60.6 +/- 9.5, and in rats 144.7 +/- 23.4, under resting conditions. Regional distribution of local PBF in dogs showed no statistical differences. Technical aspects of the HCT were described in detail. Under physiological conditions parenchymal trauma following electrode implantation was negligible in nearly all cases. More than 95% of registered clearance curves were monoexponential and showed excellent reproducibility of PBF values in repeated measurements (percentage deviationor = 6.7). Five days after initiating biliary pancreatitis by common channel ligation in opossums local PBF was 72.1 +/- 14.7 after implantation of new electrodes. Chronically implanted electrodes, however, recorded only 39.7 +/- 15.8, due to massive fibro-proliferative alterations around the implanted electrode tips. We therefore conclude that the HCT as described is a useful tool for measuring local PBF in acute experimental settings only. Biliary pancreatitis in our model causes no significant alterations of PBF after 5 days.

Introduction: Major surgery is often followed by an overwhelming systemic inflammatory response syndome (SIRS) which is considered to be the major cause of multiorgan dysfunction syndrome (MODS). The »ntestine-sepsis-hypothesis« considers the breakdown of the intestinal barrier followed by bacterial translocation a major step towards the development of SIRS. The present clinical study prospectively investigates the relation of intestinal barrier dysfunction and the risc of multiorgan failure (MOF) after major abdominal and vascular surgery. Materials and methods: 36 patients (68 ± 20 years; m : w 20 : 16) after major elective abdominal and vascular operations (esophagectomies (3), colorectal resections (18), aortic aneurysm operations (15)) were included into this study. Preoperatively and 24, 72 and 120 hours after operation clinical data as well as laboratory exams were performed. Concentrations after oral application of sugar (15 g lactulose; 0.5 g mannitol, 2.0 g rhamnose, 1.0 g xylose) were determined in urine of patients (HPLC). The clinical course was estimated by APACHE II score, MOF was evaluated by Goris-score. Results: According to APACHE II (≥ 10 points) and MOF-score (≥ 5 points) patients with bad prognosis (multiorgan failure, group 1; n = 10) and patients with good prognosis (group 2; n = 26) were differentiated. After enteral application of mono- and disaccharids an increased intestinal permeability measured by mannitol excretion into urine was found 24 hours(significant, p < 0.05 Mann-Whitney U-test, MOF vs. group2: 4.46 ± 1.20 vs. 0.89 ± 0.23) and 72 hours (significant, p < 0.05 MOF vs. group2: 0.88 ± 0.29 vs. 0.24 ± 0.03) postoperatively in the MOF group. This difference was not found 120 hours postoperatively. Mannitol concentration correlated with MOF-score and after 72 hours even with survival probability. Lactulose/rhamnose ratio also showed the tendency of increasing intestinal permeability in the multiorgan failure group, however without significance. ROC-Analysis showed that intestinal permeability 72 hours postoperatively is predictive for survival of patients after extended abdominal and vascular operations. Conclusion: Our results confirm that patients with a multiorgan failure show an increased intestinal permeability in the early phase after large visceral surgery. These observations are consistent with the »ntestine-sepsis-hypothesis« and indicate an important role of intestinal barrier disturbances in the development of MOF after extended abdominal surgery.

Hintergrund: Beim sporadischen kolorektalen Karzinom sind in etwa 15% der Falle MMRG mutiert. Untersuchungen bezuglich der Tumorcharakteristika und der Prognose dieser Subpopulation wurden bislang nur bei Patienten durchgefuhrt, die eine Mikrosatelliten-instabilitat aufwiesen. Da nicht bei allen mikrosatelliteninstabilen Tumoren Mutationen der MMRG nachweisbar sind, war es das Ziel dieser Studie zu untersuchen, welchen Einflus die MMRG auf Tumorbiologie und Verlauf ausuben.

Background Emergency surgery for colorectal cancer has become more aggressive and radical over the past decade. This retrospective review analyses the impact on outcome. Methods The results of emergency surgery within 24 h of admission were compared between 1982 and 1987 (77 patients) and 1988 and 1993 (75 patients). Patient and tumour characteristics were similar in both groups. Results Right colonic obstruction or perforation was treated by primary resection and anastomosis in 11 of 12 patients before 1988 and in all 19 patients thereafter. Primary resection was also the treatment of choice for perforated cancer of the left colon and rectum before 18 of 20) and after (20 of 21) 1988. The rate of primary resection for obstructing cancer of the left colon and rectum increased from 17 of 45 to 30 of 35. One-stage resections for obstructing cancer were performed in ten of 45 and 22 of 35 patients before and after 1988 respectively. The overall mortality rate declined from 14 of 77 to three of 75 after 1988 (P < 0·01). The rate of radical lymphadenectomy rose from six of 46 patients to 42 of 69 after 1988. The 3-year survival rate increased from 50 to 74 per cent (P < 0·05). Conclusion The data support further efforts towards improving the immediate and late outcome of emergency surgery in complicated colorectal cancer.

Conservative surgery in Crohn’s disease causes multiple enterai anastomoses. In 120 patients who underwent resectional surgery for Crohn’s disease with a total of 165 anastomoses we analyzed the risk factors (a) number of anastomoses per operation, (b) preoperative cortisone, and (c) the resection margins in relation to the major postoperative complications. With a total of five major complications and no mortality we could not observe an increased risk for a higher morbidity in Crohn’s disease surgery with multiple anastomoses.

Changes of pancreatic blood flow (PBF) during acute pancreatitis (AP) have been under investigation by means of electromagnetic flowmeters, radioactive microspheres, isotope fractionation, radioactive gas clearance, and venous outflow techniques. All methods, however, have certain drawbacks, which make the application of other techniques desirable. In this study, the hydrogen clearance technique (HCT) was tested for the first time in a well-established foxhound model of AP. PBF, systemic blood pressure, and heart rate were monitored over 90 min after the onset of AP and 60 min after therapeutic infusion of Dextran-40 (10 ml/kg body wt). Our results fully agree with the data found by other techniques in this experimental model. Sixty-five of 73 electrodes implanted into the pancreas of eight foxhounds were found working. From 1,024 registered clearance curves, 876 were identified as monoexponential. In the other cases, and only then, we found either dislocation of the electrode tips (n = 6) or perielectrodal hemorrhage during histological examination (n = 4). We believe that the HCT is a feasible and reliable tool for measuring PBF in experimental settings like AP.

Motilin and caerulein are known to affect motility of the sphincter of Oddi (SO) and the gastrointestinal tract. The role of SO-duodenal myoneural continuity in the action of these peptides was studied. Five opossums had translocation of the duodenal papilla into the jejunum, while preserving the blood supply to the SO and duodenum. Serosal electrodes were placed in the SO, duodenum, and jejunum. Five control animals had electrode placement alone. Myoelectric recording was obtained during fasting and after administration of motilin (400 ng/kg) or caerulein (500 ng/kg/hr). Motilin induced premature phase III-like activity in the SO and intestine in controls. After the translocation of the papilla, the spike frequencies during phase II and phase III were significantly lower than in controls, whereas those during phase I and phase IV were not different. Motilin caused premature intestinal phase III and increased SO spike activity. However, the increase in SO spike activity was insufficient to form phase III. Caerulein produced a sustained increase in spike activity in both regions in both groups, but the increase was less in the translocation group than in controls. These data suggest that duodenal activity stimulated by motilin and caerulein participates in the activation of SO motility via intrinsic myoneural pathways.

The data for 77 patients with colorectal cancer who underwent emergency surgery for acute intestinal obstruction (57 patients) or perforation (20 patients) within 24 h of admission were evaluated. The patients were older and had more advanced disease than patients undergoing elective surgery for colorectal cancer. Emergency surgery for carcinoma of the right colon consisted of primary resection in 95 per cent of cases and was followed by a 28 per cent mortality rate. Perforated tumours of the left colon and rectum were managed by primary resection in 82 per cent of cases with a 22 per cent mortality rate. In contrast, obstructing tumours of the left colon and rectum were treated by primary resection in 38 per cent of cases with a 6 per cent mortality rate, and by primary decompression in 62 per cent of cases with a 25 per cent mortality rate. The overall postoperative mortality rate was 23 per cent and increased with advanced tumour disease, perforation and peritonitis. Cardiac decompensation and intraabdominal sepsis were the major causes of death. Although the long-term survival rate following emergency surgery was worse than after elective surgery, improvements in outcome should be achieved by better management of the initial emergency situation.

The papilla of Vater and its sphincter of Oddi, lying at the confluence of the bile and pancreatic ducts in man, have long been suspected as a source of upper abdominal pain. Enlarging the opening of the transpapillary segment of the bile and major pancreatic ducts by using a transduodenal sphincteroplasty with transampullary septectomy resulted in death in a patient with a peripapillary diverticulum and pancreas divisum. Eight-six patients followed for 1 to 10 years experienced a 75% success rate. Thirty-six patients had a marked stenosis of their duct of Wirsung, suggesting that their pain was primarily from the pancreas. The remainder had either a generalized narrowing (40 patients) or a normal (7 patients) papilla. Pain was not satisfactorily resolved in patients with an associated pancreas divisum, chronic pancreatitis, and recurrent episodes of acute pancreatitis with alcoholism.

"Stenosing papillitis" is a descriptive term for an anatomic deformity of the papilla of Vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of Wirsung. The defect is secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. Patients with papillary stenosis from gallstones may present with episodes of severe upper-abdominal pain several years after cholecystectomy. The pain is often incapacitating, and patients are often addicted to narcotic analgesics. The work-up includes abdominal ultrasonography and CT scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal. Liver and pancreatic enzymes are not frequently elevated with the painful episodes. Transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct. Some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy, thereby ablating the sphincter of Oddi around the bile and pancreatic ducts and enlarging their openings.

Background: Manifold metastatic spread of renal cell carcinoma, even after long-term latency, is feared and unpredictable. Late recurrence after more than 10 years is not rare and then often initially

The effect of the calcium-channel blocker nifedipine on the electromyographic activity of the small bowel and sphincter of Oddi was studied in conscious opossums. Electromyographic and arterial pressure recordings were started 7-10 days after implantation of seven pairs of electrodes along the small bowel and sphincter of Oddi. Continuous infusion of nifedipine caused a dose-dependent reduction of the frequency of spike bursts in the small bowel and sphincter of Oddi. Nifedipine at high doses abolished the migrating motor complex in the gastrointestinal tract. The frequency of slow waves was unchanged. This drug possibly inhibits the membrane influx of calcium into the smooth muscle cells of the gastrointestinal tract. We conclude that nifedipine causes an intense decrease in the motility of the small bowel and sphincter of Oddi.

Arterial plasma renin activity, arterial blood pressure, heart rate and respiratory frequency were measured in 10 patients with chronically distended bladder due to benign prostatic hyperplasia before and after bladder drainage. After suprapubical bladder puncture there was a decrease in all the values. Similar changes were also found in 3 patients with artificially induced acute bladder distension, who did not suffer from infravesical obstruction. A significant correlation was found between the changes of the arterial pressure and arterial plasma renin activity. It is therefore suggested that the renin-angiotensin system might be involved in patients with bladder distension.

Continuous biliary pressure and electromyographic activity of the sphincter of Oddi and gastrointestinal tract were recorded in conscious opossums following administration of analgesic drugs. Morphine, meperidine, and pentazocin increased significantly the duration of the migrating motor complex (MMC) cycle. Periods of 1-2 minutes of intense burst of spike potentials were seen in the sphincter of Oddi and duodenum following administration of morphine (8 experiments), meperidine (6 experiments), and pentazocin (3 experiments). The biliary pressure in the control studies was similar to that following administration of all analgesics in the animals with gallbladder and following instillation of tramadol, metamizol, and acetylsalicylic acid in animals with no gallbladder. However, the biliary pressure was significantly higher following administration of morphine, meperidine, and pentazocin in the animals with no gallbladder. It is concluded from this study that morphine, meperidine, and pentazocin may cause important disturbances in the motility of the sphincter of Oddi and gastrointestinal tract. These myoelectric disturbances may cause an increase in the biliary pressure in animals that have been subjected to cholecystectomy, but not in animals with intact gallbladder. The gallbladder may accommodate the bile produced by the liver during periods of sphincter of Oddi dysfunction and thus impede an increase in the biliary pressure.

Von 1218 operativen Eingriffen wegen Carcinomen des Magens, Colons and Rectums wurden 6% unter Notfallbedingungen durchgefuhrt. 2/3 der Notfallsituationen waren durch eine Ileussymptomatik, 1/3 durch Darmperforation oder Blutungen bedingt. Die operationsbedingte Letalitat betrug hierbei 30%. Das Uberleben der notfallmasig operierten Patienten wurde neben dem oft fortgeschrittenen Alter and assoziierten Begleiterkrankungen vor allem durch die Notfallsituation an sich and weniger durch das Tumorstadium bestimmt. Eine Verbesserung der Therapieergebnisse kann somit weniger durch Einbeziehung onkologischer Behandlungskonzeptionen, als vielmehr durch rasche, sichere and definitive chirurgische Beherrschung der Notfallsituation erwartet werden.