ERN for chronic postoperative genitofemoral nerve entrapment neuropathy was successful in the majority of patients selected for the procedure. This minimally invasive approach allows simultaneous neurectomy of genitofemoral and ilioinguinal nerves.
Background: The insertion of a Totally Implantable Access Port (TIAP) is a routinely employed technique in patients who need a safe and permanent venous access. The number of TIAP implantations is increasing constantly mainly due to advanced treatment options for malignant diseases. Therefore it is important to identify the implantation technique which has the optimal benefit/risk ratio for the patient.
Liver resection as an emergency procedure in patients with liver injury due to abdominal trauma has become a rare procedure. In most cases liver trauma can be managed conservatively. Currently surgery is only indicated in hemodynamically instable patients and in cases of progredient haematoma where the main aim is control of bleeding. Anatomical liver resection should be avoided and may only be performed in cases of total vascular avulsion. Debridement of devascularized tissue can also be carried out in terms of an atypical liver resection. This article elucidates the current indications for liver resection after traumatic liver injury.
Background: Postoperative pancreatic fistula (POPF) is the most important complication after pancreatic surgery and is associated with major morbidity, increased use of resources, and prolonged hospital stay. The true economic impact of POPF is unknown. Methods: We evaluated the economic impact of POPF based on a full cost analysis of hospital expenses and reimbursements for all patients discharged after pancreatic resections at our center in 2015 with billing through the G-DRG-System. For definition and grading of POPF the 2016 update of the international definition was used. Uni-and multivariable analyses of factors associated with a deficit of >1000V per case were performed. Results: Of 505 patients with pancreatic resections, 78 (15.4%) developed POPF. The occurrence and the grade of POPF were significantly associated with increased treatment costs in all cases and in subgroups of different resections (e.g. mean costs of 15,741.51V without and of 54,023.20V with POPF after pancreatoduodenectomy; p< 0.0001). DRG reimbursements significantly increased in parallel but failed to cover the cost increase. POPF resulted in uncovered costs and was associated with a deficit in total, after different resections, and within single DRGs. POPF was the dominant independent risk factor for deficits >1000V/case. Conclusion: POPF has considerable economic impact and results in highly increased treatment costs that are currently not covered by reimbursements through the G-DRG system.
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