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Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 543 - файл
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Contents
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9.3 Malignant Diseases ................................................................................................ 243
9.3.1 Pancreatic Carcinoma ................................................................................................. 243
9.3.2 Guidelines ....................................................................................................................... 250
9.4 Cystic Neoplasms.................................................................................................... 250
9.4.1 Intraductal Papillary Mucinous Neoplasia (IPMN) ............................................ 250
9.4.2 Serous Cystic Neoplasms (SCN) ............................................................................... 254
9.4.3 Mucinous Cystic Neoplasia (MCN) ......................................................................... 255
9.4.4 Solid Pseudopapillary Neoplasia (SPN) ................................................................ 255
9.4.5 Guidelines ....................................................................................................................... 256
9.5 Endocrine Neoplasms ........................................................................................... 256
9.5.1 Denition ........................................................................................................................ 257
9.5.2 Epidemiology ................................................................................................................ 257
9.5.3 Symptoms ....................................................................................................................... 257
9.5.4 Diagnosis ......................................................................................................................... 258
9.5.5 Therapy ............................................................................................................................ 258
9.5.6 Guidelines ....................................................................................................................... 259
References....................................................................................................................... 259
10 Kidney Transplantation................................................................................ 261
XI
Bernd Jänigen, Franck Billmann, and Przemyslaw Pisarski
10.1 Introduction ............................................................................................................. 263
10.1.1 Legal Framework .......................................................................................................... 263
10.1.2 Structure in Germany.................................................................................................. 263
10.2 Indication for Transplantation and Preparation of the Recipient .......... 263
10.2.1 Indication for Transplantation ................................................................................. 263
10.2.2 Recipient Preparation ................................................................................................. 264
10.2.3 Registration in the Waiting List ............................................................................... 265
10.3 Deceased Organ Donation .................................................................................. 266
10.3.1 Organ Donation and Donor Selection .................................................................. 266
10.3.2 Organ Allocation .......................................................................................................... 267
10.3.3 Organ Retrieval ............................................................................................................. 268
10.4 Living Kidney Donation ....................................................................................... 269
10.4.1 Prerequisites ................................................................................................................... 269
10.4.2 Legal Limits in Germany ............................................................................................ 269
10.4.3 Advantages of Living Kidney Donation ............................................................... 269
10.4.4 Donor Evaluation [Preparation and Diagnosis] ................................................. 269
10.4.5 Donor Operation .......................................................................................................... 270
10.4.6 Risks and Complications ............................................................................................ 271
10.4.7 Donor Aftercare ............................................................................................................ 272
10.5 Kidney Transplantation ........................................................................................ 272
10.5.1 Back-Table Preparation of the Kidney ................................................................... 272
10.5.2 Surgical Technique of Transplantation ................................................................. 272
10.5.3 En Bloc Renal Transplantation ................................................................................. 273
10.5.4 Surgical Complications............................................................................................... 274
10.6 Postoperative Treatment ..................................................................................... 275
10.6.1 Inpatient Stay................................................................................................................. 275
10.6.2 Immunosuppression ................................................................................................... 275
10.6.3 Organ Rejection ............................................................................................................ 278
10.6.4 Infections ......................................................................................................................... 279
10.6.5 Aftercare .......................................................................................................................... 279
10.7 Results ........................................................................................................................ 280
XII
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Contents
11 Spleen ...................................................................................................................... 281
Therezia Bokor-Billmann and Franck Billmann
11.1 Spleen: Generalities ............................................................................................... 282
11.1.1 Embryology and Developmental Disorders ....................................................... 282
11.1.2 Anatomy .......................................................................................................................... 282
11.1.3 Physiology ....................................................................................................................... 284
11.2 Spleen Diseases ...................................................................................................... 284
11.2.1 Benign Haematological Diseases ........................................................................... 284
11.2.2 Other Benign Diseases ............................................................................................... 287
11.2.3 Malignant Diseases ...................................................................................................... 288
11.2.4 Spleen Trauma ............................................................................................................... 288
11.2.5 Post-splenectomy Morbidity.................................................................................... 289
References....................................................................................................................... 291
12 Peritoneum........................................................................................................... 293
Jörg Pelz
12.1 Anatomy and Physiology of the Peritoneum ................................................ 294
12.1.1 General Anatomy ......................................................................................................... 294
12.1.2 Physiology (Tasks) of the Peritoneum ................................................................... 294
12.2 Benign Diseases of the Peritoneum ................................................................. 294
12.2.1 Peritonitis ........................................................................................................................ 294
12.2.2 Peritoneal Adhesions .................................................................................................. 295
12.3 Pseudomyxoma Peritonei ................................................................................... 296
12.3.1 Denition ........................................................................................................................ 296
12.3.2 Classication .................................................................................................................. 296
12.3.3 Aetiology ......................................................................................................................... 296
12.3.4 Clinical Presentation ................................................................................................... 296
12.3.5 Therapy ............................................................................................................................ 296
12.3.6 Prognosis ......................................................................................................................... 296
12.4 Malignant Diseases of the Peritoneum ........................................................... 297
12.4.1 Mesothelioma ................................................................................................................ 297
12.4.2 Peritoneal Carcinomatosis ........................................................................................ 297
12.5 Cytoreductive Surgery (CRS) and HIPEC ......................................................... 298
12.5.1 Curative CRS and HIPEC ............................................................................................. 298
12.5.2 Prophylactic/Adjuvant CRS and HIPEC ................................................................. 301
12.5.3 Palliative Therapeutic Concepts for Ascites ........................................................ 301
12.5.4 Complications................................................................................................................ 301
12.5.5 Results .............................................................................................................................. 302
12.5.6 PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) ........................ 302
12.5.7 Guidelines ....................................................................................................................... 302
References....................................................................................................................... 303
13 Hernia ...................................................................................................................... 305
Jens Otto, Thorsten Lindenau, and Karsten Junge
13.1 Anatomy and Classication ................................................................................ 307
13.1.1 Hernia Anatomy ............................................................................................................ 307
13.1.2 Epidemiology ................................................................................................................ 307
13.1.3 Pathogenesis and Classication.............................................................................. 307
13.1.4 Hernia-Specic Complications ................................................................................ 308
Contents
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13.2 General Diagnosis and Therapy Principles .................................................... 308
13.2.1 Diagnosis ......................................................................................................................... 308
13.2.2 Therapy Principles ........................................................................................................ 308
13.3 Incisional Hernia ..................................................................................................... 308
13.3.1 Denition ........................................................................................................................ 308
13.3.2 Incidence ......................................................................................................................... 309
13.3.3 Aetiology ......................................................................................................................... 309
13.3.4 Clinical Presentation ................................................................................................... 309
13.3.5 Diagnosis ......................................................................................................................... 309
13.3.6 Surgical Therapy ........................................................................................................... 309
13.3.7 Guidelines ....................................................................................................................... 311
13.4 Inguinal and Femoral Hernia .............................................................................. 312
13.4.1 Anatomy, Denition and Classication ................................................................ 312
13.4.2 Epidemiology ................................................................................................................ 312
13.4.3 Pathophysiology ........................................................................................................... 313
13.4.4 Clinical Presentation ................................................................................................... 313
13.4.5 Diagnostic Procedures ............................................................................................... 313
13.4.6 Therapeutic Principles ................................................................................................ 313
13.4.7 Guidelines ....................................................................................................................... 317
13.5 Umbilical and Epigastric Hernia ........................................................................ 317
13.5.1 Umbilical Hernia ........................................................................................................... 317
13.5.2 Epigastric Hernia .......................................................................................................... 317
13.5.3 Clinical presentation ................................................................................................... 317
13.5.4 Diagnosis ......................................................................................................................... 317
13.5.5 Therapy ............................................................................................................................ 317
13.5.6 Guideline ......................................................................................................................... 318
13.5.7 Dierential Diagnosis: Rectus Diastasis ............................................................... 318
13.6 Parastomal Hernia .................................................................................................. 318
13.6.1 Denition ........................................................................................................................ 318
13.6.2 Epidemiology ................................................................................................................ 318
13.6.3 Risk Factors and Prevention ..................................................................................... 318
13.6.4 Clinical Presentation ................................................................................................... 319
13.6.5 Relevant Complications ............................................................................................. 319
13.6.6 Therapy ............................................................................................................................ 319
13.6.7 Guidelines ....................................................................................................................... 320
13.7 Other Rare Hernias................................................................................................. 320
13.7.1 Spieghel’s Hernia (Hernia Lineae Semilunaris) .................................................. 320
13.7.2 Hernia Obturatoria ....................................................................................................... 320
13.7.3 Hernia Ischiadica .......................................................................................................... 320
13.7.4 Hernia Perinealis ........................................................................................................... 320
13.7.5 Lumbar Hernia............................................................................................................... 320
References....................................................................................................................... 321
XIII
14 Gastrointestinal Stromal Tumors and Sarcomas ......................... 323
Daniel Oertli, Holger Bannasch, Athanasios Tampakis,
Christoph Kettelhack, and Tobias Keck
14.1 Gastrointestinal Stromal Tumours (GIST) ....................................................... 325
14.1.1 Denition ........................................................................................................................ 325
14.1.2 Epidemiology and Tumour Localisation .............................................................. 325
14.1.3 Clinical Presentation ................................................................................................... 325
XIV
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Contents
14.1.4 Pathology ........................................................................................................................ 326
14.1.5 Diagnosis ......................................................................................................................... 326
14.1.6 Therapy ............................................................................................................................ 326
14.1.7 Guidelines ....................................................................................................................... 328
14.2 Soft Tissue Tumours of the Extremities ........................................................... 328
14.2.1 General: Classication ................................................................................................ 328
14.2.2 Clinical Presentation ................................................................................................... 329
14.2.3 Diagnosis ......................................................................................................................... 330
14.2.4 Classication .................................................................................................................. 331
14.2.5 Prognosis ......................................................................................................................... 332
14.2.6 Therapeutic Principles ................................................................................................ 332
14.2.7 Guidelines ....................................................................................................................... 335
14.3 Retroperitoneal Sarcomas ................................................................................... 335
14.3.1 Epidemiology and Prognosis ................................................................................... 335
14.3.2 Pathology ........................................................................................................................ 335
14.3.3 Classication .................................................................................................................. 336
14.3.4 Molecular Genetics ...................................................................................................... 336
14.3.5 Clinical Presentation ................................................................................................... 336
14.3.6 Diagnosis ......................................................................................................................... 337
14.3.7 Therapy ............................................................................................................................ 337
14.3.8 Management of Recurrences ................................................................................... 339
14.3.9 Follow up ......................................................................................................................... 339
14.3.10 Guidelines ....................................................................................................................... 339
References....................................................................................................................... 339
15 Perioperative Medicine ................................................................................ 341
Maren Rudat and Sebastian Stehr
15.1 Preoperative Phase ................................................................................................ 342
15.1.1 Risk Stratication .......................................................................................................... 342
15.1.2 Laboratory and Blood Products .............................................................................. 343
15.1.3 Additional Investigations .......................................................................................... 343
15.1.4 Perioperative Anticoagulation ................................................................................ 343
15.1.5 Medication Management .......................................................................................... 344
15.1.6 Information from the Anaesthetist’s Point of View .......................................... 345
15.2 Intraoperative Phase ............................................................................................. 345
15.2.1 Intraoperative Monitoring According to AAGBI and BDA Guidelines ....... 345
15.2.2 Volume Management ................................................................................................. 346
15.2.3 Hemodynamics ............................................................................................................. 346
15.2.4 Heat Retention .............................................................................................................. 346
15.2.5 Perioperative Antibiotic Therapy ............................................................................ 346
15.3 Postoperative Phase .............................................................................................. 347
15.3.1 Analgesia ......................................................................................................................... 347
15.3.2 Postoperative Nausea and Vomiting (PONV) ..................................................... 348
15.3.3 Delirium/Postoperative Cognitive Decit (POCD) ............................................ 348
15.3.4 Recovery Room (PACU) .............................................................................................. 349
15.3.5 Intensive Care Unit (ICU)/Intermediate Care (IMC) .......................................... 349
15.4 Fast Track Surgery .................................................................................................. 349
15.4.1 Denition ........................................................................................................................ 349
15.4.2 Preoperative Management ....................................................................................... 349
15.4.3 Intraoperative Management .................................................................................... 350
Contents
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15.4.4 Postoperative Management ..................................................................................... 350
15.4.5 Guidelines ....................................................................................................................... 350
Reference ........................................................................................................................ 350
16 Emergency Surgery ........................................................................................ 351
XV
Benjamin Weixler, Raoul A. Droeser, Robert Mechera,
Christian A. Nebiker, Debora Nowakowski, Heidi Misteli,
and Henry Hoffmann
16.1 Polytrauma: Abdominal Trauma ....................................................................... 353
16.1.1 Anatomy of the Abdomen ........................................................................................ 353
16.1.2 Injury Mechanisms (Aetiology and Pathophysiology) .................................... 354
16.1.3 Management and Diagnosis .................................................................................... 354
16.1.4 Therapeutic Procedure ............................................................................................... 355
16.1.5 Guidelines ....................................................................................................................... 356
16.2 Ileus/Obstruction ................................................................................................... 356
16.2.1 Denition—Classication ......................................................................................... 356
16.2.2 Epidemiology ................................................................................................................ 357
16.2.3 Pathophysiology ........................................................................................................... 357
16.2.4 Diagnosis ......................................................................................................................... 357
16.2.5 Mechanical Ileus (Mechanical Obstruction) ....................................................... 358
16.2.6 Paralytic Ileus/Functional Obstruction ................................................................. 359
16.2.7 Therapy ............................................................................................................................ 361
16.2.8 Specic Therapy for Certain Types of Ileus .......................................................... 362
16.3 Abdominal Compartment Syndrome .............................................................. 363
16.3.1 Denitions ...................................................................................................................... 363
16.3.2 Aetiology ......................................................................................................................... 363
16.3.3 Clinical presentation ................................................................................................... 364
16.3.4 Diagnosis ......................................................................................................................... 365
16.3.5 Therapy ............................................................................................................................ 366
16.3.6 Guidelines ....................................................................................................................... 367
16.4 Intestinal Ischemia ................................................................................................. 367
16.4.1 General ............................................................................................................................. 367
16.4.2 Acute Intestinal Ischaemia ........................................................................................ 367
16.4.3 Chronic Mesenteric Ischaemia (CMI) ..................................................................... 370
16.4.4 Guidelines ....................................................................................................................... 370
Contributors
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Holger Bannasch Department of Plastic, Hand and Aesthetic Surgery,
Schwarzwald-Baar-Hospital Villingen-Schwenningen, Villingen- Schwenningen,
Germany
FranckBillmann Department of General, Visceral and Transplant Surgery,
University Hospital Heidelberg, Heidelberg, Germany
ThereziaBokor-Billmann Department of Dermatology, University Hospital
Heidelberg, Heidelberg, Germany
Raoul A.Droeser Clarunis—Universitäres Bauchzentrum Basel, University
Hospital Basel, Basel, Switzerland
MichelGagner Sacré Coeur Hospital, Clinique Michel Gagner, QC, Canada
CourtneyElisabethGibson Department of Endocrine Surgery, Smilow Cancer
Hospital at Yale, New Haven, CT, USA
TorbenGlatz Department of General, Visceral and Vascular Surgery, Marien
Hospital Herne, University Hospital Ruhr-University Bochum, Herne,
Germany
HenryHomann Center for Hernia Surgery and Proctology, ZweiChirurgen
GmbH, Basel, Switzerland
KatrinHomann Department of General, Visceral and Transplant Surgery,
University Hospital Heidelberg, Heidelberg, Deutschland
KimC.Honselmann Department of Surgery, University Hospital SchleswigHolstein, Luebeck, Germany
Jens Höppner Department of Surgery, University Hospital SchleswigHolstein, Luebeck, Germany
Bernd Jänigen Department of General, Visceral and Transplant Surgery,
University Hospital Freiburg, Freiburg, Germany
KarstenJunge Department of General, Visceral and Minimally-invasive Surgery,
Rhein-Maas Hospital, Würselen, Germany
TobiasKeck Department of Surgery, University Medical Center SchleswigHolstein, Luebeck, Germany
ChristophKettelhack Clarunis—Universitäres Bauchzentrum Basel, University
Hospital Basel, Basel, Switzerland
Contributors
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ThorstenLindenau Department of General, Visceral and Minimally- invasive
Surgery, Rhein-Maas Hospital, Würselen, Germany
Robert Mechera Clarunis—Universitäres Bauchzentrum Basel, University
Hospital Basel, Basel, Switzerland
HeidiMisteli Department of Surgery, Hospital Uster, Uster, Switzerland
DidierMutter Department of Digestive and Endocrine Surgery, NHC, Pôle
Hépato-Digestif, University Hospital Strasbourg, Strasbourg, France
Christian A. Nebiker Department of General Surgery, Hospital Aarau,
Aarau, Switzerland
Debora Nowakowski Department of Surgery, Hospital Baselland, Basel,
Switzerland
Daniel Oertli Department of General Surgery, University Hospital Basel,
Basel, Switzerland
JensOtto Department of General, Visceral and Minimally-invasive Surgery,
Rhein-Maas Hospital, Würselen, Germany
XVII
JörgPelz Department of General, Visceral and Oncological Surgery, St. Bernward Hospital, Hildesheim Hospital, Hildesheim, Germany
PrzemyslawPisarski Department of General, Visceral and Transplant Surgery, University Hospital Freiburg, Freiburg, Germany
Maren Rudat Interdisciplinary Intensive Care Unit, Sana Kliniken Ostholstein, Eutin Hospital, Eutin, Germany
PeterSchemmer Department of General, Visceral and Transplant Surgery,
University Hospital Graz, Graz, Austria
SebastianStehr Department of Anesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Leipzig, Germany
AthanasiosTampakis Clarunis—Universitäres Bauchzentrum Basel, University
Hospital Basel, Basel, Switzerland
OliverThomusch Department of General, Visceral and Transplant Surgery,
University Hospital Freiburg, Freiburg, Germany
RobertUdelsman Miami Cancer Institute, Miami, FL, USA
XVIII
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Contributors
JensWannenmacher Surgical Department A, Ludwigshafen Hospital, Lud-
wigshafen, Germany
Benjamin Weixler Department of General and Visceral Surgery, Campus
Benjamin Franklin, Charité—University Hospital Berlin, Berlin, Deutschland
StefanWillis Surgical Department A, Ludwigshafen Hospital, Ludwigshafen,
Germany
Abbreviations
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XIX
γGT γ-Glutamyl trans-
18
F-FDG-PET 18 F-uorodeoxyglu-
5-ASA 5-aminosalicylic
5-FU 5-Fluorouracil
5-HIAA test 5-Hyd r oxyindol-
99m
Tc-MIBI
a. a. From anocutane-
AAA Abdominal aortic
AAGBI Association of Anes-
Ab Antibody
ABBA Axillo-bilateral-
ABCDE Airway, breathing,
ACDC Acute cholecystitis:
ACE Angiotensin-con-
ACS Abdominal com-
ferase
cose positron emission tomography
acid
acetic acid test
99 m
Technetium
methoxyisobutyl isonitrile
ous line
aneurysm
thetists of Great
Britain and Ireland
breast approach
circulation, disability, exposure
sequence
early versus delayed
cholecystectomy
(study)
verting enzyme
partment syndrome
ACTH Adrenocorticotropic hor-
AD Autosomal dominant
AEG Adenocarcinoma of the
AIDS Acquired immunode-
AIS Abbreviated injury scale
AJCC American Joint Commit-
AKS Abdominal compartment
ALM Adenoma like mass
ALT Atypical lipomatous tumor
AMI Acute mesenteric ischemia
AMS Superior mesenteric artery
ANCA Antineutrophil cytoplas-
AP Alkaline phosphatase
APC Adenomatous colonic pol-
APP Abdominal perfusion pres-
Approx. Approximatively
ASA American Society of Anes-
ASCA Anti-Saccharomyces cere-
ASS Acetylsalicylic acid
AT II Angiotensin II
ATA American Thyroid Associa-
mone
esophagogastral junction,
adenocarcinoma of the
esogastric junction
ciency syndrome
tee on Cancer
syndrome
mic antibody
yposis, adenomatous polyposis coli
sure
thesiologists
visiae antibody
tion
XX
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Abbreviations
ATLS Advanced trauma life
support
ATN Acute tubular necrosis
AVPU
Scheme Alert, voice, pain,
unresponsive sch eme
AWMF Arbeitsgemeinschaft
der Wissenschaftlichen
Medizinischen Fach-
gesellschaften
BC Before christ
BDA Berufsverband Deut-
scher Anäs thesisten
BG Blood glucose
BIS Bispectral index
BMI Body mass index
BPD Biliopancreatic diver-
sion
BPD/DS Biliopancreatic diver-
sion with duodenal
switch
BS Blood sugar
BSA Body surface area
BSR Blood sedimentation
rate
BUN Blood urea nitrogen
BW Body weight
CAD Coronary artery disease
CAEK Surgical Working
Group Endocrinology
CAM-ICU Confusion Assessment
Method/Intensive Care
Unit
CAPD Continuous ambula-
tory peritoneal dialysis
CAr Cardiac arrhythmia
CASH Chemotherapy-Associ-
ated Steato Hepatitis
CaSR Calcium-sensing recep-
tor
CASTLE Carcinoma with thy-
mus-like differentiation
CC Score Completeness of cyto-
reduction score
CCC (or CC) Cholangiocarcinoma
CCDS Color-coded Doppler
sonography
CCE
(also CHE) Cholecystectomy
CCIS Cleveland clinic inconti-
CDD Classication of diverticu-
CDUS Color Doppler ultrasound
CEA Carcinoembryonic antigen,
CEEA Circular end-to-end anas-
CHD Coronary heart disease
CIBD Chronic inammatory
CLL Chronic lymphocytic leu-
CM Contrast medium
CME Complete mesocolic exci-
CMI Chronic mesenteric isch-
CMS Circulation, motor func-
CMV Cytomegalovirus
CNS Central nervous system
CO Cardiac output
COPD Chronic obstructive pul-
CRC Colorectal cancer
CRH Corticotropin-releasing
CRM Circumferential resection
CRP C-reactive protein
CRS Cytoreductive surgery
CSC Chronic sclerosing cholan-
CT Computer tomography
CUSA Cavitron ultrasonic surgi-
CVC Central venous catheter
CVD Cardiovascular disease
CVI Chronic venous insuf-
CVL Central venous line
CVP Central venous pressure
DALM Dysplasia-associated lesion
DD Differential diagnosis
DES Drug eluting stent
DGF Delayed graft function
DJ Double J catheter
nence score
lar disease
carcinoembryonal antigen
tomosis
bowel disease
kemia
sion
emia
tion, sensory function
monary disease
hormone
margin
gitis
cal aspiration
ciency
or mass
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