Skip to main content
Erschienen in: Aesthetic Plastic Surgery 2/2021

05.01.2021 | Review

Fat Processing Techniques: A Narrative Review

verfasst von: Yan Lin, Yan Yang, Dali Mu

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Objective

This study reviewed the literature regarding different fat processing techniques, in order to update the information for healthcare personnel and provide the latest evidence in selecting purification methods.

Methods

PubMed (MEDLINE), EMBASE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials were comprehensively searched to identify studies that compared different fat purification methods for animal and human studies published through July 2020. Papers were screened using inclusion and exclusion criteria, and relative data were collected for review.

Results

A total of 3292 studies were identified, of which 30 were included for review. The findings of existing clinical studies showed that the filtration and washing filtration methods performed better in the volume retention rate of adipose tissue. In terms of postoperative complications (fat necrosis, nodules, cysts, etc.), the incidence of complications of centrifugation is generally higher than that of other purification methods, while Telfa gauze and washing filtration system show better safety. More comparative studies are needed to draw conclusions about clinical efficacy and satisfaction. The existing basic science studies generally believe that centrifugation has no advantage in the integrity and metabolic activity of adipose tissue. However, there is no definite conclusion about the volume retention rate of grafts in animal experiments.

Conclusion

In recent years, studies on the cost-effectiveness of various purification methods have emerged, and the efficiency advantages of commercial systems have also been gradually reflected. In the future, the purification efficiency will be improved based on ensuring clinical efficacy, which will be translated into cost savings.

Level of evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literatur
1.
Zurück zum Zitat Ml CHEN (2019) The research process and hot topics on autologous fat transplantation. Chin J Aesthet Med 28:2–4 Ml CHEN (2019) The research process and hot topics on autologous fat transplantation. Chin J Aesthet Med 28:2–4
3.
Zurück zum Zitat Wu R, Qi Z (2017) Comparative research progress of different fat purification methods. Chin J Aesthet Plast Surg 28:687–688 Wu R, Qi Z (2017) Comparative research progress of different fat purification methods. Chin J Aesthet Plast Surg 28:687–688
4.
Zurück zum Zitat Gerth DJ, King B, Rabach L et al (2014) Long-term volumetric retention of autologous fat grafting processed with closed-membrane filtration. Aesthet Surg J 34:985–994PubMedCrossRef Gerth DJ, King B, Rabach L et al (2014) Long-term volumetric retention of autologous fat grafting processed with closed-membrane filtration. Aesthet Surg J 34:985–994PubMedCrossRef
5.
Zurück zum Zitat Asilian A, Siadat AH, Iraji R (2014) Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat. J Res Med Sci 19:556–561PubMedPubMedCentral Asilian A, Siadat AH, Iraji R (2014) Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat. J Res Med Sci 19:556–561PubMedPubMedCentral
6.
Zurück zum Zitat Sarfati I, van la Parra RFD, Terem-Rapoport CA et al (2017) A prospective randomized study comparing centrifugation and sedimentation for fat grafting in breast reconstruction. J Plast Reconstr Aesthet Surg 70:1218–1228PubMedCrossRef Sarfati I, van la Parra RFD, Terem-Rapoport CA et al (2017) A prospective randomized study comparing centrifugation and sedimentation for fat grafting in breast reconstruction. J Plast Reconstr Aesthet Surg 70:1218–1228PubMedCrossRef
7.
Zurück zum Zitat Wu R, Yang X, Jin X et al (2018) Three-dimensional volumetric analysis of 3 fat-processing techniques for facial fat grafting: a randomized clinical trial. JAMA Facial Plast Surg 20:222–229PubMedPubMedCentralCrossRef Wu R, Yang X, Jin X et al (2018) Three-dimensional volumetric analysis of 3 fat-processing techniques for facial fat grafting: a randomized clinical trial. JAMA Facial Plast Surg 20:222–229PubMedPubMedCentralCrossRef
8.
Zurück zum Zitat Gabriel A, Maxwell GP, Griffin L et al (2017) A comparison of two fat grafting methods on operating room efficiency and costs. Aesthet Surg J 37:161–168PubMedCrossRef Gabriel A, Maxwell GP, Griffin L et al (2017) A comparison of two fat grafting methods on operating room efficiency and costs. Aesthet Surg J 37:161–168PubMedCrossRef
9.
Zurück zum Zitat Kang D, Luan J (2018) Fat Necrosis After Autologous Fat Transfer (AFT) to breast: comparison of low-speed centrifugation with sedimentation. Aesthetic Plast Surg 42:1457–1464PubMedCrossRef Kang D, Luan J (2018) Fat Necrosis After Autologous Fat Transfer (AFT) to breast: comparison of low-speed centrifugation with sedimentation. Aesthetic Plast Surg 42:1457–1464PubMedCrossRef
10.
Zurück zum Zitat Ruan QZ, Rinkinen JR, Doval AF et al (2019) Safety profiles of fat processing techniques in autologous fat transfer for breast reconstruction. Plast Reconstr Surg 143:985–991PubMedCrossRef Ruan QZ, Rinkinen JR, Doval AF et al (2019) Safety profiles of fat processing techniques in autologous fat transfer for breast reconstruction. Plast Reconstr Surg 143:985–991PubMedCrossRef
11.
Zurück zum Zitat Chiu WK, Fracol M, Feld LN et al (2019) A comparison of fat graft processing techniques: outcomes in 1,158 procedures in prosthetic breast reconstructions. Plast Reconstr Surg Glob Open 7:e2276PubMedPubMedCentralCrossRef Chiu WK, Fracol M, Feld LN et al (2019) A comparison of fat graft processing techniques: outcomes in 1,158 procedures in prosthetic breast reconstructions. Plast Reconstr Surg Glob Open 7:e2276PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Butterwick KJ (2002) Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus noncentrifuged fat. Dermatol Surg 28:987–991PubMed Butterwick KJ (2002) Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus noncentrifuged fat. Dermatol Surg 28:987–991PubMed
13.
Zurück zum Zitat Botti G, Pascali M, Botti C et al (2011) A clinical trial in facial fat grafting: filtered and washed versus centrifuged fat. Plast Reconstr Surg 127:2464–2473PubMedCrossRef Botti G, Pascali M, Botti C et al (2011) A clinical trial in facial fat grafting: filtered and washed versus centrifuged fat. Plast Reconstr Surg 127:2464–2473PubMedCrossRef
14.
Zurück zum Zitat Hanson SE, Garvey PB, Chang EI et al (2019) A prospective pilot study comparing rate of processing techniques in autologous fat grafting. Aesthet Surg J 39:331–337PubMedCrossRef Hanson SE, Garvey PB, Chang EI et al (2019) A prospective pilot study comparing rate of processing techniques in autologous fat grafting. Aesthet Surg J 39:331–337PubMedCrossRef
15.
Zurück zum Zitat Minn KW, Min KH, Chang H et al (2010) Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthet Plast Surg 34:626–631CrossRef Minn KW, Min KH, Chang H et al (2010) Effects of fat preparation methods on the viabilities of autologous fat grafts. Aesthet Plast Surg 34:626–631CrossRef
16.
Zurück zum Zitat Salinas HM, Broelsch GF, Fernandes JR et al (2014) Comparative analysis of processing methods in fat grafting. Plast Reconstr Surg 134:675–683PubMedCrossRef Salinas HM, Broelsch GF, Fernandes JR et al (2014) Comparative analysis of processing methods in fat grafting. Plast Reconstr Surg 134:675–683PubMedCrossRef
17.
Zurück zum Zitat Fisher C, Grahovac TL, Schafer ME et al (2013) Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 132:351–361PubMedCrossRef Fisher C, Grahovac TL, Schafer ME et al (2013) Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 132:351–361PubMedCrossRef
18.
Zurück zum Zitat Canizares O Jr, Thomson JE, Allen RJ Jr et al (2017) The Effect of processing technique on fat graft survival. Plast Reconstr Surg 140:933–943PubMedCrossRef Canizares O Jr, Thomson JE, Allen RJ Jr et al (2017) The Effect of processing technique on fat graft survival. Plast Reconstr Surg 140:933–943PubMedCrossRef
19.
Zurück zum Zitat Condé-Green A, Wu I, Graham I et al (2013) Comparison of 3 techniques of fat grafting and cell-supplemented lipotransfer in athymic rats: a pilot study. Aesthet Surg J 33:713–721PubMedCrossRef Condé-Green A, Wu I, Graham I et al (2013) Comparison of 3 techniques of fat grafting and cell-supplemented lipotransfer in athymic rats: a pilot study. Aesthet Surg J 33:713–721PubMedCrossRef
20.
Zurück zum Zitat Kang D, Fu S, Luan J (2019) Which fat processing can achieve optimal transplantation in patients with insufficient fat resource? Ann Plast Surg 83:459–463PubMedCrossRef Kang D, Fu S, Luan J (2019) Which fat processing can achieve optimal transplantation in patients with insufficient fat resource? Ann Plast Surg 83:459–463PubMedCrossRef
21.
Zurück zum Zitat Ansorge H, Garza JR, McCormack MC et al (2014) Autologous fat processing via the Revolve system: quality and quantity of fat retention evaluated in an animal model. Aesthet Surg J 34:438–447PubMedCrossRef Ansorge H, Garza JR, McCormack MC et al (2014) Autologous fat processing via the Revolve system: quality and quantity of fat retention evaluated in an animal model. Aesthet Surg J 34:438–447PubMedCrossRef
22.
Zurück zum Zitat Yin S, Luan J, Fu S et al (2016) Is centrifugation necessary for processing lipoaspirate harvested via water-jet force assisted technique before grafting? Evidence of lipoaspirate concentration with enhanced fat graft survival. Ann Plast Surg 77:477–484PubMedCrossRef Yin S, Luan J, Fu S et al (2016) Is centrifugation necessary for processing lipoaspirate harvested via water-jet force assisted technique before grafting? Evidence of lipoaspirate concentration with enhanced fat graft survival. Ann Plast Surg 77:477–484PubMedCrossRef
23.
Zurück zum Zitat Khater R, Atanassova P, Anastassov Y et al (2009) Clinical and experimental study of autologous fat grafting after processing by centrifugation and serum lavage. Aesthet Plast Surg 33:37–43CrossRef Khater R, Atanassova P, Anastassov Y et al (2009) Clinical and experimental study of autologous fat grafting after processing by centrifugation and serum lavage. Aesthet Plast Surg 33:37–43CrossRef
24.
Zurück zum Zitat Zhu M, Cohen SR, Hicok KC et al (2013) Comparison of three different fat graft preparation methods: gravity separation, centrifugation, and simultaneous washing with filtration in a closed system. Plast Reconstr Surg 131:873–880PubMedCrossRef Zhu M, Cohen SR, Hicok KC et al (2013) Comparison of three different fat graft preparation methods: gravity separation, centrifugation, and simultaneous washing with filtration in a closed system. Plast Reconstr Surg 131:873–880PubMedCrossRef
25.
Zurück zum Zitat Condé-Green A, de Amorim NF, Pitanguy I (2010) Influence of decantation, washing and centrifugation on adipocyte and mesenchymal stem cell content of aspirated adipose tissue: a comparative study. J Plast Reconstr Aesthet Surg 63:1375–1381PubMedCrossRef Condé-Green A, de Amorim NF, Pitanguy I (2010) Influence of decantation, washing and centrifugation on adipocyte and mesenchymal stem cell content of aspirated adipose tissue: a comparative study. J Plast Reconstr Aesthet Surg 63:1375–1381PubMedCrossRef
26.
Zurück zum Zitat Ibatici A, Caviggioli F, Valeriano V et al (2014) Comparison of cell number, viability, phenotypic profile, clonogenic, and proliferative potential of adipose-derived stem cell populations between centrifuged and noncentrifuged fat. Aesthet Plast Surg 38:985–993CrossRef Ibatici A, Caviggioli F, Valeriano V et al (2014) Comparison of cell number, viability, phenotypic profile, clonogenic, and proliferative potential of adipose-derived stem cell populations between centrifuged and noncentrifuged fat. Aesthet Plast Surg 38:985–993CrossRef
27.
Zurück zum Zitat Pfaff M, Wu W, Zellner E et al (2014) Processing technique for lipofilling influences adipose-derived stem cell concentration and cell viability in lipoaspirate. Aesthet Plast Surg 38:224–229CrossRef Pfaff M, Wu W, Zellner E et al (2014) Processing technique for lipofilling influences adipose-derived stem cell concentration and cell viability in lipoaspirate. Aesthet Plast Surg 38:224–229CrossRef
28.
Zurück zum Zitat Palumbo P, Miconi G, Cinque B et al (2015) In vitro evaluation of different methods of handling human liposuction aspirate and their effect on adipocytes and adipose derived stem cells. J Cell Physiol 230:1974–1981PubMedCrossRef Palumbo P, Miconi G, Cinque B et al (2015) In vitro evaluation of different methods of handling human liposuction aspirate and their effect on adipocytes and adipose derived stem cells. J Cell Physiol 230:1974–1981PubMedCrossRef
29.
Zurück zum Zitat Rose JG Jr, Lucarelli MJ, Lemke BN et al (2006) Histologic comparison of autologous fat processing methods. Ophthalmic Plast Reconstr Surg 22:195–200PubMedCrossRef Rose JG Jr, Lucarelli MJ, Lemke BN et al (2006) Histologic comparison of autologous fat processing methods. Ophthalmic Plast Reconstr Surg 22:195–200PubMedCrossRef
30.
Zurück zum Zitat Kamel AH, Kamal A, Abou-Elghait AT (2014) A quantitative analysis of the effects of different harvesting, preparation, and injection methods on the integrity of fat cells. Eur J Plast Surg 37:469–478CrossRef Kamel AH, Kamal A, Abou-Elghait AT (2014) A quantitative analysis of the effects of different harvesting, preparation, and injection methods on the integrity of fat cells. Eur J Plast Surg 37:469–478CrossRef
31.
Zurück zum Zitat Rubino C, Mazzarello V, Faenza M et al (2015) A scanning electron microscope study and statistical analysis of adipocyte morphology in lipofilling: comparing the effects of harvesting and purification procedures with 2 different techniques. Ann Plast Surg 74:718–721PubMedCrossRef Rubino C, Mazzarello V, Faenza M et al (2015) A scanning electron microscope study and statistical analysis of adipocyte morphology in lipofilling: comparing the effects of harvesting and purification procedures with 2 different techniques. Ann Plast Surg 74:718–721PubMedCrossRef
32.
Zurück zum Zitat Li Y, Lu H, Yang X et al (2020) Optimization of the parameters of different purification techniques and comparison of their purification efficiency and their effects on the metabolic activity of adipose tissue in autologous fat transplantation. J Craniofac Surg 31:662–667PubMedCrossRef Li Y, Lu H, Yang X et al (2020) Optimization of the parameters of different purification techniques and comparison of their purification efficiency and their effects on the metabolic activity of adipose tissue in autologous fat transplantation. J Craniofac Surg 31:662–667PubMedCrossRef
33.
34.
Zurück zum Zitat Kling RE, Mehrara BJ, Pusic AL et al (2013) Trends in autologous fat grafting to the breast: a national survey of the american society of plastic surgeons. Plast Reconstr Surg 132:35–46PubMedCrossRef Kling RE, Mehrara BJ, Pusic AL et al (2013) Trends in autologous fat grafting to the breast: a national survey of the american society of plastic surgeons. Plast Reconstr Surg 132:35–46PubMedCrossRef
35.
Zurück zum Zitat Cleveland EC, Albano NJ, Hazen A (2015) Roll, spin, wash, or filter? processing of lipoaspirate for autologous fat grafting: an updated, evidence-based review of the literature. Plast Reconstr Surg 136:706–713PubMedCrossRef Cleveland EC, Albano NJ, Hazen A (2015) Roll, spin, wash, or filter? processing of lipoaspirate for autologous fat grafting: an updated, evidence-based review of the literature. Plast Reconstr Surg 136:706–713PubMedCrossRef
36.
Zurück zum Zitat Allen RJ Jr, Canizares O Jr, Scharf C et al (2013) Grading lipoaspirate: is there an optimal density for fat grafting? Plast Reconstr Surg 131:38–45PubMedCrossRef Allen RJ Jr, Canizares O Jr, Scharf C et al (2013) Grading lipoaspirate: is there an optimal density for fat grafting? Plast Reconstr Surg 131:38–45PubMedCrossRef
37.
Zurück zum Zitat Khouri RK, Rigotti G, Cardoso E et al (2014) Megavolume autologous fat transfer: part II practice and techniques. Plast Reconstr Surg 133:1369–1377PubMedCrossRef Khouri RK, Rigotti G, Cardoso E et al (2014) Megavolume autologous fat transfer: part II practice and techniques. Plast Reconstr Surg 133:1369–1377PubMedCrossRef
38.
Zurück zum Zitat Glashofer M, Lawrence N (2006) Fat transplantation for treatment of the senescent face. Dermatol Ther 19:169–176PubMedCrossRef Glashofer M, Lawrence N (2006) Fat transplantation for treatment of the senescent face. Dermatol Ther 19:169–176PubMedCrossRef
39.
Zurück zum Zitat Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthet Plast Surg 32:48–55CrossRef Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthet Plast Surg 32:48–55CrossRef
40.
Zurück zum Zitat Suga H, Eto H, Aoi N et al (2010) Adipose tissue remodeling under ischemia: death of adipocytes and activation of stem/progenitor cells. Plast Reconstr Surg 126:1911–1923PubMedCrossRef Suga H, Eto H, Aoi N et al (2010) Adipose tissue remodeling under ischemia: death of adipocytes and activation of stem/progenitor cells. Plast Reconstr Surg 126:1911–1923PubMedCrossRef
41.
Zurück zum Zitat Sadat S, Gehmert S, Song YH et al (2007) The cardioprotective effect of mesenchymal stem cells is mediated by IGF-I and VEGF. Biochem Biophys Res Commun 363:674–679PubMedCrossRef Sadat S, Gehmert S, Song YH et al (2007) The cardioprotective effect of mesenchymal stem cells is mediated by IGF-I and VEGF. Biochem Biophys Res Commun 363:674–679PubMedCrossRef
42.
Zurück zum Zitat Gabriel A, Champaneria MC, Maxwell GP (2015) Fat grafting and breast reconstruction: tips for ensuring predictability. Gland Surg 4:232–243PubMedPubMedCentral Gabriel A, Champaneria MC, Maxwell GP (2015) Fat grafting and breast reconstruction: tips for ensuring predictability. Gland Surg 4:232–243PubMedPubMedCentral
43.
Zurück zum Zitat Moore JH, Kolaczynski JW, Morales LM et al (1995) Viability of fat obtained by syringe suction lipectomy: effects of local anesthesia with lidocaine. Aesthet Plast Surg 19:335–339CrossRef Moore JH, Kolaczynski JW, Morales LM et al (1995) Viability of fat obtained by syringe suction lipectomy: effects of local anesthesia with lidocaine. Aesthet Plast Surg 19:335–339CrossRef
44.
Zurück zum Zitat Wang LJ, Qing T, Ma SL (2010) Effect of rising on fat viability. J Tissue Eng Reconstr Surg 6:222–224 Wang LJ, Qing T, Ma SL (2010) Effect of rising on fat viability. J Tissue Eng Reconstr Surg 6:222–224
Metadaten
Titel
Fat Processing Techniques: A Narrative Review
verfasst von
Yan Lin
Yan Yang
Dali Mu
Publikationsdatum
05.01.2021
Verlag
Springer US
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 2/2021
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-020-02069-3

Weitere Artikel der Ausgabe 2/2021

Aesthetic Plastic Surgery 2/2021 Zur Ausgabe

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren. 

Wie sieht der OP der Zukunft aus?

04.05.2024 DCK 2024 Kongressbericht

Der OP in der Zukunft wird mit weniger Personal auskommen – nicht, weil die Technik das medizinische Fachpersonal verdrängt, sondern weil der Personalmangel es nötig macht.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Recycling im OP – möglich, aber teuer

02.05.2024 DCK 2024 Kongressbericht

Auch wenn sich Krankenhäuser nachhaltig und grün geben – sie tragen aktuell erheblich zu den CO2-Emissionen bei und produzieren jede Menge Müll. Ein Pilotprojekt aus Bonn zeigt, dass viele Op.-Abfälle wiederverwertet werden können.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.