Skip to main content

2015 | OriginalPaper | Buchkapitel

27. Komplikationsmanagement nach thoraxchirurgischen Eingriffen

verfasst von : Hauke Winter, PD Dr. med.

Erschienen in: Komplikationsmanagement in der Chirurgie

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Verletzungen an den Luftwegen und der Lunge treten nicht nur nach thoraxchirurgischen Eingriffen auf, sondern werden auch als Folge von viszeralchirurgischen Eingriffen und nach Notfallversorgungen beobachtet. Frühzeitiges Erkennen von Verletzungen an den Luftwegen und der Lunge und zeitnahes Einleiten einer adäquaten Behandlung können entscheidend für das Überleben sein, denn eine übersehene Trachealverletzung kann unbehandelt zu einer Mediastinitis führen, die mit einer hohen Mortalität verbunden ist. Chronische Luftfisteln am Lungenparenchym oder die Insuffizienz eines Bronchusstumpfes führen unbehandelt häufig zu Pleuraempyemen und haben nicht selten eine lange Hospitalisierung zur Folge. In diesem Kapitel werden die typischen Symptome der am häufigsten auftretenden Komplikationen beschrieben und die adäquaten therapeutischen Maßnahmen erörtert.
Literatur
Zurück zum Zitat Albes JM et al (1994) Tracheal stenting for malignant tracheoesophageal fistula. Ann Thorac Surg 57(5):1263–1266PubMed Albes JM et al (1994) Tracheal stenting for malignant tracheoesophageal fistula. Ann Thorac Surg 57(5):1263–1266PubMed
Zurück zum Zitat Alkofer B et al (2004) Thoracoscopic plication of the diaphragm for postoperative phrenic paralysis: a report of two cases. Surg Endosc 18(5):868–870PubMed Alkofer B et al (2004) Thoracoscopic plication of the diaphragm for postoperative phrenic paralysis: a report of two cases. Surg Endosc 18(5):868–870PubMed
Zurück zum Zitat Al-Mufarrej F et al (2010) Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system. Surg Today 40(8):711–718PubMed Al-Mufarrej F et al (2010) Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system. Surg Today 40(8):711–718PubMed
Zurück zum Zitat Al-Zubairy A, Al-Jazairi A (2003) Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother 37(5):679–682PubMed Al-Zubairy A, Al-Jazairi A (2003) Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother 37(5):679–682PubMed
Zurück zum Zitat Amar D et al (1995) Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest 108(2):349–354PubMed Amar D et al (1995) Clinical and echocardiographic correlates of symptomatic tachydysrhythmias after noncardiac thoracic surgery. Chest 108(2):349–354PubMed
Zurück zum Zitat Ambrogi MC et al (2001) Posterior wall laceration of the thoracic trachea: the transcervical-transtracheal approach. Eur J Cardiothorac Surg 19(6):932–934PubMed Ambrogi MC et al (2001) Posterior wall laceration of the thoracic trachea: the transcervical-transtracheal approach. Eur J Cardiothorac Surg 19(6):932–934PubMed
Zurück zum Zitat Aru GM et al (2010) Intrathoracic vacuum-assisted management of persistent and infected pleural spaces. Ann Thorac Surg 90(1):266–270PubMed Aru GM et al (2010) Intrathoracic vacuum-assisted management of persistent and infected pleural spaces. Ann Thorac Surg 90(1):266–270PubMed
Zurück zum Zitat Asamura H et al (1992) Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 104(5):1456–1464PubMed Asamura H et al (1992) Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 104(5):1456–1464PubMed
Zurück zum Zitat Baumann MH, Sahn A (1990) Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 97(3):721–728PubMed Baumann MH, Sahn A (1990) Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 97(3):721–728PubMed
Zurück zum Zitat Beghetti M et al (2000) Etiology and management of pediatric chylothorax. J Pediatr 136(5):653–658PubMed Beghetti M et al (2000) Etiology and management of pediatric chylothorax. J Pediatr 136(5):653–658PubMed
Zurück zum Zitat Boudaya M et al (2013) Conservative management of postoperative bronchopleural fistulas. J Thorac Cardiovasc Surg 146(3):575–579PubMed Boudaya M et al (2013) Conservative management of postoperative bronchopleural fistulas. J Thorac Cardiovasc Surg 146(3):575–579PubMed
Zurück zum Zitat Brewer LA et al (2012) Bronchial closure in pulmonary resection: a clinical and experimental study using a pedicled Perikardial fat graft reinforcement. J Thorac Surg 1953 26(5):507–532 Brewer LA et al (2012) Bronchial closure in pulmonary resection: a clinical and experimental study using a pedicled Perikardial fat graft reinforcement. J Thorac Surg 1953 26(5):507–532
Zurück zum Zitat Brichon PY et al (2012) Successful treatment of a life-threatening air leakage, complicating severe abdominal sepsis, with a one-way endobronchial valve. Interact Cardiovasc Thorac Surg 15(4):779–780PubMedCentralPubMed Brichon PY et al (2012) Successful treatment of a life-threatening air leakage, complicating severe abdominal sepsis, with a one-way endobronchial valve. Interact Cardiovasc Thorac Surg 15(4):779–780PubMedCentralPubMed
Zurück zum Zitat Bryant A et al (2014) The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 98(1):232–235 (discussion 235-7)PubMed Bryant A et al (2014) The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 98(1):232–235 (discussion 235-7)PubMed
Zurück zum Zitat Carbognani P et al (2004) Management of postintubation membranous tracheal rupture. Ann Thorac Surg 77(2):406–409PubMed Carbognani P et al (2004) Management of postintubation membranous tracheal rupture. Ann Thorac Surg 77(2):406–409PubMed
Zurück zum Zitat Cardillo G et al (2010) Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg 37(3):581–587PubMed Cardillo G et al (2010) Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg 37(3):581–587PubMed
Zurück zum Zitat Carretta A et al (2011) Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg 35(11):2568–2574PubMed Carretta A et al (2011) Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg 35(11):2568–2574PubMed
Zurück zum Zitat Carvalho P et al (1997) Management of bronchopleural fistula with a variable-resistance valve and a single ventilator. Chest 111(5):1452–1454PubMed Carvalho P et al (1997) Management of bronchopleural fistula with a variable-resistance valve and a single ventilator. Chest 111(5):1452–1454PubMed
Zurück zum Zitat Cerfolio RJ (2001) The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Thorac Cardiovasc Surg 13(1):3–7PubMed Cerfolio RJ (2001) The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Thorac Cardiovasc Surg 13(1):3–7PubMed
Zurück zum Zitat Chan EH et al (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80(5):1864–1870PubMed Chan EH et al (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80(5):1864–1870PubMed
Zurück zum Zitat Chen EH et al (2001) A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth Analg 93(5):1270–1271PubMed Chen EH et al (2001) A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth Analg 93(5):1270–1271PubMed
Zurück zum Zitat Ciccolella DE, Daly BD, Celli BR (1992) Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis. Am Rev Respir Dis 146(3):797–799PubMed Ciccolella DE, Daly BD, Celli BR (1992) Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis. Am Rev Respir Dis 146(3):797–799PubMed
Zurück zum Zitat Clagett OT, Geraci JE (1963) A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 45:141–145PubMed Clagett OT, Geraci JE (1963) A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg 45:141–145PubMed
Zurück zum Zitat Colt HG, Meric B, Dumon JF (1992) Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree. Gastrointest Endosc 38(4):485–489PubMed Colt HG, Meric B, Dumon JF (1992) Double stents for carcinoma of the esophagus invading the tracheo-bronchial tree. Gastrointest Endosc 38(4):485–489PubMed
Zurück zum Zitat Conti M et al (2006) Management of postintubation tracheobronchial ruptures. Chest 130(2):412–418PubMed Conti M et al (2006) Management of postintubation tracheobronchial ruptures. Chest 130(2):412–418PubMed
Zurück zum Zitat Cope C (2004) Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med 10(4):311–314PubMed Cope C (2004) Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med 10(4):311–314PubMed
Zurück zum Zitat Creagh-Brown B et al (2008) A novel approach to the management of acute tracheal tear. J Laryngol Otol 122(12):1392–1393PubMed Creagh-Brown B et al (2008) A novel approach to the management of acute tracheal tear. J Laryngol Otol 122(12):1392–1393PubMed
Zurück zum Zitat Deganello A et al (2007) Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair. Acta Otorhinolaryngol Ital 27(5):258–262PubMedCentralPubMed Deganello A et al (2007) Tracheotomy-related posterior tracheal wall rupture, trans-tracheal repair. Acta Otorhinolaryngol Ital 27(5):258–262PubMedCentralPubMed
Zurück zum Zitat Demos NJ, Kozel J, Scerbo JE (2001) Somatostatin in the treatment of chylothorax. Chest 119(3):964–966PubMed Demos NJ, Kozel J, Scerbo JE (2001) Somatostatin in the treatment of chylothorax. Chest 119(3):964–966PubMed
Zurück zum Zitat Dooms CA et al (2014) Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer. Eur Respir J 43(4):1142–1148PubMed Dooms CA et al (2014) Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer. Eur Respir J 43(4):1142–1148PubMed
Zurück zum Zitat Fahimi H et al (2001) Current management of postoperative chylothorax. Ann Thorac Surg 71(2):448–450 (discussion 450-1)PubMed Fahimi H et al (2001) Current management of postoperative chylothorax. Ann Thorac Surg 71(2):448–450 (discussion 450-1)PubMed
Zurück zum Zitat Firlinger I et al (2013) Endoscopic one-way valve implantation in patients with prolonged air leak and the use of digital air leak monitoring. Ann Thorac Surg 95(4):1243–1249PubMed Firlinger I et al (2013) Endoscopic one-way valve implantation in patients with prolonged air leak and the use of digital air leak monitoring. Ann Thorac Surg 95(4):1243–1249PubMed
Zurück zum Zitat Fischer W et al (2012) Endobronchial valve therapy for pneumothorax as a bridge to lung transplantation. J Heart Lung Transplant 31(3):334–336PubMed Fischer W et al (2012) Endobronchial valve therapy for pneumothorax as a bridge to lung transplantation. J Heart Lung Transplant 31(3):334–336PubMed
Zurück zum Zitat Franksson C et al (1976) Drainage of thoracic duct lymph in renal transplant patients. Transplantation 21(2):133–140PubMed Franksson C et al (1976) Drainage of thoracic duct lymph in renal transplant patients. Transplantation 21(2):133–140PubMed
Zurück zum Zitat Freeman RK, Wozniak TC, Fitzgerald EB (2006) Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 81(5):1853–1857 (discussion 1857)PubMed Freeman RK, Wozniak TC, Fitzgerald EB (2006) Functional and physiologic results of video-assisted thoracoscopic diaphragm plication in adult patients with unilateral diaphragm paralysis. Ann Thorac Surg 81(5):1853–1857 (discussion 1857)PubMed
Zurück zum Zitat Freeman RK et al (2009) Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 88(4):1112–1117PubMed Freeman RK et al (2009) Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis. Ann Thorac Surg 88(4):1112–1117PubMed
Zurück zum Zitat Gaissert HA et al (2003) Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 126(3):744–747PubMed Gaissert HA et al (2003) Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 126(3):744–747PubMed
Zurück zum Zitat Garcia-Yuste M et al (1998) Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg 65(3):818–822PubMed Garcia-Yuste M et al (1998) Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg 65(3):818–822PubMed
Zurück zum Zitat Gazala S, Hunt I, Bedard EL (2012) Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 15(3):505–508PubMedCentralPubMed Gazala S, Hunt I, Bedard EL (2012) Diaphragmatic plication offers functional improvement in dyspnoea and better pulmonary function with low morbidity. Interact Cardiovasc Thorac Surg 15(3):505–508PubMedCentralPubMed
Zurück zum Zitat Gildea TR et al (2006) Performance of a self-expanding silicone stent in palliation of benign airway conditions. Chest 130(5):1419–1423PubMed Gildea TR et al (2006) Performance of a self-expanding silicone stent in palliation of benign airway conditions. Chest 130(5):1419–1423PubMed
Zurück zum Zitat Glover W et al (1987) Fibrin glue application through the flexible fiberoptic bronchoscope: closure of bronchopleural fistulas. J Thorac Cardiovasc Surg 93(3):470–472PubMed Glover W et al (1987) Fibrin glue application through the flexible fiberoptic bronchoscope: closure of bronchopleural fistulas. J Thorac Cardiovasc Surg 93(3):470–472PubMed
Zurück zum Zitat Gomez-Caro A et al (2006) Role of conservative medical management of tracheobronchial injuries. J Trauma 61(6):1426–1434 (discussion 1434-5)PubMed Gomez-Caro A et al (2006) Role of conservative medical management of tracheobronchial injuries. J Trauma 61(6):1426–1434 (discussion 1434-5)PubMed
Zurück zum Zitat Groetzner J et al (2009) Intrathoracic application of vacuum wound therapy following thoracic surgery. Thorac Cardiovasc Surg 57(7):417–420PubMed Groetzner J et al (2009) Intrathoracic application of vacuum wound therapy following thoracic surgery. Thorac Cardiovasc Surg 57(7):417–420PubMed
Zurück zum Zitat Groth SS et al (2010) Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: an objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg 139(6):1452–1456PubMed Groth SS et al (2010) Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: an objective evaluation of short-term and midterm results. J Thorac Cardiovasc Surg 139(6):1452–1456PubMed
Zurück zum Zitat Haghshenasskashani A et al (2011) Intrathoracic application of a vacuum-assisted closure device in managing pleural space infection after lung resection: is it an option? Interact Cardiovasc Thorac Surg 13(2):168–174PubMed Haghshenasskashani A et al (2011) Intrathoracic application of a vacuum-assisted closure device in managing pleural space infection after lung resection: is it an option? Interact Cardiovasc Thorac Surg 13(2):168–174PubMed
Zurück zum Zitat Hartmann W, Rausch V (1977) New therapeutic application of the fiberoptic bronchoscope. Chest 71(2):237PubMed Hartmann W, Rausch V (1977) New therapeutic application of the fiberoptic bronchoscope. Chest 71(2):237PubMed
Zurück zum Zitat Hazelrigg SR et al (1997) Effect of bovine Perikardial strips on air leak after stapled pulmonary resection. Ann Thorac Surg 63(6):1573–1575PubMed Hazelrigg SR et al (1997) Effect of bovine Perikardial strips on air leak after stapled pulmonary resection. Ann Thorac Surg 63(6):1573–1575PubMed
Zurück zum Zitat Hoffer EK et al (2001) Treatment of chylothorax: percutaneous catheterization and embolization of the thoracic duct. AJR Am J Roentgenol 176(4):1040–1042PubMed Hoffer EK et al (2001) Treatment of chylothorax: percutaneous catheterization and embolization of the thoracic duct. AJR Am J Roentgenol 176(4):1040–1042PubMed
Zurück zum Zitat Hofmann HS et al (2012) Vacuum-assisted closure of pleural empyema without classic open-window thoracostomy. Ann Thorac Surg 93(5):1741–1742PubMed Hofmann HS et al (2012) Vacuum-assisted closure of pleural empyema without classic open-window thoracostomy. Ann Thorac Surg 93(5):1741–1742PubMed
Zurück zum Zitat Hoier-Madsen K et al (1984) Management of bronchopleural fistula following pneumonectomy. Scand J Thorac Cardiovasc Surg 18(3):263–266PubMed Hoier-Madsen K et al (1984) Management of bronchopleural fistula following pneumonectomy. Scand J Thorac Cardiovasc Surg 18(3):263–266PubMed
Zurück zum Zitat Hollaus SH et al (1998) Endoscopic treatment of postoperative bronchopleural fistula: experience with 45 cases. Ann Thorac Surg 66(3):923–927PubMed Hollaus SH et al (1998) Endoscopic treatment of postoperative bronchopleural fistula: experience with 45 cases. Ann Thorac Surg 66(3):923–927PubMed
Zurück zum Zitat Hollaus SH et al (1999) Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle fla. Eur J Cardiothorac Surg 16(2):181–186PubMed Hollaus SH et al (1999) Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle fla. Eur J Cardiothorac Surg 16(2):181–186PubMed
Zurück zum Zitat Hsu JT, Bennett GM, Wolff E (1972) Radiologic assessment of bronchopleural fistula with empyema. Radiology 103(1):41–45PubMed Hsu JT, Bennett GM, Wolff E (1972) Radiologic assessment of bronchopleural fistula with empyema. Radiology 103(1):41–45PubMed
Zurück zum Zitat Huggins JT (2010) Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 31(6):743–750PubMed Huggins JT (2010) Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 31(6):743–750PubMed
Zurück zum Zitat Huttl TS et al (2004) Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy. Surg Endosc 18(3):547–551PubMed Huttl TS et al (2004) Laparoscopic diaphragmatic plication: long-term results of a novel surgical technique for postoperative phrenic nerve palsy. Surg Endosc 18(3):547–551PubMed
Zurück zum Zitat Itkin M et al (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589 (discussion 589-90.)PubMed Itkin M et al (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589 (discussion 589-90.)PubMed
Zurück zum Zitat Jensen GL et al (1989) Dietary modification of chyle composition in chylothorax. Gastroenterology 97(3):761–765PubMed Jensen GL et al (1989) Dietary modification of chyle composition in chylothorax. Gastroenterology 97(3):761–765PubMed
Zurück zum Zitat Kalomenidis I, Light RW (2004) Pathogenesis of the eosinophilic pleural effusions. Curr Opin Pulm Med 10(4):289–293PubMed Kalomenidis I, Light RW (2004) Pathogenesis of the eosinophilic pleural effusions. Curr Opin Pulm Med 10(4):289–293PubMed
Zurück zum Zitat Kelly RF, Shumway SJ (2000) Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 69(6):1944–1945PubMed Kelly RF, Shumway SJ (2000) Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 69(6):1944–1945PubMed
Zurück zum Zitat Kuniyoshi Y et al (2004) Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery. Ann Thorac Cardiovasc Surg 10(3):160–166PubMed Kuniyoshi Y et al (2004) Diaphragmatic plication in adult patients with diaphragm paralysis after cardiac surgery. Ann Thorac Cardiovasc Surg 10(3):160–166PubMed
Zurück zum Zitat Lardinois D et al (2002) Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps. Eur J Cardiothorac Surg 21(1):74–78PubMed Lardinois D et al (2002) Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps. Eur J Cardiothorac Surg 21(1):74–78PubMed
Zurück zum Zitat Le Pimpec-Barthes F et al (2002) Chylothorax complicating pulmonary resection. Ann Thorac Surg 73(6):1714–1719PubMed Le Pimpec-Barthes F et al (2002) Chylothorax complicating pulmonary resection. Ann Thorac Surg 73(6):1714–1719PubMed
Zurück zum Zitat Lemmer JH, Botham MJ, Orringer MB (1985) Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg 90(6):849–855PubMed Lemmer JH, Botham MJ, Orringer MB (1985) Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg 90(6):849–855PubMed
Zurück zum Zitat Lin J, Iannettoni MD (2004) Closure of bronchopleural fistulas using albumin-glutaraldehyde tissue adhesive. Ann Thorac Surg 77(1):326–328PubMed Lin J, Iannettoni MD (2004) Closure of bronchopleural fistulas using albumin-glutaraldehyde tissue adhesive. Ann Thorac Surg 77(1):326–328PubMed
Zurück zum Zitat Lindner M et al (2010) Bronchial stump coverage and postpneumonectomy bronchopleural fistula. Asian Cardiovasc Thorac Ann 18(5):443–449PubMed Lindner M et al (2010) Bronchial stump coverage and postpneumonectomy bronchopleural fistula. Asian Cardiovasc Thorac Ann 18(5):443–449PubMed
Zurück zum Zitat Mahajan AK et al (2012) Intrabronchial valves: a case series describing a minimally invasive approach to bronchopleural fistulas in medical intensive care unit patients. J Bronchology Interv Pulmonol 19(2):137–141PubMed Mahajan AK et al (2012) Intrabronchial valves: a case series describing a minimally invasive approach to bronchopleural fistulas in medical intensive care unit patients. J Bronchology Interv Pulmonol 19(2):137–141PubMed
Zurück zum Zitat Malapert G et al (2010) Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis. Ann Thorac Surg 90(6):1779–1785PubMed Malapert G et al (2010) Surgical sealant for the prevention of prolonged air leak after lung resection: meta-analysis. Ann Thorac Surg 90(6):1779–1785PubMed
Zurück zum Zitat Malave G et al (1971) Bronchopleural fistula--present-day study of an old problem. A review of 52 cases. Ann Thorac Surg 11(1):1–10PubMed Malave G et al (1971) Bronchopleural fistula--present-day study of an old problem. A review of 52 cases. Ann Thorac Surg 11(1):1–10PubMed
Zurück zum Zitat Maldonado F et al (2010) Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 339(4):314–318PubMed Maldonado F et al (2010) Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 339(4):314–318PubMed
Zurück zum Zitat Markham KM et al (2000) Octreotide in the treatment of thoracic duct injuries. Am Surg 66(12):1165–1167PubMed Markham KM et al (2000) Octreotide in the treatment of thoracic duct injuries. Am Surg 66(12):1165–1167PubMed
Zurück zum Zitat McGrath EE, Blades Z, Anderson SB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104(1):1–8PubMed McGrath EE, Blades Z, Anderson SB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104(1):1–8PubMed
Zurück zum Zitat Menard JW, Prejean CA, Tucker WY (1988) Endoscopic closure of bronchopleural fistulas using a tissue adhesive. Am J Surg 155(3):415–416PubMed Menard JW, Prejean CA, Tucker WY (1988) Endoscopic closure of bronchopleural fistulas using a tissue adhesive. Am J Surg 155(3):415–416PubMed
Zurück zum Zitat Minambres E et al (2009) Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 35(6):1056–1062PubMed Minambres E et al (2009) Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 35(6):1056–1062PubMed
Zurück zum Zitat Mineo TC, Ambrogi V (1995) Early closure of the postpneumonectomy bronchopleural fistula by pedicled diaphragmatic flaps. Ann Thorac Surg 60(3):714–715PubMed Mineo TC, Ambrogi V (1995) Early closure of the postpneumonectomy bronchopleural fistula by pedicled diaphragmatic flaps. Ann Thorac Surg 60(3):714–715PubMed
Zurück zum Zitat Mineo TC, Ambrogi V (1999) The diaphragmatic flap: A multiuse material in thoracic surgery. J Thorac Cardiovasc Surg 118(6):1084–1089PubMed Mineo TC, Ambrogi V (1999) The diaphragmatic flap: A multiuse material in thoracic surgery. J Thorac Cardiovasc Surg 118(6):1084–1089PubMed
Zurück zum Zitat Mineo TC et al (1997) Comparison between intercostal and diaphragmatic flap in the surgical treatment of early bronchopleural fistula. Eur J Cardiothorac Surg 12(4):675–677PubMed Mineo TC et al (1997) Comparison between intercostal and diaphragmatic flap in the surgical treatment of early bronchopleural fistula. Eur J Cardiothorac Surg 12(4):675–677PubMed
Zurück zum Zitat Nagasaki F, Flehinger BJ, Martini N (1982) Complications of surgery in the treatment of carcinoma of the lung. Chest 82(1):25–29PubMed Nagasaki F, Flehinger BJ, Martini N (1982) Complications of surgery in the treatment of carcinoma of the lung. Chest 82(1):25–29PubMed
Zurück zum Zitat Nair SK, Petko M, Hayward M (2007) Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 32(2):362–369PubMed Nair SK, Petko M, Hayward M (2007) Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 32(2):362–369PubMed
Zurück zum Zitat Nielsen KR et al (1994) Localization of bronchopleural fistula using ventilation scintigraphy. J Nucl Med 35(5):867–869PubMed Nielsen KR et al (1994) Localization of bronchopleural fistula using ventilation scintigraphy. J Nucl Med 35(5):867–869PubMed
Zurück zum Zitat Onotera RT, Unruh HW (1988) Closure of a post-pneumonectomy bronchopleural fistula with fibrin sealant (Tisseel. Thorax 43(12):1015–1016PubMedCentralPubMed Onotera RT, Unruh HW (1988) Closure of a post-pneumonectomy bronchopleural fistula with fibrin sealant (Tisseel. Thorax 43(12):1015–1016PubMedCentralPubMed
Zurück zum Zitat Orta DA et al (1979) Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation. Thorax 34(5):665–669PubMedCentralPubMed Orta DA et al (1979) Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation. Thorax 34(5):665–669PubMedCentralPubMed
Zurück zum Zitat Paes ML, Powell H (1994) Chylothorax: an update. Br J. Hosp Med 51(9):482–490 Paes ML, Powell H (1994) Chylothorax: an update. Br J. Hosp Med 51(9):482–490
Zurück zum Zitat Palade E, Passlick B (2011) Surgery of traumatic tracheal and tracheobronchial injuries. Chirurg 82(2):141–147PubMed Palade E, Passlick B (2011) Surgery of traumatic tracheal and tracheobronchial injuries. Chirurg 82(2):141–147PubMed
Zurück zum Zitat Palmen M et al (2009) Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann Thorac Surg 88(4):1131–1136PubMed Palmen M et al (2009) Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann Thorac Surg 88(4):1131–1136PubMed
Zurück zum Zitat Paul S et al (2009) Surgical management of chylothorax. Thorac Cardiovasc Surg 57(4):226–228PubMed Paul S et al (2009) Surgical management of chylothorax. Thorac Cardiovasc Surg 57(4):226–228PubMed
Zurück zum Zitat Phillips YY, Lonigan RM, Joyner LR (1979) A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation. Crit Care Med 7(8):351–353PubMed Phillips YY, Lonigan RM, Joyner LR (1979) A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation. Crit Care Med 7(8):351–353PubMed
Zurück zum Zitat Ponn RB et al (1993) Treatment of peripheral bronchopleural fistulas with endobronchial occlusion coils. Ann Thorac Surg 56(6):1343–1347PubMed Ponn RB et al (1993) Treatment of peripheral bronchopleural fistulas with endobronchial occlusion coils. Ann Thorac Surg 56(6):1343–1347PubMed
Zurück zum Zitat Postmus SE et al (1989) Treatment of post pneumonectomy pleural empyema by open window thoracostomy. Eur Respir J 2(9):853–855PubMed Postmus SE et al (1989) Treatment of post pneumonectomy pleural empyema by open window thoracostomy. Eur Respir J 2(9):853–855PubMed
Zurück zum Zitat Potaris K, Mihos I, Gakidis (2003) Preliminary results with the use of an albumin-glutaraldehyde tissue adhesive in lung surgery. Med Sci Monit 9(7):79–83 Potaris K, Mihos I, Gakidis (2003) Preliminary results with the use of an albumin-glutaraldehyde tissue adhesive in lung surgery. Med Sci Monit 9(7):79–83
Zurück zum Zitat Ratliff JL et al (1977) Endobronchial control of bronchopleural fistulae. Chest 71(1):98–99PubMed Ratliff JL et al (1977) Endobronchial control of bronchopleural fistulae. Chest 71(1):98–99PubMed
Zurück zum Zitat Regnard JF et al (2000) Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection. J Thorac Cardiovasc Surg 120(2):270–275PubMed Regnard JF et al (2000) Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection. J Thorac Cardiovasc Surg 120(2):270–275PubMed
Zurück zum Zitat Saadi A et al (2011) Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections. Ann Thorac Surg 91(5):1582–1589PubMed Saadi A et al (2011) Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections. Ann Thorac Surg 91(5):1582–1589PubMed
Zurück zum Zitat Salmon CJ, Ponn RB, Westcott JL (1990) Endobronchial vascular occlusion coils for control of a large parenchymal bronchopleural fistula. Chest 98(1):233–234PubMed Salmon CJ, Ponn RB, Westcott JL (1990) Endobronchial vascular occlusion coils for control of a large parenchymal bronchopleural fistula. Chest 98(1):233–234PubMed
Zurück zum Zitat Sayeed-Shah U, Strachan J, Elefteriades JA (2001) Diaphragm flap for routine prophylactic reinforcement of bronchial stump after pneumonectomy. Ann Thorac Surg 71(6):2081–2083PubMed Sayeed-Shah U, Strachan J, Elefteriades JA (2001) Diaphragm flap for routine prophylactic reinforcement of bronchial stump after pneumonectomy. Ann Thorac Surg 71(6):2081–2083PubMed
Zurück zum Zitat Schneider T et al (2009) Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg 8(5):571–576PubMed Schneider T et al (2009) Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg 8(5):571–576PubMed
Zurück zum Zitat Schneiter D et al (2001) Accelerated treatment for early and late postpneumonectomy empyema. Ann Thorac Surg 72(5):1668–1672PubMed Schneiter D et al (2001) Accelerated treatment for early and late postpneumonectomy empyema. Ann Thorac Surg 72(5):1668–1672PubMed
Zurück zum Zitat Schueckler OJ, Rodriguez MI, Takita H (1995) Delayed postpneumonectomy empyema. J Cardiovasc Surg (Torino) 36(5):515–517 Schueckler OJ, Rodriguez MI, Takita H (1995) Delayed postpneumonectomy empyema. J Cardiovasc Surg (Torino) 36(5):515–517
Zurück zum Zitat Shah RD et al (2012) Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 93(3):897–903 (discussion 903-4)PubMedCentralPubMed Shah RD et al (2012) Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 93(3):897–903 (discussion 903-4)PubMedCentralPubMed
Zurück zum Zitat Shamji FM et al (1983) Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula. J Thorac Cardiovasc Surg 86(6):818–822PubMed Shamji FM et al (1983) Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula. J Thorac Cardiovasc Surg 86(6):818–822PubMed
Zurück zum Zitat Shimizu K et al (2002) Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 124(3):499–502PubMed Shimizu K et al (2002) Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 124(3):499–502PubMed
Zurück zum Zitat Sirbu H et al (2001) Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management. Ann Thorac Cardiovasc Surg 7(6):330–336PubMed Sirbu H et al (2001) Bronchopleural fistula in the surgery of non-small cell lung cancer: incidence, risk factors, and management. Ann Thorac Cardiovasc Surg 7(6):330–336PubMed
Zurück zum Zitat Skouras VI, Kalomenidis, Chylothorax (2010) Chylothorax: diagnostic approach. Curr Opin Pulm Med 16(4):387–393PubMed Skouras VI, Kalomenidis, Chylothorax (2010) Chylothorax: diagnostic approach. Curr Opin Pulm Med 16(4):387–393PubMed
Zurück zum Zitat Sonobe M et al (2000) Analysis of risk factors in bronchopleural fistula after pulmonary resection for primary lung cancer. Eur J Cardiothorac Surg 18(5):519–523PubMed Sonobe M et al (2000) Analysis of risk factors in bronchopleural fistula after pulmonary resection for primary lung cancer. Eur J Cardiothorac Surg 18(5):519–523PubMed
Zurück zum Zitat Stamatis G et al (1994) Omentopexy and muscle transposition: two alternative methods in the treatment of pleural empyema and mediastinitis. Thorac Cardiovasc Surg 42(4):225–232PubMed Stamatis G et al (1994) Omentopexy and muscle transposition: two alternative methods in the treatment of pleural empyema and mediastinitis. Thorac Cardiovasc Surg 42(4):225–232PubMed
Zurück zum Zitat Stammberger U et al (2000) Buttressing the staple line in lung volume reduction surgery: a randomized three-center study. Ann Thorac Surg 70(6):1820–1825PubMed Stammberger U et al (2000) Buttressing the staple line in lung volume reduction surgery: a randomized three-center study. Ann Thorac Surg 70(6):1820–1825PubMed
Zurück zum Zitat Steiger Z, Wilson RF (1984) Management of bronchopleural fistulas. Surg Gynecol Obstet 158(3):267–271PubMed Steiger Z, Wilson RF (1984) Management of bronchopleural fistulas. Surg Gynecol Obstet 158(3):267–271PubMed
Zurück zum Zitat Stratakos G et al (2009) Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae. J Thorac Cardiovasc Surg 138(3):603–607PubMed Stratakos G et al (2009) Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae. J Thorac Cardiovasc Surg 138(3):603–607PubMed
Zurück zum Zitat Taghavi S et al (2005) Bronchial stump coverage with a pedicled Perikardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 79(1):284–288PubMed Taghavi S et al (2005) Bronchial stump coverage with a pedicled Perikardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 79(1):284–288PubMed
Zurück zum Zitat Takaoka K, Inoue S, Ohira S (2002) Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 122(1):374–378PubMed Takaoka K, Inoue S, Ohira S (2002) Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 122(1):374–378PubMed
Zurück zum Zitat Takuwa T et al (2013) Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 146(3):571–574PubMed Takuwa T et al (2013) Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 146(3):571–574PubMed
Zurück zum Zitat Thomas S et al (2006) A new bioabsorbable sleeve for lung staple-line reinforcement (FOREseal): report of a three-center phase II clinical trial. Eur J Cardiothorac Surg 29(6):880–885PubMed Thomas S et al (2006) A new bioabsorbable sleeve for lung staple-line reinforcement (FOREseal): report of a three-center phase II clinical trial. Eur J Cardiothorac Surg 29(6):880–885PubMed
Zurück zum Zitat Torre M et al (1987) Endoscopic gluing of bronchopleural fistula. Ann Thorac Surg 43(3):295–297PubMed Torre M et al (1987) Endoscopic gluing of bronchopleural fistula. Ann Thorac Surg 43(3):295–297PubMed
Zurück zum Zitat Travaline JM et al (2009) Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 136(2):355–360PubMed Travaline JM et al (2009) Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 136(2):355–360PubMed
Zurück zum Zitat Tsunezuka Y et al (1999) A new instrument for endoscopic gluing for bronchopleural fistulae. Ann Thorac Surg 68(3):1088–1089PubMed Tsunezuka Y et al (1999) A new instrument for endoscopic gluing for bronchopleural fistulae. Ann Thorac Surg 68(3):1088–1089PubMed
Zurück zum Zitat Turk AE et al (2000) Staged closure of complicated bronchopleural fistulas. Ann Plast Surg 45(5):560–564PubMed Turk AE et al (2000) Staged closure of complicated bronchopleural fistulas. Ann Plast Surg 45(5):560–564PubMed
Zurück zum Zitat Varker KA, Ng T (2006) Management of empyema cavity with the vacuum-assisted closure device. Ann Thorac Surg 81(2):723–725PubMed Varker KA, Ng T (2006) Management of empyema cavity with the vacuum-assisted closure device. Ann Thorac Surg 81(2):723–725PubMed
Zurück zum Zitat Venuta F et al (1998) Technique to reduce air leaks after pulmonary lobectomy. Eur J Cardiothorac Surg 13(4):361–364PubMed Venuta F et al (1998) Technique to reduce air leaks after pulmonary lobectomy. Eur J Cardiothorac Surg 13(4):361–364PubMed
Zurück zum Zitat Versteegh MI et al (2007) Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 32(3):449–456PubMed Versteegh MI et al (2007) Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. Eur J Cardiothorac Surg 32(3):449–456PubMed
Zurück zum Zitat Waclawiczek HW, Chmelizek F, Koller I (1987) Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections. Experimental and clinical experience. Surg Endosc 1(2):99–102PubMed Waclawiczek HW, Chmelizek F, Koller I (1987) Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections. Experimental and clinical experience. Surg Endosc 1(2):99–102PubMed
Zurück zum Zitat Wasmuth-Pietzuch A et al (2004) Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 93(2):220–224PubMed Wasmuth-Pietzuch A et al (2004) Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 93(2):220–224PubMed
Zurück zum Zitat Welter S et al (2010) A new endoscopic technique for intraluminal repair of posterior tracheal laceration. Ann Thorac Surg 90(2):686–688PubMed Welter S et al (2010) A new endoscopic technique for intraluminal repair of posterior tracheal laceration. Ann Thorac Surg 90(2):686–688PubMed
Zurück zum Zitat Witt C et al (1996) Multiple fistulas and tracheobronchial stenoses require extensive stenting of the central airways and esophagus in squamous-cell carcinoma. Endoscopy 28(4):381–385PubMed Witt C et al (1996) Multiple fistulas and tracheobronchial stenoses require extensive stenting of the central airways and esophagus in squamous-cell carcinoma. Endoscopy 28(4):381–385PubMed
Zurück zum Zitat Wood DE et al (2003) Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 76(1):167–172 (discussion 173-4)PubMed Wood DE et al (2003) Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 76(1):167–172 (discussion 173-4)PubMed
Zurück zum Zitat Yopp AC et al (2007) Tracheal stenting of iatrogenic tracheal injury: a novel management approach. Ann Thorac Surg 83(5):1897–1899PubMed Yopp AC et al (2007) Tracheal stenting of iatrogenic tracheal injury: a novel management approach. Ann Thorac Surg 83(5):1897–1899PubMed
Zurück zum Zitat York EL et al (1990) Endoscopic diagnosis and treatment of postoperative bronchopleural fistula. Chest 97(6):1390–1392PubMed York EL et al (1990) Endoscopic diagnosis and treatment of postoperative bronchopleural fistula. Chest 97(6):1390–1392PubMed
Zurück zum Zitat Zabeck H et al (2011) Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg 59(4):243–246PubMed Zabeck H et al (2011) Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg 59(4):243–246PubMed
Zurück zum Zitat Zelefsky MN, Freeman LM, Stern H (1977) A simple approach to the diagnosis of bronchopleural fistula. Radiology 124(3):843–844PubMed Zelefsky MN, Freeman LM, Stern H (1977) A simple approach to the diagnosis of bronchopleural fistula. Radiology 124(3):843–844PubMed
Zurück zum Zitat Zimmerman JE, Colgan DL, Mills M (1973) Management of bronchopleural fistula complicating therapy with positive end expiratory pressure (PEEP. Chest 64(4):526–529PubMed Zimmerman JE, Colgan DL, Mills M (1973) Management of bronchopleural fistula complicating therapy with positive end expiratory pressure (PEEP. Chest 64(4):526–529PubMed
Metadaten
Titel
Komplikationsmanagement nach thoraxchirurgischen Eingriffen
verfasst von
Hauke Winter, PD Dr. med.
Copyright-Jahr
2015
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-43475-8_27

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.