Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 4/2012

01.04.2012 | Review Article

Immune mediators of postoperative ileus

verfasst von: Sven Wehner, Tim O. Vilz, Burkhard Stoffels, Joerg C. Kalff

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2012

Einloggen, um Zugang zu erhalten

Abstract

Clinical background

In all patients undergoing abdominal surgery, a transient phase of interruption of bowel motility, named postoperative ileus (POI) occurs. POI is often accepted as an unavoidable “physiological” response and a self-limiting complication after surgery although it has a significant impact on patient morbidity with prolonged hospitalization and increased costs. Annual economic burden has been estimated as much as US $1.47 billion in the USA (Iyer et al. in J Manag Care Pharm 15(6):485–494, 2009).

Pathophysiology

The pathophysiology has been elucidated within the last decades, demonstrating that both, neurogenic and inflammatory mechanisms are involved in response to the surgical trauma. It is now generally accepted that POI pathogenesis processes in two phases: a first neurogenic phase is accountable for the immediate postoperative impairment of bowel motility. This is followed by a second immunological phase that can last for days and mainly affects strength and length of POI. More recent findings demonstrate a bidirectional interaction between the nervous and the immune system, and this interaction significantly contributed to our present understanding of POI pathophysiology. Although nerval mechanisms have a significant impact in the early phase of POI, the contribution of the immune system and subsequently its manipulation has risen as the most promising strategy in prevention or treatment of the clinically relevant prolonged form of POI.

Aims

The present manuscript will give an update on the inflammatory responses, the involved cell types, and participating immune mediators in POI.
Literatur
1.
Iyer S, Saunders WB, Stemkowski S (2009) Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm 15(6):485–494PubMed
2.
3.
4.
Catchpole BN (1969) Ileus: use of sympathetic blocking agents in its treatment. Surgery 66(5):811–820PubMed
5.
Zittel TT, Rothenhofer I, Meyer JH, Raybould HE (1994) Small intestinal capsaicin-sensitive afferents mediate feedback inhibition of gastric emptying in rats. Am J Physiol 267(6 Pt 1):G1142–G1145PubMed
6.
Zittel TT, Reddy SN, Plourde V, Raybould HE (1994) Role of spinal afferents and calcitonin gene-related peptide in the postoperative gastric ileus in anesthetized rats. Ann Surg 219(1):79–87PubMedCrossRef
7.
Plourde V, Wong HC, Walsh JH, Raybould HE, Tache Y (1993) CGRP antagonists and capsaicin on celiac ganglia partly prevent postoperative gastric ileus. Peptides 14(6):1225–1229PubMedCrossRef
8.
Kalff JC, Schraut WH, Simmons RL, Bauer AJ (1998) Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 228(5):652–663PubMedCrossRef
9.
Kalff JC, Buchholz B, Eskandari MK, Hierholzer C, Schraut WH, Simmons RL, Bauer AJ (1999) Biphasic response to gut manipulation and temporal correlation of cellular infiltrates and muscle dysfunction in rats. Surgery 126:498–509PubMedCrossRef
10.
Kalff JC, Carlos TM, Schraut WH, Billiar TR, Bauer AJ (1999) Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 117:378–387PubMedCrossRef
11.
Kalff JC, Turler A, Schwarz NT, Schraut WH, Lee KK, Tweardy DJ, Billiar TR, Simmons RL, Bauer AJ (2003) Intra-abdominal activation of a local inflammatory response within the human muscularis externa during laparotomy. Ann Surg 237(3):301–315PubMed
12.
Bauer AJ, Boeckxstaens GE (2004) Mechanisms of postoperative ileus. Neurogastroenterol Motil 16(Suppl 2):54–60PubMedCrossRef
13.
Boeckxstaens GE, de Jonge WJ (2009) Neuroimmune mechanisms in postoperative ileus. Gut 58(9):1300–1311PubMedCrossRef
14.
Traut U, Brugger L, Kunz R, Pauli-Magnus C, Haug K, Bucher HC, Koller MT (2008) Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane database of systematic reviews (Online) (1):CD004930. doi:10.​1002/​14651858.​CD004930.​pub3
15.
16.
Kalff JC, Schwarz NT, Walgenbach KJ, Schraut WH, Bauer AJ (1998) Leukocytes of the intestinal muscularis: their phenotype and isolation. J Leukoc Biol 63(6):683–691PubMed
17.
Kalff JC, Schwarz NT, Walgenbach KJ, Schraut WH, Bauer AJ (1998) Leukocytes of the intestinal muscularis externa: their phenotype and isolation. J Leukoc Biol 63:683–691PubMed
18.
Eskandari MK, Kalff JC, Billiar TR, Lee KKW, Bauer AJ (1997) Lipopolysaccharide activates the muscularis macrophage network and suppresses circular smooth muscle activity. Am J Physiol 273(36):G727–G734PubMed
19.
Eskandari MK, Kalff JC, Billiar TR, Lee KK, Bauer AJ (1999) LPS-induced muscularis macrophage nitric oxide suppresses rat jejunal circular muscle activity. Am J Physiol 277(2 Pt 1):G478–G486PubMed
20.
Mikkelsen HB, Larsen JO, Hadberg H (2008) The macrophage system in the intestinal muscularis externa during inflammation: an immunohistochemical and quantitative study of osteopetrotic mice. Histochem Cell Biol 130(2):363–373. doi:10.​1007/​s00418-008-0423-x PubMedCrossRef
21.
Mikkelsen HB, Larsen JO, Froh P, Nguyen TH (2011) Quantitative Assessment of Macrophages in the Muscularis Externa of Mouse Intestines. Anat Rec (Hoboken). doi:10.​1002/​ar.​21444
22.
Mikkelsen HB, Garbarsch C, Tranum-Jensen J, Thuneberg L (2004) Macrophages in the small intestinal muscularis externa of embryos, newborn and adult germ-free mice. J Mol Histol 35(4):377–387PubMedCrossRef
23.
Mikkelsen HB, Rumessen JJ (1992) Characterization of macrophage-like cells in the external layers of human small and large intestine. Cell Tissue Res 270:273–279PubMedCrossRef
24.
Wehner S, Behrendt FF, Lyutenski BN, Lysson M, Bauer AJ, Hirner A, Kalff JC (2007) Inhibition of macrophage function prevents intestinal inflammation and postoperative ileus in rodents. Gut 56(2):176–185PubMedCrossRef
25.
Wehner S, Straesser S, Vilz TO, Pantelis D, Sielecki T, de la Cruz VF, Hirner A, Kalff JC (2009) Inhibition of p38 mitogen-activated protein kinase pathway as prophylaxis of postoperative ileus in mice. Gastroenterology 136(2):619–629PubMedCrossRef
26.
Engel DR, Koscielny A, Wehner S, Maurer J, Schiwon M, Franken L, Schumak B, Limmer A, Sparwasser T, Hirner A, Knolle PA, Kalff JC, Kurts C (2010) T helper type 1 memory cells disseminate postoperative ileus over the entire intestinal tract. Nat Med 16(12):1407–1413PubMedCrossRef
27.
Schwarz NT, Kalff JC, Turler A, Speidel N, Grandis JR, Billiar TR, Bauer AJ (2004) Selective jejunal manipulation causes postoperative pan-enteric inflammation and dysmotility. Gastroenterology 126(1):159–169PubMedCrossRef
28.
Mikkelsen HB, Thuneberg L (1999) Op/op mice defective in production of functional colony-stimulating factor-1 lack macrophages in muscularis externa of the small intestine. Cell Tissue Res 295(3):485–493PubMedCrossRef
29.
Grimbaldeston MA, Chen CC, Piliponsky AM, Tsai M, Tam SY, Galli SJ (2005) Mast cell-deficient W-sash c-kit mutant Kit W-sh/W-sh mice as a model for investigating mast cell biology in vivo. Am J Pathol 167(3):835–848. doi:10.​1016/​S0002-9440(10)62055-X PubMedCrossRef
30.
Bischoff SC, Wedemeyer J, Herrmann A, Meier PN, Trautwein C, Cetin Y, Maschek H, Stolte M, Gebel M, Manns MP (1996) Quantitative assessment of intestinal eosinophils and mast cells in inflammatory bowel disease. Histopathology 28(1):1–13PubMedCrossRef
31.
de Jonge WJ, The FO, van der CD, Bennink RJ, Reitsma PH, van Deventer SJ, van den Wijngaard RM, Boeckxstaens GE (2004) Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice. Gastroenterology 127(2):535–545PubMedCrossRef
32.
The FO, Bennink RJ, Ankum WM, Buist MR, Busch OR, Gouma DJ, van der Heide S, van den Wijngaard RM, de Jonge WJ, Boeckxstaens GE (2008) Intestinal handling-induced mast cell activation and inflammation in human postoperative ileus. Gut 57(1):33–40PubMedCrossRef
33.
Snoek SA, Dhawan S, van Bree SH, Cailotto C, van Diest SA, Duarte JM, Stanisor OI, Hilbers FW, Nijhuis L, Koeman A, van den Wijngaard RM, Zuurbier CJ, Boeckxstaens GE, de Jonge WJ (2011) Mast cells trigger epithelial barrier dysfunction, bacterial translocation and postoperative ileus in a mouse model. Neurogastroenterol Motil: Off J Eur Gastrointest Motil Soc. doi:10.​1111/​j.​1365-2982.​2011.​01820.​x
34.
Hoetzel A, Dolinay T, Vallbracht S, Zhang Y, Kim HP, Ifedigbo E, Alber S, Kaynar AM, Schmidt R, Ryter SW, Choi AM (2008) Carbon monoxide protects against ventilator-induced lung injury via PPAR-gamma and inhibition of Egr-1. Am J Respir Crit Care Med 177(11):1223–1232. doi:10.​1164/​rccm.​200708-1265OC PubMedCrossRef
35.
36.
Barajon I, Serrao G, Arnaboldi F, Opizzi E, Ripamonti G, Balsari A, Rumio C (2009) Toll-like receptors 3, 4, and 7 are expressed in the enteric nervous system and dorsal root ganglia. J Histochem Cytochem 57(11):1013–1023PubMedCrossRef
37.
Rumio C, Besusso D, Arnaboldi F, Palazzo M, Selleri S, Gariboldi S, Akira S, Uematsu S, Bignami P, Ceriani V, Menard S, Balsari A (2006) Activation of smooth muscle and myenteric plexus cells of jejunum via Toll-like receptor 4. J Cell Physiol 208(1):47–54PubMedCrossRef
38.
Wehner S, Buchholz BM, Schuchtrup S, Rocke A, Schaefer N, Lysson M, Hirner A, Kalff JC (2010) Mechanical strain and TLR4 synergistically induce cell-specific inflammatory gene expression in intestinal smooth muscle cells and peritoneal macrophages. Am J Physiol Gastrointest Liver Physiol 299(5):G1187–G1197PubMedCrossRef
39.
Schmidt J, Stoffels B, Moore BA, Chanthaphavong RS, Mazie AR, Buchholz BM, Bauer AJ (2008) Proinflammatory role of leukocyte-derived Egr-1 in the development of murine postoperative ileus. Gastroenterology 135(3):926–936. doi:10.​1053/​j.​gastro.​2008.​05.​079, 936 e921-922PubMedCrossRef
40.
The FO, de Jonge WJ, Bennink RJ, van den Wijngaard RM, Boeckxstaens GE (2005) The ICAM-1 antisense oligonucleotide ISIS-3082 prevents the development of postoperative ileus in mice. Br J Pharmacol 146:252–258PubMedCrossRef
41.
42.
Wehner S, Schwarz NT, Hundsdoerfer R, Hierholzer C, Tweardy DJ, Billiar TR, Bauer AJ, Kalff JC (2005) Induction of IL-6 within the rodent intestinal muscularis after intestinal surgical stress. Surgery 137(4):436–446PubMedCrossRef
43.
Kalff JC, Schraut WH, Billiar TR, Simmons RL, Bauer AJ (2000) Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 118(2):316–327PubMedCrossRef
44.
45.
Behrendt FF, Tolba RH, Overhaus M, Hirner A, Minor T, Kalff JC (2004) Indocyanine green fluorescence measurement of intestinal transit and gut perfusion after intestinal manipulation. Eur Surg Res 36(4):210–218PubMedCrossRef
46.
Bennett A, Eley KG, Scholes GB (1968) Effect of prostaglandins E1 and E2 on intestinal motility in the guinea-pig and rat. Br J Pharmacol 34(3):639–647PubMed
47.
Bennett A, Eley KG, Scholes GB (1968) Effects of prostaglandins E1 and E2 on human, guinea-pig and rat isolated small intestine. Br J Pharmacol 34(3):630–638PubMed
48.
Scholes GB, Eley KG, Bennett A (1968) Effect of prostaglandins on intestinal motility. Gut 9(6):726PubMed
49.
Wittmann T, Vaxman F, Lambert A, Sanches O, Buliard G, Grenier JF (1990) Difference in the action of prostaglandin E2 (PGE2) on longitudinal circular muscle contractions of the colon. Experimental study in dogs. Ann Chir 44(9):718–724PubMed
50.
Schwarz NT, Kalff JC, Turler A, Engel BM, Watkins SC, Billiar TR, Bauer AJ (2001) Prostanoid production via COX-2 as a causative mechanism of rodent postoperative ileus. Gastroenterology 121(6):1354–1371PubMedCrossRef
51.
52.
de Jonge WJ, van der Zanden EP, The FO, Bijlsma MF, van Westerloo DJ, Bennink RJ, Berthoud HR, Uematsu S, Akira S, van den Wijngaard RM, Boeckxstaens GE (2005) Stimulation of the vagus nerve attenuates macrophage activation by activating the Jak2-STAT3 signaling pathway. Nat Immunol 6(8):844–851PubMedCrossRef
53.
54.
De Backer O, Elinck E, Priem E, Leybaert L, Lefebvre RA (2009) Peroxisome proliferator-activated receptor gamma activation alleviates postoperative ileus in mice by inhibition of Egr-1 expression and its downstream target genes. J Pharmacol Exp Ther 331(2):496–503. doi:10.​1124/​jpet.​109.​155135 PubMedCrossRef
55.
Moore BA, Otterbein LE, Turler A, Choi AM, Bauer AJ (2003) Inhaled carbon monoxide suppresses the development of postoperative ileus in the murine small intestine. Gastroenterology 124(2):377–391PubMedCrossRef
56.
Nakao A, Schmidt J, Harada T, Tsung A, Stoffels B, Cruz RJ Jr, Kohmoto J, Peng X, Tomiyama K, Murase N, Bauer AJ, Fink MP (2006) A single intraperitoneal dose of carbon monoxide-saturated ringer’s lactate solution ameliorates postoperative ileus in mice. J Pharmacol Exp Ther 319(3):1265–1275. doi:10.​1124/​jpet.​106.​108654 PubMedCrossRef
57.
De Backer O, Elinck E, Blanckaert B, Leybaert L, Motterlini R, Lefebvre RA (2009) Water-soluble CO-releasing molecules reduce the development of postoperative ileus via modulation of MAPK/HO-1 signalling and reduction of oxidative stress. Gut 58(3):347–356. doi:10.​1136/​gut.​2008.​155481 PubMedCrossRef
58.
Moore BA, Overhaus M, Whitcomb J, Ifedigbo E, Choi AM, Otterbein LE, Bauer AJ (2005) Brief inhalation of low-dose carbon monoxide protects rodents and swine from postoperative ileus. Crit Care Med 33(6):1317–1326PubMedCrossRef
59.
Schwarz NT, Beer-Stolz D, Simmons RL, Bauer AJ (2002) Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis. Ann Surg 235(1):31–40PubMedCrossRef
60.
Turler A, Schnurr C, Nakao A, Togel S, Moore BA, Murase N, Kalff JC, Bauer AJ (2007) Endogenous endotoxin participates in causing a panenteric inflammatory ileus after colonic surgery. Ann Surg 245(5):734–744PubMedCrossRef
61.
Bianchi ME (2007) DAMPs, PAMPs and alarmins: all we need to know about danger. J Leukoc Biol 81(1):1–5PubMedCrossRef
62.
Yang D, Chen Q, Yang H, Tracey KJ, Bustin M, Oppenheim JJ (2007) High mobility group box-1 protein induces the migration and activation of human dendritic cells and acts as an alarmin. J Leukoc Biol 81(1):59–66. doi:10.​1189/​jlb.​0306180 PubMedCrossRef
63.
Foell D, Wittkowski H, Vogl T, Roth J (2007) S100 proteins expressed in phagocytes: a novel group of damage-associated molecular pattern molecules. J Leukoc Biol 81(1):28–37PubMedCrossRef
64.
65.
Jiang D, Liang J, Fan J, Yu S, Chen S, Luo Y, Prestwich GD, Mascarenhas MM, Garg HG, Quinn DA, Homer RJ, Goldstein DR, Bucala R, Lee PJ, Medzhitov R, Noble PW (2005) Regulation of lung injury and repair by Toll-like receptors and hyaluronan. Nat Med 11(11):1173–1179PubMedCrossRef
66.
67.
Martin DK, Bootcov MR, Campbell TJ, French PW, Breit SN (1995) Human macrophages contain a stretch-sensitive potassium channel that is activated by adherence and cytokines. J Membr Biol 147(3):305–315PubMed
68.
Wu X, Cheng J, Li P, Yang M, Qiu S, Liu P, Du J (2010) Mechano-sensitive transcriptional factor Egr-1 regulates insulin-like growth factor-1 receptor expression and contributes to neointima formation in vein grafts. Arterioscler Thromb Vasc Biol 30(3):471–476. doi:10.​1161/​ATVBAHA.​109.​184259 PubMedCrossRef
69.
The FO, Boeckxstaens GE, Snoek SA, Cash JL, Bennink R, Larosa GJ, van den Wijngaard RM, Greaves DR, de Jonge WJ (2007) Activation of the cholinergic anti-inflammatory pathway ameliorates postoperative ileus in mice. Gastroenterology 133(4):1219–1228PubMedCrossRef
70.
Tsuchida Y, Hatao F, Fujisawa M, Murata T, Kaminishi M, Seto Y, Hori M, Ozaki H (2011) Neuronal stimulation with 5-hydroxytryptamine 4 receptor induces anti-inflammatory actions via alpha7nACh receptors on muscularis macrophages associated with postoperative ileus. Gut 60(5):638–647. doi:10.​1136/​gut.​2010.​227546 PubMedCrossRef
71.
Snoek SA, Verstege MI, van der Zanden EP, Deeks N, Bulmer DC, Skynner M, Lee K, Te Velde AA, Boeckxstaens GE, de Jonge WJ (2010) Selective alpha7 nicotinic acetylcholine receptor agonists worsen disease in experimental colitis. Br J Pharmacol 160(2):322–333. doi:10.​1111/​j.​1476-5381.​2010.​00699.​x PubMedCrossRef
72.
Calder PC (2004) n-3 fatty acids, inflammation, and immunity—relevance to postsurgical and critically ill patients. Lipids 39(12):1147–1161PubMedCrossRef
73.
Calder PC (2006) n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 83(6 Suppl):1505S–1519SPubMed
74.
Senkal M, Geier B, Hannemann M, Deska T, Linseisen J, Wolfram G, Adolph M (2007) Supplementation of omega-3 fatty acids in parenteral nutrition beneficially alters phospholipid fatty acid pattern. JPEN J Parenter Enteral Nutr 31(1):12–17PubMedCrossRef
75.
Senkal M, Haaker R, Linseisen J, Wolfram G, Homann HH, Stehle P (2005) Preoperative oral supplementation with long-chain Omega-3 fatty acids beneficially alters phospholipid fatty acid patterns in liver, gut mucosa, and tumor tissue. JPEN J Parenter Enteral Nutr 29(4):236–240PubMedCrossRef
76.
Wehner S, Meder K, Vilz TO, Alteheld B, Stehle P, Pech T, Kalff JC (2011) Preoperative short-term parenteral administration of polyunsaturated fatty acids ameliorates intestinal inflammation and postoperative ileus in rodents. Langenbeck’s Arch Surg/Deut Ges fur Chirurgie. doi:10.​1007/​s00423-011-0862-z
77.
78.
Beale RJ, Bryg DJ, Bihari DJ (1999) Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med 27(12):2799–2805PubMedCrossRef
79.
80.
Lubbers T, Luyer MD, de Haan JJ, Hadfoune M, Buurman WA, Greve JW (2009) Lipid-rich enteral nutrition reduces postoperative ileus in rats via activation of cholecystokinin-receptors. Ann Surg 249(3):481–487PubMedCrossRef
81.
The FO, Buist MR, Lei A, Bennink RJ, Hofland J, van den Wijngaard RM, de Jonge WJ, Boeckxstaens GE (2009) The role of mast cell stabilization in treatment of postoperative ileus: a pilot study. Am J Gastroenterol 104(9):2257–2266PubMedCrossRef
Metadaten
Titel
Immune mediators of postoperative ileus
verfasst von
Sven Wehner
Tim O. Vilz
Burkhard Stoffels
Joerg C. Kalff
Publikationsdatum
01.04.2012
Verlag
Springer-Verlag
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 4/2012
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-012-0915-y

Weitere Artikel der Ausgabe 4/2012

Langenbeck's Archives of Surgery 4/2012 Zur Ausgabe

Review Article

Biology and significance of circulating and disseminated tumour cells in colorectal cancer

Review Article

Targeting the vasculature of visceral tumors: novel insights and treatment perspectives

Abstracts

129th Congress of the German Society for Surgery

Review Article

Lynch syndrome: clinical, pathological, and genetic insights

Review Article

Energy metabolism and proliferation in pancreatic carcinogenesis

Review Article

Bacterial immunotherapy of gastrointestinal tumors

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

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

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

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.
Bildnachweise