Skip to main content
Erschienen in: Surgical Endoscopy 7/2019

18.03.2019 | Review Article

Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review

verfasst von: Taiga Wakabayashi, Emanuele Felli, Riccardo Memeo, Pietro Mascagni, Yuta Abe, Yuko Kitagawa, Patrick Pessaux

Erschienen in: Surgical Endoscopy | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

Laparoscopic repeat liver resection (LRLR) still represents a challenge for surgeons especially in case with previous open liver surgery. The aim of the study is to perform a systematic review of the current literature to investigate the feasibility of LRLR after open liver resection (OLR) for liver diseases.

Methods

A computerized search was performed for all English language studies evaluating LRLR. A meta-analysis was performed to evaluate the short-term outcomes in comparative studies between LRLR with previous laparoscopic liver resection (LLR) and OLR.

Results

From the initial 55 manuscripts, 8 studies including 3 comparative studies between LRLR after OLR and LLR were investigated. There was a total of 108 patients. Considering initial surgery, the extent of initial liver resection was major liver resection in 20% of patients in whom it was reported. In all the patients, the most frequent primary histology was hepatocellular carcinoma, followed by colorectal liver metastasis. A half of reported patients had severe adhesions at the time of LRLR. The median operative time for LRLR was ranged from 120 to 413 min and the median blood loss ranged from 100 to 400 mL. There were 11% of the patients conversions to open surgery, hand-assisted laparoscopic surgery, or tumor ablation. The overall postoperative morbidity was 15% of all the patients, and there was no postoperative mortality. The median postoperative hospital stay was ranged from 3.5 to 10 days. The meta-analysis shows that LRLR after OLR is associated with a longer operative time and a more important blood loss compared to LRLR after LLR. However, no difference between LRLR after OLR and LLR was shown as far as hospital stay and morbidity rate are concerned.

Conclusions

LRLR after OLR has been described in eight articles with favorable short-term outcomes in highly selected patients.
Literatur
1.
Zurück zum Zitat Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefPubMed Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefPubMed
2.
Zurück zum Zitat Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMed Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMed
3.
Zurück zum Zitat Minagawa M, Makuuchi M, Takayama T, Kokudo N (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710CrossRefPubMedPubMedCentral Minagawa M, Makuuchi M, Takayama T, Kokudo N (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, Majno P, Engerran L (1997) Repeat hepatectomy for colorectal liver metastases. Ann Surg 225:51–60 (discussion 60–52)CrossRefPubMedPubMedCentral Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, Majno P, Engerran L (1997) Repeat hepatectomy for colorectal liver metastases. Ann Surg 225:51–60 (discussion 60–52)CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2018) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 268:11–18CrossRefPubMed Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D (2018) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg 268:11–18CrossRefPubMed
6.
Zurück zum Zitat Goh BK, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AY (2016) Review of 103 cases of laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 26:876–881CrossRefPubMed Goh BK, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AY (2016) Review of 103 cases of laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 26:876–881CrossRefPubMed
7.
Zurück zum Zitat Dalkey N, Helmer O (1963) An experimental application of the Delphi method to the use of experts. Manag Sci 9:458–467CrossRef Dalkey N, Helmer O (1963) An experimental application of the Delphi method to the use of experts. Manag Sci 9:458–467CrossRef
8.
Zurück zum Zitat Pang YY (2002) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339. (HPB (Oxford) 4:99; author reply 99–100) Pang YY (2002) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339. (HPB (Oxford) 4:99; author reply 99–100)
9.
Zurück zum Zitat Petrie JC, Grimshaw JM, Bryson A (1995) The Scottish Intercollegiate Guidelines Network Initiative: getting validated guidelines into local practice. Health Bull (Edinb) 53:345–348 Petrie JC, Grimshaw JM, Bryson A (1995) The Scottish Intercollegiate Guidelines Network Initiative: getting validated guidelines into local practice. Health Bull (Edinb) 53:345–348
10.
Zurück zum Zitat Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA 283:2008–2012CrossRefPubMed Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA 283:2008–2012CrossRefPubMed
11.
Zurück zum Zitat Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748PubMed Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748PubMed
12.
Zurück zum Zitat Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5::13CrossRef Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5::13CrossRef
14.
Zurück zum Zitat Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L (2017) Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 31:4790–4798CrossRefPubMed Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L (2017) Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 31:4790–4798CrossRefPubMed
15.
Zurück zum Zitat Goh BKP, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AYF (2017) Laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. ANZ J Surg 87::E143–E146CrossRef Goh BKP, Teo JY, Chan CY, Lee SY, Cheow PC, Chung AYF (2017) Laparoscopic repeat liver resection for recurrent hepatocellular carcinoma. ANZ J Surg 87::E143–E146CrossRef
16.
Zurück zum Zitat Cioffi L, Belli A, Fantini C, D’Agostino A, Russo G, Belli G (2015) Repeat liver surgery by laparoscopy for a malignant recurrence after previous open or laparoscopic resection. Hepatoma Res 1:30–35CrossRef Cioffi L, Belli A, Fantini C, D’Agostino A, Russo G, Belli G (2015) Repeat liver surgery by laparoscopy for a malignant recurrence after previous open or laparoscopic resection. Hepatoma Res 1:30–35CrossRef
17.
Zurück zum Zitat Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamamoto S, Yamazoe S, Ohira G, Nakajima T (2013) Laparoscopic liver resection for treating recurrent hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 20:512–517CrossRefPubMed Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamamoto S, Yamazoe S, Ohira G, Nakajima T (2013) Laparoscopic liver resection for treating recurrent hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 20:512–517CrossRefPubMed
18.
Zurück zum Zitat Shafaee Z, Kazaryan AM, Marvin MR, Cannon R, Buell JF, Edwin B, Gayet B (2011) Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis. J Am Coll Surg 212:171–179CrossRefPubMed Shafaee Z, Kazaryan AM, Marvin MR, Cannon R, Buell JF, Edwin B, Gayet B (2011) Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis. J Am Coll Surg 212:171–179CrossRefPubMed
19.
Zurück zum Zitat Hu M, Zhao G, Xu D, Liu R (2011) Laparoscopic repeat resection of recurrent hepatocellular carcinoma. World J Surg 35:648–655CrossRefPubMed Hu M, Zhao G, Xu D, Liu R (2011) Laparoscopic repeat resection of recurrent hepatocellular carcinoma. World J Surg 35:648–655CrossRefPubMed
21.
Zurück zum Zitat Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD, Wolff BG, Roberts PL, Smith LE, Sweeney SA, Moore M (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306PubMed Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD, Wolff BG, Roberts PL, Smith LE, Sweeney SA, Moore M (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306PubMed
22.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tonnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Rosok BI, Bjornbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207CrossRefPubMed Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tonnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Rosok BI, Bjornbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207CrossRefPubMed
24.
Zurück zum Zitat Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:711–720CrossRefPubMed Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:711–720CrossRefPubMed
25.
Zurück zum Zitat Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727CrossRefPubMed Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727CrossRefPubMed
26.
Zurück zum Zitat Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777CrossRefPubMed Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777CrossRefPubMed
28.
Zurück zum Zitat Shelat VG, Serin K, Samim M, Besselink MG, Al Saati H, Gioia PD, Pearce NW, Abu Hilal M (2014) Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg 38:3175–3180CrossRefPubMed Shelat VG, Serin K, Samim M, Besselink MG, Al Saati H, Gioia PD, Pearce NW, Abu Hilal M (2014) Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg 38:3175–3180CrossRefPubMed
29.
Zurück zum Zitat Zhang J, Zhou ZG, Huang ZX, Yang KL, Chen JC, Chen JB, Xu L, Chen MS, Zhang YJ (2016) Prospective, single-center cohort study analyzing the efficacy of complete laparoscopic resection on recurrent hepatocellular carcinoma. Chin J Cancer 35:25 Zhang J, Zhou ZG, Huang ZX, Yang KL, Chen JC, Chen JB, Xu L, Chen MS, Zhang YJ (2016) Prospective, single-center cohort study analyzing the efficacy of complete laparoscopic resection on recurrent hepatocellular carcinoma. Chin J Cancer 35:25
30.
Zurück zum Zitat Isetani M, Morise Z, Kawabe N, Tomishige H, Nagata H, Kawase J, Arakawa S (2015) Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol 21:961–968CrossRefPubMedPubMedCentral Isetani M, Morise Z, Kawabe N, Tomishige H, Nagata H, Kawase J, Arakawa S (2015) Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol 21:961–968CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Chan AC, Poon RT, Chok KS, Cheung TT, Chan SC, Lo CM (2014) Feasibility of laparoscopic re-resection for patients with recurrent hepatocellular carcinoma. World J Surg 38:1141–1146CrossRefPubMed Chan AC, Poon RT, Chok KS, Cheung TT, Chan SC, Lo CM (2014) Feasibility of laparoscopic re-resection for patients with recurrent hepatocellular carcinoma. World J Surg 38:1141–1146CrossRefPubMed
Metadaten
Titel
Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review
verfasst von
Taiga Wakabayashi
Emanuele Felli
Riccardo Memeo
Pietro Mascagni
Yuta Abe
Yuko Kitagawa
Patrick Pessaux
Publikationsdatum
18.03.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 7/2019
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06754-6

Weitere Artikel der Ausgabe 7/2019

Surgical Endoscopy 7/2019 Zur Ausgabe

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.