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Video Podcasts der Schweizerischen Gesellschaft für Chirurgie 2020 Vidéo Podcasts de la Société Suisse de Chirurgie 2020 www.chirurgiekongress.ch swiss knife 2020; 17: special edition

Elektrochirurgie ist aus keinem OP wegzudenken -

CHIRURGISCHER RAUCH SCHON

Sichere Arbeitsumgebung mit dem IES3: Ein wesentli-

0,1µm beseitigt.WEITERE VORTEILE:

©Erbe Elektromedizin GmbH 2019 2019-07 D164156 non-US onlyǗ

WEITERE INFOS UNTER: SMOKE.ERBE-MED.COM

IES3

Das Rauchabsaugsystem

für saubere Luft an Ihrem

Arbeitsplatz

AD_CH-DE_IES-3_185x130mm_2019-07.indd 106.08.2019 13:00:29

Dear collegues & guests,

The present corona

special edition of swiss knife is offered online. Enjoy reading a selection of video podcast abstracts of the year 2020 davos/)

On behalf of the editorial board of

swiss knife we hope to see you at next year"s meeting in Davos!

Stay healthy!

Markus Zuber M.D.

Guest editor

swiss knife, special edition 2020

Société Suisse de Chirurgie 2020

Schweizerische Gesellschaft für

Chirurgie 2020

swiss knife 2020; 17: special edition 3 2021
107
e congrès annuel de la Société Suisse de Chirurgie

Davos, 1 - 3 juin 2021

Abstract Deadline: 11 janvier 20212021

107. Jahreskongress der Schweizerischen Gesellschaft für Chirurgie

Davos, 1. - 3. Juni 2021

Abstract Deadline: 11. Januar 2021

Shanghai. End of January 2020. By courtesy of Ms. Susanne Fiebiger

New York City, Time Square. Lockdown 2020

swiss knife 2020; 17 : special edition 5

Abstracts

Topic Page

Acute Care Surgery

6

Bariatrie und Hernien - Bariatrie

10

Bariatrie und Hernien - Parietologie

13

Brust und allgemeinchirurgische Onkologie -

Peritonealkarzinomatose

16

Endokrin

16 17

Grundlagenforschung

21

Gallenblase, Gallenwege 23

24
25
26

Oberer Gastrointestinaltrakt - Dünndarm

28

Oberer Gastrointestinaltrakt - Magen

31

Oberer Gastrointestinaltrakt - Oesophagus

33

Thorax

34
39

Unterer Gastrointestinaltrakt - Kolon

41

Unterer Gastrointestinaltrakt - Proktologie

45

Unterer Gastrointestinaltrakt - Rektum

46
Varia 47

Weiterbildung und Standespolitik -

Weiterbildung

49

Weiterbildung und Standespolitik - Andere

50
50

Polytrauma

52

Felix Largiadèr Preissitzung

52

6 swiss knife 2020; 17: special edition

Acute Care Surgery

564
Post-coital acute abdomen after laparoscopic total hysterectomy: a case report and literature review S. Canovi, R. Strano, A. Beniamin Abdelghany, D. Gianom, N. Ghisletta (Lugano)

Objective:

Surgeons are used to thinking that free abdominal air and peritonism mean perforation of a

hollow organ. A rather rare cause, the perforation of the vaginal cuff after laparoscopic hysterectomy,

occurs with an incidence of 0.3%-3.1%. The laparoscopic approach has higher incidences comparing with conventional abdominal hysterectomy, maybe because of shorter recovery time and therefore

earlier resume of sexual activities, which is the most relevant trigger event for vaginal cuff dehiscence.

Most of the vaginal cuff dehiscence presents with evisceration, there are only a few cases presenting

as acute abdomen.

Methods:

A 48 years old female, which had undergone total laparoscopic hysterectomy four months earlier, presented to our Emergency Department complaining of severe abdominal pain arising from

18 hour, after a sexual intercourse associated with vaginal bleeding. On initial presentation the patient

was afebrile with stable vital signs even if she was in severe pain distress (Visual Analogue Scale

7/10). On physical examination, the abdomen was rigid with generalized involuntary guarding, re

bound tenderness and hyperactive bowel sounds. Remarkable laboratory findings were White Blood Cell count of 20'100/mm3 with a left shift and C-reactive protein level of 58 mg/l. Computerized to mography with contrast revealed pneumoperitoneum sine causa.

Results:

In the Clinic there is no on-call gynecologist and the patient refused to be transferred to another

hospital for a gynecological evaluation. Therefore, we decided to proceed with diagnostic laparoscopy.

The exploration of the abdominal cavity revealed in the pelvic excavation a small abscess and a vagi nal cuff dehiscence. The defect was closed with a continuous V-LocTM-Suture. The patient was kept on

IV large spectrum antibiotics for a total of 48 hours and was discharged home on the fourth postopera

tive day. At the 6 weeks follow up there was no recurrence of the dehiscence.

Conclusion:

Vaginal vault rupture is a known complication after hysterectomy. Double continue suture and continuous barbed suture are recommended for the closure of the vaginal defect at the primary operation. In acute abdomen, where no other cause is evident, a focused gynecological history and examination should be obtained by the surgeon and within an exploratory laparoscopy the pelvic ex cavation should be carefully explored. 572

Recurrent volvulus with small bowel ischemia in an adolescent with intestinal malrotation - determin-

ing the border of intestinal resection utilizing indocyanine green mapping

K. Diessa, A. Lanitis, B. Egger (Fribourg)

Objective:

Small bowel volvulus in newborns with midgut malrotation is an emergency situation in

neonatal and pediatric surgery. However, even after initial operation recurrent volvulus may occur later

on. We report the case of a patient born with midgut malrotation that underwent Ladd's procedure at the age of 30 days who was admitted again at age 18 with recurrent volvulus and concomitant intes tinal ischemia. Indocyanine green mapping (ICG-M) was utilized to determine the extent of intestinal resection and performing a safe primary anastomosis.

Methods:

An 18-year-old female patient known for a midgut malrotation operated in her neonatal lifes pan was admitted to our emergency department with acute abdominal pain, nausea and vomiting.

Clinical examination showed abdominal distension and signs of peritonitis. CT-scan (figure 1) revealed

a obstructing volvulus with the lack of intestinal wall enhancement of the proximal jejunum. Emergency

laparotomy demonstrated the volvulus with a heavily dilated and necrotic proximal jejunum. Extensive adhesiolysis was performed in order to relieve the jejunal volvulus and the accompanying mesenteric strangulation. 150cm of proximal jejunum as well as the fourth part of the duodenum had to be resect ed due to irreversible tissue damage. The borders of the remaining duodenum as well of the remaining

jejunum were thereafter assessed with ICG-M in order to evaluate their viability. Accordingly, no further

resection was required and a duodeno-jejunal anastomosis was performed. Extensive intraabdominal lavage, suturing the mesenteric window and closure of the abdomen.

Results:

The postoperative course was uneventful. A postoperative paralytic ileus was successfully

treated conservatively with gradual and careful return to solid food before the patient was dismissed

home on the 12th postoperative day. Histologic evaluation revealed hemorrhagic necrosis with trans mural suffusions of the resected bowel.

Conclusion:

Midgut malrotation is a rare congenital anomaly which may lead to re-occurring intestinal

volvulus requiring an additional surgical intervention even after Ladd's procedure in the neonatal lifes

pan. This case report demonstrates that ICG-M is a valid option to determine the resection borders of

ischemic bowel in order to prevent re-operations and to perform safe primary intestinal anastomoses. 582
Abdominal compartment syndrome in severe hypovolemic shock after mushroom ingestion - a case report

K. Diessa, F. Cherbanyk, B. Egger (Fribourg)

Objective:

Abdominal compartment syndrome (ACS) is a life-threatening condition originating from a marked increase in intra-abdominal pressure associated with single or multi-organ failure. ACS may

end fatal if not treated correctly.1 We report the case of a 45-year-old woman that developed ACS after

aggressive resuscitation in severe hypovolemic choc.

Methods:

A 45-year-old female otherwise healthy patient was admitted to our emergency department with intensive abdominal pain 2 hours after morel (mushroom) consummation. She presented with hemorrhagic diarrhea and episodes of fainting and diagnosis of hypovolemic choc was made. Shortly

after admission, she also suffered from cardio-respiratory arrest requiring several reanimation cycles.

After return of spontaneous circulation, the patient was intubated and amines and extensive resusci tation were started with transfer to the ICU. CT-scan imaging showed signs of acute gastroenteritis as well as a narrow coeliac trunk and a narrow right renal artery as signs of extreme hypovolemia. Extensive hypoalbuminemia required continued aggressive resuscitation 36 hours later she presented an augmented intra-abdominal pressure of 47 cmH2O, measured through the urinary catheter and

associated with oliguria and progressive hypoxemia as clear signs of a beginning multi-organ failure.

Emergency decompression laparotomy was performed. At opening the abdomen, citrus colored as

cites (4 liters) splashed out followed by the externalization of bowel. Further exploration showed an

edematous stomach and a jejunum full of petechia without signs of intestinal suffering. The interven tion was terminated with laparostomy and VAC-dressing.

Results:

Postoperative recovery was favorable. Second/third/fourth look interventions on day 2/3/4 were performed before closing the abdomen on day 7. The patient spent another week in the ICU and another 3 weeks in hospital before being dismissed home in good general conditions.

Conclusion:

ACS is a life-threatening condition and may also occur after aggressive volumic resus citation. Surgeons have to keep in mind that ACS diagnosis may be delayed in sedated or intubated patients. Therefore, continuous measurements of intraabdominal pressure by the urinary catheter is mandatory in such patients. In cases of detection ACS the most important task is the decompression by laparotomy and laparostomy. swiss knife 2020; 17: special edition 7 586
A rare case of perforated Meckel's diverticulitis in a patient with intestinal malrotation M. Burgard, F. Cherbanyk, F. Pugin, B. Egger (Fribourg)

Objective:

Meckel's diverticulum (MD) is the most common malformation in the gastro-intestinal tract with a reported prevalence of 0,3 - 2,9% in autopsy studies. Most of MD stay asymptomatic with a lifetime onset of complications of 4%, decreasing with age. Most common complications are gastro-

intestinal bleeding, intestinal obstruction and Meckel's diverticulitis which may also lead to perforation.

Diverticulitis can manifest with abdominal pain or peritonitis; still pre-operative diagnosis is only made

in about 5-15% of cases and inflamed MD is often misdiagnosed as acute appendicitis. The combina tion of MD and intestinal malrotation (IM) is very rare and makes the diagnosis even more difficult,

especially in adult patients with unknown IM. We present the case of a 65-year-old patient with IM and

a perforated MD-diverticulitis.

Methods:

A 65-year-old male patient presented to our emergency department with diffuse abdomi

nal pain, fever and nausea. On clinical examination he showed localized peri-umbilical and left lower

quadrant abdominal tenderness. Abdominal CT revealed a complete IM and an inflamed diverticulum containing a big calculus in the left upper quadrant.

Results:

The patient underwent exploratory laparoscopy, confirming the diagnosis of a perforated

diverticulum with local peritonitis. A segmental intestinal resection with extracorporeal anastomosis

and occasional appendectomy was performed. Examination of the diverticulum confirmed the intra-

diverticular voluminous calculus. Definitive histology confirmed a perforated MD of 5x 4,5 cm. Due to

the intestinal malrotation the MD was localized in the left upper quadrant. The postoperative outcome

was uneventful with discharge from hospital at day 5.

Conclusion:

MD is a common malformation of the intestinal tract but stays often asymptomatic. Com

plicated MD in adults is unusual and can be difficult to diagnose, even more if located at an anomalous

anatomic position. The treatment of complicated MD is surgery; thus, surgeons should be aware of this

entity as a possible cause of abdominal pain and acute abdomen. Systematic resection of fortuitously diagnosed asymptomatic MD is still debated in the literature, however, in IM it should be considered (together with the appendix) if such a patient is undergoing an operation for something else.

Figure 1a

Figure 1b

Figure 1 c

Figure 1. (a, b and c) Coronal, axial CT scan and laparoscopic intraoperative images of perforated Meckelquotesdbs_dbs9.pdfusesText_15

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