@article{WillmsSchwabvonWebskyetal.2022,
  author    = {Willms, A. G. and Schwab, R. and von Websky, M. W. and Berrevoet, F. and Tartaglia, D. and S{\"o}relius, K. and Fortelny, R. H. and Bj{\"o}rck, M. and Monchal, T. and Brennfleck, F. and Bulian, D. and Beltzer, C. and Germer, C. T. and Lock, J. F.},
  title     = {Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry. Surgical technique matters},
  series = {Hernia},
  volume    = {26},
  journal   = {Hernia},
  number    = {1},
  organization    = {EURAHS Open Abdomen Group},
  issn      = {1265-4906},
  doi       = {10.1007/s10029-020-02336-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234871},
  pages     = {61-73},
  year      = {2022},
  abstract  = {Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46\%), abdominal compartment syndrome (20.5\%), burst abdomen (11.3\%), abdominal trauma (9\%), and other conditions (13.2\%). The overall definitive fascial closure rate was 57.5\% in the intention-to-treat analysis and 71\% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.},
  language  = {en}
}
@article{WidderBackhausWierlemannetal.,
  author    = {Widder, A. and Backhaus, J. and Wierlemann, A. and Hering, I. and Flemming, S. and Hankir, M. and Germer, C.-T. and Wiegering, A. and Lock, J. F. and K{\"o}nig, S. and Seyfried, F.},
  title     = {Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students},
  series = {Surgical Endoscopy},
  volume    = {36},
  journal   = {Surgical Endoscopy},
  number    = {12},
  doi       = {10.1007/s00464-022-09408-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323969},
  pages     = {8726-8736},
  abstract  = {Background Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. Methods A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. Results Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58\% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). Conclusion Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.},
  language  = {en}
}
@article{LockUngeheuerBorstetal.2020,
  author    = {Lock, J. F. and Ungeheuer, L. and Borst, P. and Swol, J. and L{\"o}b, S. and Brede, E. M. and R{\"o}der, D. and Lengenfelder, B. and Sauer, K. and Gremer, C. - T.},
  title     = {Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery},
  series = {Perioperative Medicine},
  volume    = {9},
  journal   = {Perioperative Medicine},
  doi       = {10.1186/s13741-020-00170-4},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230690},
  year      = {2020},
  abstract  = {Background Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. Methods We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. Results A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8\% vs. 1\%; p < 0.001) as well as minor bleeding events (14\% vs. 5\%; p < 0.001). Thromboembolic events were equally rare in both groups (1\% vs. 2\%; p = 0.45). No effect on mortality was observed (1.5\% vs. 1.9\%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. Conclusion Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging.},
  language  = {en}
}
@article{GuesgenAngerHaueretal.2020,
  author    = {G{\"u}sgen, C. and Anger, F. and Hauer, T. and Willms, A. and Buhr, H. J. and Germer, C.-T. and Schwab, R. and Lock, J. F.},
  title     = {Fortbildung von Allgemein- und Viszeralchirurgen in der lebensrettenden Notfallchirurgie. Ergebnisse einer Umfrage unter Operationskursteilnehmern},
  series = {Der Chirurg},
  volume    = {91},
  journal   = {Der Chirurg},
  organization    = {Chirurgische ArbeitsgemeinschaftMilit{\"a}r- und Notfallchirurgie (CAMIN) der Deutschen Gesellschaft f{\"u}r Allgemein- und Viszeralchirurgie (DGAV)},
  issn      = {0009-4722},
  doi       = {10.1007/s00104-020-01170-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-235246},
  pages     = {1044-1052},
  year      = {2020},
  abstract  = {Hintergrund Die geringe Anzahl operativ zu versorgender K{\"o}rperh{\"o}hlenverletzungen erfordert ein Umdenken in der chirurgischen Aus- und Weiterbildung. Ein entsprechendes Kursformat wird seit 2014 {\"u}ber die DGAV angeboten. Um Berechtigung, Bedarf, Nutzen und Erfolg eines solchen Kursformates zu erheben, erfolgte eine Evaluation durch die bisherigen Kursteilnehmer. Material und Methoden Kursevaluation und zus{\"a}tzliche Onlinebefragung der bisherigen Kursteilnehmer hinsichtlich Alter, Geschlecht, Ausbildungsstand, Fachrichtung, Versorgungsstufe des Krankenhauses, notfallchirurgischer Erfahrungen, der H{\"a}ufigkeit chirurgischer Notfallversorgungen, Teilnahme an anderen Kursformaten, Erfahrungen nach der Kursteilnahme, Einsch{\"a}tzung der aktuellen Fort- und Weiterbildungssituation und Finanzierung solcher Kurse. Ergebnisse Insgesamt 142 Kursteilnehmer evaluierten ihre Kursteilnahme, zus{\"a}tzlich beantworteten 83 den Onlinefragebogen. {\"U}ber 90 \% berichteten von einem nachhaltigen positiven Einfluss des Kurses auf ihr notfallchirurgisches Handeln. Mehr als die H{\"a}lfte konnte von konkreten Notfallsituationen berichten, die sie aufgrund der Kursteilnahme besser bew{\"a}ltigen konnten. In der Notfallversorgung erfahrene Chirurgen bewerteten den eigenen Lernerfolg durch die Kursteilnahme signifikant h{\"a}ufiger positiv als ihre weniger erfahrenen Kollegen. Keinen Einfluss auf den Lernerfolg hatten eine Ober- oder Chefarztposition, die Versorgungsstufe des Krankenhauses, das Alter oder Geschlecht der Teilnehmer. Die Mehrheit der antwortenden Chirurgen bef{\"u}rwortet die Integration eines solchen Kursformates in die chirurgische Weiterbildung und fordert hierzu eine finanzielle Unterst{\"u}tzung. Schlussfolgerung Kursformate, in denen notfallchirurgische Strategien und F{\"a}higkeiten vermittelt werden, sind etabliert und werden sehr positiv evaluiert. Die Fort- und Weiterbildung in notfallchirurgischen F{\"a}higkeiten und Kenntnissen liegt im gesellschaftlichen Interesse und zumindest anteilig auch in ihrer Verantwortung.},
  language  = {de}
}