Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

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expertise of the teachers and highly sophisticated disposable material. As a big player in this
field the medical industry is involved to a great extent with sponsoring. The emerging conflicts
of interests, however, can lead to ethical problems and give rise to critical questions of dependence
on industry.
Methods: As a part of a thesis for an Executive MBA a representative online survey with a questionnaire
among all chief surgeons in Swiss hospitals was carried out in order to assess the
view on future strategy concerning professional education in laparoscopic surgery.
Results: The response rate was 52%. The key results: 88% of all chief surgeons in Switzerland
are in favour of a partial financial and material participation of the medical industry in laparoscopic
training. 49% consider the conflict of interest between surgeons and industry to be
critical. According to 46% this conflict could be defused by forming a common training cooperation
between the industrial partners involved. 89% of the chief surgeons could improve their
surgical perfomance through training courses. 98% advocate that teachers in laparoscopy
courses be licensed by the Surgical Society and/or have a certain experience in laproscopic
surgery. Only 30% think that academic surgeons should teach laparoscopic surgery. 75%
prefer courses organised on national level (i.e. type GI-courses, Davos), only 12% prefer international
courses (i.e. type European Surgical Institute, Hamburg) and 12% prefer local courses.
33% believe that virtual reality simulators will totally replace all other training tools in laparascopy.
93% advocate laparoscopic training courses to be compulsory in surgical training.
More detailed results are available.
Conclusion: Professional education in laparoscopic surgery is considered to be a topic of
high importance among the opinion leaders in surgery in Switzerland. In a future strategy the
role of the medical industry should be clearly defined. Laparoscopic training courses should
be part of a compulsory training programm in surgical education. Teachers should be officially
assigned by the responsible Surgical Society.
5.10
D. Brandt 1 , P. Gervaz 2 , Y. Durmishi 3 , P. Morel 4
1 Surgery, University Hospital Geneva, Geneva/CH, 2 Surgery, University Hospital Geneva, 1211
Geneva/CH, 3 Surgery, University Hospital Geneva, Geenva/CH, 4 Visceral/transplantation
Surgery, Geneva University Hospitals, Geneva 14/CH
Percutaneous CT scan-guided drainage versus antibiotherapy alone for Hinchey stage II diverticulitis:
A case-control study
Objective: CT scan-guided percutaneous abscess drainage (PAD) of Hinchey stage II diverticulitis
is considered the best initial approach, in order to treat conservatively the abscess and
to subsequently perform an elective sigmoidectomy. However, PAD is not always technically
feasible, may expose the patient to additional morbidity, and finally has, so far, not been critically
evaluated in this indication. Therefore, this study was undertaken to compare the results
of PAD versus antibiotherapy alone in patients with Hinchey II diverticulitis.
Methods: This was a case-control study of all patients who presented in our institution with
Hinchey stage II diverticulitis between 1993 and 2005. 34 patients (median age 71 [range
34-90] years) underwent PAD under CT-scan guidance (group I). 32 patients (median age
70 [range 32-95] years were treated with antibiotherapy alone (ceftriaxone+metronidazole)
(group II), in most cases because PAD was considered technically unfeasible by the interventional
radiology team. Initial treatment was considered a failure when emergency surgery had
to be performed.
Results: The median size of abscess was 6 [range 3-18] cm in group I and 4 [3-10] cm in
group II (p=0.002). Median duration of drainage was 8 [1-18] days. Conservative treatment
failed in 11 pa-tients (33%) of group I, and in 7 patients (25%) of group II. Causes for failure
among 18 patients included persistent sepsis (10), recurring abscess (7) and fistula (1). 10
patients (29%) in group I and 6 patients (18%) in group II underwent an emergent Hartmann
procedure; there were 4 postoperative deaths (25%) in this subgroup. Twelve (35%) patients
in group I and fifteen (47%) patients in group II underwent an elective sigmoidectomy, with a
median delay of 113 [40-600] days between the initial admission and surgery. In this subgroup
of patients, there no were anastomotic leakage or postoperative death.
Conclusion: Emergency surgery for Hinchey stage II diverticulitis carries a high mortality rate
and should be avoided. In order to achieve this, systemic antibiotherapy alone seems to be a
safe alternative, whenever percutaneous drainage is technically difficult or hazardeous.
Actually, our data did not demonstrate any benefit of PAD, suggesting that the role of interventional
radiology techniques in this indication deserve further critical evaluation.
5.11
B. Roche 1 , G. Zufferey 2 , J. Robert-Yap 3 , R. Chautems 4 , P.J. Deleaval 5
1 Chirurgie, Unité de Procotlogy HUG, 1211 Geneve 14/CH, 2 Chirurgie, Hôpital Zone de Nyon,
Nyon/CH, 3 Chirurgie, hug procotologie, 1211 Geneve 14/CH, 4 Chirurgie, Kantonspital
Soloturn, Soloturn/CH, 5Chirurgie, proctology, 1211 Geneve 14/CH
The value of a new classification system in the choice of rectocele surgery
Objective: Rectoceles can be classified in 3 types based on defecogram findings. This classification
permits the selection of the most appropriate surgical procedure.
Methods: A prospective study based on 632 consecutives rectocele surgeries.
Results: The complication rate is low, at 2.2%. The one-year postoperative recurrence rate is
38% for the endo-anal approach. Recurrence rate of endo-vaginal and combined abdominovaginal
approach are 8.2 and 9.7% respectively. Failures in functional results are interdependent
with the recurrences results.
Conclusion: Conclusion The findings of this prospective study confirm the importance of classifying
rectoceles into three types in order to make the best therapeutic choice. However, a
38% recurrence rate in the endo-anal approach procedure is not optimal. The development of
new prognostic factors could improve patient’s selection for the endo-anal treatment for rectocele.
5.12
O. Pittet 1 , S. Schmidt 2 , N. Kotzampassakis 3 , J. Givel 3 , N. Peloponissios 4 , A. Denys 5 , J. Calmes 1
1 Service De Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne/CH,
2 Service De Radiologie, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 3 Service De
Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne/CH, 4 Service De
Chirurgie Viscerale, CHUV, 1011 Lausanne/CH, 5Radiology, CHUV, 1011 Lausanne/CH
Clinical and radiological differences between first and recidivant episode of acute left colonic
diverticulitis
Objective: Acute left colonic diverticulitis (ALCD)is the main complication of diverticulosis with
20% of the patient affected. Another 20% will have recidivant episodes. According to the
ASCRS guidelines edited in 2000, recidivant episodes is more subject to complications and
with each recurrent episode the patient is less likely to respond to medical therapy. However
this is still debate. The aim of the study was to evaluate clinical and radiological differences
between first and recidivant episode of ALCD.
Methods: This is a case-control study of 340 consecutive patients admitted in our institution
for ALCD between 2001 to 2004. Seventy-eight patients (23%) had recidivant ALCD (group
A) and 262 (77%) had their first episode (group B). The 2 groups were comparable for age
and sex, with median age of 61 years. Patients were treated conservatively with antibiotherapy
and bowel rest, excepted for severely ill-defined patients for which surgical management at
admission was mandatory. More than 30 clinical and radiological parameters were analysed.
Unpaired student T-test was applied for statistical analysis. Significance was accepted at
a p