Anorectal Manometry in 3D NEW! - Swiss-knife.org

More documents

Recommendations

Info

28.3 Bilateral total extraperitoneal inguinal hernia repair (TEP) has similar outcomes compared to unilateral TEP: population-based analysis of prospective data of 6’505 patients J.-M. Gass 1 , L. Rosella 2 , D. Candinas 1 , U. Güller 1 ( 1 Berne, 2 Toronto/CDN) Objective: The use of total extraperitoneal inguinal hernia reapir (TEP) has become increasingly popular over the past decade. Whether bilateral TEP is associated with worse outcomes compared to unilateral TEP continues to be a matter of great debate. The objective of the present analysis is to compare outcomes between large cohorts of patients undergoing unilateral TEP versus bilateral TEP. Methods: Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTC), all patients undergoing elective unilateral or bilateral TEP for inguinal hernia from 1995-2006 were included. The following outcomes were compared: Conversion rates, intra-operative complications, surgical post-operative complications, general post-operative complications, duration of operation and length of hospital stay. Unadjusted and risk-adjusted multivariable analyses were performed. Results: Data on 6’505 patients undergoing unilateral (n=3’457) and bilateral (n=3’048) TEP for inguinal hernia were prospectively collected. Average age, BMI, and ASA were similar in both groups. Patients undergoing bilateral TEP had a slightly increased rate of intraoperative complications (bilateral: 5.48%, unilateral: 3.91%, p=0.003) and surgical postoperative complications (bilateral: 3.15%, unilateral: 2.26%, p=0.026). Operation time was longer for bilateral TEP (86 minutes bilateral vs. 67 unilateral, p< 0.001). There were no differences between the two groups regarding postoperative length of hospital stay, general postoperative complications, and conversion rates . Conclusion: This is the first population-based analysis in the literature comparing different outcomes in a prospective cohort of over 6’500 patients undergoing bilateral vs. unilateral TEP. Although intraoperative complications and surgical postoperative complications were significantly higher in patients undergoing bilateral TEP (due to large sample size and high power), the absolute differences were small and of minor clinical relevance. Bilateral TEP is associated with a minimal increase in operating time and similar length of hospital stay, general postoperative complications, and conversion rates compared to unilateral TEP. In patients with bilateral inguinal hernia, an endoscopic approach represents an excellent therapeutic approach, which can be performed with similar outcomes compared to a unilateral endoscopic hernia repair. 28.4 Prophylactic VAC ® system application may prevent wound infection and incisional hernia formation after laparotomy for peritonitis T. Ursprung, A. Meyer, A. Andrès, J.-M. Michel, B. Egger (Fribourg) Objective: Acute bacterial peritonitis are life threatening affections requiring urgent surgical management. There is ongoing worldwide debate whether the skin should be closed or left open after such interventions. Everybody agrees that, in cases of wound infections, the consequences for the patient (prolonged hospital stay, reoperation, readmission, incisional hernia) are important. We present here our experience with a pilot study of prophylactic application of the Vacuum Assisted Closure ® Therapy system (VAC ® system; KCI, San Antonio, Texas) in patients operated on for bacterial peritonitis. Methods: We analyzed prospectively 68 consecutive patients between July 2007 and October 2009, who underwent emergency laparotomy for bacterial peritonitis. 2 groups have been selected: group A with direct closure of the skin after lavage and group B with initial application of the VAC ® system and delayed skin closure after 4-8 days. The selection of the patients into the groups was surgeon related since 2 of 10 surgeons selected all their patients into group B. All patient’s data were recorded in a prospective database. End-point of this pilot study was the development of incisional hernias. All the patients underwent follow-up on a outpatient‘s base. Results: Sixteen (18%) out of 49 patients in group A died during the first days after the operation for septic reasons. Four (21%) out of 19 patients in group B died. All these patients were excluded from the study. The mean follow-up for all others was 12.5 months (2-29 months). 7 (21%) out of 33 survivors in group A developed wound infections (re-opening of the skin and secondary VAC ® system application) and 7 an incisional hernia (21%). One (6%) out of 15 survivors in group B developed an incisional hernia and no wound infection was observed after delayed skin closure. Conclusion: The results of this pilot study demonstrates that direct application of a VAC ® system after laparotomy for peritonitis with delayed skin closure is feasible. Although the difference of incisional hernia development (A:7/33 vs. B:1/19) is not statistically different (p=0,179; Mann Whitney-U test; SPSS, Zürich, Switzerland), there seems to be a trend towards less incisional hernia formation in Group B. Based on these data we are designing now a prospective randomized trial evaluating development of incisional hernias and other endpoints. 28.5 Dialyse péritonéale (DP) immédiate après pose de cathéter de DP et/ou cure de hernie abdominale. Peut-on se passer d’une hémodialyse transitoire? R. Chautems, V. Reinmann, J.-P. Barras (Solothurn) Objective: Afin d’éviter le recours à une hémodialyse transitoire, un protocole associant une étanchéité primaire du site opératoire et une dialyse péritonéale (DP) adaptée (volumes de dialysat réduits, DP plus fréquente) immédiate après pose de cathéter de DP et/ou cure de hernie abdominale (inguinale, ombilicale) chez des patients déjà en DP, a été évalué. Methods: Entre mai 2003 et novembre 2009, 29 patients insuffisants rénaux ont eu une pose de cathéter de DP et/ou une cure de hernie abdominale. Chez 12 d’entre eux (1 femme, 11 hommes, Age 39-81 {moy.: 64.4}), en raison d’une indication à une dialyse urgente, une DP a été débutée dans les 48 heures suivant l’opération. Chez 6 de ces patients la DP a eu lieu après pose du cathéter, chez 7 d’entre eux après cure de hernie et chez un patient après pose de cathéter et cure de hernie synchrone. L’étanchéité du site opératoire est testée durant l’opération et la DP est effectuée avec des volumes de 24 swiss knife 2010; 7: special edition dialysat réduits sur un mode plus fréquent (1000 ml., 6 x / jour). Results: Chez les 12 patients, une DP immédiate a pu être débutée dans les 48 heures. Chez 11 patients il n’y eu aucune fuite de dialysat de la plaie opératoire. Chez le douzième, une fuite a été suspectée et infirmée lors de la révision chirurgicale du cathéter au 5ème jour postopératoire. Il y eu un saignement cutané au point de sortie du cathéter de DP nécessitant une hémostase locale. Conclusion: Grâce à un concept associant une étanchéité primaire lors de la pose de cathéter de DP et / ou de la cure de hernie et un protocole de DP postopératoire adapté, une hémodialyse transitoire et la morbidité potentielle qui y est liée, peut être évitée. 28.6 Mesh implantation for the complicated closure of the abdomen is safe and feasible M. Scholtes, G. Beldi, A. Kurmann, C. A. Seiler, D. Candinas (Berne) Objective: Complicated closure of the abdominal wall include primary or secondary laparostomy or secondary dehiscence of the sutured fascia. These situations are associated with significant early and late postoperative morbidity and mortality. Implantation of modern dual layered meshes represent a new therapeutic tool in such situations. The aim of this study was to compare the outcome after surgical treatment of the complicated closure of the abdomen with versus without mesh implantation. Methods: A total of 99 patients were included in a case series with complicated abdominal wounds who were treated in a single institution between 2002 and 2009. Since 2005 dual layered meshes were implanted intraperitoneally in patients with laparostomy or secondary dehiscence of the abdominal closure. Intraabdominal infection was not a contraindication for mesh implantation. We compare 50 patients treated with mesh implantation with 49 patients treated without a mesh. Average follow-up for patients with mesh are 9 months (1-47), for patients without mesh 17 (2-83) months. Results: Cohort A: 26 patients presenting with laparostomy: meshes were implanted in 16 patients (61.5%). Patients with mesh exhibited a shorter stay on the intensive care unit (median 4 days with mesh vs. 7 days without mesh), similar duration of hospitalization (55 vs. 52 days), lower incidence of fistula (2 vs. 4 patients), and comparable mortality rate (44% vs. 50%). Cohort B: 73 patients presenting with postoperative fascial dehiscence: meshes were implanted in 34 patients (46.6%). Patients with mesh exhibited a lower incidence of superficial surgical site infection (with mesh 6 (18%) vs. 11 (28%) patients without mesh) and lower incidence of postoperative hernia (3 (9%) vs. 7 (18%) patients). No difference was found for mortality rate (4 (12%) vs. 6 (15%)), duration of hospitalization (36 vs. 38 days), and incidence of fistula (3 (9%) vs. 5 (13%)). Conclusion: Intraperitoneal mesh implantation for complicated and potentially contaminated abdominal wall closure is safe and not associated with additional morbidity in response to mesh infection. 28.7 MINI-IPOM: Mono-INzisionale-Inguinale Intra-Peritoneale-Onlay-Mesh Technik für Inguinalhernien W. Schweizer 1,2,3 , H. Marlovits 1 ( 1 Schaffhausen, 2 Zürich, 3 Winterthur) Objective: NOTES-Techniken sind nicht minimalinvasiv und perforieren innere Organe mit den möglichen neuen Komplikationen. Die Instrumente sind kompliziert, die Technik ist teuer. Einfache Lösungen sind gesucht. Wir schlagen für die Inguinalhernie eine modifizierte IPOM-Technik mit alleinigem Zugang durch den Nabel, für den Patienten schmerzarm und fast narbenfrei, vor. Methods: Der Patient wird über die Verschiedenheit der Methode gegenüber herkömmlichen endoskopischen Netztechniken und den alleinigen Zugang durch den Nabel aufgeklärt. Die Erfahrungen mit IPOM werden erläutert. Wir verwenden eine 45°-Optik am Nabel mit zwei 5 mm Trokaren in derselben Inzision paramedian. Der Bruchsack wird mit einem PDS-2-0-Endoloop zusammen mit der ins Abdomen gezogenen Transversalisfaszie an der Basis gerafft und ligiert. Als Netz verwenden wir Parietex composite 15 x 10 cm fixiert mittels Absorbatac. Results: 50 Patienten (Alter 53 (21-80) (5 f, 45 m) haben wir zwischen 12/2008 und 11/2009 mit MINI-IPOM operiert. Als Komplikationen sahen wir eine Blutung aus einem A. epigastrica-Ast, was einen medianen Zugang nötig machte, welcher später eine mediane Narbenhernie verursachte, die dann offen mittels IPOM versorgt wurde. Einmal trat 4 Tage postop. eine Divertikelperforation mit Peritonitis auf, was mit Sigmaresektion ohne Stoma behandelt wurde. Eine Blasenverletzung wurde während neun Tagen mittels Blasenkatheter und Douglasdrain saniert. Alle andern Operationen verliefen komplikationslos. Die Patienten wurden nach 2 und 12 Wochen nachkontrolliert. Die postop. Schmerzen sind gering, die postop. Aufenthaltsdauer beträgt 1,3 Tage, nach 12 Wochen fanden wir 2 Rezidive mit verrutschtem Netz, was in beiden Fällen erneut mit MINI-IPOM versorgt wurde. Es traten keine Nervenschmerzen auf, ausser Blähungen sahen wir keine weiteren intraabdominellen Probleme. Die Zufriedenheit der Patienten ist hoch. Conclusion: Mit einer einfachen Methode konnten wir bei geringen Schmerzen ein gutes funktionelles und kosmetisches Resultat erzielen. Die drei Komplikationen dürfen als Lernkurve interpretiert werden. Allen drei Patienten geht es gut, sie sind bezüglich der Hernie saniert. Alle Patienten sind nachkontrolliert zufrieden und rezidivfrei. Die Methode ist neu, lehnt sich an TAP, TEP und IPOM an und der Langzeitverlauf muss lückenlos nachverfolgt werden. Ausserhalb einer Studie ist die Methode nicht ohne Instruktion freizugeben. 28.8 Long-term follow-up comparing open and laparoscopic large incisional hernia repair A. Kurmann, G. Beldi, E. Visth, S. Vorburger, D. Candinas (Berne) Objective: Short term feasibility and safety of laparoscopic repair of incisional hernia has been shown in prospective trials. However, long-term follow-up, in particular for large incisional hernia repair remains to be determined. The aim of this prospective study was to compare long-term results of laparoscopic versus open repair for large incisional hernia. Methods: A total of 428 patients underwent incisional hernia repair at our institution between 2/2003
and 6/2009 and were prospectively followed. Only patients with a hernia diameter of ≥ 5cm were included in this study. We compared 56 patients who underwent open incisional hernia repair with 69 patients who underwent laparoscopic repair. Rives technique using a prosthetic mesh was performed in the open group, whereas an intraperitoneal dual layered onlay mesh repair was implanted in the laparoscopic group. Clinical long-term follow-up investigations were performed at our institution. Results: The demographic parameters including gender, age, BMI, and operative time were not significantly different between the two groups. Conversion rate to open implantation of an intraperitoneal mesh in the laparoscopic group was 10%. Median hospital stay was significant shorter in the laparoscopic group (6 days, range 1-23 vs. 7 days, range 1-67; p=0.014). Incidence of surgical site infections was reduced in the laparoscopic group compared to the open group (5.8% vs. 26.8%; p=0.0011). One fistula was found in the open group, none in the laparoscopic group (p=n.s.). Bulging of the implanted mesh was observed in 17.4% in the laparoscopic group and in 7.1% in the open group (p=n.s). Chronic pain occurred in 19% in the laparoscopic group and in 10% in the open group (p=n.s.). Incapacity for work was 3 weeks after laparoscopic and 6 weeks after open surgery (p=n.s). After a median follow-up of 65 months (1-80) in the open group and 33 months (1-62) in the laparoscopic group a recurrence rate of 18% in the open group and 16% in the laparoscopic group was found (p=n.s). Conclusion: Laparoscopic repair of large incisional hernia repair is associated with a significant shorter hospital stay and fewer surgical site infections. At long-term follow-up recurrence rate is comparable to open surgery. Abdominal bulging is a specific problem associated with laparoscopic repair of large incisional hernia. 28.9 Prophylactic intraperitoneal onlay mesh (IPOM) to prevent incisional hernia is feasible and safe - preliminary results of a randomized controlled trial P. Glauser 1 , P. Kissling 1 , E. Kuhnt 2 , D. Strub 1 , S. Käser 1 , C. A. Maurer 1 ( 1 Liestal, 2 Leipzig/DE) Objective: Incisional hernias occur in up to 20% of all open abdominal surgeries. This study examines the use of a prophylactic intraperitoneal onlay mesh (IPOM) to prevent incisional hernia following midline laparotomy. Methods: This prospective, randomized and controlled trial was started in August 2008. Patients undergoing median laparotomy are randomly allocated either to abdominal wall closure according to Everett alone with a PDS-loop running suture (group A) or to the same procedure with additional IPOM (group B). The primary endpoint is the incidence of incisional hernias at 2 and 5 years following midline laparotomy. Secondary endpoints are the feasibility and safety of the mesh implantation even in contaminated situations (Altemeier grade I – III), and the identification of risk factors for incisional hernias. Patients with contaminated situation grade IV were excluded from this study. The postoperative pain is recorded by visual analogue scale (VAS). This study is registered on www.clinicaltrial.gov. Results: Up to date, 74 patients were included in this study, 36 patients in group A and 38 patients in group B. Separated to the different grade of wound contamination the allocation in group A is n= 17 grade I; n= 2 grade II, n= 17 grade III, and in group B: n= 12 grad I; n= 8 grad II; n= 18 grad III, respectively. In all of these patients, no wound infection was encountered and no mesh had to be removed. No mesh penetration and no bowel obstruction with the need for surgical reintervention did occur. One burst abdomen occurred in group A, none in group B. Up to date, no incisional hernia was detected. There is no difference in postoperative pain. Conclusion: The preliminary short-term results indicate that the placement of an IPOM with prophylactic intention is a feasible and safe procedure, even in contaminated situations like colorectal surgery. Visceral Surgery – Novel Technologies 33 33.1 Integration of computer assisted surgery and intraoperative navigation in complex liver surgery and tumorablation: first results after treatment of 10 patients A. vom Berg, D. Inderbitzin, M. Peterhans, L. Nolte, S. Weber, D. Candinas (Berne) Objective: Intraoperative tissue deformation in liver surgery complicates the integration of preoperative planning datasets. Furthermore detection of lesions by intraoperative sonography in cirrotic liver tissue or after effective neoadjuvant chemotherapy can be difficult and impede tissue sparing surgery. The integration of computer navigated tool guidance improves surgical orientation. We report our experience in navigated hepatic surgery in 10 patients. Methods: Ten patients with primary or secondary liver cancer were scheduled for computer assisted hepatic surgery over a time period of 5 month; eight patients with colorectal liver metastasis, and two with primary liver cancer. Parenchyma dissection and ablation was guided by the optical tracking system and navigated ultrasound for updating the preoperative planning data (MeVis Distant Services). Postoperative data was analysed for assessment of feasability and simplification of surgical procedures. Results: Navigated liver surgery was successful in 8 patients. Preoperative planning was realised in all patients. Mean error of projection of preoperative data in the operative situs was 5mm (range 0-15mm). Mean operation time was prolonged by a mean set up time for the system of 15 min (5- 25 min). R0 resection was achieved in 7 out of 8 patients. In one case intraoperative detection of lesions by sonography was not possible after neoadjuvant therapy but the projection of preoperative tomography-based planning data on the operative situs allowed R0 resection. Conclusion: Parenchyma preserving oncological resection and ablation for primary or secondary liver tumor is faciliated by computer assisted surgery. In addition, navigated hepatic surgery has the potential to expand the surgical spectrum of resectability on currently non resectable patients. 33.2 Female population perception of transvaginal versus transumbilical single access and standard laparoscopy P. Bucher, S. Ostermann, F. Pugin, Ph. Morel (Geneva) Objective: Laparoendoscopic single-site (LESS) and natural orifice translumenal endoscopic (NOTES) surgery may be the future of minimally invasive surgery. Aim was to evaluate concerns of female population regarding transvaginal NOTES and transumbilical LESS. Methods: Anonymous survey (describing laparoscopic, transumbilical LESS, and transvaginal NOTES cholecystectomy without regards to potential risk or advantages) were given to 300 females: paramedical staff n=100, patients n=100 and population n=100. They (median age 35, 16-79 years) were queried about preferred techniques, marital status, sexuality, children, formattion, and worries regarding transvaginal and transumbilical access. Among them, 54% had children, 79% had a stable relationship, and 96% were sexually active (vaginal intercourse). Results: With similar operative risk, 87% preferred LESS, 4% preferred NOTES and 8% laparoscopy. LESS and NOTES choice were influenced by a desire of improved cosmesis (82%) and pain (44%). For single access, 96% choose transumbilical and 4% transvaginal. 96% had worries regarding transvaginal access. Worries were fear of vaginal pain during intercourse (68%), fear of decrease sensibility during intercourse (43%), refuse of short term sexual abstinence (40%), fears of infertility (23%) or sterility (6%), and others (14%). 62% reported that they fears the use of a too intimate body part for surgical access, while only 9% reported it for transumbilical route. LESS evocated worries in 35% of participants. 19% reported fear of umbilical pain, 15% about post-op umbilical sensibility, and 11% about incisional hernia. Post-op intercourse abstinence after NOTES worried 76% (defined as 3 weeks in survey). Worries were: feel less attractive (40%), less feminine (32%), fear of tension with intimate (35%), though their lover wouldn’t accept it (20%), possibility of abortion of new relationship (26%), feel less comfortable in social relationship (16%), and 14% others. Conclusion: The high acceptation rate for transumbilical LESS approach compare to transvaginal NOTES may be related to fears regarding post-operative sexuality and fertility. The importance of temporary post-operative sexual abstinence (vaginal intercourse) is important and may be difficult to influence. However, these issues may be related to cultural factors and may explain the difference in acceptation rates of transvaginal NOTES among different regions. 33.3 Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation of 150 patients in routine clinical practice G. R. Linke, I. Tarantino, J. Janczak, R. Hoetzel, R. Warschkow, I. Siercks, J. Lange, A. Zerz (St. Gallen) Objective: Transvaginal rigid-hybrid NOTES cholecystectomy (tvCCE) reduces abdominal wall incisions and might decrease surgical trauma by combining endoluminal access and laparoscopic techniques. We assessed the feasibility and safety of tvCCE in routine practice for symptomatic cholecystolithiasis and acute cholecystitis in low-selected patients. Methods: From September 2008 to December 2009, 150 of 211 (71%) consecutive symptomatic cholecystolithiasis (n=108) or cholecystitis (n=42) patients were scheduled for tvCCE with 9 different surgeons. Patients were not excluded because of age, obesity, previous surgery, or degree of gallbladder inflammation. A pre- and two-week postoperative gynaecological examination was performed. Sexual function was assessed pre-, 6 weeks and 12 months postoperatively. Results: Patients` mean age was 52.3 ± 17.5 (range 18-87) years and mean body mass index was 27.2 ± 6.1 (range 17.6-43.8) kg/m 2 . Four patients had conversion to conventional laparoscopic cholecystectomy. There were no intraoperative complications. Three major complications occurred: one stroke, one herniation within the transumbilical access, and one infected douglas haematoma, which was laparoscopically evacuated. Minor complications were reported in 16 (11%) patients. Apart from the douglas hametoma, there were no serious postoperative gynaecological findings. Six weeks (n=146) and 12 months (n=26) postoperatively, dyspareunia symptoms did not differ compared to the preoperative state. Conclusion: TvCCE is feasible and safe in routine practice for symptomatic cholecystolithiasis and acute cholecystitis. 33.4 Laparoendoscopic single-site visceral surgery: single-center experience and lesson learned with the first 200 cases P. Bucher, F. Pugin, Ph. Morel (Genève) Objective: Single port access (SPA), or laparoendoscopic single-site (LESS) surgery has rapidly entered clinical practice and undergone various mutations in its instrumentation since two years. To present operative and peri-operative outcomes in an observational cohort of patients who underwent LESS surgery at a single academic center. Methods: Prospective study evaluating patient outcomes after LESS visceral surgery from July 2007 to September 2009. Demographic data including age, body mass index, operative time, operative indications, complications, hospital stay, and postoperative Subjective post-operative results were evaluated using validated body image scales and QoL scale (SF12). Visual Analog Pain Scale scores were accrued. Data were prospectively collected in an institutional database. Results: 200 patients have undergone a visceral LESS procedure. Majority of cases were: cholecystectomies (64 cases), appendectomies (37), 3 Inguinal hernias (TEP), primary and incisional hernias (TIPP) (39), followed by colectomies with anastomosis, emergency procedures (including perforated gastroduodenal ulcer repair, bowel strangulation, hartmann), pancreatic necrosectomies (including tail resection), gastrojejunostomy, splenectomy, cancer staging LESS laparoscopy with biopsy. Median patient age was 45 (18-94) years. Median patients BMI was 25 (19-42). Overall conversion rate was 3.5% (5 cases with additional ports and 2 conversion for open surgery), but none of them for intraop- swiss knife 2010; 7: special edition 25
Page 1 and 2: Abstracts 97. Jahreskongress der Sc
Page 3 and 4: Der Jahreskongress der Chirurgische
Page 5 and 6: Abstracts Session Topic Page 02 Vis
Page 7 and 8: Visceral Surgery - Cholecystitis &
Page 9 and 10: performed were recorded. Descriptiv
Page 11 and 12: avec délai dans le diagnostic, ang
Page 13 and 14: group (conventional: n=13, RS=1.8 +
Page 15 and 16: time-efficient all-in-one 3D visual
Page 17 and 18: (CHI=54 [6.49%]; SWI=27[4.98%]) wer
Page 19 and 20: Conclusion: Both procedures markedl
Page 21 and 22: 22.7 Transplantation of kidneys fro
Page 23: of the remaining 40 patients with a
Page 27 and 28: Conclusion: In our patient cohort,
Page 29 and 30: plantation. With the introduction o
Page 31 and 32: Results: SLN negative patients were
Page 33 and 34: Conclusion: This is the first study
Page 35 and 36: were grouped into four age groups a
Page 37 and 38: gain up to the 20 th procedure (Fig
Page 39 and 40: ��
Page 41 and 42: normal angiogenesis induced by cell
Page 43 and 44: 52.4 Sham-feeding of patients with
Page 45 and 46: Methods: Erfasst wurden Aggressions
Page 47 and 48: Conclusion: Pharmacological inhibit
Page 49 and 50: 54.19 Gene chip analysis of A20 exp
Page 51 and 52: 55.10 Optimized intrapleural cispla
Page 53 and 54: 62.7 Posttraumatic symptomatic cyst
Page 55 and 56: Conclusion: Only patients older 75
Page 57 and 58: no sign of occlusion. No further th
Page 59 and 60: packing as part of damage control s
Page 61 and 62: sonalführung und werden auch in de
Page 63 and 64: Figure 3 Figure 2 Figure 4 71.2 Tec
Page 65 and 66: formed 5 months later, again with a
Page 67 and 68: 99.16 3-D endo-stomal ultrasound (
Page 69 and 70: tional recanalization. Conclusion:
Page 71 and 72: 99.37 Extended Clavien-Dindo classi
Page 73 and 74: ial colitis was excluded by stool c
Page 75 and 76:
99.55 Complexes de von Meyenburg(ha
Page 77 and 78:
99.64 Traumatic abdominal wall hern
Page 79 and 80:
99.75 Isolated dorso-medial disloca
Page 81 and 82:
FRAGMIN ® DER ERFAHRENE WEGGEFÄHR
Page 83 and 84:
Kalbermatten Daniel, PD Dr., CHUV C
Page 85 and 86:
Meyer Antoine, Dr., Hôpital canton
Page 87 and 88:
Covidien Switzerland Limited multip
show all

Anorectal Manometry in 3D NEW! - Swiss-knife.org

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?