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Conclusion: As described for the first time in the present study, ThightRope ® Fixation seems to be a
promising and safe alternative for treatment of posterior SCJ dislocation offering an anatomical reduction
with a restricted amount of exogenic material needed, resulting in a quick, easy to perform and
dynamically stable treatment with excellent short-term outcome.
70.12
Seltene Differentialdiagnose einer akuten Appendizitis
P. Kissling, P. Glauser, S. A. Käser, C. A. Maurer (Liestal)
Methods: Fallbericht.
Results: Einweisung einer 52-jährigen Patientin mit Verdacht auf akute Appendizitis bei 10 - stündiger
Anamnese von rechtsseitigen Unterbauchschmerzen. Bei der klinischen Untersuchung lag eine
Druckdolenz im rechten Unterbauch mit deutlichen Zeichen der lokalen Peritonitis vor. Laborchemisch
erhöhte Entzündungswerte. In der Abdomen - Sonographie und Computertomographie fanden sich
keine Auffällig-keiten. Aufgrund der deutlichen Klinik mit rechtsseitigem Unterbauchperitonismus wurde
eine diagnostische Laparoskopie durchgeführt. Dabei zeigte sich als Überraschungsbefund eine
Zahnstocherperforation am Zökum. Der Zahnstocher konnte problemlos entfernt werden, die Perforationsstelle
mitsamt der Appendix wurde mittels Stapler reseziert. Der postoperative Verlauf gestaltete
sich komplikationslos. Postoperativ erinnerte sich die Patientin an den Verzehr eines Cordon bleu zwei
Wochen präoperativ.
Conclusion: In der Review - Arbeit von Li S. F. et al. zeigten sich die Prädilektionsstellen der Zahnstocherperforationen
im Duodenum und Sigma. In einigen Fällen penetrieren die Zahnstocher aus dem
Darm in benachbarte Organe wie Leber, Lunge, Perikard, Ureter oder Harnblase. Todesfälle sind beschrieben,
die Gesamtmortalität wird mit 18% angegeben. Zur Diagnostik sind bildgebende Verfahren
unzuverlässig, die Sensitivität der Sonographie beträgt lediglich 29%, die der Computertomographie
15%. Auch in unserem Fall konnte die Diagnose präoperativ nicht gestellt werden. Dies demonstriert
den Stellenwert der Anamnese und insbesondere der klinischen Untersuchung. Ausserdem sollte bei
jedem unklaren Abdomen auch an seltene Differentialdiagnosen wie Zahnstocherperforation gedacht
und die Diagnose mittels Laparoskopie oder Laparotomie erzwungen werden.
70.13
Refixation of bony avulsion of the posterior cruciate ligament over a simplified direct posterior Burks
approach - our experiences in two cases
R. J. Jenni, M. Turina, J. Schmitt, H.-P. Simmen, G. A. Wanner (Zürich)
Objective: Open reduction and internal fixation is considered the standard treatment for displaced bony
avulsions of the posterior cruciate ligament (PCL). However, the classic posterior approach to the tibial
insertion of the PCL (Trickey) through dissection of the neurovascular bundle is hazardous and timeconsuming.
Robert Burks published a simplified posterior approach from the medial border of the medial
gastrocnemius muscle, leaving the neurovascular bundle protected by the overlying soft tissues
laterally. The aim of our present study is to report our experiences using this approach.
Methods: Two patients with dislocated bony avulsions of the PCL were treated using the posterior
Burks approach, one of whom had sustained a complex knee injury including rupture of the anterior
cruciate ligament and fracture of the posteromedial tibial plateau. Internal stabilization was performed
using 3.5 mm hook plates. Accurate photographic and radiographic documentation was performed,
and patients were followed until complete osseous consolidation and functional recovery.
Results: In both cases, easy and rapid access to the posterior tibial head and the knee joint was obtained
using the Burks approach. Mean total operative time was 110 minutes. No intra- or postoperative
complications occurred, especially no neurovascular problems. In one case, radiographic consolidation
as well as complete functional and occupational recovery occurred within three months. The second
patient with the complex knee injury is free of pain and resuming his work at 6 months postoperative,
again with complete radiographic consolidation.
Conclusion: Compared to the classic Trickey approach, the Burks approach in our experience is an
easy and safe way to gain access to the posterocentral part of the tibial head. It provides adequate
exposure of the area of interest to allow for reconstruction and plate osteosynthesis while avoiding
potential access morbidity by eliminating the need to dissect the neurovascular bundle.
70.14
Tissue banking in a cantonal hospital: a promising future concept?
M. von Strauss und Torney 1 , F. Rezaeian 1 , S. Loher 1 , P. Brosi 1 , L. Terracciano 2 , M. Zuber 1 ( 1 Olten, 2 Basel)
Objective: In the age of genetic tumor profiling and tailored therapies, adequately preserved tissue
material for research and diagnostic purposes has become mandatory. Modern oncological research
requires vital tissue provided by fresh frozen tissue banking. The aim of this study was therefore to
establish the first tissue banking in a cantonal hospital lacking an institute of pathology.
60 swiss knife 2010; 7: special edition
Methods: Ethical approval was conceded in October 2008. Study eligibility criteria included patients
with resectable cancer of the breast and colon. Sample collection was performed from both the malignant
and the surrounding healthy tissue by applying snap freezing using the isopentan technique one
hour after tumor resection. The tissue was stored at -80°C before the transfer to the main tissue bank
of a University Institute of Pathology. The patients’ data were recorded prospectively and reversibly
made anonymous.
Results: The investment value accounted for CHF 38’253.- accompanied by running costs of approximately
CHF 1’000.- per year. During the first 13 months of the project 43 samples were collected from
41 patients while 45 patients were operated due to suspected malignancy of colon or breast. No patient
denied consent after patient information. Nine samples of breast and 34 samples of colorectal
tumors were collected (12 sigmoid carcinomas and 18 from the right hemicolon, including 2 double
carcinomas, additionally 4 non malignant lesions). Three colorectal tumors were missed due to emergency
operations, one breast tumor due to human failure. Taken together 91% (41 of 45 patients) of the
tissue could be sampled. The review of the pathological reports showed no interference with standard
pathological staging and grading due to sample collection. Until January 2010 no patient was lost to
follow up while 3 patients died without recurrence.
Conclusion: Establishing tissue banking in a cantonal hospital without an institute of pathology is feasable,
but generous public or private funding is mandatory. Sample collection by surgeons seems to
be safe and does not interfere with pathological diagnosis. High quality follow up data can be accomplished
with moderate time and effort. In the future, tissue banking and patient data collection in a
network of cantonal hospitals in collaboration with an academic institution could lead to easy access
to vital specimens of tumor tissue with high quality follow up data.
70.15
Comparative anatomy of osseous structures in the ovine and human knee
G. Osterhoff 1,2 , S. Löffler 2 , H. Steinke 2 , C. Feja 2 , C. Josten 2 , P. Hepp 2 ( 1 Zürich, 2 Leipzig/DE)
Objective: Comparative quantitative anatomical measurements of the ovine and human knee are
missing. Thus, the objective of this study was to describe and measure the osseous anatomy of the
ovine stifle in comparison to the human knee.
Methods: 24 human cadaver knees and 24 stifles of skeletal-mature merino-sheep were dissected and
distances between selected anatomical structures of the patella, the distal femur, and the proximal
tibia were measured using a digital calliper and documented. Based on these, cortical index, patella
aspect ratio, intercondylar ratio, and tibial aspect ratio were calculated.
Results: Regarding medial condylar width, lateral condylar width, epicondylar width, and the tibial dimensions,
the ovine stifle can be regarded as a human knee scaled down by one third. Sheep though
have a narrower femoral intercondylar notch and a smaller trochlear width than humans resulting in
lower relative values for intercondylar height and intercondylar width. Sheep have a massive bone
stock below their tibial plateau and a proximal tibial shaft with thick cortical bone. In contrast, the distal
femur’s cortical index is the same in both species.
Conclusion: The ovine stifle can be considered as a useful model for the human knee. Nonetheless,
future studies have to consider the differences in the patellofemoral joint’s biomechanics, the femoral
intercondylar notch width, and the proximal tibia’s cortical bone stock.
70.16
Iatrogenic colonoscopic perforation: a surgical point of view and review of the literature about 6 cases
W. Oulhaci de Saussure, F. Volonte, F. Schwenter, Ph. Morel (Geneva)
Objective: Videocolonoscopy is widely adopted, and its use for colorectal cancer (CRC) screening is
increasingly popular. Considering a reported perforation rate of about 1 in 1000, a rising incidence of
iatrogenic colonic perforations is anticipated.
Methods: We report on an unsual series of 6 patients referred to the emergency surgical unit in 1 week
for post-colonoscopy colonic perforation.
Results: The 6 colonoscopies had been performed by 4 gastroenterologists (3 senior practitioners and
1 fellow). Indications were: CRC screening (n= 3), iron deficiency anemia (n=2) and renal allograft
work-up (n= 1). The sites of perforation were: sigmoid colon (n= 3), caecum (n= 1), rectum (n=1)
and terminal ileum (n=1). The perforation was directly caused by mechanical force in 2 patients, and
polypectomy in 4. The delay between the colonoscopy and the emergency referral was longer when
the cause of perforation was a polypectomy. One patient received conservative treatment. Five underwent
surgery : segmental colon resection with anastomosis (n=3), Hartmann (n=1), and faecal
diversion colostomy (n=1). The evolution was favorable for all.
Conclusion: Although a random effect probably accounts for the high density of post-colonoscopy
perforations recently observed, this acts as a reminder of this potential risk. Recent evidence based
on the tracking of 300000 colonoscopies shows that perforation occurs in 1 out of 1000 procedures,
only a minority of which is associated with polypectomy. Endoscopic polypectomy is simple. However
for polyps located in terminal ileum or in the lower rectum its risks may outweigh its benefit. High
standards of clinical and technical skills is warranted among gastroenterologists to minimize the rate
of complications. In 2009, we find it adequate to refute the misconception that surgery is the failure of
endoscopy and to admit that these two are complementary rather than opposite. A detailed synthesis
of the recent literature on the topic will be presented at the Congress.
70.17
Welche Zielvereinbarungen werden mit Assistenzärzten einer chirurgischen Klinik bei Mitarbeitergesprächen
getroffen?
U. Pfefferkorn, U. Laffer (Biel)
Objective: Mitarbeitergespräche und Zielvereinbarungen sind häufig eingesetzte Instrumente der Per-