Thun is another Swiss1Chirurgie location.

The need for professional services in obesity surgery is increasing. Also in Thun and the surrounding area. And so it was only a logical step that the clinic of Dr. Naef in Thun now became part of the network of specialized facilities of Swiss1Chirurgie. You can learn more about this in the article.

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Hernia surgery at Bern Visceral Surgery Steffen AG

Treat unpleasant tissue breakdowns professionally

The medical term for a hernia is colloquially known as a hernia. This does not mean broken bones, but rather weaknesses in an organic structure that lead to a bulge in the further course. In many cases, organs are pushed or shifted from their original physical position to other areas, which can also be visually recognisable.

Known hernias are, for example, umbilical hernia, incisional hernia, inguinal hernia or hiatal hernia.

In addition to the unpleasant physical sensations and sometimes also cosmetic impairments, a hernia can also lead to disturbances in the respective organ function and even to dramatic courses of disease. Therefore, even smaller or inconspicuous hernias should initially be treated by a specialist.

Complicated hernias require interdisciplinary intervention

Complex hernias are not only associated with the familiar visual appearances, but also with severe pain and, in extreme cases, disruption of the respective organ function. Surgical intervention is urgently required here, but this should rarely be based on the hernia alone, but also on the environmental conditions in the physical surroundings. Finally, it is a question of treating the hernia itself on the one hand, but on the other hand also of recognising the conditions of its development and, if possible, ruling them out for the future.

Our patients in the swiss1chirurgie clinic (Berner Viszeralchirurgie Steffen AG) benefit from the interdisciplinary interaction of medical experts. In our clinic we have all the possibilities to discuss and treat complicated hernias in a multidisciplinary team. In this way, radiologists, physiotherapists, internists and of course the operating surgeons can achieve the best conditions for a successful course of treatment in interdisciplinary work.

Modern surgical planning and surgical experience

Surgical planning using computer tomography (CT) and derived 3D animation is extremely helpful for a promising treatment approach. This gives us clear impressions in the team of how the hernia has formed, what its dimensions are and which surgical method is most promising.

Subsequently, the patients are treated precisely according to the clinical picture. Superfluous interventions are avoided and interventions are always carried out to the extent that exactly fits the picture of the hernia obtained.

Smaller hernias, i.e. tissue openings of up to 2 centimetres, are usually closed directly. Anything above this requires laparoscopic surgery, which also involves the use of nets. These nets securely close the affected hernia and prevent the recurrence of a hernia at the same site to within one percent. Without the use of nets, the risk of recurrence of the fracture was about ten percent with the corresponding need for repeat surgical interventions.

Incidentally, nets are also used almost without exception in high-risk patients, such as overweight people, in order to largely reduce the risk of a new fracture in the same part of the body.

Overall, we thus ensure an extremely professional treatment of hernias, which is associated with the lowest possible risk and the highest degree of quality of life to be gained, especially for our patients.

The surgery team of the swiss1chirurgie clinic (Berner Viszeralchirurgie Steffen AG9 with Dr. Jörg Zehetner and Dr. Rudolf Steffen stands for professional surgery that is first and foremost committed to people.

Heartburn and belching – Can medication and diets alone help with reflux?

How to manage chronic reflux disease

Everyone is familiar with occasional acid regurgitation or heartburn. As unpleasant as such a physical reaction may be, it is quickly over and forgotten. Until next time. Triggers for stomach burns and acid regurgitation are often spicy foods, alcohol consumption, coffee, carbonated drinks or even citrus fruits. Especially when it becomes chronic, we speak of chronic reflux disease (GERD= gastro-esophageal reflux disease).

Many doctors then advise drug treatment or controversial dietary measures. The swiss1chirurgie clinic then follows a more holistic approach that considers cause, effect, appearance and comprehensive treatment options as a whole.

Medicinal approaches and dietary measures for belching and stomach burns

These are often the remedies of choice when acid regurgitation and heartburn are to be countered. At least in the first approach, acid blockers are often recommended, some of which are available without prescription. If no sustainable success is achieved here, it is not uncommon for additional so-called diet measures to be discussed, which are then recommended as the next remedy of choice.

In patients with mild to moderate symptoms, “dietary measures” are recommended instead of acid blockers or as an adjunct to drug therapy, which can be something like the following:

  1. Avoiding the following “reflux-producing foods”:
  • Onion and garlic
  • Tomato, Cucumber, Paprika
  • Fried food, Spicy food
  • Alcoholic beverages, especially white wine, prosecco, champagne
  • Chocolate
  • Coffee
  • Carbonated drinks
  • Citrus fruits
  1. Adaptation of eating habits in case of reflux:
  • Early dinner
  • Do not overeat, smaller portions
  • No smoking
  • Sit straight after a meal
  • Do not eat directly before going to bed

However, such dietary measures are always accompanied by restrictions in lifestyle habits and thus also in the individual’s quality of life. And not always with the hoped-for success. After all, it is not only diet and certain lifestyle habits alone that promote belching and heartburn, but often also organic constellations that cannot simply be eliminated with diets and/or medication.

What works well for some people does not lead to any changes for others and in the worst case only prolongs the history of suffering with the corresponding limitations. This becomes clear when significant complaints still occur despite acid blockers and dietary measures. These manifest themselves, for example, in chronic cough, voice changes, tooth erosions, nocturnal acid attacks and similar unpleasant phenomena.

Surgical intervention can help with reflux

Those who cannot get chronic problems with heartburn and belching under control will quickly despair of medication and diets. Then the path usually leads to the gastroenterologist, who looks for organic causes for the complaints by means of a gastroscopy.

In the same context, we recommend going to the swiss1chirurgie clinic of Bern Visceral Surgery Steffen AG. Here, expert surgeons are available for consultation and can also provide long-term help if the symptoms are suitable.

Reflux surgery is then often recommended, which involves a minimally invasive procedure. Usually, such a procedure takes between 30 and 60 minutes and involves a stay of one to two days in hospital. As a result of the small operation, patients are usually completely symptom-free. And ideally without any medication or diets that restrict the quality of life.

A visit to the swiss1chirurgie clinic of Berner Viszeralchirurgie Steffen AG can therefore be very worthwhile in the case of reflux and is a very good alternative to chronic complaints of stomach burns or acid regurgitation. The specialised surgeons in the swiss1chirurgie clinic will be happy to tell you in a personal consultation what can be done in a specific individual case.

Oesophagus – Jörg Zehetner from ISDE Worldcongress 2018

Jörg Zehetner from the ISDE Worldcongress 2018 in Vienna, Austria
(International Society of the Diseases of the Esophagus)

What is the oesophagus?

Oesophagus is the medical term for the oesophagus. The oesophagus is a muscular tube that pumps our food from the mouth into the stomach. To prevent the oesophagus from being burned all the time by the gastric juice (stomach acid), there is a valve at the end of the oesophagus: the lower oesophageal muscle.

Disorders in the oesophageal area

If the lower oesophageal muscle (this region is also called the cardia) becomes slack, weak or defective, then it is relatively easy for stomach acid to flow back into the oesophagus and cause symptoms such as heartburn, stomach burn, acid regurgitation or burning in the chest area. This backflow of stomach acid into the oesophagus is medically called reflux.

Persistent reflux (chronic reflux) is a risk factor for oesophageal cancer. People often try to get a grip on the problem with acid blockers and diet tips. However, all these methods only alleviate the acute symptoms, not the causes. The mechanical problem – the defective stomach valve – remains. This means that there is still a risk of the disease progressing, which in the final stage can end in oesophageal cancer.

How chronic reflux can be countered

Only an operation, today simply performed as a minimally invasive short procedure, can stop the reflux and thereby reduce the discomfort as well as the risk of cancer to zero.

With such an operation, the mechanical defect in the cardia muscle is repaired so that normal function can be fully restored.

In order to be able to understand the entire pathological course of reflux up to oesophageal cancer, please watch the video that was created in cooperation with Hirslanden, the basis for this video was my idea and my concept.

Diverticulitis

Dietary tips for large bowel obstruction and colitis

The colon is part of the digestive system and reabsorbs water and electrolytes through the colon mucosa. In addition, the large intestine fends off diseases and bacteria and also functions as a storage facility for stool. Colitis (inflammation of the colon) is an inflammatory process that can be acute or chronic. One of the most common forms of colitis is the widespread and well-known appendicitis.

Diverticulitis should be distinguished from such acute inflammatory processes. Diverticulitis describes chronic infections of mucosal protrusions as a chronic process with recurring symptoms.

In connection with diverticulitis, questions are repeatedly asked about a diet that suits the disease. It must also be taken into account that diverticulitis is a typical disease in Western civil societies and is practically not observed at all in Asia or Africa. Accordingly, it can be assumed that one of the main causes of the disease patterns is to be found in lifestyle and diet. In this context, it is also interesting that long-time vegetarians are significantly less affected.

Diet in the acute stage of diverticulitis

In the acute course of diverticulitis, one or more diverticula (protrusions of the intestinal mucosa) are usually infected. Typical symptoms are pain in the left lower abdomen, fever and increased inflammation values in the laboratory test. In case of such manifestations, the family doctor should be consulted urgently, who may also prescribe hospital care, antibiotic medication and a sparing diet. In an extreme emergency, surgery must be performed immediately, especially if fever and an unstable circulation are accompanied by the typical pain.

If no surgery is required acutely, special attention must be paid to nutrition in the acute stage of diverticulitis. It is advisable to completely avoid solid food for a few days. Liquid food and sparing food are compulsory and can be gradually built up to a light sparing food under individual nutritional counselling.

A diet plan in the sequence could then look something like this: Start with water, continue with tea and rusks, clear soups, creamy soups and yoghurt. This sequence is spread over a time frame of several days and must be set individually.

In the phase of the build-up diet, it is imperative to avoid fatty, spicy or flatulent foods in order not to further irritate the intestines. As soon as intestinal activity returns to normal, other foods can gradually be reintroduced into the diet.

A change in diet is recommended after diverticulitis

The top recommendation is: Change your diet to a high-fibre diet, similar to diverticular prophylaxis, even after an infection. In this way, you prevent a new inflammatory episode and also prevent a new diverticulum formation through a softer and more voluminous stool.

It is important when changing to a high-source diet that you also drink enough now. Water and tea are preferable.

In summary, we would like to give the following tips on dietary changes after diverticulitis:

  • Eat plenty of fruit and vegetables. Important are the vegetable fibres and high water content.
  • Drink a lot! Dietary fibre is only helpful if you drink at least two litres of water or tea in parallel.
  • Prefer vegetables of the easily digestible variety such as tomatoes, carrots and courgettes.
  • Wholemeal bread and wholemeal pasta are more suitable for diverticulitis nutrition than white bread.
  • If you have diverticulosis, you should avoid hard, pointed and hard-to-digest food components, such as the seeds of apples, pears or melons.
  • Wheat or oat bran and ground linseed are also good. Avoid constipating foods such as black tea, chocolate, cocoa, bananas and white flour products.

Allow time for the change to a diet rich in fibre and source material. And above all, stay consistent.

Robot surgery

What is and what can robotic surgery do?

Robots have been used in the operating room for more than 20 years. Especially in urology, the DaVinci robot is used to remove the prostate or for partial kidney resections. The company Intuitive Surgical calls its surgical robot DaVinci, so the term DaVinci Surgery is often used alongside the term robotic surgery.

Minimally invasive surgery with robotics

Minimally invasive surgery has been the standard for operations in the abdominal cavity since the beginning of the 90s, especially for operations in the upper abdomen and the small pelvis. The swiss1chirurgie clinic has an accomplished robotic surgeon in Dr Zehetner who then uses this technology whenever it makes sense.

The robot further refines and simplifies the minimally invasive surgical technique, but in the hands of experts, it has not yet shown any directly measurable benefits for the patient. With the latest generation of DaVinci surgical robots, a new tissue-sparing technique is possible that will also bring directly measurable benefits for the patient in the future. Responsible experts like Dr. Zehetner know when the use of a new expensive method makes sense and when it does not.

Individual decisions for minimally invasive robotic surgery

In the swiss1chirurgie clinic, the options for robotic surgery are always presented individually and used with the patient’s consent. In the interest of the patient, the focus is always on the ideal operation, surgical technique and the appropriate medical environment.

Robotic surgery can be used in oesophageal surgery, reflux surgery, oncological surgery, hernia surgery and colorectal surgery, especially in cases of complicated procedures, the use of the DaVinci robot can simplify and support the surgery through better ergonomics, better movement of the instruments through control with increased degrees of freedom, as well as through 3D HighDefinition optics.

Using the possibilities of robotic surgery

The swiss1chirurgie clinic has the opportunity to use the DaVinci surgical robot in a targeted manner at the Hirslanden Clinics (Salem Hospital) in Bern. This is always an option if the individual requirements are right and the type of surgical intervention makes the use of DaVinci robots sensible.

Especially for the use of robotic surgery, personal consultation at swiss1chirurgie is the tried and tested way to dispel prejudices and concerns and to give patients the certainty that they will be treated with the optimal surgical technique in their particular case.

More information on the field of application of robotic surgery is also available at www.zfbc.ch.

Gallstones: A common complaint

When the bile comes up: Do you occasionally have pain after eating?

Anyone who has frequent digestive problems, bloating or upper abdominal pain, especially in the upper abdomen on the right, should see their doctor. You may be plagued by gallstones. The gallbladder is a temporary store of bile. Bile is produced in the liver and released into the small intestine via the common bile duct. We need bile to digest fat. More bile is needed, especially with fatty and flatulent foods, and is also needed from the intermediate store.

Gallstones – A painful evil

If the gallbladder is not continuously filled and emptied via the main duct, the bile can thicken in the gallbladder, crystals fall out and form stones. There are cholesterol stones and bilirubin stones. The stones can be of different sizes, and the number also varies. A simple ultrasound examination by the specialist can determine whether single or multiple stones are present and how large they are.

Small stones have the risk of moving out of the gallbladder into the main duct, this leads to pain called biliary colic. The stones can possibly also block the main corridor. This can lead to jaundice (icterus). If the pancreatic duct is blocked at the same time, life-threatening pancreatic infection can be the result.

Large stones have the risk of irritating the gallbladder, causing infection. The patient feels this as pain in the right upper abdomen. In addition to pain, the infection is noticeable through fever, fatigue, loss of appetite and occasional nausea. A visit to the doctor is necessary to make the diagnosis by means of laboratory tests and ultrasound. The blood count shows elevated levels of inflammation. The ultrasound examination shows the infection as thickening of the gallbladder wall, or as congestion of the gallbladder (hydrops).

Treat infection of the gallbladder surgically

If the gallbladder is inflamed, a quick operation is recommended. Delaying a procedure can make the operation unnecessarily difficult. For gallstones with occasional upper abdominal pain, surgery is recommended to prevent infection of the gallbladder, colic or pancreatitis.

The operation is a simple routine procedure that usually takes no more than 20-40min. The gallbladder (including the stones) can be removed laparoscopically through four small incisions in the upper abdomen. Removing the stones alone is pointless. The disturbed function of the gallbladder is the problem, so in this respect the gallbladder must always be removed, otherwise new stones would form immediately.

After the gallbladder has been removed, digestion quickly returns to normal, and the liver is able to compensate well for the lack of intermediate storage by increasing bile storage in the main duct.

Do you have gallstones and don’t know if you need an operation? In the swiss1chirurgie clinic of Bern Visceral Surgery Steffen AG, they will explain the operation to you. You can find out what can or must be done in a specific individual case from the specialised surgeons in the swiss1chirurgie clinic in a personal consultation.

Appendicitis

Why quick surgery is better than antibiotics alone

It is hard to believe: In the last two decades, great efforts have been made to prove that antibiotic therapy is better than laparoscopic (minimally invasive) surgery for mild appendicitis.

What is the appendix? When does appendicitis occur?

The appendix is a more or less pointless appendix on the large intestine in the right lower abdomen. It is between 5-10 centimetres long, about one centimetre wide and can become inflamed at any time. The reasons for infection are always debated. The fact is that appendicitis can occur in early childhood as well as in old age, practically at any time.

How do you notice an appendicitis?

It usually starts with diffuse abdominal pain and loss of appetite, sometimes nausea and vomiting. The pain then moves to the right lower abdomen. Later, fever and a rapid pulse may also occur.

It is important to go to a hospital emergency quickly. If the clinical examination by the doctor is clear and the situation is urgent, surgery may be performed immediately. However, an ultrasound scan or computer tomography is often performed to confirm the diagnosis or to exclude other causes for the abdominal pain.

How we treat appendicitis in the swiss1chirurgie clinic

Rapid surgery is the best therapy! This is also confirmed by a study just published in October 2018 in the well-known journal “Surgery”. The study uses a large American database to describe the safety of a rapid laparoscopic appendectomy (appendectomy, through three small incisions with minimally invasive instruments). This solves the problem once and for all. Antibiotic therapy alone in uncomplicated appendicitis (i.e. only mild infection) is often advocated, but the initial success rate is at most 75%. The risk of having another infection afterwards is almost 20%.

Antibiotics are therefore only given directly before the operation and are only necessary after an operation if the appendix had already broken through (perforation, pus discharge, abscess). Antibiotic therapy for 5-7 days is then necessary, possibly even with inpatient intravenous administration.

More about the swiss1chirurgie clinic, appendicitis and other of our focal points at www.drzehetner.ch. You can find out more about the Centre for Bariatric Surgery at www.zfbc.ch.

Football/Soccer: YOUNG BOYS BERN VERSUS JUVENTUS TURIN 12.12.2018

YB’s run of success in the 2017/2018 season redeemed Bern from a 30-year curse: they finally did it again, the Young Boys, and the championship title was celebrated extensively in the city of Bern over 3 evenings. Then the team cleared another hurdle: qualifying for the Champions League!!! The draw brought arguably the best possible draw: in a group with Manchester United, Valencia and Juventus Turin. Who would have thought that players like Pogba and Ronaldo would be playing on the artificial turf at the Stade de Suisse Wankdorf Bern Stadium this autumn? Will Ronaldo actually play on 12.12.?

YB’s run of success has also brought together doctors from the Hirslanden Group’s Salem Hospital and Beau-Site Hospital: a group of over 20 doctors – cardiologists, orthopaedists, urologists, internists and surgeons – meet at their own expense on 2 tables in the YB Pub area for a joint YB event. This brings interdisciplinary cooperation, exchange among colleagues, new projects, and above all supports YB and thereby Bern.

Many doctors will also be in the stadium on 12 December: this time, however, not in the VIP area, but distributed among all Bernese to also take a look at Ronaldo and Co. Hup YB!!

The swiss1chirurgie clinic and the Centre for Bariatric Surgery join forces with Hirslanden to support the Young Boys Bern football team.