A J Kroesen

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlín, Berlin, Germany

Are you A J Kroesen?

Claim your profile

Publications (76)122.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe courses of Crohn's disease (CD) during pregnancy are rare. However, if occurring, the risk of miscarriage and low birth weight is increased. At present, only limited data is available on the treatment of CD during pregnancy. In particular, there are no standard guidelines for surgical therapy. Nevertheless, surgery is often unavoidable if complications during the course of the disease arise. This study provides a critical overview of conventional and interventional treatment options for CD complications during pregnancy and analyses the surgical experience gained thus far. For illustrative purposes, clinical cases of three young women with a severe clinical course during pregnancy are presented. After treatment-refractory for conservative and interventional measures, surgery remained as the only treatment option. In all cases, a split stoma was created after resection to avoid anastomotic leaks that would endanger the lives of mother and child. The postoperative course of all three patients was uneventful, and pregnancy remained intact until delivery. No further CD specific medication was required before birth. The management of CD patients during pregnancy requires close interdisciplinary co-operation between gastroenterologists, obstetricians, anaesthetists and visceral surgeons. For the protection of mother and child treatment should thus be delivered in a specialised centre. This article demonstrates the advantages of surgical therapy by focusing on alleviating CD complaints and preventing postoperative complications.
    International Journal of Colorectal Disease 05/2014; · 2.24 Impact Factor
  • H J Buhr, A J Kroesen
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgery for inflammatory bowel disease under immunosuppressant drugs is a widely discussed topic. Because therapeutic concepts have significantly changed, almost no patient is currently without an immunosuppressant or biologic agent prior to surgery. However, the data whether biological agents and immunosuppressant are a risk factor are very inconsistent. Concerning Crohn's disease, monotherapy with immunosuppressants or biological agents seems to have no negative influence on the postoperative results. In contrast, however, for ulcerative colitis more publications recognise biologic agents and immunosuppressants as a single therapy as a risk factor for infections. To reduce the general risk, all risk factors have to be reduced. In Crohn's disease, nutritional status must be optimised, corticoids should be reduced, biological agents and immunosuppressant drugs should be stopped, protection of an eventual anastomosis by a stoma. For ulcerative colitis in high-risk patients, a three-stage restaurative proctocolectomy is favoured to a one- or two-staged proctocolectomy.
    Der Chirurg 10/2013; · 0.52 Impact Factor
  • H.J. Buhr, A.J. Kroesen
    [Show abstract] [Hide abstract]
    ABSTRACT: Operieren unter Immunsuppression ist ein hochaktuelles Thema in der Chirurgie chronisch entzündlicher Darmerkrankungen. Durch den Wandel der Therapieregime kommt kaum noch ein Patient ohne Immunsuppression zur Operation. Die Datenlage, inwiefern diese Substanzen im Falle einer Operation tatsächlich einen Risikofaktor darstellen, ist allerdings sehr uneinheitlich. Beim M. Crohn scheint eine Monotherapie mit Immunmodulatoren und Biologika keinen negativen Einfluss zu haben. Allerdings potenzieren sich die einzelnen Substanzen in ihrer Wirkung. Bei der Colitis ulcerosa überwiegen die Arbeiten, die ein erhöhtes Risiko für infektiöse Komplikationen nach Biologika und Immunsuppression aufzeigen. Zur Herabsetzung des Risikos müssen alle Risikofaktoren reduziert werden. Beim M. Crohn sind das in erster Linie eine Optimierung des Ernährungsstatus, eine Reduktion der Kortikoidtherapie, Pausierung der Biologika und Immunsuppression, Splitstoma/protektives Stoma. Bei der Colitis ulcerosa sollte zusätzlich beim Hochrisikopatienten eine dreizeitige statt eine ein-/zweizeitige restaurative Proktokolektomie vorgenommen werden.
    Der Chirurg 01/2013; 84(11). · 0.52 Impact Factor
  • A J Kroesen
    [Show abstract] [Hide abstract]
    ABSTRACT: Conservative treatment of fecal incontinence and obstructive defecation can be treated by many conservative treatment modalities. This article presents the options of medication therapy, spincter exercises, electric stimulation, transcutaneous tibial nerve stimulation, anal irrigation and injection of bulking agents. These methods are presented with reference to the currently available literature but the evidence-based data level for all methods is low. For minor disorders of anorectal function these conservative methods can lead to an improvement of anorectal function and should be individually adapted.
    Der Chirurg 01/2013; 84(1):15-20. · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Recurrent Crohn's disease activity at the site of anastomosis after ileocecal resection is of great surgical importance. This prospective randomized multi-center trial with an estimated case number of 224 patients was initially planned to investigate whether stapled side-to-side anastomosis, compared to hand-sewn end-to-end anastomosis, results in a decreased recurrence of Crohn's disease following ileocolic resection (primary endpoint). The secondary endpoint was to focus on the early postoperative results comparing both surgical methods. The study was terminated early due to insufficient patient recruitment and because another large study investigated the same question, while our trial was ongoing. METHODS AND STUDY DESIGN: Patients with stenosing ileitis terminalis in Crohn's disease who underwent an ileocolic resection were randomized to side-to-side or end-to-end anastomosis. Due to its early discontinuation, our study only investigated the secondary endpoints, the early postoperative results (complications: bleeding, wound infection, anastomotic leakage, first postoperative stool, duration of hospital stay). RESULTS: From February 2006 until June 2010, 67 patients were enrolled in nine participating centers. The two treatment groups were comparable to their demographic and pre-operative data. BMI and Crohn's Disease Activity Index were 22.2 (±4.47) and 200.5 (±73.66), respectively, in the side-to-side group compared with 23.3 (±4.99) and 219.6 (±89.03) in the end-to-end group. The duration of surgery was 126.7 (±42.8) min in the side-to-side anastomosis group and 137.4 (±51.9) min in the end-to-end anastomosis group. Two patients in the end-to-end anastomosis group developed an anastomotic leakage (6.5%). Impaired wound healing was found in 13.9% of the side-to-side anastomosis group, while 6.5% of the end-to-end anastomosis group developed this complication. The duration of hospital stay was comparable in both groups with 9.9 (±3.93) and 10.4 (±3.26) days, respectively. CONCLUSIONS: Because of the early discontinuation of the study, it is not possible to provide a statement about the perianastomotic recurrence rates regarding the primary endpoint. With regard to the early postoperative outcome, we observed no difference between the two types of anastomosis.
    Langenbeck s Archives of Surgery 01/2012; · 1.89 Impact Factor
  • Zeitschrift für Gastroenterologie 08/2011; 49(9):1276-341. · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sigmoid resection is now considered as a standard procedure for acute and recurrent sigmoid diverticulitis (SD). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy. PATIENTS UND METHODS: Consecutive admissions of 1,154 patients from January 1995 to December 2009 with acute SD were prospectively included. In terms of pre-operative and intraoperative findings and postoperative course 3 treatment periods (TP) were distinguished: TP I 1995-1999, TP II 2000-2004 and TP III 2005-2009. CT scanning was used in more than 90% of cases since TP II compared to 51% during TP I (p<0.001). The ratio of emergency versus elective surgery significantly increased in favor of elective surgery (p<0.001). The rate of laparoscopy-assisted sigmoid resections showed a continuous increase from 53% in TP I to 71% in TP III (p<0.001) while the rate of Hartmann's procedures decreased over time (p<0.001). Overall, the rate of surgically treated patients decreased during the time periods studied despite an increase in the total number of patients with SD (TP III versus TP I +41%.) The rate of conservatively treated patients increased significantly (p<0.001). The morbidity rate decreased (p<0,001) whereas mortality rates remained at a constantly low level (p=0.175). The increasing use of CT diagnosis and the laparoscopic approach led to a shift from emergency surgery with a high complication rate to elective surgery with a high rate of primary restoration of continuity and low morbidity. However, the indications for surgery and therefore the overall rate of patients who underwent surgery did not increase due to these changes.
    Der Chirurg 03/2011; 82(8):701-6. · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Conventional defecography can reveal abnormalities in patients with evacuatory disorders. With fast dynamic MR imaging systems, MR-defecography has become possible, which does not expose patients to ionizing radiation. The purpose of this study was to assess the correlation of both methods after rectopexy. Twenty-one consecutive patients underwent abdominal sigmoidectomy and rectopexy due to evacuatory disorders. Postoperatively, all patients were investigated by cineradiographic defecography. Fourteen patients underwent MR-defecography additionally. The results were screened for anorectal angle and pelvic floor position (rest, squeezing, and evacuation). The findings were depicted in Box plot analysis and compared with the Friedman-test. Descent of pelvic organs was also assessed. In MR-defecography, anorectal angle at rest was smaller than in conventional defecography, but there was no difference during squeezing and defecation. Concerning pelvic floor position, during squeezing, MR-defecography illustrated a lower perineum and a broader range of pelvic settings, but no difference at rest and during evacuation. In four patients, MR-defecography visualized a descent of the bladder. However, in four patients with complete evacuation in cineradiography and with no clinical complaints about incomplete evacuation, MR imaging showed deficient evacuation. Overall continence of patients was significantly improved through surgery, but there was no change in sphincter pressure, radial asymmetry, or sphincter length. In general, with respect to anorectal angle and perineal motility, both methods revealed consistent results. The concomitant depiction of structures in MR-defecography is helpful in the assessment of descent of pelvic organs and permits visualization of enteroceles. However, in 30% of patients, MR-defecography wrongly showed incomplete evacuation.
    Journal of Surgical Research 01/2011; 165(1):52-8. · 2.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: HintergrundDie Sigmaresektion gilt heute als Standardverfahren bei der komplizierten und rezidivierenden Sigmadivertikulitis (SD). Im letzten Jahrzehnt hat sich ein deutlicher Wandel in der präoperativen Diagnostik (CT) und im operativen Zugangsweg (Laparoskopie) vollzogen. Ziel dieser Studie war es, zu prüfen, ob sich hierdurch eine Veränderung der Indikationsstellung zur chirurgischen Therapie ergeben hat. Patienten und MethodenIn die Studie wurden 1154Patienten mit der chirurgischen Therapie einer akuten SD über einen Zeitraum von 15 Jahren (1995 bis 2009) prospektiv eingeschlossen. In Hinblick auf die prä- und intraoperativen Befunde sowie den postoperativen Verlauf wurden 3 Therapiezeiträume (ZR) unterschieden: ZRI 1995–1999, ZRII 2000–2004, ZRIII 2005–2009. ErgebnisseDie CT-Untersuchung kam ab dem ZRII in über 90% der Fälle zur Anwendung im Vergleich zu 51% im ZRI (p<0,001). Das Verhältnis Notfall- zu Elektivoperation nahm zugunsten der Elektiveingriffe signifikant zu (p<0,001). Der Anteil an laparoskopisch-assistierten Sigmaresektionen stieg von 53% im ZRI auf 71% im ZRIII (p<0,001) bei abnehmender Rate an Diskontinuitätsresektionen (p<0,001). Insgesamt nahm der Anteil an operierten Patienten trotz Zunahme der SD-Patienten (ZRIII vs. I + 41%) über die Jahre ab (p<0,001). Dagegen nahm der Anteil an konservativ therapierten Patienten signifikant zu. Die Morbiditätsrate sank (p<0,001) bei auf niedrigem Niveau konstanter Mortalitätsrate (p=0,175). SchlussfolgerungDurch den Einsatz der CT-Diagnostik sowie der laparoskopischen Resektionstechnik kam es zu einer Verschiebung von der notfallmäßigen Operation mit hoher Komplikationsrate zur elektiven Operation mit hoher Rate an primären Rekonstruktionen und geringer Morbidität. Die Operationsquote nahm hierbei jedoch nicht zu. Insgesamt nahm der Anteil an operativ therapierten Patienten zugunsten von konservativ therapierten Patienten sogar signifikant ab. IntroductionSigmoid resection is now considered as a standard procedure for acute and recurrent sigmoid diverticulitis (SD). In the last decade significant changes in preoperative diagnosis with computed tomography (CT) scanning and surgical access (laparoscopy) have been implemented. The aim of this study was to examine whether this has led to changes in the indications for surgical therapy. Patients und MethodsConsecutive admissions of 1,154Patients from January 1995 to December 2009 with acute SD were prospectively included. In terms of pre-operative and intraoperative findings and postoperative course 3 treatment periods (TP) were distinguished: TP I 1995–1999, TP II 2000–2004 and TP III 2005–2009. ResultsCT scanning was used in more than 90% of cases since TP II compared to 51% during TP I (p<0.001). The ratio of emergency versus elective surgery significantly increased in favor of elective surgery (p<0.001). The rate of laparoscopy-assisted sigmoid resections showed a continuous increase from 53% in TP I to 71% in TP III (p<0.001) while the rate of Hartmann’s procedures decreased over time (p<0.001). Overall, the rate of surgically treatedPatients decreased during the time periods studied despite an increase in the total number ofPatients with SD (TP III versus TP I +41%.) The rate of conservatively treatedPatients increased significantly (p<0.001). The morbidity rate decreased (p<0,001) whereas mortality rates remained at a constantly low level (p=0.175). ConclusionThe increasing use of CT diagnosis and the laparoscopic approach led to a shift from emergency surgery with a high complication rate to elective surgery with a high rate of primary restoration of continuity and low morbidity. However, the indications for surgery and therefore the overall rate ofPatients who underwent surgery did not increase due to these changes. SchlüsselwörterAkute Sigmadivertikulitis–Sigmaresektion–Komplizierte Divertikulitis–Laparoskopie–CT-Diagnostik KeywordsAcute sigmoid diverticulitis–Sigmoid resection–Severe divertivulitis–Laparoscopy–CT scanning
    Der Chirurg 01/2011; 82(8):701-706. · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The pathophysiology of rectal prolapse and intussusception has not yet been clarified. This is reflected in the multiplicity of surgical procedures. The aim of this prospective study was to measure morphological and functional changes of the pelvic floor and the rectum before and after resection rectopexy. A total of 21 patients (mean age 60 years; 2 men, 19 women) with manifest rectal prolapse and rectoanal intussusception underwent sigmoidectomy and rectopexy with an absorbable polyglactin mesh graft. The following analyses were performed preoperatively and, on average, 15 months (range 6-21 month) postoperatively: radiologic defecography, rectal volumetry, sphincter manometry, and evaluation of clinical symptoms. Postoperatively there was no patient with rectal prolapse, and only one with an intussusception. Rectal compliance increased from 6.4 to 10.2 ml/mmHg. Rectal volumetry showed a decrease of the thresholds for the sensation of "desire to defecate" and "maximal tolerated volume" (100-75 ml, 175-150 ml). Postoperatively, there was a higher level of the pelvic floor during contraction. The anorectal angle, vector volume, radial asymmetry, sphincter length, and resting and squeezing pressures were unchanged. Surgery improved rectal evacuation (p = 0.03), continence (p = 0.01), stool consistency (p = 0.03), and warning period (p = 0.01). Patients' personal assessment showed an improved overall satisfaction. Resection rectopexy is a reliable method for treating rectal prolapse and rectoanal intussusception with clear improvement of the patient's clinical symptoms. The restored anorectal function can be attributed to improved rectal compliance, a lower sensory threshold, an elevation of the pelvic floor during squeezing, and an improved rectal evacuation.
    World Journal of Surgery 11/2010; 34(11):2710-6. · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical approach for ulcerative colitis and familial adenomatous polyposis. This study evaluated predictors of the need for a permanent ileostomy to identify patients at high risk of IPAA failure. This was a retrospective analysis of patients who underwent proctocolectomy and IPAA between 1997 and 2008. A logistic regression model was used for multivariable analysis of potential risk factors. Proctocolectomy was combined with IPAA in 185 patients, of whom 169 had a loop ileostomy formed. IPAA and ileostomy closure were successful in 162 patients (87.6 per cent). Reasons for not closing the ileostomy included pouch failure (16 patients), patient choice (5) and death (2). Thus one in eight patients had a permanent ileostomy after planned IPAA. Age was the major predictor of the need for a permanent ileostomy in multivariable analysis (P = 0.002) with a probability of more than 25 per cent in patients aged over 60 years. However, advancing age was associated with colitis, co-morbidity, obesity and corticosteroid use. The probability of the need for a permanent ileostomy after IPAA increases with age.
    British Journal of Surgery 10/2010; 97(10):1561-6. · 4.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sacral nerve stimulation (SNS) can improve fecal incontinence, though the exact mechanism is not known. This study examines the following hypotheses: SNS leads to contraction of the pelvic floor, influences rectal perception, and improves continence and quality of life. Fourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospectively. Morphological and functional assessment was done by endosonography, manometry, and volumetry with the stimulator turned on and off in direct succession. Questionnaires were used to determine incontinence and quality of life. With the stimulator turned on, rectal filling conditions were perceived only at higher volumes; in particular, the defecation urge was sensed only at higher volumes. There was also a reduction in the diameters of the external and internal anal sphincters and a decrease in the distance between the anal mucosa and the symphysis as a sign of pelvic floor elevation. Six months after surgery, continence and quality of life were markedly better than before the operation. We were able to confirm the hypotheses given above. The improvements of pelvic floor contraction and rectal perception are rapid adjustment processes in response to stimulation of sacral nerves S3/S4 when turning on the stimulator.
    Journal of Gastrointestinal Surgery 04/2010; 14(4):636-44. · 2.36 Impact Factor
  • Zeitschrift Fur Gastroenterologie - Z GASTROENTEROL. 01/2010; 48(08).
  • A J Kroesen, J Gröne, H J Buhr, J P Ritz
    [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic colorectal surgery is nowadays also widely used in surgery of inflammatory bowel disease. With the correct indications laparoscopic surgery is an attractive cosmetic alternative for the predominantly juvenile patients. Refractory fistulizing Crohn's proctocolitis is a very severe disease with a maximal limitation on the quality of life. Proctocolectomy with a Brooke ileostomy represents a very effective option for these patients. The laparoscopic technique can at least spare the patients a salvage laparotomy incision. We report about our preliminary experiences A total of 8 patients (mean age 25 years, range 19 Background 31 years, female:male ratio 5:3) were operated on. The mean preoperative time course of the disease was 28 months (range 12 Background 156 months). All patients had received long-term prednisolone therapy of >15mg, 2 patients received azathioprine medication, 2 underwent anti TNF-alpha therapy and 6 received 5-aminosalicylic acid (5-ASA). The mean preoperative BMI was 19 (range 15 Background 21). All patients suffered from Crohn's pancolitis with anorectal fistulas. Laparoscopic proctocolectomy was performed using 4 trocars place in a semicircular fashion. The resected tissue was salvaged transanally and the Brooke ileostomy was drained via the right lateral trocar. The terminal exit of the rectum occurred transanally with preservation of the pelvic floor and the anal sphincter and the anal fistulas were separated. The small pelvis was filled by a transanally fixed omentum. The median time for surgery was 236.5 mins (range 220-330 mins). A complication of postoperative paralysis of the bowel occurred in two patients and 4 patients could be discharged problem-free according to the fast-track concept. Cosmetic results were excellent in all cases. Perianal and perirectal manifestations healed completely after a median of 4 weeks. Incisionless proctocolectomy represents a good and realizable alternative to open surgery. The main advantages are excellent cosmetic results and a better preservation of the external integrity of the abdomen.
    Der Chirurg 06/2009; 80(8):730-3. · 0.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The etiology of pouchitis after coloproctomucosectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis is still unknown. Beside changes in luminal antigens, the immunological predisposition is assumed to be responsible. In previous electrophysiological studies, we showed that mucosal barrier and transport function in pouchitis is markedly reduced. Thus, the aim of the present study was to analyze barrier function on the molecular level. Pouch biopsies of 36 ulcerative colitis patients were analyzed. Time points were (1) intraoperative immediately prior to ileal pouch-anal anastomosis (n = 13), (2) >1 year after ileostomy closure (pouch, n = 12), and (3) during pouchitis (n = 11). Control terminal ileum biopsies were obtained from eight patients undergoing hemicolectomy due to carcinoma. Expression of tight junction proteins was analyzed by Western blotting and confocal laser-scanning microscopy. To elucidate effects on epithelial barrier properties, impedance spectroscopy was performed in miniaturized Ussing chambers. In pouchitis, epithelial resistance was markedly reduced compared to non-inflamed pouch and control ileum. Expression of tight junction proteins claudin-1, 3, 4, 5, and 7 and occludin revealed differential expression regulation with the tightening tight junction protein claudin-1 being decreased and an increase of the pore-forming claudin-2, whereas other claudins remained constant. Morphometry indicated the mucosal surface to be unchanged. Pouchitis is characterized by a selective change of tight junction proteins in favor of opening the epithelial tight junction and, thus, the paracellular pathway, which contributes to the inflammatory process. This resembles changes in inflammatory bowel disease (IBD) and indicates IBD recurrence in pouchitis.
    International Journal of Colorectal Disease 06/2009; 24(10):1149-56. · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The staging of anal cancer is extremely important for therapy and prognosis. Transanal endoscopic ultrasound and magnetic resonance imaging are routinely applied. The aim of this prospective comparative study is to evaluate whether tumor staging is concordant between these techniques. Forty-five anal cancer patients underwent endoscopic ultrasound and magnetic resonance imaging. Histological confirmation was obtained in all patients. The two test methods were compared with the kappa concordance index and sensitivity for the initial method of tumor detection was calculated. For six patients who were operated upon because of tumor progression, the results were evaluated against the histological tumor stage. High concordance was found in the assessment of tumor size and nodal status (kappa index 0.63 and 0.77). Cancer patients were correctly identified with 100% sensitivity (45/45) by endoscopic ultrasound and with 88.9% (40/45) sensitivity by magnetic resonance imaging. In the six operated patients, T stage was correctly assessed in four of six patients by endoscopic ultrasound and in three of six patients by magnetic resonance imaging. The results of endoscopic ultrasound strongly coincide with those of magnetic resonance imaging. Endoscopic ultrasound may be superior to magnetic resonance imaging for detection of small superficial tumors. However, magnetic resonance imaging is needed for N staging.
    Journal of Gastrointestinal Surgery 05/2009; 13(7):1292-8. · 2.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies of human mucosal lymphoid follicles are rare and have been limited to children's Peyer's patches, which are visible at endoscopy. We investigated lymphoid follicles in ileum biopsies of 87 patients and surgical colon specimens from 66 cancer patients, and examined phenotype and function of isolated follicular immune cells. Two (0-10) and 12 (0-117) follicles per patient were found in ileum and colon samples respectively (P < 0.001). The number of lymphoid follicles mononuclear cells (LFMC) that could be isolated per patient was higher from colon compared with ileum specimens [725 000 (0-23 Mio) versus 100 000 (0-1.3 Mio), P < 0.001]. T cells were predominant in both LFMC and lamina propria mononuclear cells (LPMC), but B cells were more and plasma cells less frequent in LFMC. T cells from mucosal follicles were more frequently CD4-positive and CD62L-positive, but less frequently CD8-positive, CD103-positive and CD69-positive than lamina propria T cells. LFMC from ileum compared with colon showed no differences in mononuclear cell composition. Anti-CD3/CD28 stimulation induced similar proliferation of LFMC and LPMC from ileum and colon, as well as secretion of high levels of interferon-gamma, tumour necrosis factor-alpha and interleukin (IL)-2, but lower levels of IL-4, IL-6 and IL-10. LFMC from colon secreted more IL-2 than those from ileum. Our study shows that mucosal lymphoid follicles can be identified clearly in adult human colon and yield viable immune cells sufficient for phenotypical and functional analysis. The cellular composition of LFMC from ileum and colon is similar, and both secrete predominantly T helper type 1 cytokines.
    Clinical & Experimental Immunology 01/2009; 156(2):232-7. · 3.41 Impact Factor
  • A.J. Kroesen, J. Gröne, H.J. Buhr, J.P. Ritz
    [Show abstract] [Hide abstract]
    ABSTRACT: Die laparoskopische kolorektale Chirurgie hat auch bei den chronisch entzündlichen Darmerkrankungen Einzug gehalten. Bei entsprechender Indikation ist die laparoskopische Operation gerade für die überwiegend jugendlichen Patienten eine wertvolle kosmetische Alternative. Die therapierefraktäre fistulierende Proktocolitis Crohn ist in den meisten Fällen eine medikamentös nicht zu durchbrechende Erkrankung mit einer maximalen Einschränkung der Lebensqualität. Die chirurgisch sehr effektive Therapie besteht in einer Proktokolektomie mit endständigem Brooke-Ileostoma. Hier kann die laparoskopische Technik den Patienten zumindest eine Bergeinzision ersparen. Wir berichten über unsere ersten Erfahrungen.Acht Patienten (Alter 25 [19–32] Jahre, w:m=5:3) wurden operiert. Die präoperative Erkrankungsdauer betrug 28 (12–156) Monate. Alle Patienten standen unter eine Prednisolon-Dauertherapie von >15 mg, 2 Patienten erhielten eine Azathioprin-Medikation, 2 wurden vorab mit Anti-TNF-α, 6 mit 5-ASA behandelt. Der präoperative BMI betrug 19 (15–21). Bei allen Patienten bestand eine Pancolits Crohn mit ausgedehnter anorektaler Fistulierung.Die laparoskopische Proktokolektomie wurde mittels 4 halbkreisförmig angeordneter Trokare durchgeführt. Die Bergung des Resektats erfolgte transanal und das Brooke-Ileostoma wurde über den ehemaligen rechts-lateralen Trokar ausgeleitet. Die terminale Auslösung des Rektums geschah transanal unter Erhalt des Beckenbodens und Analsphinkters, wobei die Analfisteln gespalten wurden. Das kleine Becken wurde mit einer nach transanal ausgeleiteten Omentum-majus-Plombe versehen.Die mediane Operationszeit betrug 236,5 (220–330) min. Als Komplikationen ereignete sich in 2 Fällen eine postoperative Darmatonie. 4 Patienten konnten nach dem Fast-track-Konzept problemlos geführt werden. Das kosmetische Ergebnis war in allen Fällen exzellent. Die perianalen und perirektalen Manifestationen heilten nach im Median 4 Wochen komplett ab.Die bergeinzisionslose Proktokolektomie stellt eine gut realisierbare Alternative zur offenen Operation dar. Die Hauptvorteile bestehen im kosmetischen Ergebnis und der fehlenden Beeinträchtigung der Integrität der Bauchwand.
    Der Chirurg 01/2009; 80(8). · 0.52 Impact Factor
  • A C Schulz, C Bojarski, H J Buhr, A J Kroesen
    [Show abstract] [Hide abstract]
    ABSTRACT: Proctocolectomy with ileoanal pouch construction is the standard therapy for patients with familial adenomatous polyposis coli (FAP) to prevent the genesis of colorectal carcinomas. In our patient population, we observed the postoperative development of adenomas not only in the pouch but also in the remaining small intestine. The exact incidence of these ileal polyps is still unknown, since the diagnostic possibilities of examining the small intestine are limited. We performed wireless capsule endoscopy (CE) in patients who developed postoperative pouch adenomas (PA) to record the simultaneous occurrence of small bowel adenomas and PA. We operated on 46 patients with FAP (m:f 17:10, age 33 +/- 9 years). Thirty-five patients underwent proctocolectomy with ileoanal pouch creation. Pouch endoscopy was performed in regular intervals at 3 months and then annually after proctocolectomy. Capsule endoscopy was additionally carried out in all patients with PA. Ileal PA occurred in 22.8% (n = 8) of the patients with proctocolectomy (n = 35) after a mean of 5 years after surgery. Eight PA patients (all with PA) also had adenomas in the small intestine diagnosed by CE. Since jejunal and ileal adenomas occur in all patients with PA, we recommend regular follow-up examinations, which include pouch endoscopy at 3 months and annually after surgery in the presence of PA after proctocolectomy and pouch creation. On the basis of our observations, we recommend adding CE or double-balloon enteroscopy to the follow-up examination.
    International Journal of Colorectal Disease 05/2008; 23(4):437-41. · 2.24 Impact Factor
  • U Zurbuchen, A J Kroesen, H J Buhr
    [Show abstract] [Hide abstract]
    ABSTRACT: The optimization of surgical techniques has made it possible to now treat patients with deep-seated rectal cancer by performing deep anterior rectal resection with coloanal anastomosis while avoiding a permanent stoma. To prevent a high bowel movement frequency and limited continence with an imperative need to empty the bowel, the coloanal pouch operation was developed to construct a rectal substitute. Nowadays, patients with ulcerative colitis or familial adenomatous polyposis of the colon undergo proctocolectomy as the definitive treatment for their underlying disease. Continuity is restored by creating an ileoanal reservoir. This contribution describes the surgical indications and pathophysiological changes for the colon J-pouch and ileoanal reservoir. In addition, explanations of the surgical techniques for both procedures are presented. The functional results are compared with those of other reconstruction options and discussed, taking our own results into consideration.
    Der Urologe 02/2008; 47(1):18-24. · 0.46 Impact Factor

Publication Stats

792 Citations
122.27 Total Impact Points


  • 2013
    • Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie
      Berlín, Berlin, Germany
  • 2009–2013
    • Krankenhaus Porz am Rhein
      Porz am Rhein, North Rhine-Westphalia, Germany
  • 2011
    • Frankfurt Diakonia Clinics
      Frankfurt, Hesse, Germany
  • 2006–2011
    • Charité Universitätsmedizin Berlin
      • • Surgery
      • • Department of General, Visceral and Transplantation Surgery
      Berlín, Berlin, Germany
  • 1998–2009
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany
  • 2004
    • Ruhr-Universität Bochum
      • Medizinische Fakultät
      Bochum, North Rhine-Westphalia, Germany
  • 1995
    • Universität Heidelberg
      • Surgical Hospital
      Heidelberg, Baden-Wuerttemberg, Germany