AJ Kroesen

Krankenhaus Porz am Rhein, Porz am Rhein, North Rhine-Westphalia, Germany

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Publications (83)172.41 Total impact

  • AJ Kroesen · M Utzig · C Isbert · HJ Buhr
    Zeitschrift für Gastroenterologie 08/2015; 41(08). DOI:10.1055/s-0035-1555308 · 1.67 Impact Factor
  • AJ Kroesen · M Utzig · C Isbert · HJ Buhr
    Zeitschrift für Gastroenterologie 08/2015; 41(08). DOI:10.1055/s-0035-1555287 · 1.67 Impact Factor
  • AJ Kroesen · MJ Utzig · C Isbert · HJ Buhr
    Zeitschrift für Gastroenterologie 08/2015; 41(08). DOI:10.1055/s-0035-1555560 · 1.67 Impact Factor
  • C Seifarth · J P Ritz · U Pohlen · A J Kroesen · B Siegmund · B Frericks · H J Buhr
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    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; 29(6). DOI:10.1007/s00384-014-1880-4 · 2.42 Impact Factor
  • H J Buhr · A J Kroesen
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    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
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    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). DOI:10.1007/s00104-013-2516-x · 0.52 Impact Factor
  • A J Kroesen
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    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. DOI:10.1007/s00104-012-2348-0 · 0.52 Impact Factor
  • Zeitschrift für Gastroenterologie 09/2011; 49(9):1276-1341. DOI:10.1055/s-0031-1281666 · 1.67 Impact Factor
  • Zeitschrift für Gastroenterologie 08/2011; 49(9):1276-341. · 1.67 Impact Factor
  • J.-P. Ritz · K.S. Lehmann · A.J. Kroesen · H.J. Buhr · C. Holmer
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    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 08/2011; 82(8):701-706. DOI:10.1007/s00104-011-2074-z · 0.52 Impact Factor
  • C Seifarth · J Gröne · A Kroesen · HJ Buhr · JP Ritz
    Zeitschrift für Gastroenterologie 08/2011; 49(08). DOI:10.1055/s-0031-1285499 · 1.67 Impact Factor
  • J-P Ritz · K S Lehmann · A J Kroesen · H J Buhr · C Holmer
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    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
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    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. DOI:10.1016/j.jss.2009.08.009 · 2.12 Impact Factor
  • S D Otto · J P Ritz · J Gröne · H J Buhr · AJ Kroesen
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    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. DOI:10.1007/s00268-010-0735-6 · 2.35 Impact Factor
  • A G Wibmer · A J Kroesen · J Gröne · N Slavova · A Weinhold · H J Buhr · J-P Ritz
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    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. DOI:10.1002/bjs.7135 · 5.21 Impact Factor
  • C Seifarth · N Slavova · A Kroesen · HJ Buhr · JP Ritz
    Zeitschrift für Gastroenterologie 08/2010; 48(08). DOI:10.1055/s-0030-1263678 · 1.67 Impact Factor
  • J Gröne · JC Lauscher · U Zurbuchen · AJ Kroesen · HJ Buhr · JP Ritz
    Zeitschrift für Gastroenterologie 08/2010; 48(08). DOI:10.1055/s-0030-1263648 · 1.67 Impact Factor
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    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. DOI:10.1007/s11605-009-1122-1 · 2.39 Impact Factor
  • Zeitschrift für Gastroenterologie 09/2009; 47(09). DOI:10.1055/s-0029-1241287 · 1.67 Impact Factor
  • A.J. Kroesen · J. Gröne · H.J. Buhr · J.P. Ritz
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    ABSTRACT: Hintergrund 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. Patienten und Methoden 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. Ergebnisse 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. Schlussfolgerung 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 08/2009; 80(8):730-733. DOI:10.1007/s00104-009-1723-y · 0.52 Impact Factor

Publication Stats

1k Citations
172.41 Total Impact Points

Institutions

  • 2010–2014
    • Krankenhaus Porz am Rhein
      Porz am Rhein, North Rhine-Westphalia, Germany
  • 2013
    • Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie
      Berlín, Berlin, Germany
  • 2011
    • Frankfurt Diakonia Clinics
      Frankfurt, Hesse, Germany
  • 2006–2010
    • Charité Universitätsmedizin Berlin
      • • Surgery
      • • Department of General, Vascular and Thoracic Surgery
      Berlín, Berlin, Germany
  • 2000–2003
    • Freie Universität Berlin
      • Institute of Social and Cultural Anthropology
      Berlín, Berlin, Germany
  • 1995
    • Universität Heidelberg
      • Surgical Hospital
      Heidelberg, Baden-Wuerttemberg, Germany