[show abstract][hide abstract] ABSTRACT: BACKGROUND: The literature dealing with abdominal wall surgery is often flawed due to lack of adherence to accepted reporting standards and statistical methodology. MATERIALS AND METHODS: The EuraHS Working Group (European Registry of Abdominal Wall Hernias) organised a consensus meeting of surgical experts and researchers with an interest in abdominal wall surgery, including a statistician, the editors of the journal Hernia and scientists experienced in meta-analysis. Detailed discussions took place to identify the basic ground rules necessary to improve the quality of research reports related to abdominal wall reconstruction. RESULTS: A list of recommendations was formulated including more general issues on the scientific methodology and statistical approach. Standards and statements are available, each depending on the type of study that is being reported: the CONSORT statement for the Randomised Controlled Trials, the TREND statement for non randomised interventional studies, the STROBE statement for observational studies, the STARLITE statement for literature searches, the MOOSE statement for metaanalyses of observational studies and the PRISMA statement for systematic reviews and meta-analyses. A number of recommendations were made, including the use of previously published standard definitions and classifications relating to hernia variables and treatment; the use of the validated Clavien-Dindo classification to report complications in hernia surgery; the use of "time-to-event analysis" to report data on "freedom-of-recurrence" rather than the use of recurrence rates, because it is more sensitive and accounts for the patients that are lost to follow-up compared with other reporting methods. CONCLUSION: A set of recommendations for reporting outcome results of abdominal wall surgery was formulated as guidance for researchers. It is anticipated that the use of these recommendations will increase the quality and meaning of abdominal wall surgery research.
[show abstract][hide abstract] ABSTRACT: Einleitung: Sehr tiefe Rectumanastomosen gelten als komplikationsträchtig. Es sollten daher die Risikofaktoren für die chirurgisch wesentlichste
Komplikation, die Anastomoseninsuffizienz, analysiert werden. Methoden: Uni- und multivariate Analyse des Zusammenhangs zwischen Anastomoseninsuffizienz und 18 patienten- bzw. operationsbezogenen
Variablen bei 98 Patienten mit tiefen colorectalen oder coloanalen Anastomosen. Ergebnisse: In 18 % der Fälle kam es zu einer Insuffizienz. Zwei Patienten, die beide kein protektives Stoma erhalten hatten, verstarben
hieran (Gesamtletalität 2 %). Unter allen untersuchten Variablen zeigte sich nur Rauchen als unabhängiger Risikofaktor für
eine Insuffizienz. Für alle anderen Merkmale, insbesondere protektive Stomaanlage, Erfahrung des Operateurs, Stadium, Radiatio
und Konservenverbrauch bestand kein signifikanter Zusammenhang. Schlußfolgerungen: Anhand der untersuchten Parameter ist die Definition einer typischen Risikokonstellation für eine Anastomoseninsuffizienz
mit Ausnahme des Rauchens nicht möglich. Es ist davon auszugehen, daß diese Komplikation durch viele, zumeist schwer zu quantifizierende
Faktoren, wie z. B. eine vorbestehende oder intra- bzw. postoperativ entstehende Mikroperfusionsstörung bedingt ist. Solange
sich diese Situation nicht genauer klären läßt, ist der großzügige Einsatz des protektiven Stomas, welches die Insuffizienz
zwar nicht verhindert, aber die Folgen abschwächt, gerechtfertigt.
Introduction: Very low colorectal anastomoses are considered to be more prone to complications than other anastomoses. We aimed to analyze
possible risk factors for the surgically most relevant complication, anastomotic leakage. Methods: Uni- and multivariate analysis of the relation between leakage and 18 patient- and procedure-dependent variables were performed
in 98 patients after very low colorectal or coloanal anastomosis. Results: In all, 18 patients developed a dehiscence. Two patients, both without a protective stoma, died because of the leakage (overall
mortality 2 %). From all analyzed variables, only smoking remained as an independent risk factor for anastomotic dehiscence.
For all other parameters, such as protective stoma, experience of the surgeon, stage of tumor, radiation therapy, or the need
for blood transfusions there was no significant correlation. Conclusions: From our study, a typical risk pattern for anastomotic dehiscence, with the exception of being a smoker, cannot be defined.
Presumably, anastomotic leakage is being caused by a multitude of factors, such as a preexisting or intra-/postoperatively
developing reduction of microperfusion, which have a strong influence but cannot be as readily evaluated as other parameters.
Until this situation improves, protective stomata, which do not prevent leakage but attenuate the consequences, should be
Der Chirurg 05/2012; 71(11):1365-1369. · 0.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Intraabdominale Organläsionen im Rahmen eines stumpfen Bauchtraumas gehören zu den am häufigsten initial übersehenen Verletzungen,
insbesondere beim polytraumatisierten Patienten. Dies ist besonders tragisch, da diese Verletzungen bei rechtzeitiger Diagnosestellung
und chirurgischer Intervention meist folgenlos zu beherrschen sind, ein Nichterkennen jedoch mit einer hohen Morbiditäts-
und Mortalitätsrate verbunden ist. Im vergangenen Jahrzehnt hat sich die Sonographie als Screeningmethode für intraabdominale
Verletzungen etabliert. Durch standardisierte Schnittebenen gelingt der Nachweis freier intraabdominaler Flüssigkeit als indirektes
Zeichen für eine Organverletzung auch weniger erfahrenen Untersuchern mit einer Sensitivität von bis zu 99% bei sehr kurzen
Untersuchungszeiten. Nach den Angaben in der Literatur und eigenen Erfahrungen bei >1000 Traumapatienten werden infolge von
zweizeitigen Verletzungsformen etwa 10% der Verletzungen erst im Rahmen von Verlaufskontrollen erkannt, welche somit obligatorischer
Bestandteil der Basisdiagnostik sein müssen. Anhand eigener Ergebnisse und verschiedener Fallbeispiele wird die Problematik
der Diagnostik beim stumpfen Bauchtrauma unter besonderer Berücksichtigung von sonographischen Verlaufskontrollen demonstriert.
Intraabdominal organ lesions after blunt abdominal trauma often are missed, especially in patients with multiple trauma. Missed
abdominal injuries have a high rate of morbidity and mortality. Surgical treatment is often successful with a low rate of
complications when the case of correct diagnosis is promptly made, which means this is especially tragic, particularly in
younger patients. During the past decade abdominal ultrasound has become the primary screening technique of choice for blunt
abdominal trauma. With standard views free fluid volumes, as an indirect sign of organic lesions, can be detected in matter
of minutes with a high sensitivity of up to 99%. It is reported in the literature that about 10% of abdominal injuries are
discovered only on re-examinations carried out because of secondary lesions; our own experience in over 1000 trauma patients
was similar. Therefore, repeated examinations are mandatory in all cases to avoid misdiagnosis and delayed therapy. Our own
results with a standardized time schedule of ultrasound examinations and different case reports are used to illustrate the
typical difficulties in diagnosis following blunt abdominal trauma.
[show abstract][hide abstract] ABSTRACT: Seit über einhundert Jahren sind peritoneale Adhäsionen als häufige Folge abdomineller Eingriffe bekannt. Intraoperative
Läsionen des Mesothels durch Abrasion, Ischämie, Austrocknung und Fremdkörper führen zu Beschwerden, Passagestörungen, weiblicher
Infertilität und Problemen bei Reeingriffen. Weltweit führen eine Steigerung von Lebenserwartung und Operationszahlen zu einer
Zunahme der Komplikationen durch Adhäsionen und den damit verbundenen, sozio-ökonomischen Belastungen. Bis heute steht keine
sichere und zuverlässige Prophylaxe zur Verfügung. Zielsetzung der Forschung sollte eine flüssige Substanz sein, die nach
einmaliger, intraabdomineller Applikation ohne negativen Einfluss auf Blutgerinnung und Wundheilung das Auftreten postoperativer
Verwachsungen mit vertretbaren Kosten signifikant reduziert.
For more than a century peritoneal adhesions are being recognized as frequent sequelae following abdominal surgery. Intraoperative
lesions of the mesothelial lining by abrasion, ischemia, dissication, and foreign bodies result in complaints, intestinal
obstruction, female infertility, and problems during reoperations. The global increase of life expectancy and surgical procedures
are leading to rising incidences of adhesion-related complications and subsequent socio-economic implications. As of today,
there is no safe and efficient prophylaxis available. Scientific efforts should be aimed at a liquid substance for single
intraperitoneal application which significantly reduces postoperative adhesions at reasonable cost without adverse effects
on blood coagulation and wound healing.
Der Chirurg 04/2012; 71(5):510-517. · 0.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Als abdominelles Kompartmentsyndrom ist eine intraabdominelle Druckerhöhung über 20 mmHg mit Anstieg des Beatmungsdrucks
und Oligurie definiert. Bei dem primären abdominellen Kompartmentsyndrom bedingt eine Akuterkrankung (Peritonitis, Ileus,
Abdominal- oder Beckentrauma) direkt die intraabdominelle Druckzunahme. Das sekundäre abdominelle Kompartmentsyndrom ist Folge
eines forcierten Bauchdeckenverschlusses nach chirurgischen Interventionen (Ileus, Peritonitis, große Bauchwandhernien). Auswirkungen
eines abdominellen Kompartmentsyndroms sind: Abnahme des Herzzeitvolumens, basale pulmonale Atelektasen, Oligo- bis Anurie,
hepatische und intestinale Minderperfusion. Sinnvolles Monitoring ist eine standardisierte Messung des Blasendrucks. Normalwerte
nicht operierter Patienten betragen 0–7 cm H2O, Normalwerte nach elektiven Laparotomien 5–12 cm H2O, der kritische Grenzbereich liegt zwischen 15–25 cm H2O, sicher pathologisch sind Werte > 25 cm H2O. Prophylaxe bzw. Therapie der Wahl bei manifestem abdominellem Kompartmentsyndrom ist die Anlage eines druckentlastenden
Laparostomas mit resorbierbarem Netz. Zwischen 1988 und 1999 wurden bei 377 Patienten druckentlastende Laparostomata angelegt.
Bei 16 % bestand ein primäres abdominelles Kompartmentsyndrom mit einem Blasendruck von 31 ± SD 4 cm H2O praeoperativ und von 17 ± 4 cm H2O nach Entlastung durch Laparostoma. Eine frühelektive Bauchwandrekonstruktion war bei 18 % der Patienten möglich. Schlußfolgerung: Das abdominelle Kompartmentsyndrom ist eine unterschätzte chirurgische Problemsituation, die multiple Organsysteme funktionell
und strukturell schädigt. Der temporären Anlage eines druckentlastenden Laparostomas ist gegenüber einer erzwungenen Rekonstruktion
der Bauchwandintegrität um jeden Preis der Vorzug zu geben. Ein pathophysiologisch orientiertes Verständnis für die funktionellen
und systemischen Auswirkungen des Handelns ist Grundlage für moderne Chirurgie. Entsprechend kann ein erzwungener Bauchdeckenverschluß
mit Stahldrähten und Gegendruckplatten keinen Platz im Konzept differenzierten chirurgischen Handelns mehr haben.
Abdominal compartment syndrome is defined by increased intraabdominal pressure above 20 mmHg with increased pulmonary peak
pressure and oliguria. In primary abdominal compartment syndrome the increased intraabdominal pressure is caused directly
by peritonitis, ileus or abdominal and pelvic trauma. Secondary compartment syndrome is a result of forced closure of the
abdominal wall after abdominal surgery. The effects are decreased cardiac output, pulmonary atelectasis, oliguria to anuria
and hepatic as well as intestinal reduction of perfusion. Effective monitoring is done by standardised measuring of urinary
bladder pressure. Normal values are between 0 and 7 cm H2O, after elective laparotomies 5–12 cm H20. Above 25 cm H20 they are definitely pathological. For the prevention and therapy of manifested abdominal compartment syndrome the application
of a laparostomy using a resorbable mesh is recommended. Between 1988 and 1999 we applied a laparostomy to lower the intraabdominal
pressure in 377 patients. In 16 % of the cases it was indicated by primary abdominal compartment syndrome with a bladder pressure
of 31 ± 4 cm H20 preoperatively, which could be lowered to 17 ± 4 cm H20 by laparostomy. An early reconstruction of the abdominal wall could be performed in 18 % of the cases. Conclusions: The abdominal compartment syndrome is an often underestimated problem in abdominal surgery involving multiple organ systems.
The temporary laparostomy lowering intraabdominal pressure rather than a forced closure of the abdominal wall should be used
in all circumstances.
Der Chirurg 04/2012; 71(8):918-926. · 0.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background and Purpose: The purpose of the present study was to quantify bacterial translocation to mesenteric lymph nodes due to different levels of intraabdominal hypertension (15 vs. 30mmHg) lasting for 24h in a porcine model.
Methods: We examined 18 intubated and anaesthetized pigs (52.3kg SD4.7) over a period of 24 hours. In 6 animals the intraabdominal pressure (IAP) was increased to 30mmHg (IAP-30) using a CO2 insufflator. In the 2nd group IAP was risen to 15mmHg (IAP-15) while IAP remained unchanged in the residual 6 pigs (controls). Standard hemodynamic parameters and blood gases were recorded periodically. Moreover, peripheral and portal vein blood samples were taken for microbiological examinations. Lymph nodes from the ileo-cecal junction were sampled during an intravital laparatomy 24h after the onset of IAH. After sacrifying the animals bowel tissue samples and corresponding mesenteric lymph nodes [MLN] were extracted from small and large bowel for histopathological and microbiological analyses.
Results: Cardiac output decreased in all groups, while CVP significantly rose in both study groups. MAP in the IAP-30 group declined while MAP in the IAP-15 group significantly grew (controls unchanged). PO2 and PCO2 remained unchanged. Depending on the intra-abdominal pressure head, bowel specimen showed an increasing ischemic damage. According to histo-pathological results, the amount of translocated bacterial in intestinal wall specimen as well as in MLN significantly raised with the level of IAH. Gram-positive bacteria were more often identified when compared to Gram-negative species. Lymph node cultures confirmed the dependence of BT to IAP, most often cultivated species were E. coli, Staphylococcus, Clostridium, Pasteurella and Streptococcus. Blood cultures however, only were occasionally positive in all three groups (n.s.) and showed typically gut-derived bacteria such as Proteus, Klebsiella and E. coli .
Conclusion: In this porcine model, a higher ischemic damage and more bacterial translocation was observed in animals subjected to an IAP of 30 mmHg when compared to animals with 15 mmHg or unchanged IAP (controls).
The American surgeon 07/2011; 77(7):S100. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined.
In rats, polypropylene sutures (USP size 1, 3-0 and 7-0) were placed in the subcutis of the abdominal wall without knot or tension. On postoperative days 3, 7 and 21, specimens were excised. The expressions of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 were measured by immunohistochemistry.
In the absence of tension, sutures were surrounded by a foreign body granuloma with an inflammatory infiltrate not encircling the fibre but forming almost symmetric comet-tail-like infiltrates on opposite sides. The expression of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 was significantly reduced over time in the comet tail, but not in the granuloma.
Even in tension-free conditions, surgical sutures cause a foreign body response with infiltrates of inflammatory cells. This reaction is shaped like a comet tail, and its extension depends on the diameter of the used fibre. Therefore, for reduction of perifilamental infiltrates, not only absence of tension is required, but also a small-sized fibre textile.
European Surgical Research 01/2011; 46(2):73-81. · 0.75 Impact Factor
[show abstract][hide abstract] ABSTRACT: Mesh implantation is regarded as the standard treatment of inguinal hernias. Obstructive azoospermia induced by mesh implantation is a rare but serious complication. Whether different operative techniques or mesh materials used have an effect on the integrity of the testicle and spermatic cord remains unclear.
In 12 minipigs a bilateral inguinal hernia repair, either open or laparoscopic, was performed using a standard small-pore polypropylene (PP) or large-pore polyvinyliden fluoride (PVDF) mesh. Next to measurement of the testicular size, thermography of the groin and testicle as a parameter for perfusion was performed preoperatively and at a follow-up at 6 months. Obstructions of the vas deferens were estimated radiographically. Testicular function (Johnson score) and mesh integration (granuloma size, apoptotic cells) were analyzed histologically.
Mean testicular size did not change significantly in follow-up compared to preoperative values. Technique and mesh material used failed to have a significant influence. Thermography of the groin following the Lichtenstein technique had significantly higher values at follow-up regardless of the mesh used. This could not been shown for laparoscopic treatment. Thermographic measurements at the testicle showed a significantly increased temperature in all groups compared to preoperative measurements. Only the Lichtenstein PP group showed significantly decreased values in testicular function. Quantity and quality of obstructions seen at vasography were most detectable in the Lichtenstein PP group. There was significantly decreased granuloma formation following PVDF mesh implantation compared to the PP mesh group regardless of the technique used.
Both the technique and the mesh material have an impact on integrity of spermatic cord and testicular function. According to the results of this study, the laparoscopic TAPP procedure using a large-pore PVDF mesh has the least effect compared to preoperative values.
[show abstract][hide abstract] ABSTRACT: Die Sonographie hat in der Viszeralchirurgie eine weite Verbreitung gefunden und besitzt nicht nur einen hohen Stellenwert
in der apparativen Diagnostik, sondern auch in der interventionellen Anwendung. Hierbei wird zwischen diagnostischen und therapeutischen
Interventionen unterschieden. Die diagnostischen Interventionen umfassen die gezielte Entnahme von Gewebeproben sowie die
Punktion von Flüssigkeitsansammlungen zur mikrobiologischen, zytologischen oder histologischen Untersuchung. Die therapeutischen
Maßnahmen umfassen dauerhafte Drainagen von Abszessen, Empyemen und Ergüssen mit Hilfe von Kathetersystemen sowie unterschiedliche
Techniken zur Ablation von Tumoren und Zysten.
[show abstract][hide abstract] ABSTRACT: Die erste laparoskopische Cholezystektomie 1987 bildete den Startpunkt für einen breiten klinischen Einsatz der Laparoskopie
in der Chirurgie. Geringere postoperative Schmerzen, eine rasche Rekonvaleszenz und bessere Kosmetik faszinierten gleichermaßen
Chirurgen und Patienten und bewirkten eine explosionsartige weltweite Verbreitung laparoskopischer Operationen. Initial engagierten
Enthusiasten vorbehalten sind laparoskopische Operationstechniken heutzutage etablierter und unverzichtbarer Bestandteil des
[show abstract][hide abstract] ABSTRACT: Eosinophilic oesophagitis (EO), primarily a gastro-enterological disease, should be known to the surgeon and endoscopist as a differential diagnosis of dysphagia. We present a chronic and recurrent case of EO. As frequently seen, macroscopic findings are indicative of the causal illness. The diagnosis is finally made by the histological findings of a macroscopically inconspicuous mucosa of the esophagus, which is found in 10% of cases with EO. Random biopsies are necessary for the diagnosis. A short overview of therapy and course and a review of the literature are given.
Der Chirurg 11/2010; 81(11):1026-8, 1030. · 0.52 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anastomotic failure is one of the most frequent complications in abdominal surgery. During anastomotic healing. the strength of the intestinal tissue nearby is closely related to the accumulation of collagen in interlinked scar tissue. This in turn is influenced, among other things, by single groups of matrixmetalloproteinases, especially collagenases (MMP-1, -8, and -13) and gelatinases (MMP-2 and -9). EPO is known to induce the expression of tissue-inhibitor-of-matrixmetalloproteinases-1 (TIMP-1) and thereby to down-regulate MMPs.
We used a rat as an experimental model and applied a high dose of EPO (5U/g BW s.c.), one dose 24 h before operation (as pre-conditioning) and one dose directly after performing a colonic anastomosis. After 3 and after 5 d, respectively, immunohistochemical stainings for MMP-2, -8, and -9 as well as TIMP-1 were carried out and evaluated semiquantitatively for each layer of the colonic wall. Sirius-red staining and cross-polarization microscopy were evaluated and the collagen I/III ratio calculated. Anastomotic and colonic tissue distal to the anastomosis were used to determine collagen content.
We found increased bursting pressure 5 d post-surgery after applying erythropoietin. It was thus shown that EPO influences collagen metabolism and changes the collagen I/III ratio in the colon distal to the anastomosis. The evaluation of immunohistochemistry did not show the expected ubiquitous up-regulation of TIMP-1 and down-regulation of MMPs. Nevertheless, correlations between TIMP-1, MMP-8, and collagen I/III ratio could only be established after the application of EPO.
Contrary to our hypothesis, the picture of TIMP-1 and of the regulation of the MMPs after the application of EPO is not as clear as expected. EPO improves anastomotic bursting strength and the correlation of TIMP-1, MMP-8, and collagen type I/III ratio can only be seen after the application of EPO.
Journal of Surgical Research 10/2010; 163(2):e67-72. · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Repair of giant incisional hernias may lead to an increase in intra-abdominal pressure (IAP) and, sometimes, to abdominal compartment syndrome. Measurement of IAP using Kron's technique (Kron et al. in Ann Surg 199:28-30, 1984) is currently accepted as the gold standard, whereas Harrahill has described a simple measurement setup using urinary drainage manometry (Harrahill in J Emerg Nurs 24:465-466, 1998). The aim of this clinical trail was to evaluate the correlation, reproducibility and effectiveness of this device.
A prospective cohort study was performed in 43 patients undergoing elective standard abdominal intervention with laparotomy. These patients remain under surveillance in the intensive care unit and require a urinary catheter because of the operation. We performed comparative measurements of IAP using both Korn's (IVM) and Harrahill's (UDM) technique.
Evaluating the correlation between the IVM and UDM techniques, we measured median IAPs of 9.8 +/- 4.1 mmHg (2.9-19.9 mmHg) and 10.0 +/- 4.1 mmHg (min-max: 1.5-19.9 mmHg), respectively. Pearson's coefficient of correlation was r = 0.97. The average of difference between UDM and IVM was -0.2 +/- 0.9 mmHg with limits of agreement of -1.7 to 2.0 mmHg. Evaluating the reproducibility of Harrahill's technique, we found median IAPs of 10.4 +/- 2.1 mmHg (min-max: 2.9-19.1 mmHg) and 10.4 +/- 2.7 mmHg (3.7-19.9 mmHg), respectively, in 43 comparative measurements (Pearson's coefficient of correlation, r = 0.97. The average difference between both measurements was -0.1 +/- 1.1 mmHg with limits of agreement of -2.3 to 2.2 mmHg.
We were able to demonstrate good correlation and high reproducibility of IAP measurement using Harrahill's technique compared to the gold standard Korn method. We consider this technique as a suitable method for quick and simple screening test for intra-abdominal hypertension, especially after repair of giant incisional hernias.
[show abstract][hide abstract] ABSTRACT: The incidence of clinically significant anastomotic leaks after upper gastrointestinal surgery is approximately 4 % - 20 %, and the associated mortality can be as high as 80 %. Depending on the clinical presentation, the treatment options are surgery, conservative treatment with external drainage, or endoscopic treatment. This report presents 39 cases of clinically apparent anastomotic leaks or fistulas after surgery for upper gastrointestinal cancers that were treated by endoscopy with insertion of fibrin glue alone (n = 24) or with a combination of Vicryl plug and fibrin glue (n = 15). Thirteen of the 15 patients who underwent Vicryl/fibrin treatments showed complete healing of the anastomotic leak or fistula after one to four sessions. Long-term follow-up results are presented. Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with low morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repeated major surgery and its associated risks.
[show abstract][hide abstract] ABSTRACT: Little is known about species differences in the peripheral nerve system and quantitative evaluation of main tissue components has rarely been done. Nevertheless, animal models are used for example in pain research without exact knowledge of degree of fibrosis in pathological states which would determine possible treatment options. It would therefore be of crucial interest to describe the degree of fibrosis and the remaining functional nerve tissue as exact as possible. In the present study we evaluated collagen (stroma) and nerve fiber (parenchyma) composition of peripheral nerves in three species (human, rat, pig) and used digital colour-separation and analysis for collagen type differentiation and quantification of immuno-positive-stained area. We found similar ratios of collagen types I and III in epineurium and similar immuno-positive area for staining of neurofilament and S-100beta. In contrast, we measured significantly different ratios of collagen type I to type III in the endoneurium. This combined analysis of the main tissue components of peripheral nerves could be an easy-to-use tool in evaluating changes during damage caused by scaring, systemic disease or compression syndromes. The calculated collagen type I/III ratio may serve as an objective diagnostic value for the description or as prognostic marker for therapeutic approaches in peripheral nerve pathology. However, in particular studies of collagen accumulation in nerves, species dependant differences have to be considered.
Journal of neuroscience methods 06/2010; 190(1):112-6. · 2.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: Mesh implants are frequently used in congenital diaphragmatic hernia. This experimental study aimed to examine the influence of different materials on the diaphragmatic movement over time as well as their mechanical qualities after 4 months. Ultrapro®, Surgisis®, and Proceed® were implanted onto a diaphragmatic defect in growing rabbits. Diaphragmatic mobility was determined at three time points. At 4 months, defect shrinkage and mechanical properties were measured. The break strength decreased for Ultrapro® and Surgisis®, but did not change relevantly for Proceed®. Ultrapro® (32.46 N/cm) and Proceed® (31.75 N/cm) showed a four-fold higher resistance to tearing than Surgisis® (8.31 N/cm). The elasticity of Ultrapro® showed no significant difference compared to Surgisis® (p = 0.75). Proceed®, on the other hand, was more than twice as elastic as Ultrapro® or Surgisis® (p = 0.015). Ultrapro® had a higher spring rate (6.48 N/mm) compared to Surgisis® (3.82 N/mm) or Proceed® (5.23 N/mm). Observing the standardized movement rates of the diaphragm for each mesh group over time the only statistical differences were seen for the Proceed® group. On account of its material qualities Ultrapro® was found to be the most suitable mesh material for demanding locations in our model.
Journal of Biomaterials Applications 03/2010; 25(8):771-93. · 2.64 Impact Factor
[show abstract][hide abstract] ABSTRACT: Various techniques for repair of an incisional hernia are available for the surgeon. Conventional suture techniques are quick and easy to perform but they are associated with an unacceptable rate of recurrence and therefore should only be used in exceptional cases. An underlying systemic disturbance of collagen metabolism is assumed to exist in patients with an incisional hernia. In such patients the mechanisms of wound healing and remodeling of the abdominal wall following laparotomy are insufficient, which necessitates reinforcement of the abdominal wall with a non-resorbable alloplastic mesh prosthesis to enable a long-term cure. The implantation of such meshes can be carried out laparoscopically or by an open approach. The gold standard of open repair techniques is the retromuscular placement of a mesh prosthesis. The retromuscular mesh placement as a reinforcement of the abdominal wall (augmentation) must be categorically differentiated into the abdominal wall replacement by mesh bridging. In this technique the mesh is likewise placed in the retromuscular space, however a complete closure of the ventral fascia is not necessary. Retromuscular augmentation enables an extra-peritoneal placement of the prosthesis, an optimization of tissue integration by plane coverage of the prosthesis by well vascularized muscular tissue and a sufficient overlap in cranio-caudal and lateral directions. Mesh fixation is best made with absorbable suture material but is better suited for technical simplification. The use of a prophylactic drainage should be decided depending on the individual patient's risk factors, because sufficient evidence-based data are currently not available. If augmentation is not possible bridging is necessary and then the mesh has to be fixed without underlying support. Current data reveal that the recurrence rate following incisional hernia repair by retromuscular mesh augmentation has decreased promisingly in comparison to simple suture techniques. In total the recurrence rate following retromuscular mesh placement ranges between 2 and 12%. Current results of prospective randomized multicentre trials are not available. However, it is to be expected that further development of mesh materials as well as improvement of surgical techniques with avoidance of typical pitfalls will lead to further reduction of the recurrence rate with an improvement in patient satisfaction.
Der Chirurg 03/2010; 81(3):192-200. · 0.52 Impact Factor