Publications (23)68.46 Total impact
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Article: Assessment of Disease Behavior in Patients with Crohn's Disease by MR Enterography.
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ABSTRACT: BACKGROUND:: Magnetic resonance imaging (MRI) of the bowel is an increasingly used modality to evaluate patients with Crohn's disease. The Montreal classification of the disease behavior is considered as an excellent prognostic and therapeutic parameter for these patients. In our study, we correlated the behavior assessment performed by a radiologist based on MRI with the surgeons' clinical assessment based on the assessment during abdominal surgery. METHODS:: We evaluated 76 patients with Crohn's disease, who underwent bowel resection and had an MRI within 4 weeks before surgery. Radiological behavior assessment was performed by 2 radiologists based on MRI. Behavior was classified into B1 (nonstricturing and nonpenetrating), B2, and B3 (penetrating) disease. Surgical assessment was done by the same surgeon, who performed all bowel resections, based on intraoperative findings and histologic results. RESULTS:: The surgical assessment identified 4 patients (5%) as B1, 16 patients (21%) as B2, and 56 patients (74%) as B3. In 97% (n = 74) of all patients, the intraoperative and radiological assessment were identical with interobserver agreement of 0.937. In one case, B2 was radiological considered as B1, and in another case, B3 was diagnosed as B2. The diagnosis of a stricture had the highest sensitivity of 96%, whereas the detection of inflammatory mass showed the lowest sensitivity of 81%. Abscesses had the lowest positive predictive value of 68% with a specificity of 88%. Best correlation was found for fistulae (0.895). CONCLUSIONS:: MRI represents an excellent imaging modality to correctly assess the Montreal classification-based disease behavior in patients scheduled for bowel resection with Crohn's disease.Inflammatory Bowel Diseases 03/2013; · 4.86 Impact Factor -
Article: Karydakis Flap for Recurrent Pilonidal Disease.
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ABSTRACT: BACKGROUND: Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present retrospective analysis was performed to compare long-term results in patients with recurrent disease undergoing midline excision surgery compared to patients undergoing the Karydakis flap procedure. METHODS: Only patients with previous excision surgery apart from simple abscess incision were included. Disease recurrence was defined as the need for repeat surgery. RESULTS: A total of 124 patients underwent surgery for recurrent pilonidal disease. Group 1 consisted of 37 patients (25 excision + midline closure, 12 excision + lay-open). Group 2 consisted of 87 patients (Karydakis flap). There were no statistically significant differences between the groups with regard to patient's age, duration of disease, body mass index, or sex. The average number of previous surgeries was significantly higher in group 1 patients (2.1 vs. 1.8, p = 0.019). The overall 1-year recurrence rate was 43 % in group 1 and 3 % in group 2 (p < 0.0001). The wound dehiscence rate after the Karydakis flap procedure was as high as 43 % between years 2005 and 2009, but it fell to 10 % thereafter (p = 0.02). CONCLUSIONS: Karydakis flap procedure is superior to midline excision surgery in patients presenting with recurrent pilonidal disease.World Journal of Surgery 02/2013; · 2.36 Impact Factor -
Article: Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection.
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ABSTRACT: Laparoscopic resection of rectal cancer has already become the standard procedure in many hospitals. The splenic flexure mobilization (SFM) is an important preparational step. Several methods are used for laparoscopic SFM; however, studies comparing different approaches are lacking. In the present study, three different approaches for SFM have been compared to each other. Between January 1998 and December 2010, 415 patients with rectal adenocarcinoma underwent laparoscopic rectal resection at one center. Of these, 303 patients received complete splenic flexure mobilization. The SFM was performed using either a medial (SFM-M; n = 41), lateral (SFM-L; n = 214), or anterior (SFM-A; n = 48) approach. There was a significantly higher rate of intraoperative complications in the SFM-L group as compared to the SFM-M or the SFM-A group (p = 0.038). Postoperative surgical complications occurred in 5 (10.6 %) patients of the SFM-A group compared to 38 patients (17.7 %) in the SFM-L group (p = 0.002) and 5 (12.1 %) patients in the SFM-M group (p = 0.037). SFM-L was also associated with a higher frequency of overall postoperative morbidity which was mainly due to wound infection rates (p = 0.001). The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.International Journal of Colorectal Disease 05/2012; 27(11):1521-9. · 2.38 Impact Factor -
Article: Low risk of Clostridium difficile infections in hospitalized patients with inflammatory bowel disease in a German tertiary referral center.
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ABSTRACT: Many reports, mainly from the US and Canada but also a recent report from a center in Europe, have documented the increasing impact of Clostridium difficile infections in patients with inflammatory bowel disease (IBD) during the last years. To determine the prevalence of C. difficile infections in hospitalized IBD patients in a tertiary referral center in Germany, we conducted this retrospective analysis. Data of all IBD in-patients treated due to an acute flare of their IBD at the Department of Internal Medicine I of the University of Regensburg between January 1, 2001, and June 30, 2008, were analyzed. In patients with a concomitant diagnosis of C. difficile infection, further variables such as IBD-related treatment at the time of infection or outcome were examined. In total, 995 in-patients with IBD were treated in this hospital [638 patients with Crohn's disease (CD), 357 with ulcerative colitis (UC)] during the study period. Of these, 279 patients with CD and 242 patients with UC were admitted with an acute flare and suffering from diarrhea and abdominal pain. Only 10 of those were diagnosed as having a concomitant infection with C. difficile. Six patients were female and the median age was 49 years (range: 15-80). Six patients with C. difficile infections suffered from UC and 4 patients from CD, all with previous colonic involvement. Eight patients used immunosuppressive therapies; only 2 patients were treated with antibiotics before infection. In contrast to recent reports from other countries, only a low percentage of hospitalized patients with acute flares of their IBD were identified as having an underlying C. difficile infection in this German tertiary referral center. However, in IBD patients with an acute flare, a concomitant C. difficile infection should be excluded, especially in patients with immunosuppressive treatment and colonic involvement of their disease. Further research is needed to evaluate if regions with different risks of C. difficile infections exist and to find out more about potential reasons for this observation.Digestion 06/2011; 84(3):187-92. · 2.05 Impact Factor -
Article: Treatment of the anastomotic complications in patients with Crohn's disease.
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ABSTRACT: Postoperative anastomotic complications in patients with Crohn's disease undergoing bowel resections have a detrimental influence on the long-term outcome. The aim of this study was to evaluate whether patients' prognosis is affected by various treatment strategies of anastomotic complications. The term anastomosis-related "intraabdominal septic complication" (IASC) was used for anastomotic leaks, intraabdominal abscesses, anastomotic fistula, peritonitis. Only patients with these complications have been included in the study. Outcome parameters were "surgical recurrence" (i.e., need for repeat bowel resections) and "good surgical outcome" (i.e., no death, no surgical recurrence, no stoma, no enterocutaneous fistula). Patients in group 1 were treated by taking the affected anastomosis down and creating an end stoma. The anastomosis has been preserved in patients of group 2. Between 1992 and Aug 2009, IASC occurred after 56 ileocolic resections for ileal disease and after 26 resections for Crohn's colitis. In patients with ileal disease, 5-year surgical recurrence rate was lower (0% vs. 65%, p = 0.0020) and a good surgical outcome was achieved more frequently at 2 years (100% vs. 25%, p = 0.0001) in group 1 than in group 2. There was no significant difference of long-term outcome between groups in patients with Crohn's colitis. In patients suffering anastomotic complications after ileocolic resection for ileal Crohn's disease, the prognosis can be significantly improved by taking down the anastomosis and creating an end ileostomy. Anastomosis can be preserved without an outcome impairment in many patients with Crohn's colitis.International Journal of Colorectal Disease 02/2011; 26(2):239-44. · 2.38 Impact Factor -
Article: Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease.
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ABSTRACT: Severe postoperative intra-abdominal septic complications (IASC) such as an anastomotic leak, intra-abdominal abscess, and fistula are significantly associated with the presence of spontaneous intra-abdominal abscess at the time of laparotomy in patients with Crohn's disease (CD). The purpose of this study was to compare the incidence of severe postoperative IASC in patients undergoing intestinal resections with and without preoperative percutaneous abscess drainage (PAD) before definitive surgery. Using a prospective surgical database, we searched for patients with CD and spontaneous intra-abdominal abscesses who underwent intestinal resection at our hospital from May 2005 to February 2009. Postoperative IASC were defined as anastomotic leaks, abscess, and fistula within 1 month after surgery. We compared the incidence of postoperative IASC in patients with (group I) and without (group II) preoperative PAD (Fisher's exact test). We identified 25 patients (15 men, 10 women; mean age, 31 years) with spontaneous intra-abdominal abscesses. PAD was performed in 12 of 25 patients (48%), with an average of 37 days before surgery (range, 6-83 days). The overall rate of postoperative IASC was 48% (12 of 25 patients). In group I, postoperative IASC occurred in 3 of 12 patients (25%). In group II, postoperative IASC were assessed in 9 of 13 patients (69%). The differences between these two groups were considered to be statistically significant (p = 0.04). PAD of intra-abdominal abscesses before surgery could significantly reduce the occurrence of severe postoperative IASC in patients with CD.International Journal of Colorectal Disease 02/2011; 26(6):769-74. · 2.38 Impact Factor -
Article: Perforating Crohn's ileitis: delay of surgery is associated with inferior postoperative outcome.
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ABSTRACT: A perforating phenotype is associated with an increased postoperative morbidity in patients with Crohn's disease undergoing ileocolic resection. Sequential conservative treatment attempts applied to patients with unrecognized perforating complications may lead to a delay of surgery and a further increase in morbidity. In all, 197 patients underwent 231 bowel resections for perforating ileitis between 1992 and 2009. The duration or clinical deterioration was calculated from the onset of clinical exacerbation unresponsive to any medical treatment to the date of surgery. The median duration of clinical deterioration leading to surgery was 5 months. Patients with preoperative exacerbation lasting for >5 months had a higher number of structures involved in the inflammatory mass (3.3 versus 2.8 structures, P = 0.013), and had a higher probability to take immunosuppressive drugs (26% versus 14%, P = 0.042), budesonide (29% versus 14%, P = 0.009), and a multiple-drug combination (31% versus 16%, P = 0.015) at the time of surgery. Patients with symptoms lasting >5 months prior to surgery had a higher incidence of postoperative septic complications (31% versus 13%, P = 0.002), both by univariate and multivariate analysis. There was a significant increase in duration of preoperative clinical deterioration, size of the inflammatory mass, incidence of preoperative weight loss, intake of immunosuppressants and multiple-drug combination, and postoperative morbidity during the last 5 years of the study. Delay of surgery in patients presenting with symptoms attributable to perforating ileitis is associated with an increased postoperative risk.Inflammatory Bowel Diseases 12/2010; 16(12):2125-30. · 4.86 Impact Factor -
Article: Single-incision retroperitoneoscopic adrenalectomy and single-incision laparoscopic adrenalectomy.
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ABSTRACT: Single-incision surgery is by now practicable in many fields of surgery, including surgery of the adrenal gland. We report on first experience with laparoscopic transperitoneal and retroperitoneoscopic single-incision adrenalectomy. Between September 2009 and February 2010, eight patients underwent single-incision adrenalectomy. Four patients received single-incision retroperitoneoscopic adrenalectomy, and four patients transperitoneal single-incision laparoscopic adrenalectomy. Technical feasibility and perioperative data are presented. All patients had benign adrenal tumors (Conn's adenoma, n = 7; pheochromocytoma, n = 1). Tumor size ranged between 1.2 and 2.4 cm. Mean operation time was 76 minutes for single-incision retroperitoneoscopic adrenalectomy and 82 minutes for single-incision laparoscopic adrenalectomy. Blood loss was irrelevant in both groups. Single-incision adrenalectomy is safe and feasible in appropriate operation time, both by the retroperitoneoscopic technique and by the laparoscopic technique. It is also associated with good cosmetic outcome.Journal of endourology / Endourological Society 11/2010; 24(11):1765-70. · 1.75 Impact Factor -
Article: Fistula-associated anal adenocarcinoma in Crohn's disease.
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ABSTRACT: Adenocarcinoma arising from perianal fistulae in patients with Crohn's disease (CD) is rare. The literature consists mainly of case reports and small series making characterization of this clinical entity difficult. We present 6 patients with CD and fistula-associated anal adenocarcinoma (FAAA) and a systematic review of published series. Retrospective charts were reviewed of 6 consecutive patients with FAAA in CD treated from 1992 through 2007. All available variables of our patients and of all available published cases were included for statistical analysis. All patients treated at our institution had severe perianal CD at presentation. The average age at time of diagnosis was 45.5 years. All patients underwent abdominoperineal resection (APR) and 4 received chemoradiation. Four patients died with metastatic disease, 1 is alive with pelvic recurrence at 55 months, and 1 is alive without evidence of disease at 19 months follow-up. A total of 23 publications including 65 patients (37 female, mean age 53 years) with FAAA were reviewed in our systematic review. The average fistula duration was 14 years. Mean delay of cancer diagnosis was 11 months. APR was performed in 56 patients with an overall 3-year survival rate of 54%. Thirteen of 15 patients with node-positive tumors died with recurrent disease following surgery. Adenocarcinoma arising from long-standing perianal CD fistulae is being increasingly reported. The outcome is poor following operative treatment, especially if perirectal lymph nodes are involved. Periodical cancer surveillance should be performed in all patients with long-standing perianal CD fistulae.Inflammatory Bowel Diseases 02/2010; 16(10):1643-8. · 4.86 Impact Factor -
Article: Laparoscopic TME in rectal cancer--electronic supplementary: op-video.
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ABSTRACT: Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not available. Compared to conventional surgery, the laparoscopic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss (Leung et al., Lancet 363:1187-1192, 2004; Braga et al., Dis Colon Rectum 48:217-223, 2005; Jayne et al., J Clin Oncol 25:3061-3068, 2007; Agha et al., Surg Endosc 22:2229-2237, 2008). The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. With regard of the oncological dimension, the laparoscopic TME technique is not different compared to the open procedure. However, a standardized laparoscopic step-by-step procedure may simplify the operation and can reduce operation time. There are no studies available which compare different types of TME procedures. Most surgeons start the operation left laterally mobilizing the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier, and the identification of the left ureter may be simplified. After multiple workshops and extensive discussion with national and international experts, we developed a standardized laparoscopic "10 step TME procedure." Reviewing the results of laparoscopic TME the studies do not allow firm conclusions as to the questions of whether the safety and efficacy of laparoscopic TME is equal or superior to open TME (Breukink et al. 2006). Actually, we are waiting for large prospective randomized studies comparing laparoscopic TME with the traditional open procedure (Bonjer et al., Dan Med Bull 56:89-91, 2009). Laparoscopic TME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer based on evidence mainly from nonrandomized studies (Breukink et al. 5). In nearly all published studies, the efficacy and technical feasibility of laparoscopic surgery for rectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized laparoscopic TME technique can be strongly recommended.Langenbeck s Archives of Surgery 02/2010; 395(2):181-3. · 1.81 Impact Factor -
Article: Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.
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ABSTRACT: A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically.Journal of vascular and interventional radiology: JVIR 05/2009; 20(4):533-6. · 1.81 Impact Factor -
Article: Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis.
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ABSTRACT: We present three cases of patients (at the age of 56 years, 49 years and 74 years respectively) with severe acute pancreatitis (SAP), complicated by intra-abdominal compartment syndrome (ACS) and respiratory insufficiency with limitations of mechanical ventilation. The respiratory situation of the patients was significantly improved after decompression laparotomy (DL) and lung protective ventilation was re-achieved. ACS was discussed followed by a short review of the literature. Our cases show that DL may help patients with SAP to recover from severe respiratory failure.World Journal of Gastroenterology 10/2008; 14(35):5467-70. · 2.47 Impact Factor -
Article: Intraabdominal septic complications following bowel resection for Crohn's disease: detrimental influence on long-term outcome.
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ABSTRACT: A number of studies deal with factors affecting postoperative recurrence; however, they do not analyze the influence of postoperative morbidity on the long-term outcome. This was the aim of the present study. Two hundred eighty-two patients underwent 331 intestinal resections for primary or recurrent Crohn's disease between 1992 and 2005. Closure of ileostomy or colostomy, isolated stricturoplasty, abdominoperineal resection for perianal disease, and reoperations for postoperative complications were excluded. "Surgical recurrence" was defined as a development of stricturing or perforating disease necessitating repeat surgical therapy. Anastomotic leak, intraabdominal abscess, enterocutaneous fistula (intraabdominal septic complications, IASC) occurred after 46 operations (16%). Four patients died (1.2%). By multivariate analysis, articular disease manifestation (p = 0.03), duration of symptoms leading to surgery (p = 0.009), and weight loss (p = 0.03) were associated with occurrence of postoperative complications. Surgical recurrence occurred following 86 bowel resections, and 36 occurred during the first postoperative year. The following factors were associated with an increased risk of surgical recurrence by multivariate analysis: postoperative IASC (p = 0.0002) and previous bowel resections (p = 0.002). Patients suffering IASC had statistically significantly higher 1-, 2-, 5-, and 10-year surgical recurrence rate (25%, 29%, 50%, and 57%) than patients without IASC (4%, 7%, 19%, and 38%, p = 0.0003). The incidence of the postoperative IASC is predominantly determined by preoperative disease severity. IASC have a detrimental influence on the long-term outcome following intestinal resections in patients with Crohn's disease, leading to increased number of repeat resection surgery.International Journal of Colorectal Disease 09/2008; 23(12):1167-74. · 2.38 Impact Factor -
Article: Combination of hand-assisted and laparoscopic proctocolectomy (HALP): Technical aspects, learning curve and early postoperative results.
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ABSTRACT: Various techniques for laparoscopic proctocolectomy have been reported worldwide. We evaluated the technical aspects and early postoperative results of hand-assisted laparoscopic proctocolectomy (HALP) with construction of an ileal pouch-anal anastomosis through a Pfannenstiel incision. Between June 2004 and May 2006, 20 patients (median age 28 years) underwent combined HALP at our institution. Preoperative diagnosis included ulcerative colitis (n = 16), indeterminate colitis (n = 1), familial adenomatous polyposis (n = 2), and carcinoma of the rectum associated with ulcerative colitis (n = 1). All patients were under immunosuppressive therapy. Laparoscopic mobilisation of rectum, sigmoid and descending colon was performed first. Subsequently, hand-assisted laparoscopic mobilization of the transverse and ascending colon as well as creation of an ileal J-pouch were performed through a Pfannenstiel incision. Ileal pouch-anal anastomosis was completed by transrectal stapling device and protected by a loop ileostomy. The ileal pouch-anal anastomosis could be achieved in 19 cases (95%). There was one conversion (5%) to open surgery with construction of an end-ileostomy. No intraoperative blood transfusions were necessary. The median operating time was 210 minutes (range 180 min to 330 min). It was longer for the first five procedures but then remained constant. Two patients (10%) developed anastomotic leakage, which could be treated conservatively. Mean length of hospital stay was 11 days (range 7-32 days). Combined HALP with construction of an ileal J-pouch-anal anastomosis can be performed safely and effectively. The Pfannenstiel incision proved to be advantageous for hand-assisted mobilisation of the transverse colon. Additionally, it was useful for the specimen removal and the J-pouch construction. Our new technique not only proved to be safe, but also resulted in a shortened total operation-time after a learning curve of about five procedures.Surgical Endoscopy 07/2008; 22(6):1547-52. · 4.01 Impact Factor -
Article: Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients.
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ABSTRACT: The efficacy and feasibility of laparoscopic resection for rectal cancer has been proved, but the results of prospective, randomized studies are not yet available. Here we present a prospective observational study evaluating oncological and clinical outcome after laparoscopic surgery in patients with rectal cancer. Between January 1998 and March 2005, 225 patients with rectal adenocarcinoma underwent laparoscopic surgery at the University of Regensburg Medical Center. Clinical and oncological outcome of these patients including perioperative and long-term complications was evaluated. Survival curves were calculated according to the Kaplan-Meier method. Minimum follow-up was 24 months. The distribution of the International Union against Cancer (UICC) stages was: 37.7% stage I, 20.5% stage II, 24.9% stage III, and 16.9% stage IV. Local recurrence was diagnosed in 5.8% and distant metastases in 8.1% of cases after mean follow-up of 36.4 months. The 5-year overall survival rate was 75.7% after curative and 40.7% after palliative surgery (p<0.05). The stage-related survival rates were 86.7% for UICC stage I, 61.7% for stage II, 68.1% for stage III, and 40.1% for stage IV. Our results demonstrate the efficacy and technical feasibility of laparoscopic surgery for rectal cancer regarding the perioperative morbidity and the oncological outcome.Surgical Endoscopy 07/2008; 22(10):2229-37. · 4.01 Impact Factor -
Article: Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. Assessment of factors affecting patients' survival.
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ABSTRACT: Metastases of renal cell carcinoma (RCC) to the thyroid gland are uncommon. There is no clear consensus regarding the role of surgery in metastatic disease to the thyroid since most clinical studies include small numbers of patients. Also, risk factors associated with disease progression following thyroidectomy are not yet defined. We examined the determinants of the outcome in patients undergoing surgery for thyroid metastases of RCC. The medical records of 45 patients undergoing resection of thyroid metastases of RCC at 15 institutions in Germany and Austria were reviewed retrospectively. The outcome parameters assessed were overall survival and tumor-related survival. Factors associated with disease progression following thyroid surgery have been calculated. The overall 5-year survival rate following thyroid metastasectomy was 51%. Nineteen patients died during the study: 14 of disseminated disease and 5 of non-tumor-related causes. In the multivariate analysis, the prognosis was significantly worse in patients older than > or = 70 years and in patients who had undergone nephrectomy for metastases in the contralateral kidney during the course of the disease. Nine patients developed a thyroid recurrence following surgery. No local disease relapse occurred if resection margins were documented to be free of the tumor. Of the 45 patients with thyroid metastases, 14 (31%) developed pancreatic metastases during the course of disease. Ten of these patients also underwent pancreatic surgery with a 5-year survival rate of 43% in this subgroup. The overall survival of patients undergoing thyroidectomy for metastases of RCC is affected rather by general health status than by tumor-related factors. There is a significant coincidence of thyroid and pancreatic metastases of RCC.Thyroid 06/2008; 18(6):615-24. · 4.79 Impact Factor -
Article: Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn's disease.
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ABSTRACT: Local surgical procedures in the presence of Crohn's disease have a markedly reduced success rate, especially in the treatment of recurrent anovaginal and distant rectovaginal fistulas. In these patients, local surgery (e.g., flap closure) has unsatisfactory results if the anal canal is destroyed by ulceration and indurations or in patients with extensive defects of the perineum. Over a period of 6 years (2000 to 2006), 12 patients with recurrent rectovaginal fistulas were treated with graciloplasty. The age of the female patients ranged from 24 to 47 years, the mean age being 38 years. The presence of Crohn's disease in all patients had a mean duration of 12 years. Corticosteroids, mesalazin, or azathioprin were administered preoperatively. All patients were diverted by a temporary ileostomy before graciloplasty. RESULTS Rectovaginal fistula was closed in 11 of 12 patients after graciloplasty with a mean follow-up of 3.4 years. One rerecurrence of a rectovaginal fistula was documented. One of 12 ileostomies was not closed due to persistence of the fistula tract. One patient had a pouch-anal and, additionally, a pouch-vaginal fistula. In this patient, the first transposition of the gracilis muscle was unsuccessful. After a few months, she underwent renewed graciloplasty. There was no recurrence of a fistula within the follow-up period. Reconstruction of the perineum constituted an additional positive effect of the graciloplasty. In one patient, the preexisting fecal incontinence persisted, even after secondary implantation of a pacemaker. Due to diarrhea and persistent fecal incontinence, the patient opted for a renewed ileostomy. In our series, gracilis transposition in the treatment of recurrent anovaginal and rectovaginal fistulas in patients with Crohn's disease has excellent short-term results. In addition, graciloplasty can reconstruct the perineal defect.International Journal of Colorectal Disease 05/2008; 23(4):349-53. · 2.38 Impact Factor -
Article: Phase I-II trial of cetuximab, capecitabine, oxaliplatin, and radiotherapy as preoperative treatment in rectal cancer.
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ABSTRACT: To evaluate the safety and activity of preoperative radiotherapy (RT) with concurrent cetuximab, capecitabine, and oxaliplatin in rectal cancer patients. A total of 60 patients with rectal cancer (T3-T4 or N+, M1 allowed) entered the trial at five investigator sites; the data from 58 patients were assessable. Cetuximab was given as an initial dose of 400 mg/m2 7 days before the start of RT, and then at 250 mg/m2 once weekly during RT (50.4 Gy in 28 fractions). Capecitabine and oxaliplatin were administered according to an established schedule of oxaliplatin (50 mg/m2 on Days 1, 8, 22, and 29) and capecitabine (Days 1-14 and 22-35) at three dose levels: 1,000, 1,300, and 1,650 mg/m2/d during the Phase I part of the study. The main endpoint of the Phase II was the pathologic complete response rate. Thirteen patients were included in the Phase I part of the study, and the maximal tolerated dose was not reached. Overall, 48 patients were treated at the recommended dose of capecitabine (1,650 mg/m2) and 45 patients (94%) underwent surgery. A pathologic complete response was observed in 4 patients (9%), and moderate (n=12), minimal (n=10), and no tumor regression (n=2) was noted in 24 (53%) of 45 patients. The mean radiation dose intensity, cetuximab, capecitabine, oxaliplatin was 98%, 95%, 94%, and 94%, respectively. The incidence of Grade 3-4 diarrhea was restricted to 19%. Postoperative complications of any grade occurred in 33% of patients. The results of our study have shown that cetuximab can be combined safely with capecitabine and oxaliplatin plus RT. The low pathologic complete response rate achieved should stimulate additional preclinical investigations to establish the best sequence of triple combinations.International Journal of Radiation OncologyBiologyPhysics 04/2008; 70(4):1081-6. · 4.11 Impact Factor -
Article: Surgical treatment of substernal goiter: an analysis of 59 patients.
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ABSTRACT: Substernal goiter is defined as a thyroid mass of which more than 50% is located below the thoracic inlet. In this article we report the diagnosis, symptoms, thyroid function, treatment, and postoperative complications of 59 patients with substernal goiter. Between 1992 and 2005, 59 patients underwent surgery for substernal goiter at our institution. The indications for surgery were multinodular goiter in 46 cases, follicular adenoma in two cases, and Hashimoto's thyroiditis in one case. Ten patients were operated on for recurrent thyroid disease. The leading preoperative symptoms were dyspnea (49.2%), dysphagia (13.6%), hyperhidrosis (10.2%), and cardiac dysfunction (6.8%). All but two thyroid glands could be removed through a Kocher transverse collar incision. The most common postoperative complications were persistent (5.1%) or temporary (3.4%) paresis of the recurrent laryngeal nerve, transient hypocalcemia (3.4%), and hematoma (3.4%). A tracheotomy was required in one patient with bilateral vocal cord paresis (1.7%). (1) We conclude that a subtotal thyroidectomy is also the treatment of choice for asymptomatic benign substernal goiter. (2) Transverse collar incision should be the standard approach for most patients. (3) The visual identification of at least two parathyroid glands is essential to prevent permanent postoperative hypoparathyroidism.Surgery Today 02/2008; 38(6):505-11. · 1.22 Impact Factor -
Article: Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome
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ABSTRACT: BackgroundA number of studies deal with factors affecting postoperative recurrence; however, they do not analyze the influence of postoperative morbidity on the long-term outcome. This was the aim of the present study. Materials and methodsTwo hundred eighty-two patients underwent 331 intestinal resections for primary or recurrent Crohn’s disease between 1992 and 2005. Closure of ileostomy or colostomy, isolated stricturoplasty, abdominoperineal resection for perianal disease, and reoperations for postoperative complications were excluded. “Surgical recurrence” was defined as a development of stricturing or perforating disease necessitating repeat surgical therapy. ResultsAnastomotic leak, intraabdominal abscess, enterocutaneous fistula (intraabdominal septic complications, IASC) occurred after 46 operations (16%). Four patients died (1.2%). By multivariate analysis, articular disease manifestation (p = 0.03), duration of symptoms leading to surgery (p = 0.009), and weight loss (p = 0.03) were associated with occurrence of postoperative complications. Surgical recurrence occurred following 86 bowel resections, and 36 occurred during the first postoperative year. The following factors were associated with an increased risk of surgical recurrence by multivariate analysis: postoperative IASC (p = 0.0002) and previous bowel resections (p = 0.002). Patients suffering IASC had statistically significantly higher 1-, 2-, 5-, and 10-year surgical recurrence rate (25%, 29%, 50%, and 57%) than patients without IASC (4%, 7%, 19%, and 38%, p = 0.0003). ConclusionThe incidence of the postoperative IASC is predominantly determined by preoperative disease severity. IASC have a detrimental influence on the long-term outcome following intestinal resections in patients with Crohn’s disease, leading to increased number of repeat resection surgery.International Journal of Colorectal Disease 01/2008; 23(12):1167-1174. · 2.38 Impact Factor
Top co-authors
Top Journals
Institutions
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2007–2012
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Universitätsklinikum Regensburg
Regensburg, Bavaria, Germany
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2008–2010
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Caritas-Krankenhaus St. Josef
Regensburg, Bavaria, Germany
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2005–2010
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Universität Regensburg
- Lehrstuhl für Chirurgie
Regensburg, Bavaria, Germany
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