Michael Boettcher

University Medical Center Mannheim · Pediatric Surgery

Thrombosis and inflammation cooperate in the development of intestinal infarction. Recent studies suggest that extracellular DNA released by damaged cells or neutrophils in form of extracellular traps (NETs) contributes to organ damage in experimental models of ischemia-reperfusion injury. Here we compared the therapeutic effects of targeting fibri...

Background: Infants with ileostomies often suffer from sodium depletion, ultimately leading to a failure to thrive. Moreover, early-infantile microbial dysbiosis may potentially aggravate weight faltering. Given that sodium supplementation has been used to restore weight gain and feeding practices largely determine infantile microbiota, the current...

Extracellular chromatin, for example in the form of neutrophil extracellular traps (NETs), is an important element that propels the pathological progression of a plethora of diseases. DNA drives the interferon system, serves as autoantigen, and forms the extracellular scaffold for proteins of the innate immune system. An insufficient clearance of e...

Introduction Severe burns cause unique pathophysiological alterations especially on the immune system. A murine scald model was optimized as a basis for the understanding of immunological reactions in response to heat induced injury. The understanding of the roles of neutrophil extracellular traps (NETs) and DNases will support the development of n...

Hintergrund: Komplexe Fehlbildungen erfordern eine ressourcenintensive Versorgung. Vergütungsmuster der korrektiven Fehlbildungschirurgie wurden vor dem Hintergrund der Versorgungslandschaft bisher nicht analysiert. Methoden: Krankenhausabrechnungsdaten zu Korrekturoperationen von zehn ausgewählten komplexen Fehlbildungen von 2020–2022 wurden anal...

Worldwide, 150 children are born each day with congenital diaphragmatic hernia (CDH), a diaphragmatic defect with concomitant abnormal lung development. Patients with CDH with large defects are particularly challenging to treat, have the highest mortality, and are at significant risk of long-term complications. Advances in prenatal and neonatal tre...

Background: Abdominal tumors rarely occur in childhood but are associated with great psychological stress for patients and their families. Parents playing a central role in their children’s treatment may experience adverse effects on their Health-Related Quality of Life (HRQoL) and mental health due to the children’s illness and required treatment....

Hirschsprung’s disease (HSCR, incidence 1/5000 live births) is caused by the failure of neural crest-derived precursors to migrate, survive, proliferate, or differentiate during the embryonic development of the Enteric Nervous System (ENS), which could be disrupted by many factors, including inflammatory processes. The NF-κB family controls several...

Tuberculosis (TB) remains one of the top 10 causes of death worldwide and still poses a serious challenge to public health. Recent attention to neutrophils has uncovered unexplored areas demanding further investigation. Therefore, the aim of this study was to determine neutrophil activation and circulatory neutrophil extracellular trap (NET) format...

Necrotizing enterocolitis (NEC) is one of the most devasting diseases affecting preterm neonates. However, despite a lot of research, NEC’s pathogenesis remains unclear. It is known that the pathogenesis is a multifactorial process, including (1) a pathological microbiome with abnormal bacterial colonization, (2) an immature immune system, (3) ente...

Purpose: Congenital diaphragmatic hernia (CDH) affects 1 in 3000-5000 newborns. In survivors, long-term complications include gastroesophageal reflux (GER), feeding difficulties, and failure to thrive. Data from the parents' perspective remain scarce. This study aims to report the prevalence and impact of feeding difficulties on CDH families after...

Background/Objectives: In patients diagnosed with uncomplicated acute appendicitis (UAA), the absence of calcified deposits or stones, called appendicoliths, often leads to consideration of non-operative treatment (NOT), despite the notable treatment failure rate associated with this approach. Previous research has indirectly estimated the prevalen...

Pediatric thermal injuries can have profound physical and psychological effects. Long-term care, including wound dressing selection, significantly impacts outcomes. This study compared treatment related variables and long-term results of bacterial nanocellulose (BNC) and polyurethane foam (PU-foam) dressings in pediatric burn care.

Hirschsprung disease (HSCR, incidence 1/5000 live births) is caused by failure of neural crest-derived precursors to migrate, survive, proliferate or differentiate during the embryonic development of the Enteric Nervous System (ENS), which could be disrupted by many factors, in-cluding inflammatory processes. The NF-κB family controls several biolo...

Chimeric antigen receptor (CAR) T cell therapy has effectively complemented the treatment of advanced relapsed and refractory hematological cancers. The remarkable achievements of CD19- and BCMA-CAR T therapies have raised high expectations within the fields of hematology and oncology. These groundbreaking successes are propelling a collective aspi...

Introduction Abdominal adhesions following surgery can lead to complications like intestinal obstruction and pelvic pain. While no molecular therapies currently target the underlying adhesion formation process, various barrier agents exist. 4DryField® has shown promise in reducing bleeding and adhesions in adults. This study aimed to assess its eff...

Post-surgical abdominal adhesions, although poorly understood, are highly prevalent. The molec-ular processes underlying their formation remain elusive. This review aims to assess the rela-tionship between neutrophil extracellular traps (NETs) and the generation of postoperative perito-neal adhesions and to discuss methods for mitigating peritoneal...

Necrotizing enterocolitis (NEC) is a leading cause of neonatal death and long-term morbidity, involving complex pathophysiology including prematurity, abnormal bacterial colonization, and ischemia-reperfusion injury, partially mediated by neutrophils. However, development of targeted therapies for NEC is hindered by the limitations of current anima...

Objective: We aim to provide a template structured report of fetal Magnetic Resonance Imaging in congenital diaphragmatic hernia (CDH) that was locally validated by the CDH study group in Mannheim. Methods: A selection of 50 fetal MRIs of patients with an isolated diaphragmatic, hernia and associated radiology reports from five different senior rad...

Despite limited research, existing studies using generic quality of life (QOL) tools indicatedecreased physical health and compromised emotional functioning in children with IF. This studyinvestigates QOL in children with short bowel syndrome (SBS) and its determinants. The studyincluded 57 pediatric patients with SBS treated at Mannheim’s Universi...

A better understanding of the function of neutrophil extracellular traps (NETs) may facilitate the development of interventions for sepsis. The study aims to investigate the formation and degradation of NETs in three murine sepsis models and to analyze the production of reactive oxygen species (ROS) during NET formation. Murine sepsis was induced b...

Background: Pleural effusion and chylothorax are common complications in the treatment of congenital diaphragmatic hernia (CDH). We set out to identify risk factors for chylothorax development in patients with CDH and to investigate the association of pleural effusion and chylothorax with neonatal morbidity and mortality. Methods: In this retrospec...

This comprehensive review examines the role of Neutrophil Extracellular Traps (NETs) in pediatric surgery. Focusing on NET formation, functions, and implications, this study highlights their dual impact in infection control and contribution to tissue damage after surgery. It covers the role of NET formation in a range of pediatric conditions includ...

This comprehensive review examines the role of Neutrophil Extracellular Traps (NETs)in pediatric surgery. Focusing on NET formation, functions, and implications, this study highlightstheir dual impact in infection control and contribution to tissue damage after surgery. It covers therole of NET formation in a range of pediatric conditions including...

Purpose CITED2 both modulates lung, heart and diaphragm development. The role of CITED2 in the pathogenesis of congenital diaphragmatic hernia (CDH) is unknown. We aimed to study CITED2 during abnormal lung development in the nitrofen model. Methods Timed-pregnant rats were given nitrofen on embryonic day (E) 9 to induce CDH. Fetal lungs were harv...

Background: Defining risk factors for long-term comorbidities in patients after neonatal repair of congenital diaphragmatic hernia (CDH) is an important cornerstone of the implementation of targeted longitudinal follow-up programs. Methods: This study systematically assessed serial chest radiographs of 89 patients with left-sided CDH throughout a...

Introduction Neutrophil extracellular traps (NETs) have various beneficial and detrimental effects in the body. It has been reported that some bacteria may evade the immune system when entangled in NETs. Thus, the aim of the current study was to evaluate the effects of a combined DNase and antibiotic therapy in a murine model of abdominal sepsis....

Objective: Fetal magnetic resonance imaging (MRI) is broadly used as a method for assessing prognosis in congenital diaphragmatic hernia (CDH). In addition to the extent of lung hypoplasia, determined by measuring the lung volume, cardiac impairment due to pulmonary hypertension and left cardiac hypoplasia is decisive for the prognosis. The percen...

A study in Germany found appendicoliths in 71 % of acute appendicitis cases, suggesting the prevalence in former studies is underestimated. Improved detection methods revealed higher rates of appendicoliths in complicated cases, correlating with severe outcomes and longer hospital stays, indicating a need for revised diagnostic protocols. DOI: 10....

Purpose: Children with congenital diaphragmatic hernia suffer from long-term morbidity, in-cluding lung function impairment. Our study aims to analyze lung morphology characteristics via radiomic-assisted extraction of lung features in patients after congenital diaphragmatic hernia repair. Materials and Methods: 72 patients were retrospectively ana...

Background: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic laparoschisis (FETO-LAP). Case summary: A life-threaten...

(1) Background: Embryonal abdominal tumors are one of the most common entities of solid childhood cancer types. Our study aims to assess the psychosocial situation of affected children to get a comprehensive picture of their health status and uncover a possible gap in healthcare. (2) Methods: The sample consisted of 54 children who were treated for...

Peritoneal adhesions are a poorly understood but highly prevalent conditions that can cause intestinal obstruction and pelvic pain requiring surgery. While there is consensus that stress-induced inflammation triggers peritoneal adhesions, the molecular processes of their for-mation still remain elusive. We performed murine models and analyzed huma...

Eine multizentrische, randomisierte, kontrollierte Studie in Schweden Metabolic and bariatric surgery in comparison to intensive nonsurgical treatment in adolescents with severe obesity A multicenter randomized controlled study in Sweden

(1) Background: As increases in intra-abdominal pressure (IAP) result in irreversible tissue damage, monitoring IAP in critically ill patients using the common urinary bladder catheter method is essential. However, this method can result in complications and is not suitable for very low birth weight neonates. The aim of this study was to establish...

Abstract Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with thoracic constriction (defined as elevated Haller-Index > 3.25 determined by cardiac magnetic resonance imaging (CMR)) without visible evidence of PE, leading to similar compl...

Neutrophil extracellular traps (NETs) are associated with various diseases, and immunofluorescence is often used for their visualization. However, there are various staining protocols, and, in many cases, only one type of tissue is examined. Here, we establish a generally applicable protocol for staining NETs in mouse and human tissue.

Introduction: Pediatric surgeons have yet to reach a consensus whether a gastric sleeve pull-up or delayed primary anastomosis for the treatment of esophageal atresia (EA), especially of the long-gap type (LGEA) should be performed. Thus, the aim of this study was to evaluate clinical outcome, quality of life (QoL), and mental health of patients wi...

Early life is characterized by extraordinary challenges, including rapid tissue growth and immune adaptation to foreign antigens after birth. During this developmental stage, infants have an increased risk to immune-mediated diseases. Here, we demonstrate that tissue-resident, IL-13 and IL-4-producing ILC2s are enriched in human infant intestines c...

Necrotizing enterocolitis (NEC) continues to be one of the most common causes of mortality and morbidity in preterm infants. Although not fully elucidated, studies suggest that prematurity, formula feeding, imbalanced vascular supply, and altered bacterial colonization play major roles in the pathogenesis of NEC. NEC is characterized by increased c...

Background: Severe infections that culminate in sepsis are associated with high morbidity and mortality. Despite continuous efforts in basis science and clinical research, evidence based-therapy is mostly limited to basic causal and supportive measures. Adjuvant therapies often remain without clear evidence. The objective of this study was to eval...

Objective To evaluate the utilization of double-J stents in children with congenital hydronephrosis in order to avoid or postpone more invasive surgical intervention. Numerous studies have demonstrated that congenital hydronephrosis caused by ureteropelvic junction obstruction (UPJO) or primary obstructive megaureter (POM) may require a surgical co...

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 10...

Almost 2 years into the pandemic and with vaccination of children significantly lagging behind adults, long-term pediatric humoral immune responses to SARS-CoV-2 are understudied. The C19.CHILD Hamburg (COVID-19 Child Health Investigation of Latent Disease) Study is a prospective cohort study designed to identify and follow up children and their ho...

In the western world, mutilating hand injuries such as amputations and severe avulsions are more common in the working population than in children (Pomares G et al. Orthop Traumatol Surg Res 2018; 104: 273–276). An epidemiologic retrospective study from France identified 1715 traumatic upper-limb amputations over a 10-years period with the majority...

Thermische Verletzungen im Kindesalter sind häufig und insbesondere Kleinkinder sind gefährdet. Behandelnde Ärzte stehen oft vor Fragen und Herausforderungen. Was kann am- bulant, was muss stationär therapiert werden? Welche Wundauflage ist geeignet, welcher Verlauf normal? Wann sollte die Zuweisung in ein Schwerbrandverletztenzentrum erfolgen? Auf...

Background Inguinal hernia repair is one of the most common operations in children. To improve outcome, several techniques are used. However, it has not been established if the open or the closed hernia sac preparation technique is superior in (premature) neonates and older children. Methods Retrospective study including all cases of inguinal hern...

One potential comorbidity after congenital diaphragmatic hernia (CDH) is gastroesophageal reflux (GER), which can have a substantial effect on patients’ quality of life, thriving, and complications later in life. Efforts have been made to reduce gastroesophageal reflux with a preventive anti-reflux procedure at the time of CDH repair. In this follo...

Since there are no data available on the influence of the time point of ECMO initiation on morbidity and mortality in patients with congenital diaphragmatic hernia (CDH), we investigated whether early initiation of ECMO after birth is associated with a beneficial outcome in severe forms of CDH. All neonates with CDH admitted to our institution betw...

Since there are no data available on the influence of the time point of ECMO initiation on morbidity and mortality in patients with congenital diaphragmatic hernia (CDH), we investigated whether early initiation of ECMO after birth is associated with a beneficial outcome in severe forms of CDH. All neonates with CDH admitted to our institution betw...

Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerb...

Background Severe infections that culminate in sepsis are associated with high morbidity and mortality. Despite continuous efforts in basis science and clinical research, evidence based-therapy is mostly limited to basic causal and supportive measures. Adjuvant therapies, often remain without clear evidence. The objective of this study was to evalu...

Introduction: The lockdown caused by the SARS-CoV-2 coronavirus has prompted drastic public health measures by governmental organizations which impacted especially daily life for children around the world. The aim of this study was to investigate the effect of closure of schools and kindergarten as well as restriction of leisure activities on the e...

In patients with congenital diaphragmatic hernia (CDH) postoperative small bowel obstruction (SBO) is a life-threatening event. An incidence of 20% and an association with patch repair and ECMO-treatment have been reported. Adhesions develop due to peritoneal damage and underly various biochemical and cellular processes. This longitudinal cohort st...

The aim of this paper is to assess the effectiveness and perioperative complications of splenic surgeries in children. In 41 splenectomies, an anterior abdominal laparoscopic approach was used, with 35 including a partial laparoscopic splenectomy. Of these, three needed a conversion to open. Six patients had a total splenectomy, three of which were...

Hirschsprung disease (HSCR) or aganglionic megacolon is characterized by congenital absence of intrinsic innervation, due to deficits in either migration or proliferation of the intrinsic neural stem cells. Despite surgical intervention, children´s quality of life is significantly reduced and the identification of a better therapy remains a major c...

CAR T cell therapy has revolutionized immunotherapy in the last decade with the successful establishment of chimeric antigen receptor (CAR)-expressing cellular therapies as an alternative treatment in relapsed and refractory CD19-positive leukemias and lymphomas. There are fundamental reasons why CAR T cell therapy has been approved by the Food and...

Background : Several motor learning models have been used to teach highly complex procedural skills in medical education. Two approaches are often employed amongst health care professionals: Halsted’s “See one - do one – teach one” concept and Peyton’s Four-step approach. Peyton’s deconstruction of the learning process into 4 sub-steps was reported...

Background: Currently, a range of different antibiotics are administered perioperatively during appendectomy surgery in the pediatric population. One reason for the lack of a uniform treatment regimen is the paucity of large studies on microbiologic data and susceptibility patterns. Methods: A retrospective, monocentric study on antibiotic susce...

Introduction: Surgical complications occur in up to third of children, limiting the benefits of tunneled central venous catheters (tCVCs) in children. We aimed to identify risk factors for complications related to catheter implantation. Methods: All children and adolescents undergoing tCVC implantation at a single center over a period of 9 years...