Christian D Klink

RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany

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Publications (65)119.56 Total impact

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    ABSTRACT: Background: Rectovaginal fistula is an extremely distressing condition for the patients. There is still no generally accepted standard surgical treatment strategy. Especially the influence of diversion stoma creation on patients' outcome remains controversial. Thus, the aim of this study was to analyze the influences of diversion stoma on the outcome of patients treated because of rectovaginal fistula with special regard to perioperative complications and recurrence rates. Methods: Between 2003 and 2013, all patients treated due to rectovaginal fistula in our institutions were retrospectively analyzed. A total of 81 procedures were performed in 62 patients. Procedures were divided into two groups depending on the presence of a diversion stoma or not (diversion stoma, n=42 vs. no stoma, n=39). Results: The overall rate of fistula recurrence was 44 % without statistical significance in-between the study groups (49 vs. 38 %; p = 0.603). Diversion stoma had no influence on complication rates, wound infections or number of operative revisions. Patients treated with diversion stoma had significantly higher ASA-scores (2.6 ± 0.6 vs. 2.1 ± 0.8; p = 0.011), higher rates of malignoma (58 vs. 17 %; p = 0.001) and larger sizes of fistula (1.67 ± 0.08 vs. 1.51 ± 0.46 mm; p = 0.012). The in-hospital stay was significantly longer in these patients (30 ± 66 vs. 15 ± 15 days; p = 0.023). Conclusions: Our data suggest that diversion stoma creation does not influence the outcome of patients with rectovaginal fistula with special regard to rates of fistula recurrence. On the other hand it is mainly used in complex cases of sick patients and larger fistula sizes. Prospective clinical studies need to be conducted to reinforce these findings.
    No preview · Article · Dec 2015 · International Journal of Surgery (London, England)
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    ABSTRACT: High suture tension is one of the causes for many wound-healing problems. Constriction of tissue within the suture loops of nonelastic sutures can lead to cutting of the suture through tissues and necrosis of the tissue within these loops. The use of elastic materials in new suture types could give the material the ability to adapt tension to the tissue requirements and subsequently lead to more vital tissue within its loops. We evaluated the foreign body host response, as indicator of biocompatibility, to a new thermoplastic poly(carbonate) urethane (TPU) synthetic suture material in a rat model compared with standard nonelastic polypropylene (PP) sutures. Tissue samples were collected at 7 and 21 days, and host response was evaluated. Subsequently, suture tension curves of the new elastic sutures for the first 30 min after knotting were recorded in a pig model. The new TPU sutures showed an improved foreign body response when compared with that of PP, with a reduction in the amount of macrophages surrounding the material. Tension experiments showed a superior tension curve for TPU sutures, with a major reduction in peak suture tension when compared with that of standard PP sutures, while still retaining adequate tension after 30 min. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2015.
    No preview · Article · Oct 2015 · Journal of Biomedical Materials Research Part B Applied Biomaterials
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    ABSTRACT: Background: Postsurgical adhesions severely affect the patients' quality of life causing various complications like bowel obstruction or chronic pain. Especially the implantation of alloplastic prostheses in IPOM position for hernia repair carries a high risk of adhesion formation due to the close contact between mesh and viscera. The extent of adhesions mainly depends on the type and textile characteristics of the implanted mesh. The aim of this study was to examine the degree of adhesion formation of a newly developed, elastic thermoplastic polyurethane (TPU) mesh in comparison to polypropylene (PP) meshes in IPOM position in a rabbit model. Methods: Sixteen female chinchilla rabbits were laparoscopically operated. Two different meshes were placed to the left and the right lower abdominal wall in IPOM position in each rabbit. After 7 or 21 days, midline laparotomy was performed, the degree of adhesion formation was examined by the Diamond score and mesh elongation was measured under a force of 3N. Finally, the abdominal walls were explanted for immunohistochemical and histopathological investigations. Results: TPU meshes showed significantly lower Diamond scores than PP meshes. After explantation, mesh elongation of the TPU mesh was significantly larger than expansion of PP under a force of 3N. Thus, the TPU mesh preserved its elastic properties after 7 and 21 days. The amount of CD68 positive, Ki67 positive and apoptotic cells within the granuloma around the fibers did not show significant differences between the study groups. Conclusions: The newly developed TPU mesh seems to reduce peritoneal adhesion formation in IPOM position in a rabbit model compared to PP meshes after 7 and 21 days. Immunohistochemistry did not reveal differences in biocompatibility of the two meshes used.
    No preview · Article · Sep 2015
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    ABSTRACT: Background: Although acute appendicitis is the most common cause for abdominal surgery in children, its etiology is still largely unknown. The aim of this study was to evaluate the role of bacterial and viral pathogens for the etiology of appendicitis in children. Methods: Between 2000 and 2010, 277 children underwent appendectomy in our institution. On this collective, a retrospective study was performed on to identify the presence of bacterial or viral pathogens. Results: Intraoperatively, 39% of cases showed acute, 9% of cases chronic, and 41% of cases ulcerous inflammation. Bowel perforation was found in 7% of cases and four percent of the children had no inflammation of the appendix at all. Escherichia coli was the predominant bacterium with an incidence of 27.4%, followed by streptococci (9.8%). Concerning viral pathogens, adenovirus was the most common with an incidence of 5.4% followed by rotavirus (4.7%). Significant correlations between histopathological findings and present pathogens were found: in cases of bowel perforation there were significantly more infections with E. coli bacteria (32.2%, p < .001), streptococci (12.2%, p < 0.001), and Pseudomonas aeruginosa (6.7%, p < .001) whereas chronic inflammations were accompanied with a significantly elevated rate of yersinia infections (2.5%, p = .016). Acute inflammations were significantly more often associated with campylobacter (1.7%, p = .011) and oxyures infections (6.1%, p < .001). In relation to the patients' age, a significant accumulation of different pathogens was observed. CRP- and leukocyte counts showed differences between viral and bacterial inflammations. Conclusions: Our data indicates that appendicitis in children might be triggered by bacterial and viral pathogens and that the type of pathogen directly correlates with patient age, type of inflammation, and level of inflammation values. To confirm and further evaluate these findings, additional studies need to be conducted.
    No preview · Article · Sep 2015 · Journal of Investigative Surgery

  • No preview · Article · Aug 2015 · Zeitschrift für Gastroenterologie
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    ABSTRACT: Intestinal anastomosis is a fundamental procedure in general surgery and required to restore intestinal continuity following resection. The aim of this study was to evaluate whether a gentamicin-coated polyvinylidene fluoride (PVDF) suture material has beneficial effect on anastomotic healing. Ninety Sprague-Dawley rats were divided into three groups: a PVDF-suture group, a gentamicin-coated PVDF (GPVDF)-suture group and a control group using Maxon® (polyglycolid-co-trimethylene carbonate). For each animal, a colonic anastomosis was performed. Ten animals from each group were sacrificed on postoperative days 3, 5, and 14. Measurements of anastomotic bursting pressure were performed on days 3 and 5. At each time, collagen type I/III ratio, MMP 2 and MMP-9 expression and the proliferation index (Ki67) were analyzed. In total, 90 animals underwent surgery without postoperative complications. Bursting strength in the GPVDF group was significantly elevated on day 5. Immunohistochemistry showed significant increase of the collagen type I/III ratio for PVDF and GPVDF on days 3 and 5. MMP2 was significantly increased for PVDF on days 3 and 5 and for GPVDF on day 5. The analysis of MMP9 revealed significant increase compared to control on day 3 and 5 (GPVDF) as well as on day 5 (PVDF). Staining for Ki67 revealed a significant elevation on postoperative day 3 for the PVDF and the GPVDF group. The present data shows the feasibility of PVDF as suture material for colonic anastomosis and confirms the ability of gentamicin to increase the stability of colonic anastomosis when used as coating material.
    No preview · Article · Aug 2015 · International Journal of Colorectal Disease

  • No preview · Article · Aug 2015 · Der Chirurg
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    ABSTRACT: Pyogenic liver abscesses are currently treated by either percutaneous computer tomography (CT)-guided drainage or by laparoscopic and a conventional liver resection when conservative treatment fails but may be associated with substantial morbidity and mortality. A minimally invasive technique involving debridement of right liver abscesses was employed using a minimally invasive video-assisted hepatic abscess debridement (VAHD) after unsuccessful percutaneous CT-guided drainage. Clinical data, complication rates and outcomes of patients were recorded retrospectively. Between 2011 and 2014, VAHD was performed on 10 patients at two centres with no observed recurrence of a liver abscess. The median age of the patients was 57 years (range 42-78) with a median pre-operative size of a liver abscess of 78 mm (range 40-115). The median operation time was 47 min (range 23-75), and the median postoperative hospital stay was 9 days (range 7-69). One patient developed a subcutaneous abscess that required further surgery. No patient died, and there were no major complications related to the VAHD. Video-assisted hepatic abscess debridement is a feasible technique that shows promising results for the treatment of a recurrent right liver abscess. © 2015 International Hepato-Pancreato-Biliary Association.
    No preview · Article · Jun 2015 · HPB
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    ABSTRACT: Bariatric surgery has gained increasing relevance due to the dramatic rise in morbid obesity prevalence. A sound body of scientific literature demonstrates positive long-term outcome of bariatric surgery in decreasing mental and physical health morbidity. Still, there is a need for a manageable presurgical screening to assess major mental disorders. The aim of this study was to assess the frequency of common psychiatric syndromes in bariatric surgery candidates using a computerized version of the Patient Health Questionnaire (PHQ). In a prospective cohort study from August 2009 to July 2011 morbidly obese individuals seeking bariatric treatment were evaluated for mental health disorders using the PHQ (computerized German version). A total of 159 patients were included in this study. The median age of participants was 42 years, the median BMI was 49 kg/m(2). The PHQ revealed a prevalence of 84 % for mental health disorders, 50 % of the participants had three or more mental health disorders. A high somatic symptom burden (46 %), depressive syndromes (62 %) and anxiety disorders (29 %) were the most frequent psychiatric syndromes. The median number of psychiatric syndromes was 3 for women and 1 for men (p = 0.007). No correlation between BMI and a single syndrome or the sum of syndromes was observed. 84 % of the patients seeking bariatric treatment were screened positive for at least one mental health disorder. The computerized PHQ with automated reporting appears to be a useful instrument for presurgical assessment of bariatric patients in routine medical settings.
    Full-text · Article · Jun 2015 · Health and Quality of Life Outcomes
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    ABSTRACT: Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obese patients as well as its recovery after bariatric surgery with a noninvasive test method. In a prospective cohort study from October 2011 to May 2014, morbidly obese individuals receiving bariatric surgery were investigated for functional liver recovery (n = 34). Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2) preoperatively, 6 and 12 months postoperatively. Liver biopsy specimens were obtained from 18 participants and classified according to the nonalcoholic fatty liver disease (NAFLD) activity score (NAS). The mean age of participants was 44 years, and the mean body mass index (BMI) was 52 kg/m(2). The mean percent excess BMI loss (%EBMIL) was 53 % after 6 months and 68 % after 1 year. Mean liver function capacity increased significantly from 255 μg/kg/h preoperative to 324 μg/kg/h after 6 months and 342 μg/kg/h after 12 months. A negative correlation was observed between %EBMIL and alteration of liver function capacity in the first 6 months. Finally, the median NAS showed a negative correlation with liver function capacity. Bariatric surgery leads to a significant functional recovery of the liver. An initial marked weight loss may negatively influence functional liver recovery.
    Full-text · Article · Apr 2015 · Obesity Surgery
  • C. Krones · C. Klink · A. Lambertz

    No preview · Article · Apr 2015 · Allgemein- und Viszeralchirurgie up2date
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    ABSTRACT: Background: Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model. Methods: In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI). Results: The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 μm) and the smallest CTI length (343 ± 60 μm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials. Conclusions: Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted.
    No preview · Article · Feb 2015 · European Surgical Research
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    ABSTRACT: Background: Midline laparotomy wound failure like burst abdomen remains one of the major complications after abdominal surgery. The use of sutures with a closer resemblance to abdominal wall physiology, like elastic threads, could decrease the risk of these complications occurring. Thus, we evaluated the possibility of using a new elastic thread composed of thermoplastic polyurethane (TPU) as a suture for the closure of midline laparotomies compared to conventionally used polypropylene (PP) in a rabbit model. Methods: The elastic TPU thread was processed and tensile tests were performed. Twenty female chinchilla rabbits underwent midline laparotomy. They were randomized to a TPU and a PP group depending on the suture used for fascia closure. After 7 or 21 days, the abdominal walls were assessed macroscopically for wound healing complications and were explanted for histopathological investigation. Results: Tensile tests showed a mean elastic elongation of 55.5% and a sufficient material strength of the TPU thread. In animal experiments, there was no difference between the groups at 7 days; however, the TPU suture showed significantly less CD68 positive cells (p < 0.001) and a higher collagen I/III ratio (p = 0.011) than PP did after 21 days. The amount of apoptotic cells was significantly elevated in the TPU group (p = 0.007) after 21 days. No differences were found concerning granuloma size and number of Ki67-positive cells. Conclusions: The newly developed TPU thread shows promising tensile characteristics. Midline laparotomy closure is feasible and safe in a rabbit model. Immunohistochemistry indicates similar biocompatibility and wound healing after implantation compared to PP after 21 days. To confirm these findings and to proof long-term capability further studies need to be conducted.
    Full-text · Article · Feb 2015 · Journal of Biomedical Materials Research Part B Applied Biomaterials
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    ABSTRACT: Background: In hernia surgery, meshes with small pores tend to be filled by fibrous tissue which reduces their stretchability and causes patient complaints. Due to inelasticity of current meshes, mechanical strain might cause pores to collapse even in large pore mesh constructions. In this study a mesh with elastic thermoplastic polyurethane (TPU) filaments was constructed to prevent pore size changes even under mechanical strain and its biocompatibility in comparison to polyvinylidenfluorid (PVDF) was evaluated.Methods: A mesh was constructed using PVDF with elastic TPU filaments and mechanically tested. After midline laparotomy in twenty rabbits, we placed a 15x3cm mesh as inlay in the defect. Animals were randomized to either the TPU or PVDF group. After 7 or 21 days, mesh expansion was measured under pneumoperitoneum and abdominal walls were explanted for immunohistochemical investigations.Results: In vitro, TPU meshes showed a slight reduction of effective porosity from 46% at tension free conditions to 26% under longitudinal and to 34% under transverse strain. The non-elastic PVDF meshes showed a marked reduction of effective pores from 70% to 7% and 52% respectively. The TPU mesh had a breaking elongation of 101% and a tensile strength of 35N/cm. In vivo, both meshes achieved healing of the incision without hernial defect. The TPU mesh maintained its elasticity under pneumoperitoneum. The amount of CD68 positive, Ki67 positive and apoptotic cells was significantly lower in the TPU group after 7 and 21 days.Conclusions: The newly developed TPU mesh shows elasticity, structural stability and preserved effective porosity under mechanical strain. Immunohistochemistry indicates superior biocompatibility of TPU mesh compared to PVDF after 7 and 21 days. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jan 2015 · Journal of Biomedical Materials Research Part A
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    ABSTRACT: Background: The surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called "open abdomen" has become the standard of care in damage-control procedures as well as in the management of intra-abdominal hypertension and in severe intra-abdominal sepsis. Whereas open abdomen has been closed in two stages traditionally, a modern trend is to close the fascial layers within the initial hospitalization to avoid complications like enterocutaneous fistula and hernia formation. The aim of this study was to determine crucial factors influencing the possibility of fascial closure after open abdomen. Methods: Between 2003 and 2013, 355 adult patients were treated with open abdomen in our institution. Their data were collected and retrospectively analyzed. They were divided into two groups depending on fascial closure or not (fascial closure, n = 137 (39%) vs. non-fascial closure, n = 218 (61%)). Results: The patients who reached fascial closure had a significantly higher rate of initially performed open abdomen (97 patients (71%) vs. 118 (54%), p = 0.002) and the periods of time until a second and a third look operation were significantly shorter (2.7 ± 2.5 vs. 4.2 ± 6.6 days, p = 0.021 and 5.6 ± 3.7 vs. 8.5 ± 8.6 days, p = 0.006). Furthermore, the presence of peritonitis (64 patients (47%) vs. 83 patients (38%), p = 0.023) and large bowel resection (74 patients (54%) vs. 90 patients (41%), p = 0.022) were significantly higher in this group. Rates of in-hospital mortality (97 patients (44%) vs. 38 patients (28%), p = 0.002) and the presence of pancreatitis (19 patients (9%) vs. 3 patients (2%), p = 0.013) were significantly higher in the non-fascial closure group. Conclusions: The probability to reach fascial closure after open abdomen seems to increase when open abdomen is performed initially and when early second and third look operations are performed. The presence of pancreatitis seems to be the only negative prognostic marker concerning fascial closure. Copyright © 2014. Published by Elsevier Ltd.
    No preview · Article · Nov 2014 · International Journal of Surgery (London, England)
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    ABSTRACT: Recurrence rate of hiatal hernia can be reduced with prosthetic mesh repair; however, type and shape of the mesh are still a matter of controversy. The purpose of this study was to investigate the biomechanical properties of four conventional meshes: pure polypropylene mesh (PP-P), polypropylene/poliglecaprone mesh (PP-U), polyvinylidenefluoride/polypropylene mesh (PVDF-I), and pure polyvinylidenefluoride mesh (PVDF-S). Meshes were tested either in warp direction (parallel to production direction) or perpendicular to the warp direction. A Zwick testing machine was used to measure elasticity and effective porosity of the textile probes. Stretching of the meshes in warp direction required forces that were up to 85-fold higher than the same elongation in perpendicular direction. Stretch stress led to loss of effective porosity in most meshes, except for PVDF-S. Biomechanical impact of the mesh was additionally evaluated in a hiatal hernia model. The different meshes were used either as rectangular patches or as circular meshes. Circular meshes led to a significant reinforcement of the hiatus, largely unaffected by the orientation of the warp fibers. In contrast, rectangular meshes provided a significant reinforcement only when warp fibers ran perpendicular to the crura. Anisotropic elasticity of prosthetic meshes should therefore be considered in hiatal closure with rectangular patches. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014.
    No preview · Article · Oct 2014 · Journal of Biomedical Materials Research Part B Applied Biomaterials
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    ABSTRACT: Background Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30 % in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Methods Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Results Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p
    No preview · Article · Sep 2014 · Pediatric Surgery International
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    ABSTRACT: Background: The systemic palliative chemotherapy of locally extended gastrointestinal and hepatobiliary tumors is associated with a considerable burden for the patient. The aim of this project was to develop a new drug release system to improve the local stent therapy in these patients as a proof of concept study. For this purpose, polymer filaments were modified with drug-loaded polymer microgels that allow selective release of the active substance by photochemical triggering using laser radiation. Integrated into a stent system, the better local tumor control could thus contribute to a significant increase in the quality of life of patients. Methods: A standard mammalian cell line and two carcinoma cell lines were established. By Fluorescence activated cell sorting (FACS), the cytotoxicity of the different materials was determined in vitro before and after drug loading with the chemotherapeutic agent 5-Fluorouracil (5-FU). For this purpose, the locally applied 5-FU concentration was previously determined by Bromdesoxyuridin assay. 5-FU dimer was synthesized by photo-induced dimerization of 5-FU in the presence of benzophenone in methanol. The chemical structure of 5-FU dimer was confirmed with Hydrogen-1 nuclear magnetic resonance and Fluorine-19 nuclear magnetic resonance. 5-FU dimer is nonsoluble in water and can be easily incorporated in polymer microgels modified with hydrophobic binding domains (cyclodextrin). After laser irradiation, 5-FU dimer decomposes and 5-FU can be released from microgels. Finally, the measurements were repeated after this laser-induced drug release. Results: In FACS analysis, neither the microgels nor the microgel cumarin complexes showed a significant difference in comparison with the negative control with H2O and therefore no toxic effect on the cell lines. After loading with the 5-FU dimer, there was no significant cell death (contrary to the pure 5-FU monomer, which dose had been previously tested as highly toxic). After laser-induced dissociation back to monomer and the associated drug release, FACS analysis showed cytotoxicity. Conclusions: It was possible to develop 5-FU dimerloaded microgels, which show no cytotoxic effect on cell lines before laser irradiation. After dissociation back to 5-FU monomer by selective photochemical triggering using laser irradiation, the active substance was released. Thus, a new drug release system has been created and tested in vitro. For further development, integration into a stent system and for in vivo follow-up evaluation more studies need to be conducted.
    No preview · Article · Jul 2014 · Journal of Surgical Research
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    ABSTRACT: Introduction: After two-dimensional plane MRI-visible mesh implants could be successfully visualized in phantom and small animal model, the aim of the underlying study was to explore the feasibility of an MRI visualization of complex three-dimensional mesh geometry in close contact to the intestine. We therefore used a MR-visible three-dimensional intra-peritoneal stoma (IPST) mesh in a porcine model. Materials and methods: Laparoscopic terminal sigmoid colostomy has been done with implantation of a prophylactic MRI-visible IPST mesh in two animals. MRI investigations were done after 1 week, 6 months and in case of clinical impairment. These findings were compared to endoscopy and makroscopical and histological investigation of the preparation. Results: The first animal has to be killed because of an ileus 4 weeks after operation. The second animal has to be killed after 7 weeks because of recurrent obstipation. In all cases MRI investigation could identify the IPST mesh and could clearly separate between mesh and intestine. MRI revealed a big bowl ileus due to a funnel dislocation in the first animal. In the second animal, MR diagnostic explored a functional stenosis because of a too small diameter of the central funnel in combination with sticky feces and distension of the terminal sigmoid before discharging into the funnel. Endoscopy, makroscopical and histological investigation of the preparation supported MRI findings. Conclusion: Although complicate clinical course was a diagnostic challenge exploring 3D implants such as IPST, visualization of this new MRI-visible IPST mesh could be proved and turned out as an effective diagnostic possibility. Further studies are necessary to analyze long-time effects such as shrinkage, mesh migration and tissue integration using MRI scanning.
    No preview · Article · Jun 2014 · Hernia
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    ABSTRACT: "Spoilt for choice." How to keep track in the continuously growing multiplicity of mesh prostheses, not to mention the final decision to pick the right mesh. The mesh prostheses itself does not guarantee the success of the repair, rather connection of the material and the operative procedure are paving the way. Criteria for an ideal mesh depend on methods of treatment. The "one and only" mesh does not exist currently. However, as general recommendation for textile implants for the reinforcement of the abdominal wall is deemed to be that the mesh should be made of non-resorbable monofilamental polymer with a breaking strength of 16 N/cm. Furthermore is should have large pores with a vertical stretchability of approximately 20%. Additionally induction of foreign body reaction should be low as well as the perifilamentary scar formation and remodelling. In particular conditions special demands and properties have to be achieved limiting the choice of possible meshes at least. In case of bacterial infection and decontamination either polyglycolacid-meshes of non-crosslinked collagen biologicals should be used. In the intraabdominal position, both laparoscopically or conventional, coated PP- or PVDF-materials are recommended, nevertheless the optimal prosthesis for the intraabdominal position has to be found yet.
    No preview · Article · Jun 2014 · Chirurgische Praxis

Publication Stats

338 Citations
119.56 Total Impact Points

Institutions

  • 2010-2015
    • RWTH Aachen University
      • Department of Surgery
      Aachen, North Rhine-Westphalia, Germany
  • 2009-2015
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany