V Schumpelick

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

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Publications (864)1116.33 Total impact

  • Article: Education

    No preview · Article · Apr 2015 · Hernia
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    ABSTRACT: Porcine models are well established for studying intestinal anastomotic healing. In this study, we aimed to clarify the anatomic differences between human and porcine small intestines. Additionally, we investigated the influences of longitudinal and circular sutures on human small intestine perfusion. Intestines were obtained from human cadavers (n = 8; small intestine, n = 51) and from pigs (n = 10; small intestine, n = 60). Vascularization was visualized with mennige gelatin perfusion and high-resolution mammography. Endothelial cell density was analyzed with immunohistochemistry and factor VIII antibodies. We also investigated the influence of suture techniques (circular anastomoses, n = 19; longitudinal sutures, n = 15) on vascular perfusion. Only human samples showed branching of mesenteric vessels. Compared to the pig, human vessels showed closer connections at the entrance to the bowel wall (p = 0.045) and higher numbers of intramural anastomoses (p < 0.001). Porcine main vessels formed in multifilament-like vessel bundles and displayed few intramural vessel anastomoses. Circular anastomoses induced a circular perfusion defect at the bowel wall; longitudinal anastomoses induced significantly smaller perfusion defects (p < 0.001). Both species showed higher vascular density in the jejunum than in the ileum (p < 0.001). Human samples showed similar vascular density within the jejunum (p = 0.583) and higher density in the ileum (p < 0.001) compared to pig samples. The results showed significant differences between human and porcine intestines. The porcine model remains the standard for studies on anastomotic healing because it is currently the only viable model for studying anastomosis and wound healing. Nevertheless, scientific interpretations must consider the anatomic differences between humans and porcine intestines.
    No preview · Article · Feb 2015 · International Journal of Colorectal Disease
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    ABSTRACT: Purpose: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. Methods: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. Results: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). Conclusions: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015.
    Full-text · Article · Apr 2014 · Hernia
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    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.
    Full-text · Article · May 2013 · Hernia
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    M Miserez · R J Fitzgibbons · V Schumpelick

    Preview · Article · Jan 2013 · Hernia
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    Full-text · Article · Jan 2013 · Hernia
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    M Miserez · R J Fitzgibbons · V Schumpelick

    Preview · Article · Aug 2012 · Hernia
  • R. Kasperk · B. Philipps · M. Vahrmeyer · S. Willis · V. Schumpelick
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    ABSTRACT: 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 used regularly.
    No preview · Article · May 2012 · Der Chirurg
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    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.
    No preview · Article · May 2012 · Trauma und Berufskrankheit
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    Ch. Töns · A. Schachtrupp · M. Rau · Th. Mumme · V. Schumpelick
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    ABSTRACT: 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.
    Preview · Article · Apr 2012 · Der Chirurg
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    R J Fitzgibbons · M Miserez · V Schumpelick

    Preview · Article · Aug 2011 · Hernia
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    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).
    No preview · Article · Jul 2011 · The American surgeon
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    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.
    No preview · Article · Feb 2011 · European Surgical Research
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    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.
    No preview · Article · Jan 2011 · Surgical Endoscopy
  • S. Truong · Dr. med. M. Binnebösel · V. Schumpelick
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    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.
    No preview · Chapter · Dec 2010
  • Carsten J. Krones · Volker Schumpelick · Karsten Junge
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    ABSTRACT: The rising of lifespan and operable age-related diseases stresses the impact of surgery in older ages. Besides the operative technique, the perioperative management is of great importance. Short operation times, control of temperature, fast track recovery, forced airway therapy; early mobilisation and the prevention of cognitive dysfunction are the leading parameters. Surgical indication and risk-assessment have to regard the physiologic degeneration of various organ systems. The most complex severity of multifocal diseases in the elderly needs a close interdisciplinary approach. Thus, the chronologic age is not longer a general risk factor in great resection of liver, pancreas or rectum.
    No preview · Article · Dec 2010 · Perioperative Medizin
  • S Froeschen-Behrens · N Kuth · N Gassler · Y Temur · V Schumpelick · S Truong · G Böhm
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    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.
    No preview · Article · Nov 2010 · Der Chirurg
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    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.
    No preview · Article · Oct 2010 · Journal of Surgical Research
  • J Otto · M Binnebösel · K Junge · M Jansen · R Dembinski · V Schumpelick · A Schachtrupp
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    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.
    No preview · Article · Aug 2010 · Hernia
  • G Böhm · A Mossdorf · C Klink · U Klinge · M Jansen · V Schumpelick · S Truong
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    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.
    No preview · Article · Jul 2010 · Endoscopy

Publication Stats

12k Citations
1,116.33 Total Impact Points

Institutions

  • 1995-2015
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
    • Christian-Albrechts-Universität zu Kiel
      Kiel, Schleswig-Holstein, Germany
  • 2013
    • AZ Maria Middelares
      Gand, Flanders, Belgium
  • 1987-2012
    • RWTH Aachen University
      • • Department of Surgery
      • • Neurochirurgische Klinik
      Aachen, North Rhine-Westphalia, Germany
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 2011
    • Creighton University
      • Department of Surgery
      Omaha, Nebraska, United States
  • 2004
    • Universitätsklinikum Jena
      • Institute of Pathology
      Jena, Thuringia, Germany
  • 2003
    • St. Franziskus-Hospital
      Köln, North Rhine-Westphalia, Germany
  • 2002
    • Georg-August-Universität Göttingen
      • Center for Biochemistry and Molecular Cell Biology
      Göttingen, Lower Saxony, Germany
  • 1999
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 1996
    • Ludwig-Maximilians-University of Munich
      • Department of Surgery
      München, Bavaria, Germany
  • 1993
    • City of Hope National Medical Center
      Duarte, California, United States
  • 1990-1993
    • University of Hamburg
      • Department of Urology
      Hamburg, Hamburg, Germany