Load on the inguinal region under standard conditions in pigs.

Objective: To find out the effect of standardised stress on the load of the inguinal region.

Design: Experimental study.

Setting: Surgical university clinic, Germany.

[Prognostic factors for development of peritoneal carcinosis in stomach carcinoma].

Objective: Several adjuvant therapy concepts have been developed to improve the treatment of gastric cancer patients. Dealing with intraperitoneal chemotherapy, it seems to be useful to determine suitable prognostic factors for the occurrence of peritoneal carcinosis, as it is possible to select patients who may profit from this therapy.

Methods: Between June 1975 and December 1999 resection of gastric cancer was performed in 575 patients.

Influence of suture technique on laparotomy wound healing: an experimental study in the rat.

A suture length to wound length ratio (SLWL ratio) of 4:1 for laparotomy closure has proven in clinical studies to reduce incisional hernia incidence. The effect of different SLWL ratios on the mechanical qualities of the healing incision has not been examined experimentally. In 50 rats, the musculo-fascial layer of median laparotomies was closed with polypropylene sutures using SLWL ratios of 8:1, 4:1, 2:1 and 1.

Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection.

The tendency towards sphincter-preserving resection for distal rectal cancers has led to the technique of straight coloanal anastomosis (CAA) and colonic J-pouch anal anastomosis (CPA) after low anterior resection. The aim of the present study was to compare complication rate, anorectal physiology and functional results after both types of reconstruction after ultra-low intersphincteric resection. A total of 31 patients who had undergone CPA were followed up prospectively using anorectal manometry and a standardised questionnaire and were compared with 63 patients who had undergone CAA and were followed up in the same way.

Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model.

This study set out to compare adhesion reformation after conventional and laparoscopic adhesiolysis using two different laparoscopic dissection techniques. In a first operation, 36 rabbits underwent fixation of 6 cm2 of the cecum with the serosa removed to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed laparoscopically (n = 12) or via laparotomy (n = 12) using sharp and blunt dissection.

Operative treatment of a congenital pancreatic pseudocyst: a case report.

Congenital pancreatic pseudocysts are very rare and have so far been described in only 4 cases. We report on a patient with a congenital pancreatic pseudocyst diagnosed only intraoperatively. We show with this case that diagnosis is difficult.

[Evidence-based surgery of rectal carcinoma].

The surgery of rectal cancer has seen significant development in recent years. When there is a multitude of therapeutic options available, it is essential to identify what can be considered a proven standard or, at least, what has to be included in planning a surgical treatment. Therefore, at this point of time a distal resection margin of 2 cm, total mesorectal excision, en-bloc resection of adherent structures, colonic pouch reconstruction after very deep resections and limitation of local excision to T1/G1 tumors have to be regarded as standards of the surgical strategy.

Shorter postoperative atony after laparoscopic-assisted colonic resection? An animal study.

Background: The duration of the postoperative ileus after laparoscopic surgery remains a controversial topic. The aim of our study was to compare the restoration of intestinal motility after laparoscopically assisted and conventional resection of the distal colon in a canine model.

Methods: Two weeks after the implantation of three electrodes on the jejunum, the distal colon was resected in a laparoscopic-assisted or conventional procedure in two groups of four dogs each.

Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia.

Since many years the importance of a weakness of the soft tissue for the development of hernias is discussed controversially. The tensile strength of the tissue is supposed to depend largely on the varying proportion of type I collagen with its high tensile strength and the immature type III collagen. Their relation is regulated by several collagenases, mainly matrix metalloproteinases-1 and -13 (MMP-1 and MMP-13), whereas fibronectin plays a key role for the adherence of cells within the extracellular matrix.

Experimental studies on small intestinal pouch motility and evacuation.

Unlabelled: The aim of the study was to investigate pouch motility and evacuation under standardised conditions with a minimum of external influence.

Methods: Ileal J-pouches had been constructed 30 cm proximal to the ileocecal valve in 10 dogs (6 pelvic/4 gastric configuration). After 8 weeks the following examinations were performed: (1) measurement of pouch compliance by balloon distension, (2) measurement of pouch contractions by strain gauge transducers, (3) radiological imaging of pouch contractions and evacuation, (4) evacuation scintigraphy and (5) radiological determination of small intestinal transit time.

Functional assessment and tissue response of short- and long-term absorbable surgical meshes.

Within the last few years meshes have become essential for the temporary closure of the abdominal cavity to avoid the development of an intra-abdominal compartment syndrome. The interposition of a mesh as an inlay reduces the intra-abdominal pressure and improves markedly the blood circulation, particularly for the intestines and kidneys. Whereas non-absorbable meshes usually tend to produce fistulas in direct contact to the bowels, the interposition of short-term absorbable meshes result in large incisional hernias in almost all cases.

[Laparoscopic surgery: expectations and reality].

Despite the rapid development and widespread application of laparoscopic operation techniques, only laparoscopic cholecystectomy and laparoscopic fundoplication have replaced the open operations as standard techniques. Nowadays only about 10% of appendectomies and 25% inguinal hernias are performed by the laparoscopic approach. Colorectal operations are rarely performed laparoscopically.

Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias.

The late appearance ofincisional hernias several years after laparotomy and the high recurrence rates after operation strongly imply the presence of a disorder of the connective tissue, although a specific defect in patients with incisional hernias has not yet been identified. In the present study we used both immunohistochemistry and Western blot analysis to evaluate the ratio of collagen I and III and the expression of the metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional or recurrent incisional hernias. Samples of healthy skin or stable skin scar in patients without hernias served as controls.

Pancreatoblastoma: ultrastructural and image DNA cytometric analysis.

Background: Since the first description of a pancreatoblastoma as a malignant pancreatic tumour of childhood in 1957, approximately 60 cases have been reported. We present the symptoms, pathology, and therapy of this rare tumour in a 17-year-old girl.

Case Report: The patient initially presented with upper gastro-intestinal bleeding.

[Intra-abdominal lymphangioma].

Mesenteric cystic tumors are very rare. The incidence of the cystic lymphangioma, which belongs to this group, is even lower. Often it is mistakenly classified together with the chylous mesenteric cysts.

Colon interposition for esophageal replacement: isoperistaltic or antiperistaltic? Experimental results.

Background: Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice.

Methods: In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically in 4 dogs. Three months later five strain-gauges were implanted and evacuation was investigated by motility testing, barium studies, and scintigraphy.

Influence of suture material and suture technique on collagen fibril diameters in midline laparotomies.

Background: Although laparotomy closure is associated with a cumulative 15% failure rate, the effect of different suture techniques and materials on the ultrastructural composition of the healing incision has not been investigated.

Method: in 40 Wistar rats the collagen fibril diameters and the regenerative tissue were compared using electron microscopy 14 and 28 days after midline laparotomy. Wounds were closed with single and running sutures using either polypropylene or polyglactin 910.

Efficacy of adhesion prevention and impact on wound healing of intraperitoneal phospholipids.

Background: Postoperative peritoneal adhesions are a major complication of abdominal surgery. Adjuvant therapy is needed to prevent adhesion formation and subsequent sequelae. Previously published data proved the efficacy of phospholipids (PL) for this indication; however, additional information on drug safety was still outstanding.

New adhesion formation after laparoscopic and conventional adhesiolysis: a comparative study in the rabbit.

This study aimed to compare new adhesion formation after laparoscopic and conventional adhesiolysis. In a first operation, 24 rabbits underwent fixation of deserosated cecum (6 cm2) to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed by laparoscopy (n = 12) or laparotomy (n = 12).