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Extracellular matrices for gastrointestinal surgery:Ex vivo testing and current applications

World Journal of Gastroenterology 2010年第32期16卷 4031-4038页

作者： jens hoeppner Goran Marjanovic Peter Helwig Ulrich Theodor Hopt Tobias Keck Department of General and Visceral Surgery University of FreiburgFreiburg 79106Germany Department of Orthopedics and Traumatology University of FreiburgFreiburg 79106Germany

AIM:To assess the effects of bile and pancreatic juice on structural and mechanical resistance of extracellular matrices(ECMs) in ***:Small-intestinal submucosa(SIS),porcine dermal matrix(PDM),porcine pericardial matrix(PPM) and bovine pericardial matrix(BPM) were incubated in human bile and pancreatic juice in *** were examined by macroscopic observation,scanning electron microscopy(SEM) and testing of mechanical ***:PDM dissolved within 4 d after exposure to bile or pancreatic ***,PPM and PDM retained their integrity for > 60 d when incubated in either digestive *** effect of bile was found to be far more detrimental to mechanical stability than pancreatic juice in all tested *** SIS,the loss of mechanical stability after incubation in either of the digestive secretions was less distinct than in PPM and BPM [mFmax 4.01/14.27 N(SIS) vs 2.08/5.23 N(PPM) vs 1.48/7.89 N(BPM)].In SIS,the extent of structural damage revealed by SEM was more evident in bile than in pancreatic *** PPM and BPM,structural damage was comparable in both ***:PDM is less suitable for support of gastrointestinal *** SIS,PPM and BPM should also be evaluated experimentally for gastrointestinal indications.

关键词： Extracellular matrix Intestinal regeneration Ex-vivo testing Gastrointestinal surgery Gastrointestinal fistula Bioscaffolding

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Limited resection for duodenal gastrointestinal stromal tumors:Surgical management and clinical outcome

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World Journal of Gastrointestinal Surgery 2013年第2期5卷 16-21页

作者： jens hoeppner Birte Kulemann Goran Marjanovic Peter Bronsert Ulrich Theodor Hopt Department of General Surgery University of Freiburg79106 FreiburgGermany Department of Pathology University of Freiburg79106 FreiburgGermany

AIM:To analyze our experience in patients with duodenal gastrointestinal stromal tumors(GIST) and review the appropriate surgical ***:We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and *** files,operative reports,radiological charts and pathology were *** surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection(LR).For extended resection pancreatoduodenectomy was ***,gender,clinical symptoms of the tumor,anatomical localization,tumor size,mitotic count,type of resection resectional status,neoadjuvant therapy,adjuvant therapy,risk classification and follow-up details were investigated in this retrospective ***:Nine patients(5 males/4 females) with a median age of 58 years were surgically *** median follow-up period was 45 mo(range 6-111 mo).The initial symptom in 6 of 9 patients was gastrointestinal bleeding(67%).Tumors were found in all four parts of the duodenum,but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients(33%).Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before *** one patient,the GIST resection was done by *** 8 LRs included a segmental resection of pars 4 of the duodenum,5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y *** of these LRs was done minimally invasive;seven were done in open *** median diameter of the tumors was 54 mm(14-110 mm).Using the Fletcher classification scheme,3/9(33%) tumors had high risk,1/9(11%) had intermediate risk,4/9(44%) had low risk,and 1/9(11%) had very low risk for aggressive *** resections showed microscopically negative transsection margins(R0),two showed positive margins(R1).No patient developed local r

关键词： Gastrointestinal stromal tumor Duodenum Surgery Limited resection Survival

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Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses

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World Journal of Gastroenterology 2011年第10期17卷 1308-1316页

作者： Philipp Anton Holzner Birte Kulemann Simon Kuesters Sylvia Timme jens hoeppner Ulrich Theodor Hopt Goran Marjanovic Surgical Metabolic and Anastomotic Research Team Department of General and Visceral SurgeryAlbert Ludwigs University of Freiburg Institute of Pathology Albert Ludwigs University of Freiburg

AIM： To investigate the influence of remote ischemic preconditioning （RIPC） on anastomotic integrity. METHODS： Sixty male Wistar rats were randomized to six groups. The control group （n = 10） had an end- to-end ileal anastomosis without RIPC. The preconditioned groups （n = 34） varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis （n = 9）. On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosat ischemic injury were collected. The data are given as median （range）.RESULTS： On postoperative day 4, median bursting pressure was 124 mmHg （60-146 mmHg） in the control group. The experimental groups did not show a statistically significant difference （P 〉 0.05）. Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group. CONCLUSION： RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning.

关键词： Anastomotic healing Hydroxyproline Bursting pressure Mucosal injury index Wound healing Remote ischemic preconditioning

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