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Complications of newborn enterostomies

World Journal of Clinical Cases 2018年第16期6卷 1101-1110页

作者： Lea Wolf Stefan Gfroerer Henning Fiegel udo rolle Department of Pediatric Surgery University Hospital Frankfurt Goethe-University Frankfurt am Main

AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal *** A 10-year retrospective cohort study(2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study(corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis(NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson's χ2 test or Fisher's exact test for categorical variables and the Wilcoxon-Mann-Whitney U-Test for continuous variables. RESULTS In total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC(Group 1) were significantly older at enterostomy for-mation than the neonates of Group 2 [median(range), 11(2-75) d vs 4(1-101) d, P = 0.004)]. Significantly more ileostomies were created in Group 1 [47(92.2%) vs 16(64.0%), P = 0.007], whereas colostomies were performed significantly more often in Group 2 [2(3.9%) vs 8(32.0%), P = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median(range), 5(3-13) vs 3(1-9), P < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2(P =

关键词： Enterostomy closure Enterostomy Stoma Necrotizing enterocolitis Neonates Complications Enterostomy formation

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Changes of smooth muscle contractile filaments in small bowel atresia

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World Journal of Gastroenterology 2012年第24期18卷 3099-3104页

作者： Stefan Gfroerer Henning Fiegel Priya Ramachandran udo rolle Roman Metzger Department of Paediatric Surgery Goethe-University Frankfurt60590 FrankfurtGermany Kanchi Kamakoti Childs Trust Hospital Chennai 600034India Department of Paediatric Surgery University of Leipzig04317 LeipzigGermany

AIM:To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia ***:Resected small bowel specimens from small bowel atresia patients(n = 12) were divided into three sections(proximal,atretic and distal).Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers-smooth muscle actin(SMA) and desmin using conventional paraffin sections of the proximal and distal *** bowel from agematched patients(n = 2) undergoing Meckel's diverticulum resection served as ***:The smooth muscle coat in the proximal bowel of small bowel atresia patients was thickened compared with control tissue,but the distal bowel was *** of smooth muscle contractile fibres SMA and desmin within the proximal bowel was slightly reduced compared with the distal bowel and control *** were no major differences in the architecture of the smooth muscle within the proximal bowel and the distal *** proximal and distal bowel in small bowel atresia patients revealed only minimal differences regarding smooth muscle morphology and the presence of smooth muscle contractile filament ***:Changes in smooth muscle contractile filaments do not appear to play a major role in postoperative motility disorders in small bowel atresia.

关键词： Small bowel atresia Enteric nervous sys-tem Smooth muscle Motility disorder

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Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns

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World Journal of Gastroenterology 2010年第45期16卷 5716-5721页

作者： Stefan Gfroerer Roman Metzger Henning Fiegel Priya Ramachandran udo rolle Department of Paediatric Surgery Johann Wolfgang Goethe-University Frankfurt/MTheodor-Stern-Kai 760590 Frankfurt/MGermany Department of Paediatric Surgery University of Leipzig04103 LeipzigGermany Department of Pediatric Surgery Kanchi Kamakoti Childs Trust Hospital12-A ChennaiIndia

AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel ***: Resected small bowel specimens from affected patients (n = 7) were divided into three parts (proximal, atretic, distal). Standard histology and enzyme immunohistochemistry anti-S100, anti-protein gene product (PGP) 9.5, anti-neurofilament (NF), antic-kit-receptor (CD117) was carried out on conventional paraffin sections of the proximal and distal part. RESULTS: The neuronal and glial markers (PGP 9.5, NF, S-100) were expressed in hypertrophied ganglia and nerve fibres within the myenteric and submucosal plexuses. Furthermore, the submucous plexus contained typical giant ganglia. The innervation pattern of the proximal bowel resembled intestinal neuronal dysplasia. The density of myenteric ICCs was clearly reduced in the proximal bowel, whereas a moderate number of muscular ICCs were found. The anti-CD117 immunore- action revealed additional numerous mast cells. The distal bowel demonstrated normal morphology and density of the ENS, the ICCs and the mast ***: The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs.

关键词： Small bowel atresia Enteric nervous system Gastrointestinal motility Interstitial cells of Cajal

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Comparison of outcomes between complete and incomplete congenital duodenal obstruction

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World Journal of Gastroenterology 2019年第28期25卷 3787-3797页

作者： Stefan Gfroerer Till-Martin Theilen Henning C Fiegel Anoosh Esmaeili udo rolle Department of Pediatric Surgery and Pediatric Urology University Hospital Frankfurt Frankfurt 60590 Germany Department of Pediatric Cardiology University Hospital Frankfurt Frankfurt 60590 Germany

BACKGROUND Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. AIM To quantify and compare the association between CCDO and ICDO with outcome parameters. METHODS We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27;atresia type 1-3, annular pancreas) and ICDO (n=23;annular pancreas, web, Ladd′s bands). RESULTS In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%;CCDO vs ICDO, P<0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P≤0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group (P<0.01). CONCLUSION CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.

关键词： Congenital duodenal obstruction Duodenal atresia Duodenal stenosis Prenatal ultrasonographic detection rate Clinical presentation Preoperative diagnostics Adverse events Outcome

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Abdominal cocoon in children: A case report and review of literature

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World Journal of Gastroenterology 2021年第37期27卷 6332-6344页

作者： Daniel Keese Andrea Schmedding Kerstin Saalabian Georgy Lakshin Henning Fiegel udo rolle Goethe-University Frankfurt Department of Paediatric Surgery and Paediatric UrologyUniversity HospitalFrankfurt 60590Germany

BACKGROUND Abdominal cocoon or“encapsulating peritoneal sclerosis”(EPS)is an uncommon and rare cause of intestinal *** a few cases have been reported in paediatric ***,EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal *** patients are asymptomatic or present with abdominal pain,which is likely to occur secondary to subacute bowel *** at imaging,such as ultrasound,computed tomography,and magnetic resonance imaging,are often *** diagnosed,EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory *** membrane forms a fibrous tissue sheet that covers,fixes,and finely constricts the gut,compromising its *** SUMMARY We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal *** was no history of peritoneal dialysis or drug *** In this report,we sought to highlight the diagnostic,surgical,and histopathological characteristics and review the current literature on EPS in paediatric patients.

关键词： Abdominal cocoon Peritoneal encapsulation Encapsulating peritoneal sclerosis Intestinal obstruction Children Case report

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Persistent bowel dysfunction after surgery for Hirschsprung’s disease:A neuropathological perspective

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World Journal of Gastrointestinal Surgery 2021年第8期13卷 822-833页

作者： Sanne J Verkuijl Florian Friedmacher Patrick N Harter udo rolle Paul MA Broens Department of Pediatric Surgery University Hospital FrankfurtGoethe University FrankfurtFrankfurt 60590Germany Neurological Institute(Edinger-Institute) University Hospital FrankfurtGoethe University FrankfurtFrankfurt 60528Germany Department of Surgery Division of Pediatric SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningen 9700 RBNetherlands

Hirschsprung’s disease(HD)is a congenital disorder,characterized by aganglionosis in the distal part of the gastrointestinal *** complete surgical resection of the aganglionic segment,both constipation and fecal incontinence persist in a considerable number of patients with limited treatment *** is growing evidence for structural abnormalities in the ganglionic bowel proximal to the aganglionosis in both humans and animals with HD,which may play a role in persistent bowel *** abnormalities include:(1)Histopathological abnormalities of enteric neural cells;(2)Imbalanced expression of neurotransmitters and neuroproteins;(3)Abnormal expression of enteric pacemaker cells;(4)Abnormalities of smooth muscle cells;and(5)Abnormalities within the extracellular ***,a better understanding of these previously unrecognized neuropathological abnormalities may improve follow-up and treatment in patients with HD suffering from persistent bowel dysfunction following surgical *** the long term,further combination of clinical and neuropathological data will hopefully enable a translational step towards more individual treatment for HD.

关键词： Hirschsprung disease Aganglionosis Proximal Ganglionic Constipation Incontinence©The Author(s)2021

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Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 979-987页

作者： Mohamed Makansi Martin Hutter Till-Martin Theilen Henning C Fiegel udo rolle Stefan Gfroerer Department of Pediatric Surgery and Pediatric Urology University Hospital FrankfurtFrankfurt am Main 60590Germany Department of Pediatric Surgery and Pediatric Urology Helios Clinic Berlin-BuchBerlin 13125Germany

BACKGROUND In order to avoid consequences of total splenectomy,partial splenectomy(PS)is increasingly *** purpose of this study was to compare perioperative outcomes of laparoscopic PS(LPS)and open PS(OPS)in children and *** To compare perioperative outcomes of patients with LPS and *** After institutional review board approval,a total of 26 patients that underwent LPS or OPS between January 2008 and July 2018 were identified from the database of our tertiary referral *** total,10 patients had LPS,and 16 patients underwent *** loss was calculated by Mercuriali’s *** scores,analgesic requirements and complications were *** Wilcoxon rank sum test was used for *** compare categorical variables,Fisher’s exact test was *** LPS was performed in 10 patients;16 patients had ***(except for body mass index and duration of follow-up),indicating primary disease,preoperative spleen size and postoperative spleen volume,perioperative hematological parameters,postoperative pain scores,analgesic requirements,adverse events according to the Clavien-Dindo classification and the comprehensive complication index,median time from operation to initiation of feeds,median time from operation to full feeds,median time from operation to mobilization and median length of hospital stay did not differ between LPS and ***(range)operative time(min)was longer in LPS compared to the OPS group[185(135-298)vs 144(112-270),respectively;P=0.048].Calculated perioperative blood loss(mL of red blood cell count)was higher in the LPS group compared to OPS[87(-45-777)vs-37(-114-553),respectively;P=0.039].CONCLUSION This is the first study that compared outcomes of LPS and *** operative approaches had comparable perioperative *** appears to be a viable alternative to OPS.

关键词： Laparoscopic vs open Laparoscopy Partial splenectomy Perioperative outcome Children Adolescents

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Pediatric intestinal motility disorders

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World Journal of Gastroenterology 2015年第33期21卷 9683-9687页

作者： Stefan Gfroerer udo rolle Department of Pediatric Surgery and Pediatric Urology Goethe-University Frankfurt/M.60590 Frankfurt/M.Germany

Pediatric intestinal motility disorders affect many children and thus not only impose a significant impact on pediatric health care in general but also on the quality of life of the affected ***,some of these conditions might also have implications for *** intestinal motility disorders frequently present as chronic constipation in toddler age *** of these conditions are functional,meaning that constipation does not have an organic etiology,but in 5% of the cases,an underlying,clearly organic disorder can be *** with organic causes for intestinal motility disorders usually present in early infancy or even right after *** most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn *** sign is highly indicative of the presence of Hirschsprung disease(HD),which is the most frequent congenital disorder of intestinal *** is a rare but important congenital disease and the most significant entity of pediatric intestinal motility *** etiology and pathogenesis of HD have been extensively studied over the last several decades.A defect in neural crest derived cell migration has been proven as an underlying cause of HD,leading to an aganglionic distal end of the *** basic science and clinical research related studies have been conducted to better diagnose and treat *** of the aganglionic bowel remains the gold standard for treatment of *** recent studies show,at least experimentally,the possibility of a stem cell based therapy for *** editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis,dysganglionosis,chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine *** organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as possible.

关键词： Intestinal motility disorder Children Hirschsprung

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