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| 1 | Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns显示文摘AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel atresia.METHODS: 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 cells.CONCLUSION: The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs. | Stefan Gfroerer Roman Metzger Henning Fiegel Priya Ramachandran Udo Rolle | 2010 | World Journal of Gastroenterology2010，16，45： | 9 |
| 2 | Complications of newborn enterostomies显示文摘AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODS 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 = 0.073). Most patients suffered from two complications(23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2(P = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients(30.6% in Group 1 and 16.7% in Group 2, P = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48(65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification(CDC) < Ⅲ], while 25(34.2%) required surgery to address the complications(CDC ≥Ⅲ). Early reversal of the enterostomy was performed significantly more often(P = 0.003) and the time to full enteral nutrition after closure was significantly longer [median(range), 7(3-87) d vs 12(5-93) d, P = 0.006] in infants with a CDC grading ≥Ⅲ than in infants with a CDC grading < Ⅲ. CONCLUSION Complications occur in almost all infants with enterostomies. The majority of these complications are minor and do not require surgical treatment. There is a clear trend that neonates with NEC have a higher risk for developing complications than those without NEC. | Lea Wolf Stefan Gfroerer Henning Fiegel Udo Rolle | 2018 | World Journal of Clinical Cases2018，6，16： | 5 |
| 3 | Changes of smooth muscle contractile filaments in small bowel atresia显示文摘AIM:To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients.METHODS: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.Small bowel from agematched patients(n = 2) undergoing Meckel's diverticulum resection served as controls.RESULTS:The smooth muscle coat in the proximal bowel of small bowel atresia patients was thickened compared with control tissue,but the distal bowel was unchanged.Expression of smooth muscle contractile fibres SMA and desmin within the proximal bowel was slightly reduced compared with the distal bowel and control tissue.There were no major differences in the architecture of the smooth muscle within the proximal bowel and the distal bowel.The 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 markers.CONCLUSION:Changes in smooth muscle contractile filaments do not appear to play a major role in postoperative motility disorders in small bowel atresia. | Stefan Gfroerer Henning Fiegel Priya Ramachandran Udo Rolle Roman Metzger | 2012 | World Journal of Gastroenterology2012，18，24： | 1 |
| 4 | Comparison of outcomes between complete and incomplete congenital duodenal obstruction显示文摘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. | Stefan Gfroerer Till-Martin Theilen Henning C Fiegel Anoosh Esmaeili Udo Rolle | 2019 | World Journal of Gastroenterology2019，25，28： | 1 |
| 5 | Pediatric intestinal motility disorders显示文摘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 patient.Furthermore,some of these conditions might also have implications for adulthood.Pediatric intestinal motility disorders frequently present as chronic constipation in toddler age children.Most 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 identified.Patients with organic causes for intestinal motility disorders usually present in early infancy or even right after birth.The most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn period.This sign is highly indicative of the presence of Hirschsprung disease(HD),which is the most frequent congenital disorder of intestinal motility.HD is a rare but important congenital disease and the most significant entity of pediatric intestinal motility disorders.The 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 gut.Numerous basic science and clinical research related studies have been conducted to better diagnose and treat HD.Resection of the aganglionic bowel remains the gold standard for treatment of HD.Most recent studies show,at least experimentally,the possibility of a stem cell based therapy for HD.This editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis,dysganglionosis,chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine metaplasia.Underlying organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as possible. | Stefan Gfroerer Udo Rolle | 2015 | World Journal of Gastroenterology2015，21，33： | 0 |
| 6 | Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents显示文摘BACKGROUND In order to avoid consequences of total splenectomy,partial splenectomy(PS)is increasingly reported.The purpose of this study was to compare perioperative outcomes of laparoscopic PS(LPS)and open PS(OPS)in children and adolescents.AIM To compare perioperative outcomes of patients with LPS and OPS.METHODS 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 center.In total,10 patients had LPS,and 16 patients underwent OPS.Blood loss was calculated by Mercuriali’s formula.Pain scores,analgesic requirements and complications were assessed.The Wilcoxon rank sum test was used for comparison.To compare categorical variables,Fisher’s exact test was applied.RESULTS LPS was performed in 10 patients;16 patients had OPS.Demographics(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 OPS.Median(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 OPS.Both operative approaches had comparable perioperative outcomes.LPS appears to be a viable alternative to OPS. | Mohamed Makansi Martin Hutter Till-Martin Theilen Henning C Fiegel Udo Rolle Stefan Gfroerer | 2021 | World Journal of Gastrointestinal Surgery2021，13，9： | 0 |
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