Rainer Engemann – författare

The anastomotic technique plays a predominant role in gastrointestinal surgery. A feared complication is leakage due to the sutures. Such leakage cannot be detected early; consequently, infection spreads locally and systemically. An anastomotic method is generally evaluated according to its rate of leakage, related to the localization, bur real scientific comparisons, i.e., controlled studies, are almost totally lack­ ing. The criteria of evaluation include the type of suture, the localization, the auxiliary technical tools, practicability, the different forms of wound healing, angiogenesis, and vascularization, among others. The postoperative criteria are complications shortly after surgery, such as bleeding, ruptures, and stenoses of the anastomosis. A standard comparison is made difficult by the variety of cytophysiological and biochemical factors that influence wound healing. In the comparison of larger series one must always take into account differences of auxiliary tools, strategies, and inhomogeneity of patients. A change of one auxiliary tool or of one strategy implies the modification of various target criteria. Often enough, however, one does not sufficiently consider the surgeon's most. important role.

Der Einzug der minimalinvasiven Chirurgie hat in der Chirurgie in den letzten 3 Jahren zu einem Umbruch gef}hrt. Aber erst die Einf}hrung von speziell entwickelten Klammer- nahtinstrumenten f}r den laparoskopischen undthorakosko- pischen Einsatz hat zur Verbreitung dieser Techniken f}hren k|nnen. Dies ist eine aktuelle Zusammenstellung der M|glichkeiten und Indikationsgebiete f}r die Anwendung von Klammernaht- instrumenten in der konventionellen und minimalinvasiven Chirurgie. Das Buch behandelt schwerpunktm{~ig die klinische und praktische Anwendung der Klammernahtinstrumente, zeigt neue Perspektiven f}r die minimalinvasive Chirurgie durch die Anwendung von Klammernahtinstrumenten auf und gibt eine ]bersicht }ber Indikationen, Ergebnisse und Komplikationen.

In this book, the recent developments in immunology and the impact on the treatment of infections in critical care and in surgery are presented, also describing how cellular immunology influences clinical treatment. This information helps in understanding the pathogenesis of infections in surgery and critical care. The impact of a standard treatment such as antibiotic therapy is evaluated and possible future therapy modalities outlined. This book will be of interest to clinicians and immunologists as scientists of both specialties have contributed to the book.

Biofragmentable anastomoses rings represent a fascinating concept: Stan­ dardization of anastomoses, secure technique in application, expulsion of the material without residuals. In addition, one single technique allows to perform the classical end to end, end to side, and side to side anastomoses in most areas of the gastrointestinal tract, without any auxiliary tool. This means a great advantage of practicability. Controlled studies evidenced that the rate of complications is very small for the intestinal tract. Therefore, it is important to establish the localization for present indication and contra­ indications. Two chapters especially deal with upper GI anastomoses in­ cluding esophagus anastomoses and with BAR anastomoses in inflammatory bowel disease. This is done by analysing the data and by an exchange of experience between the clinical research groups. This book is to communi­ cate experimental data and to increase understanding about pathophysiology of the healing of anastomoses by means of compression anastomoses. Wiirzburg, Germany, Prof. Dr. R. ENGEMANN October 1994 Prof. Dr. A. THIEDE Contents Experimental Research Histological and Clinical Aspects of Early Healing of the Valtrac Anastomosis in the Colon R. GULLICHSEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Colorectal Intramural Blood Supply and Microcirculation in Man M. A. R. AL FALLOUJI (With 5 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Biofragmentable Anastomosis Ring Versus Stapled Anastomoses in the Extraperitoneal Rectum: Experimental Study in Dogs N. G. CZECZKO, B. POLONIO, L. F. COLA

Preclinical experimental transplantation research that is based on microsurgical models in rats fulfills two indispensable conditions for modern organ transplanta­ tion research: Almost all organ grafts can be performed on the rat with an amount of technical effort that is still justifiable. Thus transplantation models that are analogous to human organ transplantation can be developed, tested, and evaluated. This fulfills a necessary condition from the standpoint of surgery. With the species rat, we have a great variety of genetically different inbred strains. From the immunological point of view this is an indispensable prerequisite for the investigation of preclinical transplantation models that can be expected to produce controllable, reproducible results. In vivo experimental results can be supplemented by and correlated to in vitro tests. Lately these experimental results are being greatly expanded and more precisely defined by the application of immunohistological methods that have been established recently in Kiel. In this book we hope to present a cross section of the microsurgical models in use today and of current immunological and immunohistological models. Furthermore, we wish to record the present state of microsurgical organ transplantation research and to show its relationship to the current state and development of clinical organ transplantation. A special aspect of our Kiel research group is the long-term, well-functioning, interdisciplinary cooperation between surgery, immunology, and pathology. Through this cooperation we attempt to provide an atmosphere in which theoretical and practical viewpoints can mutually influence each other.

Preclinical experimental transplantation research that is based on microsurgical models in rats fulfills two indispensable conditions for modern organ transplanta­ tion research: Almost all organ grafts can be performed on the rat with an amount of technical effort that is still justifiable. Thus transplantation models that are analogous to human organ transplantation can be developed, tested, and evaluated. This fulfills a necessary condition from the standpoint of surgery. With the species rat, we have a great variety of genetically different inbred strains. From the immunological point of view this is an indispensable prerequisite for the investigation of preclinical transplantation models that can be expected to produce controllable, reproducible results. In vivo experimental results can be supplemented by and correlated to in vitro tests. Lately these experimental results are being greatly expanded and more precisely defined by the application of immunohistological methods that have been established recently in Kiel. In this book we hope to present a cross section of the microsurgical models in use today and of current immunological and immunohistological models. Furthermore, we wish to record the present state of microsurgical organ transplantation research and to show its relationship to the current state and development of clinical organ transplantation. A special aspect of our Kiel research group is the long-term, well-functioning, interdisciplinary cooperation between surgery, immunology, and pathology. Through this cooperation we attempt to provide an atmosphere in which theoretical and practical viewpoints can mutually influence each other.

The anastomotic technique plays a predominant role in gastrointestinal surgery. A feared complication is leakage due to the sutures. Such leakage cannot be detected early; consequently, infection spreads locally and systemically. An anastomotic method is generally evaluated according to its rate of leakage, related to the localization, bur real scientific comparisons, i.e., controlled studies, are almost totally lack­ ing. The criteria of evaluation include the type of suture, the localization, the auxiliary technical tools, practicability, the different forms of wound healing, angiogenesis, and vascularization, among others. The postoperative criteria are complications shortly after surgery, such as bleeding, ruptures, and stenoses of the anastomosis. A standard comparison is made difficult by the variety of cytophysiological and biochemical factors that influence wound healing. In the comparison of larger series one must always take into account differences of auxiliary tools, strategies, and inhomogeneity of patients. A change of one auxiliary tool or of one strategy implies the modification of various target criteria. Often enough, however, one does not sufficiently consider the surgeon''s most. important role.

In this book, the recent developments in immunology and the impact on the treatment of infections in critical care and in surgery are presented, also describing how cellular immunology influences clinical treatment. This information helps in understanding the pathogenesis of infections in surgery and critical care. The impact of a standard treatment such as antibiotic therapy is evaluated and possible future therapy modalities outlined. This book will be of interest to clinicians and immunologists as scientists of both specialties have contributed to the book.